BIOMEDICAL WASTE MANAGEMENT SYSTEM

Ms. HIRVA SALVI

CONTENT• DEFINITION• TYPES OF BIOMEDICAL WASTE• CATEGORIES OF BIOMEDICAL WASTE• PROBLEM ASSOCIATED WITH BIOMEDICAL WASTE• NEED FOR BIOMEDICAL WASTE MANAGEMENT• COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL

OF BIO-MEDICAL WASTES• TREATMENT TECHNIQUES• BIOMEDICAL WASTE MANAGEMENT IN INDIA• ENVIRONMENTAL LEGISLATION 2

CONTENT• INCINERATION• AUTOCLAVE TREATMENT• HYDROCLAVE TREATMENT• MICROWAVE TREATMENT• CHEMICAL DISINFECTION• DEEP BURIAL• NEW EMERGING TECHNOLOGIES• CASE STUDY• REFERENCES

3

BIOMEDICAL WASTE

Definition :

•“Biomedical Waste” means any waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining there to or in the production or testing of bio medicals.•Who estimates

• 85% non-hazardous waste• 10% is infectious• 5% non-infectious but hazardous.

4

TYPES OF BIOMEDICAL WASTEWASTE CATEGORY TYPE OF WASTE

Category No. 1 Human Anatomical WasteCategory No. 2 Animal Waste

Category No. 3 Microbiology & Biotechnology Waste

Category No. 4 Waste Sharps

Category No. 5 Discarded Medicine and Cytotoxic drugs

Category No. 6 Soiled WasteCategory No. 7 Solid Waste Category No. 8 Liquid WasteCategory No. 9 Incineration Ash

Category No.10 Chemical Waste 5

CATEGORIES OF BIOMEDICAL WASTEWASTE WASTE

CATEGORYCATEGORY TYPE OF WASTETYPE OF WASTE TREATMENT AND TREATMENT AND DISPOSAL OPTIONDISPOSAL OPTION

Category No. Category No. 11

Human Anatomical Waste Human Anatomical Waste (Human tissues, organs, body (Human tissues, organs, body parts)parts)

Incineration/deep Incineration/deep burialburial

Category No. Category No. 22

Animal WasteAnimal Waste(Animal tissues, organs, body (Animal tissues, organs, body parts, bleeding parts, blood and parts, bleeding parts, blood and experimental animals used in experimental animals used in research, waste generated by research, waste generated by veterinary hospitals and colleges, veterinary hospitals and colleges, discharge from hospitals, animal discharge from hospitals, animal houses)houses)

Incineration/deep Incineration/deep burialburial

Category No. Category No. 33

Microbiology & Biotechnology Microbiology & Biotechnology Waste (Wastes from laboratory Waste (Wastes from laboratory cultures, human and animal cell cultures, human and animal cell cultures used in research and cultures used in research and infectious agents from research infectious agents from research and industrial laboratories)and industrial laboratories)

Autoclaving/ Autoclaving/ microwaving / microwaving / incinerationincineration 6

Category No. 4

Waste Sharps (Needles, syringes, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps)

Disinfecting (chemical treatment / autoclaving / microwaving and mutilation / shredding

Category No. 5

Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines)

Incineration/ destruction and drugs disposal in secured landfills

Category No. 6

Soiled Waste (Items contaminated with body fluids including cotton, dressings, soiled plaster casts, bedding and other materials contaminated with blood.)

Incineration / autoclaving / microwaving

Category No. 7

Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, intravenous sets, etc.)

Disinfecting by chemical treatment/ autoclaving / microwaving and shredding

7

Category No. 8

Liquid Waste (Waste generated from the laboratory and washing, cleaning, house keeping and disinfecting activities)

Disinfecting by chemical treatment 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.

8

PROBLEM ASSOCIATED WITH BMW

ORGANISM DISEASES CAUSED RELATED WASTE ITEM

VIRUSESHIV, Hepatitis B, Hepatitis A,C, Arboviruses, Enteroviruses

AIDS, Infectious Hepatitis,Infectious Hepatitis,Dengue, tick-bornefevers, etc.

Infected needles, bodyFluids, Human excreta, Blood.

