Bio Medical Waste Management

BIOMEDICAL WASTE MANAGEMENT Biomedical waste: Biomedical wastes are defined as waste that is generated during the

diagnosis, treatment or immunization of human beings or animals, or in research activities pertaining thereto, or in the production of biological. Major sources of biomedical waste: Broadly, biomedical waste is generated in the hospitals, nursing homes, clinics, pathology/microbiology laboratories, blood banks, animal house and veterinary institutes. Such a waste can also be generated at home if the health care is being provided there to the patient (e.g. dialysis, insulin, injections, dressing materials etc)

Biomedical waste management: Bio medical waste management refers to the classification, identification, segregation and scientific disposal of bio medical waste management Hospital wastes have always been considered as potentially hazardous in view of the inherent potential for dissemination of infection. In recent years, a wider variety of potentially hazardous ingredients including antibiotics, cytotoxic drugs, corrosive chemicals and radioactive substance have become a part of the hospital waste. Hospital waste management is an area, which has come to the limelight recently as a result of the notification of the bio medical waste (management in handling) rules 1998. This fulfills a long felt need of hospital administrators, nursing administrators, hospital engineers, sanitation supervisors, laboratory personnel and student of hospital and health administration. It is the waste generated by the health care establishments, research facilities and laboratories. Waste may be generated during: Diagnosis, treatment of disease and immunization of diseases associated bio medical research, and production and testing of biological.

Biohazard means any of the following:

Laboratories waste, including but not limited to, specimen cultures from medical and pathological laboratories, culture and stock of infectious agent from research and industrial laboratories, wastes from the production of biological agents, discarded live and attenuated vaccines, and culture dishes and devices used to transfer, inoculate and mix cultures or materials which may contain infectious agents and may pose a substantial threat to health. All non-sterilized cultures shall be presumed to be bio hazardous. Any specimens sent to a laboratory for micro biological analysis shall be presumed to be bio hazardous. Surgical specimens include human or animal parts or tissues removed surgically or by autopsy shall be presumed to bio hazardous. CLASSIFICATION AND CATEGORIES OF HOSPITAL WASTES.

Approximately 75-90% of biomedical waste is innocuous and a harmless as any other municipal wastes. The remaining 10-25% however differs from other waste in that it can be injurious to human or animal health and deleterious to environment. It must be remembered that if both these types are mixed together then the whole lot becomes harmful. Categorization and classification of waste is very important. There are different types of classification depending upon how a particular kind of waste is to be handled, treated and finally disposed.

Classification According to the Ministry of Environment and Forest Rules 1998: CATEGORIES OF BIO MEDICAL WASTE (as per rules) S.No Waste category Treatment and disposal Category Human anatomical Incineration and deep burial No.1 waste (Human body parts) Category Animal wastes (Animal Incineration and deep burial No.2 tissue organs , Body parts ,carcasses, bleeding parts, fluid, blood and experimental animal used in research, waste generate by vetenary hospitals) Category Microbiology and Local Autoclaving/ microwaving/ No.3 Biotechnology Incineration wastes(Wastes from laboratory cultures, stock or specimens of micro organism, live or attenuated vaccines , human and animal cell culture used in research and infectious agent from research and industrial laboratories ,waste from production of biological toxins, dishes, and devices used in transfer of cultures.) Category Waste sharps (Needles, Disinfection (chemical/ autoclaving/ No.4 Syringes. scalpels, microwaving and mutilation/ shredding) blades, glass, etc.that are capable of causing puncture and cuts. this includes both used and unused sharps.)

Category No.5

Category No.6

Category No.7

Category No.8

Category No.9 Category No.10

Discarded medicines and cytotoxic drugs (Waste comprising of outdated, contaminated and discarded drugs and medicines.) Solid Waste (Items contaminated with blood and body fluids including cotton, dressing, soiled plaster casts, linens, beddings, other materials contaminated with blood) Solid waste (Waste generated from disposable items other than the waste sharp such as tubing, catheters, Iv sets, etc.) Liquid waste (Wastes generated from laboratories and washing, cleaning, housekeeping and disinfection activities.) Incineration Ash (Ash from incineration of any Biomedical waste) Chemical wastes (Chemicals used in production of biological, chemicals used in disinfection, as insecticides, etc.)

