Bio Medical Waste Management
Content
1
BIO-MEDICAL WASTE MANAGEMENT
2
3
Definition : Acc to bio medical waste rules ,1998 of India “ bio-medical 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.
Any unwanted residual material which cannot be discharged directly, or after suitable treatment can be discharged in the atmosphere or to a receiving water source, or used for landfill is waste. (Wilson, 1981)
4
Hospital waste: refers to all waste, biological or non biological, that is discarded and is not intended for further use
Medical waste: refers to materials generated as a result of patient diagnoses, treatment, immunization of human beings or animals
5
Infectious waste: are the portion of medical waste that could transmit an „infectious disease‟.
Pathological waste : waste removed during surgery/ autopsy or other medical procedures including human tissues, organs, body parts, body fluids and specimens along their containers.
6
Reduce the impact waste management . Reduction in the incidence of infection and accidental injuries to hospital staff. Cost-effective disposal of hospital waste.
7
GLOBALLY- Developed countries generate 1 to 5 kg/bed/day Developing countries: meager data, but figures are lower. 1-2kg/pt./day WHO Report: 85% non hazardous waste : 10% infective waste : 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive) INDIA:-No national level study - local or regional level study shows hospitals generate roughly 1-2 kg/bed/day
8
The Ministry of Environment and Forest has drafted certain rules in exercise of powers conferred by sections 6,8 and 25 of the environment (protection) act, 1986
The Gazette of India extraordinary , part II – section 3- subsection (ii) On 20th July 1998
9
CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I
WASTE CATEGORY
Category No. 1 TYPE OF WASTE Human Anatomical Waste (Human tissues, organs, body parts)
TREATMENT AND DISPOSAL OPTION
Incineration@ / deep burial*
Category No. 2
Animal Waste (Animal tissues, organs, body parts, carcasses, bleeding parts, fluid, blood and Incineration@ / deep experimental animals used in research, burial* waste generated by veterinary hospitals and colleges, discharge from hospitals, animal houses) Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, human and animal Local autoclaving/ cell cultures used in research and microwaving / infectious agents from research and incineration@ industrial laboratories, wastes from production of biologicals, toxins and devices used for transfer of cultures)
Category No. 3
10
Category No. 4
Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps) Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines)
Disinfecting (chemical treatment@@ / autoclaving / microwaving and mutilation / shredding## Incineration@ / destruction and drugs disposal in secured landfills
Category No. 5
Category No. 6
Soiled Waste (Items contaminated with body fluids including cotton, Incineration@ / dressings, soiled plaster casts, lines, autoclaving / bedding and other materials microwaving contaminated with blood.) Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.)
Category No. 7
Disinfecting by chemical treatment@@ / autoclaving / microwaving and mutilation / shredding# 11
Category No. 8
Liquid Waste (Waste generated from Disinfecting by the laboratory and washing, chemical treatment@@ cleaning, house keeping and and discharge into disinfecting activities) drains
Category No. 9
Incineration Ash (Ash from Disposal in municipal incineration of any biomedical waste) landfill
Chemical Waste (Chemicals used in production of biologicals, chemicals Category No.10 used in disinfecting, as insecticides, etc.)
Chemical treatment @@ and discharge into drains for liquids and secured landfill for solids.
12
13
Waste category Infectious waste
Pathological waste
Description And Examples • Lab cultures • Waste from isolation wards • Tissues(swabs) • Materials/equipments of infected patients • Excreta • Human tissues/fluids • Body parts • Blood or body fluids
14
Pathological waste
15
Blood bags found in the municipal waste stream in violation of rules for such waste. 16
Sharp waste
• • • •
Pharmaceutical waste Genotoxic waste
•
• • • •
•
Needles Infusion Sets Scalpels Knives Blades Broken Glass Expired Pharmaceuticals Contaminated Pharmaceuticals Banned Pharmaceuticals Waste Containing Cytotoxic Drugs(often Used In Cancer Theraphy) Genotoxic Chemicals
17
Pharmaceutical Waste
Sharp Waste
18
Chemical waste Waste with high content of heavy metals Pressurized containers Radioactive waste
• • • • • • •
•
• •
•
•
Lab reagents Film developer Expired disinfectants Expired solvents Batteries Broken thermometers Blood pressure guages etc Gas cylinders Gas catridges Aerosol cans Radiotherapy/lab research liquids Contaminated glass wares, packages, absorbent papers
19
Genotoxic waste
Cytotoxic drugs
Chemical waste
Lab reagents
20
Waste with high content of heavy metals
Worn out batteries
Blood pressure guages
21
Aerosol cans
PRESSURISED CONTAINERS
Gas cartridges
Gas cylinders
22
Radioactive waste
23
Government/private hospitals Nursing homes Physician/dentist office or clinic Dispensaries Primary health care centers Medical research and training centers animal./slaughter houses labs/research organizations Vaccinating centers Bio tech institutions/production units
24
25
1. Know what hazards you have 2. Purchase smallest quantity needed, and don‟t purchase hazardous materials if safe alternative exists
**Use mercury-free thermometers
26
3. Limit use and access to trained persons with personal protective gear
27
28
Don‟t accumulate unneeded products Don‟t let peroxides and oxidising agents turn into bombs
Photo of bomb robot called into hospital to dispose of picric acid.