BACTERIASalmonella typhi, Vibrio cholerae, Clostridium Tetani, Pseudomonas, Streptococcus

Typhoid, Cholera, TetanusWound infections,septicemia, rheumaticfever, skin and soft tissue infections

Human excreta andbody fluid in landfills and hospital wards, Sharps such as needles, surgical blades in hospital waste.

9

NEED FOR BMW MANAGEMENT

Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers.

Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash.

Risk of infection outside hospital for waste handlers and scavengers, other peoples.

10

 COLOUR CODING AND TYPE OF CONTAINER FOR

DISPOSAL OF BIO-MEDICAL WASTESColour coding

Type of Container

Waste Category Treatment options

Yellow Plastic bag Human, animal, microbiology, soiled waste

Incineration/deep burial

Red Disinfected container/ plastic bag

Microbiology, solid & soiled waste

Autoclaving/Microwaving/Chemical Treatment

Blue / White

Plastic bag/puncture proof container / Sharps Blaster

Waste sharps & solid waste

Autoclaving/Microwaving/Chemical Treatment & destruction/shredding

Black Plastic bag Discarded medicine, cytotoxic drugs, incineration ash & Chemical waste

Disposal in secured landfill

11

TREATMENT TECHNIQUES

1. Incineration2. Autoclaving and shredding 3. Chemical treatment4. Microwave treatment5. Deep Burial

12

BIO MEDICAL WASTE MANAGEMENT RULES IN INDIA

Biomedical waste (management and handling) rule 2016, prescribed by the ministry of environment and forests, Government of India, came into force on 28th march 2016.

This rule applies to those who generate, collect, receive, store, dispose, treat or handle bio medical waste in any manner.

Thus bio medical waste should be segregated into containers/bags at the point of generation of waste. Thus colour coding & type of containers used for disposal of waste.

13

MAJOR DIFFERENCE BETWEEN BMW RULES 1998 & 2016

1998 20161 Occupiers with more

than 1000 beds required to obtain authorization

Every occupier generating BMW, Including health camp requires to obtain authorization

2 Operator duties absent Duties of the operator listed3 Rules restricted to HCEs

with more than 1000 beds

Treatment and disposal of BMW made mandatory for all the HCEs

4 No format for annual report

A format for annual report appended with the rules

5 Schedule I, II, III, IV,V Change of Schedule I, II, III, IV 14

ENVIRONMENTAL LEGISLATION THE ENVIRONMENT (PROTECTION) ACT, 1986 THE BIOMEDICAL WASTE (MANAGEMENT & HANDLING) RULES, 1998 THE MUNICIPAL SOLID WASTE (MANAGEMENT & HANDLING) RULES,

2000 THE HAZARDOUS WASTE (MANAGEMENT & HANDLING) RULES, 1989 THE AIR (PREVENTION AND CONTROL OF POLLUTION) ACT, 1981

15

INCINERATION• High thermal process• Oil fired or electrically powered or combination both of.• Types of incinerators:• Multiple hearth, rotary kiln, controlled type• All types have two chambers 1. Primary combustion chamber 2. Secondary combustion

chamber• The primary chamber operates a temperature range - 800

(+/-) 50 deg. C. • The secondary chamber operates a temperature range - 1050

(+/-) 50 deg. C16

Rotary Kiln Type Incinerator

• The chimney height should be minimum 30 meters above ground level. • In the bio-medical waste (management and handling) rules, incineration has

been recommended for human anatomical waste, animal waste, cytotoxic drugs, discarded medicines, soiled waste.

• Advantages:1.Waste volumes are reduced 80-95%.2.Waste incineration plants can be located near where waste is generated, which

decreases the costs and energy associated with transporting waste.3.Through waste-to-energy processes, incineration can be used to produce

electricity and heat that can be used to power and heat nearby buildings, and the ash produced can be used by the construction industry.