Incineration/destruction and disposal in land fills

Incineration/autoclaving/microwaving

Disinfection by chemical treatment/autoclaving/microwaving and multilation/shreding

Disinfection by chemical treatment and discharge into drains

Disposal into municipal land fill Chemical treatment and discharge in drain for liquids and or secured land fill for solids.

HOSPITAL WASTE MANAGEMENT

General hospital hygiene is a pre-requisite for good medical waste management; it will be useless in terms of prevention of nosocomial infection to start improving hospital waste management if the hospital doesn’t have a reliable supply of safe water and basic sanitation facilities accessible to hospital personnel, patients and visitors. Most hospitals in India lack these basic amenities. It is vital that the whole hospital be kept clean and in a satisfactory state of hygiene to prevent spread of infection from patient to patient, patient to health care providers and vice-versa. In terms of prevention of spread of infections outside the hospital careful management of waste from the point of generation to safe disposal is of paramount importance. Waste survey is an important component of the waste management scheme. A survey helps in evaluating both the type and quantity of waste generated in the hospital. A survey aims to:

Differentiate the type of waste Quantify the waste generated Determine the point of generation and the type of waste generated at each point Determine the level of generation and disinfect ion within the hospital To find out the type of disposal carried out and Get familiar with the personnel at all levels

SEGREGATION AND SAFE STORAGE:

Segregation at source and safe storage is the key to whole hospital waste management process because it is at this stage that wastes are segregated into different streams. Incorrect classification of waste can lead to many problems at a later stage. Segregation should be carried out at the point of generation, to keep general waste from becoming infectious. If the infectious wastes, which forms a small part of hospital waste, is fixed with the other hospital waste the entire waste will have to be treated as the infectious waste. To treat entire waste as infectious is an expensive option and is also dangerous practice specially if the waste is dumped without any prior treatment. Thus, by segregation, a hospital can: Reduce total treatment cost Reduce the impacts of this waste on the community, and Reduce the changes of infecting healthcare workers. It is essential that all sharps (whether infected or not), infected waste not containing sharps, chemicals and pharmaceuticals other than cytotoxic drugs, other hazardous waste are segregated by medical and paramedical personnel users and are kept separately in readily identifiable, preferably color coded container. Radioactive wastes, cytotoxic drugs and highpressure containers require a special handling and disposable channels. Ministry of environment and forest has notified the type of container and their color codes for storage of different categories of hospital wastes as appended below. Color Code Type of Waste Category Treatment Options Container Yellow Plastic Human and animal wastes, Incineration/ deep burial bags microbial and biotechnological wastes and solid wastes. (Cat.1, 2,3,6) Red Disinfected Microbiological and Autoclaving / container / biotechnological wastes, solid Microwaving/Chemical plastic waste (Cat. 3,6,7) Treatment bags Blue/White Plastic bag/ Waste sharp and solid wastes Autoclaving/microwavin transparent puncture (Cat.4, 7) g/Chemical treatment, proof destruction and containers shredding Black Plastic bag Discarded medicines, Disposal in secured cytotoxic drug, incineration landfills ash and chemical waste (Cat.5,8,9) According to NABH guidelines Statutory provisions with regard to Bio-medical Waste (BMW) management are complied with Objective elements

a) The hospital is authorised by prescribed authority for the management and handling of Bio-medical Waste. b) Proper segregation and collection of Bio-medical Waste from all patient care areas of the hospital is implemented and monitored. c) The organization ensures that Bio-medical Waste is stored and transported to the site of treatment and disposal in proper covered vehicles within stipulated time limits in a secure manner. d) Bio-medical Waste treatment facility is managed as per statutory provisions (if inhouse) or outsourced to authorised contractor(s). e) Requisite fees, documents and reports are submitted to competent authorities on stipulated dates. f) Appropriate personal protective measures are used by all categories of staff handling Bio-medical Waste

THE SCHEDULES The Biomedical Waste (Management and Handling) Rules have six schedules. Schedule I: classification of biomedical waste in various categories. Schedule II: Color coding and type of containers to be used for each category of biomedical waste Schedule III: Proforma of label to be used on container / bag Schedule IV: Proforma of label for transport of waste container / bag Schedule V: standards for treatment and disposal of waste Schedule VI: deadlines for creation of waste treatment facilities Form VII: format of application for authorization Form II: format of annual report Form III: format of accident reporting