29
Examples of hazard labels:
30
Job description Posters on doors Labels on hazards Give feedback on use of PPE and disposal in evaluation Role model safe use and disposal Contact point who is responsible
31
32
Slide 33
Separate sharps and infectious waste where they are used
◦ This prevents injuries that can occur when people sort the trash after it is disposed
Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members
34
35
Treatment and Disposal Methods of Hospital Waste
36
Waste minimization & recycling of waste Identification of points of generation of waste Waste segregation at source Compiling the inventory of waste Waste treatment (disinfection etc.) at the site Waste collection and transportation, on-site and offsite Waste treatment , on-site & off the site Final disposal of waste Occupational safety Continuous monitoring of the system Training of the staff.
37
TREATMENT/DI SPOSAL METHOD
ADVANTAGES
Adequate
DISADVANTAGES
High
–all infect waste most Chemical waste Pharmaceutical waste Pyrolytic Adequate –all incineration infect waste Most pharmaceutical waste Chemical waste Rotary kiln
investment and operating costs
Incomplete
destruction of cytotoxics Relative high investment
38
ROTARY KILN
PYROLYTIC INCINERATOR
39
Singlechamber incinerator
Good
dis infection efficiency Drastic reduction of wt & volume of waste Residues disposed in landfills No need of high trained operators Low investment/operating cost
Significant
emissions of atmos pollutants Need for periodic removal of slag &soot Inefficient in destroying thermally resistant chem /drugs
Massive
Drum/ brick incinerator
Drastic
reduction of wt &volume of waste Very low investment & operation
emission of black smoke, ash toxic flue gas
40
SINGLE CHAMBER INCINERATOR
DRUM/BRICK INCINERATION
41
Chemical disinfection
Highly
efficient disinfection under good operating conditions Chemical disinfectants are relatively inexpensive
Requires
highly
Wet thermal treatment
qualified technicians for operating of the process Uses hazardous substances that requires comprehensive safety measures Environmentally sound Shredders are subject to Relatively low frequent investment/operating breakdowns costs Poor functioning
42
CHEMICAL DISINFECTION
43
WET THERMAL TREATMENT
Off-site wet thermal (or "steam autoclave") treatment facility
44
requires qualified technicians Inadequate for anatomical, pharmaceutical,chemic al waste ,waste that is not steam permeable MicroGood disinfection High investment& wave efficiency under operating costs irradiation appropriate Potential operation conditions Maintenance Drastic reduction in problems waste volume Environmentally sound
45
Operating
MICROWAVE IRRADIATION
46
Encapsulation Simple
Low
Safe
Not
cost
recommended for non sharp infectious waste
Safe burying
Low
cost Safe only if access to Relatively safe site is limited and if access to site certain precautions are taken is restricted
Relatively
inertisation
inexpensive
Not applicable to infectious waste
47
ENCAPSULATION
48
Inertisation, Immobilisation
49
Biomedical waste (management &handling) rule 1998, prescribed by The Ministry of Environment and Forests, Govt of India, came into force on 20th July 1998. 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 is came into existence which is shown as follows
50
Colour coding
Type of container
Waste category
Treatment options
Yellow
Plastic bag
Human
anatomical
waste Animal waste Microbiology &biotech waste, solid waste Red Dis infected container/pla stic bag
Micro&biotech Solid
Incineration/ deep burial
waste
Autoclaving Microwaving Chem
waste Solid waste
Rx
51
Black
Plastic
bag
Discarded
Disposal
medicines Cytotoxic drugs Incineration ash chemicals
in secured landfills
Blue/ white transl ucent
Plastic bag Puncture proof container
Sharp
waste Solid waste
Autoclaving Microwaving Chem
Rx Destruction/ shredding
52
• Thus refuse disposal cannot be solved without public education. • Individual participation is required. • Municipality and government should pay importance to disposal of waste economically. • Thus educating and motivating oneself first is important and then preach others about it. • Start disposing waste first from within your home, then outside home, then neighborhood ,then your street, your area ,city and then the nation and the world.
• Lets make this world a better place to live in.