• Disadvantages:1.It is expensive to build, operate, and maintain.2.Smoke and ash emitted by the chimneys of incinerators include acid gases,

nitrogen oxide, heavy metals, particulates, and dioxin, which is a carcinogen.17

AUTOCLAVE TREATMENT• This is a process of steam sterilization under pressure. • It is a low heat process in which steam is brought into direct contact with

the waste material for duration sufficient to disinfect the material. • These are also of three types : gravity type, pre-vacuum type and retort

type• Gravity typeAir is evacuated with the help of gravity alone. Temperature - 121 deg. C. And steam pressure of 15 psi. For 60-90

minutes. • Pre-vacuum typeVacuum pumps are used to evacuate air from the pre-vacuum autoclave

system so that the time cycle is reduced to 30-60 minutes. Temperature - 132 deg. C.

18

Autoclave Treatment

• Retort type It handle much larger volumes and operate at much higher steam

temperature and pressure.• Autoclave treatment has been recommended for microbiology and

biotechnology waste, waste sharps, soiled and solid wastes. • This technology renders certain categories of bio-medical waste innocuous

and unrecognizable so that the treated residue can be landfilled. • Advantages:1.Low cost2.No hazardous emission 3.No pre and post treatment required• Disadvantages:1.Need drying mechanism2.Foul order problem

19

HYDROCLAVE TREATMENT• Hydroclave is an innovative equipment for steam sterilization process. • The system operates at 132 deg.C. And 36 psi steam pressure for

sterilization time of 20 minutes. • Hydroclave process: Stage IBagged waste, in ordinary bagsSharps containersLiquid containersCardboard containers

20

Stage II:A.Powerful rotators mix the waste and breaks it into small pieces.B.Steam fills the double wall (jacket) of the vessel and heats the vessel interior.C.The liquids in the waste turn to steam.D.After 20 minutes the waste and liquids are sterile.Stage III:A.The vent is opened, and the vessel de-pressurizes.B.Steam heat and mixing continue until all the liquids are evaporated and the waste is dry.

21

Stage II

Stage III

STAGE IV:A.The unloading door is opened.B.The mixer now rotates in the opposite direction, so angled blades on the mixer can push the waste out the unloading door.C.The dry, sterile waste can be fine-shredded further or dropped in a waste disposal bin.Results:Dry waste, regardless of its original water content.Low odor, due to the dryness.Volume reduction to 85%Weight reduction to 70%Accepted as harmless waste.

22

Stage VI

MICROWAVE TREATMENT• High frequency microwaves (300-300,000 megahertz) causes

particles in waste to vibrate.• Vibrations lead to generation of heat which disinfects waste

material.• Advantages:1.Less maintenance cost.2.No harmful air emissions & liquid discharges. 3.Reduced volume of waste residues. Safe for landfill disposal.4.Effective on sharps & bulk liquid.• Disadvantages:1.High investment cost

23

CHEMICAL DISINFECTION

• This treatment is recommended for waste sharps, solid and liquid wastes as well as chemical wastes.

• Chemical treatment involves use of at least 1% hypochlorite solution with a minimum contact period of 30 minutes or other equivalent chemical reagents such as phenolic compounds, iodine, hexachlorophene, iodine-alcohol or formaldehyde-alcohol combination etc.

• Pre-shredding of the waste is desirable for better contact with the waste material.• In the USA, chemical treatment facility is also available in mobile vans. In one version, the

waste is shredded, passed through 10% hypochlorite solution (dixichlor) followed by a finer shredding and drying. The treated material is landfilled.

24

• Advantages:1.Significant waste volume reduction 2.Ability to make waste unrecognizable 3.Rapid processing 4.Waste deodorization • Disadvantages:1.High investment cost 2.Lack of suitability for some waste types 3.Production of uncharacterized air emissions 4.Need for chemical storage and use 

25

DEEP BURIAL• This is accomplished by excavating a pit or trench, placing the deceased and objects in it, and

covering it over.• A pit or trench should be dug about two meters deep. It should be half filled with waste, then covered

with lime within 50 cm of the surface, before filling the rest of the pit with soil.• It must be ensured that animals do not have any access to burial sites. Covers of galvanised iron or

wire meshes may be used.• When wastes are added to the pit, a layer of 10 cm of soil shall be added to cover the wastes.• Burial must be performed under close and dedicated supervision.• The deep burial site should be relatively impermeable and no shallow well should be close to the site.• The pits should be distant from habitation, and located so as to ensure that no contamination occurs to

