BioMedical Waste Management Issues Challenges

7/30/2019 BioMedical Waste Management Issues Challenges

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Bio-medical Waste Management

Issues and Challenges

Dr. Selwyn A ColacoChief Operating Officer

Narayana Hrudayalaya Hospitals, Bangalore



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I. Environmental Legislation

The Air (Prevention and Control of Pollution) Act, 1981

The Environment (Protection) Act, 1986

The Hazardous Waste (Management & Handling) Rules,

1989 The National Environmental Tribunal Act, 1995

The Biomedical Waste (Management & Handling) Rules,1998

The Municipal Solid Waste (Management & Handling) Rules, 2000



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BMW Rules have been adopted and notified with the objective to stop the indiscriminate disposal of

hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment.

Implementation of

BIO-MEDICAL WASTE RULES 1998



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Health care waste includes Waste generated by the health care facilities Research facilities Laboratories

Biomedical waste in hospitals 85% are non-infectious 10% are infectious

5% are hazardous

Implementation of

BIO-MEDICAL WASTE RULES 1998



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Segregation and safe containment of waste at thehealth facility level

Processing and storage for terminal disposal

Basic Principles



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Bio-medical waste shall not be mixed with other wastes.

Segregation at source – both at ward and unit level Color coding to support segregation at source Bio-medical waste shall be segregated into containers/bags at the point of generation in accordance with ScheduleII (BMW Rules 1998) prior to its storage, transportation,treatment and disposal.

Basic Principles



The containers shall be labeled according to Schedule III(BMW Rules 1998) Transport waste safely to pick up site Identify destination for each type of waste and ensure

safe disposal Keep track of usage

Basic Principles



Untreated biomedical waste shall be transported only invehicles authorized for the purpose by the competent authorityas specified by the government.

Untreated bio-medical waste shall not be kept/stored beyond

a period of 48 hours.

If for any reason it becomes necessary to store the wastebeyond such period, measures must be taken to ensure that

the waste does not adversely affect human health and theenvironment.

Transportation & Storage of BMW



Use/Reuse of

equipment

Unsafe collection Unsafe disposal

Biomedical Waste Management - Issues




• Not considered important

– Lack of interest from senior management

– No ownership of the process

– Awareness of problems

– Appreciate the need for constant monitoring



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– Segregation of waste not taken seriously at user level – Non compliance with color coding – Monitoring segregation at source – low budgets allocated – costs are not always known – Cost of color coding, staff, transport and disposal – Quantification of waste generated is not accurately done




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– Protection of healthcare workers not given adequatethought – Clinical waste dumped with non infectious waste - Risk forhealthcare workers and public – Waste disposal not effective, often dumped in open landfills




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– Responsibility for waste disposal – head of facility, butdevolved to members of the waste management team – Each healthcare worker – segregation and appropriatedisposal – Private companies – from collection point in hospital todisposal – Medical waste segregation awareness and Informationshould be available in all areas of hospital

Biomedical Waste Management - responsibilities



Challenges: Need for protocol and policies… To provide protection for

– Healthcare workers

– Patients

– Community at large - from the risk of infections

• Compliance with statutory requirements• Government of India -1998 biomedical waste management

and handling rules under EPA (compels hospitals, clinics, labs to ensure safe and environmentally sound management of waste generated at their establishments)



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Challenges

Establishing robust waste management policies within theorganization Organization wide awareness about the health hazards Sufficient financial and human resources

Monitoring and control of waste disposal Clear responsibility for appropriate handling and disposal of waste.



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ADRESSING THE ISSUES

1. Need to build-up of a comprehensive system, addressresponsibilities, resource allocation, handling anddisposal

2. This is a long-term process, sustained by gradual

improvements.3. Specific personnel need to be assigned to monitor the

bio-medical waste management in the hospital.4. Man power needs and other resources for the BMWM of

hospital to be addressed.5. Quality assessment of bio-medical waste management

should be done from time to time.



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6. Segregated collection and transportation - The use of

color coding and labeling of hazardous waste.7. Clear directives in the form of a posters and notice to

be displayed in all concerned areas in English and locallanguages.

8. Safety of handlers.9. Raising Awareness about risks related to health-carewaste; training staff and HCW on safe practices.