53
HCRW Management.ppt
7/03
Slide 54
55
BIO-MEDICAL WASTE MANAGEMENT
2
3
Definition : Acc to bio medical waste rules ,1998 of India “ bio-medical 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.
Any unwanted residual material which cannot be discharged directly, or after suitable treatment can be discharged in the atmosphere or to a receiving water source, or used for landfill is waste. (Wilson, 1981)
4
Hospital waste: refers to all waste, biological or non biological, that is discarded and is not intended for further use
Medical waste: refers to materials generated as a result of patient diagnoses, treatment, immunization of human beings or animals
5
Infectious waste: are the portion of medical waste that could transmit an „infectious disease‟.
Pathological waste : waste removed during surgery/ autopsy or other medical procedures including human tissues, organs, body parts, body fluids and specimens along their containers.
6
Reduce the impact waste management . Reduction in the incidence of infection and accidental injuries to hospital staff. Cost-effective disposal of hospital waste.
7
GLOBALLY- Developed countries generate 1 to 5 kg/bed/day Developing countries: meager data, but figures are lower. 1-2kg/pt./day WHO Report: 85% non hazardous waste : 10% infective waste : 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive) INDIA:-No national level study - local or regional level study shows hospitals generate roughly 1-2 kg/bed/day
8
The Ministry of Environment and Forest has drafted certain rules in exercise of powers conferred by sections 6,8 and 25 of the environment (protection) act, 1986
The Gazette of India extraordinary , part II – section 3- subsection (ii) On 20th July 1998
9
CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I
WASTE CATEGORY
Category No. 1 TYPE OF WASTE Human Anatomical Waste (Human tissues, organs, body parts)
TREATMENT AND DISPOSAL OPTION
Incineration@ / deep burial*
Category No. 2
Animal Waste (Animal tissues, organs, body parts, carcasses, bleeding parts, fluid, blood and Incineration@ / deep experimental animals used in research, burial* waste generated by veterinary hospitals and colleges, discharge from hospitals, animal houses) Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, human and animal Local autoclaving/ cell cultures used in research and microwaving / infectious agents from research and incineration@ industrial laboratories, wastes from production of biologicals, toxins and devices used for transfer of cultures)
Category No. 3
10
Category No. 4
Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps) Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines)
Disinfecting (chemical treatment@@ / autoclaving / microwaving and mutilation / shredding## Incineration@ / destruction and drugs disposal in secured landfills
Category No. 5
Category No. 6
Soiled Waste (Items contaminated with body fluids including cotton, Incineration@ / dressings, soiled plaster casts, lines, autoclaving / bedding and other materials microwaving contaminated with blood.) Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.)
Category No. 7
Disinfecting by chemical treatment@@ / autoclaving / microwaving and mutilation / shredding# 11
Category No. 8
Liquid Waste (Waste generated from Disinfecting by the laboratory and washing, chemical treatment@@ cleaning, house keeping and and discharge into disinfecting activities) drains
Category No. 9
Incineration Ash (Ash from Disposal in municipal incineration of any biomedical waste) landfill
Chemical Waste (Chemicals used in production of biologicals, chemicals Category No.10 used in disinfecting, as insecticides, etc.)
Chemical treatment @@ and discharge into drains for liquids and secured landfill for solids.
12
13
Waste category Infectious waste
Pathological waste
Description And Examples • Lab cultures • Waste from isolation wards • Tissues(swabs) • Materials/equipments of infected patients • Excreta • Human tissues/fluids • Body parts • Blood or body fluids
14
Pathological waste
15
Blood bags found in the municipal waste stream in violation of rules for such waste. 16
Sharp waste
• • • •
Pharmaceutical waste Genotoxic waste
•
• • • •
•
Needles Infusion Sets Scalpels Knives Blades Broken Glass Expired Pharmaceuticals Contaminated Pharmaceuticals Banned Pharmaceuticals Waste Containing Cytotoxic Drugs(often Used In Cancer Theraphy) Genotoxic Chemicals
17
Pharmaceutical Waste
Sharp Waste
18
Chemical waste Waste with high content of heavy metals Pressurized containers Radioactive waste
• • • • • • •
•
• •
•
•
Lab reagents Film developer Expired disinfectants Expired solvents Batteries Broken thermometers Blood pressure guages etc Gas cylinders Gas catridges Aerosol cans Radiotherapy/lab research liquids Contaminated glass wares, packages, absorbent papers
19
Genotoxic waste
Cytotoxic drugs
Chemical waste
Lab reagents
20
Waste with high content of heavy metals
Worn out batteries
Blood pressure guages
21
Aerosol cans
PRESSURISED CONTAINERS
Gas cartridges
Gas cylinders
22
Radioactive waste
23
Government/private hospitals Nursing homes Physician/dentist office or clinic Dispensaries Primary health care centers Medical research and training centers animal./slaughter houses labs/research organizations Vaccinating centers Bio tech institutions/production units
24
25
1. Know what hazards you have 2. Purchase smallest quantity needed, and don‟t purchase hazardous materials if safe alternative exists
**Use mercury-free thermometers
26
3. Limit use and access to trained persons with personal protective gear
27
28
Don‟t accumulate unneeded products Don‟t let peroxides and oxidising agents turn into bombs
Photo of bomb robot called into hospital to dispose of picric acid.