surface water or ground water. The area should not be prone to flooding or erosion.• The location of the deep burial site shall be authorized by the prescribed authority.• The institution shall maintain a record of all pits used for deep burial.• The ground water table level should be a minimum of six meters below the lower level of deep burial

pit.26

NEW EMERGING TECHNOLOGY IN BIOMEDICAL WASTE

27

SOLAR AUTOCLAVE• Solar energy generates steam through solar collector tube. Steam is

collected in a vessel which under pressure is used as autoclave.• Advantages:1.Easy set up & cost effective. Useful in rural areas.2.Useful in rural area3.Less maintenance cost• Disadvantages:1.Time taking procedure.2.Not useful in insufficient sunlight areas.3.Not useful in rainy season. 28

Source: Google Images

PLASMA PYROLYSIS• Based on thermo-chemical properties of plasma.• Generation of high temperature by plasma torches (> 1000 c) disintegration ͦ

of organic waste by intense heat in absence of oxygen.• Advantages:1.Eco-friendly & green technology. Disposal of all types of waste (solid

municipal, bio-medical & hazardous). 2.No production of toxic residues.• Disadvantages:1.Technique specific apparatus & set up is required

29

Source: Google Images

CASE STUDY OF BIO-MEDICAL WASTE MANAGEMENT IN NURSING HOMES AND

SMALLER HOSPITALS IN DELHI

• The survey conducted in 2001 by center for environment education under 2005-2006. • A total 53 nursing homes, with bed strengths ranging

from 20 to over 200 were included.

30

• A large nursing homes/hospitals have proper outdoor and indoor facilities, as well as diagnostic facilities, such as a full laboratory, x-ray, scan, and (perhaps) an MRI. Specialty nursing homes/ hospitals are those where only a particular type of patient care is offered, such as maternity homes, cardiac, etc.

• A large number of healthcare facilities use the services of private vendors for the collection, transportation, treatment, and disposal of their biomedical waste.

• Health care establishments were stratified into six groups are upto 40 beds fall under group I, 41 to 80 falls under group II, 81 to 120 falls under group III, 121 to 160 falls under group IV, 161 to 200 falls under group V and above 200 falls under group VI.

31

RESULTS

• The study revealed that 69.90% of HCFs handed over their laboratory waste and 88.60% of HCFs handed over their plastic waste to the service provider without disinfection.

• The average quantity of sharps and infected plastic waste generated per day ranged between 48 kg (57.83% of total BMW) in group I to 102 (53.15% of total BMW) kg in group IV. Percentage wise, it was lowest (17.63% of total BMW) in group VI (over 200 beds) and highest (57.83% of total BMW) in group I.

32

RECOMMENDATION• Ensuring development and practice of HCW management protocol at each HCF,• Guidelines on safe management practices, and safety procedures,• Continuous awareness programs at all HCFs,• Guidelines for liquid waste management,• Ensuring a proper HCWM plan and protocol before grant or at the time of HCF license renewal,

use of information posters, signage, audio-visual aids, lectures and demonstrations, etc.,• Audit of HCWM practices at HCFs and• Ensuring proper collection, transportation, treatment, and disposal practices by service

providers.

33

CONCLUSION

• It is concluded that there has been improvement in the management of biomedical waste in nursing homes and small healthcare facilities in delhi.

• Awareness and training programs should not only target doctors, nurses, and paramedics; but also the waste handlers.

• Training of waste handlers should be practical and demonstrative. • Improved training and awareness amongst all healthcare workers.• Proper HCWM is crucial to health and to patient safety.• This study brings out some improvements and remaining

deficiencies in management of HCW in the nursing homes and other hcfs in delhi. 34

REFERENCES

• Bio-medical Waste (Management And Handling) Rules, 2016.• Lalji K. Verma, Shyamala Mani, Nitu Sinha, Sunita Rana “Biomedical Waste

Management In Nursing Homes And Smaller Hospitals In Delhi” Waste Management, 2008, ISSN: 2723–2734

• Maryam Khadem Ghasemi, Rosnah Bt. Mohd. Yusuff, “Advantage And Disadvantage Of Healthcare Waste Treatments And Disposal Alternatives: Malaysian Scenario”, Pol. J. Environ. Stud., 2016 Vol. 25, No. 1, 17-25.

35

THANK YOU

36