10.Selection of safe and environmentally friendlymanagement options, to protect people from hazards

when collecting, handling, storing, transporting, treatingor disposing of waste.



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11.Issue of all protective clothes such as, gloves, aprons,masks etc. to all HCW.

12.Regular medical check-up (half-yearly) of staff associated with BMWM.

13.Maintenance of Record registers for this purpose.14.Containers should be robust and leak proof 15.Tracking of Bio Medical Waste upto point of Disposal.16.Proper treatment and final disposal.



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Thank you

Any Questions?

S h d l I



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Option Waste Category Treatment & Disposal

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, fluid, blood and

experimental animals used in research,

waste generated by veterinary hospitals,

colleges, discharge from hospitals, animal

houses)

incineration@/deep burial*

Category No. 3 Microbiology & Biotechnology Waste

(Wastes from laboratory cultures, stocks or

micro-organisms live or vaccines, human

and animal cell culture used in research and

infectious agents from research and

industrial laboratories, wastes from

production of biologicals, toxins, dishes and

devices used for transfer of cultures)

local autoclaving/micro-

waving/incineration@

Category No. 4 Waste Sharps

(needles, syringes, scalpels, blade, glass,

etc. that may cause punture and cuts. This

includes both used and unused sharps)

disinfection (chemical treatment

@@@/auto claving/microwaving

and mutilation/shredding##

Category No. 5 Discarded Medicines and Cytotoxic drugs

(Waste comprising of outdated,contaminated and discarded medicines)

incineration@/destruction and

drugs disposal in securedlandfills

Schedule-I

CATEGORIES OF BIO-MEDICAL WASTE

S h d l I



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Category No. 6 Soiled Waste

(items contaminated with blood,

and body fluids including cotton,dressings, soiled plaster casts,

lines, bedding, other material

contaminated with blood)

incineration@autoclaving/micro

waving

Category No. 7 Solid Waste

(Waste generated from disposal

items other than the sharps such a

tubings, catheters, intravenoussets etc.)

disinfection by chemical

treatment@@

autoclaving/microwaving and

mutilation/shredding##

Category No. 8 Liquid Waste

(Waste generated from laboratory

and washing, cleaning,

housekeeping and disinfecting

activities)

disinfection by chemical

treatment@@ and discharge

into drains

Category No. 9 Incineration Ash

Ash from incineration of any bio-

medical waste)

disposal in municipal landfill

Category No. 10 Chemical Waste

(Chemicals used in production of

biologicals, chemicals used in

production of biologicals,

chemicals used in disinfection, asinsectricides, etc.)

chemical treatment@@ and

discharge into drains for liquids

and secured landfill for solids

Schedule-I

CATEGORIES OF BIO-MEDICAL WASTE (continued)

S h d l I



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Note :

@ There will be no chemical pretreatment before incineration. Chlorinated

plastics shall not be incinerated.

* Deep burial shall be an option available only in towns with population less

than five lakhs and in rural areas.

@@ Chemicals treatment using at least 1% hypochlorite solution or any other

equivalent chemical reagent. It musts be ensured that chemical treatment

ensures disinfection.

## Multilation/shredding must be such so as to prevent unauthorised reuse.

Schedule-I

CATEGORIES OF BIO-MEDICAL WASTE (continue)

Schedule II



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Schedule-II

COLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIO

MEDICAL WASTES

Colour

Coding

Type of

Container

Waste

Category

Treatment options

Yellow Plastic BagCategories1, 2, 3 & 6.

Incineration/ deep burial

Red Disinfectedcontainer/Plasticbag

Categories3, 6, 7

Autoclaving/Micro-waving/ChemicalTreatment

Blue/WhiteTranslucent

Plastic Bag/puncture proof containers

Cat. 4,Cat. 7

Autoclaving/Micro-waving/ ChemicalTreatment & Destruction / shredding

Black Plastic BagCategories5, 9, 10

Disposal in secured landfill.

Notes: 1. Colour coding of waste categories with multiple treatment options as defined in schedule 1, shall be selected depending on treatment option chosen, which shall be as specified in Schedule I.2. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics.

3. Categories 8 and 10 (liquid) do not require containers/bags.

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BioMedical Waste Management Issues Challenges