29
Examples of hazard labels:
30
Job description Posters on doors Labels on hazards Give feedback on use of PPE and disposal in evaluation Role model safe use and disposal Contact point who is responsible
31
32
Slide 33
Separate sharps and infectious waste where they are used
◦ This prevents injuries that can occur when people sort the trash after it is disposed
Janitors can reinforce separation of sharps waste disposal by reporting sharps in garbage to Hospital Infection Control Committee members
34
35
Treatment and Disposal Methods of Hospital Waste
36
Waste minimization & recycling of waste Identification of points of generation of waste Waste segregation at source Compiling the inventory of waste Waste treatment (disinfection etc.) at the site Waste collection and transportation, on-site and offsite Waste treatment , on-site & off the site Final disposal of waste Occupational safety Continuous monitoring of the system Training of the staff.
37
TREATMENT/DI SPOSAL METHOD
ADVANTAGES
Adequate
DISADVANTAGES
High
–all infect waste most Chemical waste Pharmaceutical waste Pyrolytic Adequate –all incineration infect waste Most pharmaceutical waste Chemical waste Rotary kiln
investment and operating costs
Incomplete
destruction of cytotoxics Relative high investment
38
ROTARY KILN
PYROLYTIC INCINERATOR
39
Singlechamber incinerator
Good
dis infection efficiency Drastic reduction of wt & volume of waste Residues disposed in landfills No need of high trained operators Low investment/operating cost
Significant
emissions of atmos pollutants Need for periodic removal of slag &soot Inefficient in destroying thermally resistant chem /drugs
Massive
Drum/ brick incinerator
Drastic
reduction of wt &volume of waste Very low investment & operation
emission of black smoke, ash toxic flue gas
40
SINGLE CHAMBER INCINERATOR
DRUM/BRICK INCINERATION
41
Chemical disinfection
Highly
efficient disinfection under good operating conditions Chemical disinfectants are relatively inexpensive
Requires
highly
Wet thermal treatment
qualified technicians for operating of the process Uses hazardous substances that requires comprehensive safety measures Environmentally sound Shredders are subject to Relatively low frequent investment/operating breakdowns costs Poor functioning
42
CHEMICAL DISINFECTION
43
WET THERMAL TREATMENT
Off-site wet thermal (or "steam autoclave") treatment facility
44
requires qualified technicians Inadequate for anatomical, pharmaceutical,chemic al waste ,waste that is not steam permeable MicroGood disinfection High investment& wave efficiency under operating costs irradiation appropriate Potential operation conditions Maintenance Drastic reduction in problems waste volume Environmentally sound
45
Operating
MICROWAVE IRRADIATION
46
Encapsulation Simple
Low
Safe
Not
cost
recommended for non sharp infectious waste
Safe burying
Low
cost Safe only if access to Relatively safe site is limited and if access to site certain precautions are taken is restricted
Relatively
inertisation
inexpensive
Not applicable to infectious waste
47
ENCAPSULATION
48
Inertisation, Immobilisation
49
Biomedical waste (management &handling) rule 1998, prescribed by The Ministry of Environment and Forests, Govt of India, came into force on 20th July 1998. 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 is came into existence which is shown as follows
50
Colour coding
Type of container
Waste category
Treatment options
Yellow
Plastic bag
Human
anatomical
waste Animal waste Microbiology &biotech waste, solid waste Red Dis infected container/pla stic bag
Micro&biotech Solid
Incineration/ deep burial
waste
Autoclaving Microwaving Chem
waste Solid waste
Rx
51
Black
Plastic
bag
Discarded
Disposal
medicines Cytotoxic drugs Incineration ash chemicals
in secured landfills
Blue/ white transl ucent
Plastic bag Puncture proof container
Sharp
waste Solid waste
Autoclaving Microwaving Chem
Rx Destruction/ shredding
52
• Thus refuse disposal cannot be solved without public education. • Individual participation is required. • Municipality and government should pay importance to disposal of waste economically. • Thus educating and motivating oneself first is important and then preach others about it. • Start disposing waste first from within your home, then outside home, then neighborhood ,then your street, your area ,city and then the nation and the world.
• Lets make this world a better place to live in.
53
HCRW Management.ppt
7/03
Slide 54
55
