Biomedical Waste Management

 

Biomedical Waste Management

The biomedical waste is the 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 or testing of biological components. The different location or points of generation of waste in a health care establishment are: 1.

Operation theatres / wards / labour rooms

2.

Dressing rooms

3.

Injection rooms

4.

Intensive Care Units

5.

Dialysis room

6. Laboratory 7. Corridor 8.

Compound of hospital or nursing home

Biomedical Waste Rules The Government of India as contemplated under Section 6,8 and 25 of the Environment (Protection) Act, 1986, has made the Biomedical Wastes (Management & Handling) Rules, 1998. The rules are applicable to every institution generating biomedical waste which includes hospitals, nursing homes, clinic, dispensary, veterinary institutions, animal houses, pathological lab, blood bank, the rules are applicable to even handlers.

Responsibilities of hospitals It is mandatory for such institutions to:  

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Set up requisite biomedical waste waste treatment facilities like incinerators, autoclave and microwave systems for treatment of the wastes, or ensure requisite treatment of the waste at a common waste treatment facility

 

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Make an application to the concerned concerned authorities for grant grant of authorization. A fee as prescribed shall accompany each application for grant of authorization

 

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Submit a report tto o the prescribed authority by 31 January every year. The report should include information about the categories and quantities of bio-medical wastes handled during the preceding year.

 

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Maintain rrecords ecords about the generation, collection, reception, reception, storage, transportation, treatment, disposal and / or any form of handling of bio-medical waste.

 

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Report of any accident to the prescribed authority.

 

Ca Categories tegories of waste The biomedical wastes are categorized into ten according to its characteristics taking into account treatment and disposal. The different categories of waste as per the rule are given in Table 1.  1. 

Table 1

Categories Ca tegories of Biomedical Waste  Waste 

Waste Category Category Category No. 1

Type of waste Human Anatomical Waste (Human tissues,

Treatment And Dispos al Option Incineration/deep burial

organs, body parts) Category No. 2

Animal Waste (Animal tissues, organs,

Incineration/ deep burial

body parts, carcasses, Bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals and colleges, discharge from hospitals, animal houses) Category No. 3

Microbiology & Biotechnology Waste

Local autoclaving/ microwaving /

(Wastes from laboratory cultures, stocks or

incineration

specimen of live micro organisms or attenuated vaccines, human and animal cell cultures used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins and devices used for transfer of cultures) Category No. 4

Waste Sharps (Needles, syringes, scalpels,

Disinfecting (chemical

blades, glass,

treatment / autoclaving / microwaving and mutilation / shredding

Category No. 5

Discarded Medicine and Cytotoxic

Incineration / destruction and

drugs (Wastes comprising of outdated,

drugs disposal in secured

contaminated and discarded

landfills

medicines)

 

  Category No. 6

Soiled Waste (Items contaminated with

Incineration / autoclaving /

body fluids including cotton, dressings,

microwaving

soiled plaster casts, lines, bedding and other materials contaminated with blood.)

Category No. 7

Category No. 8

Category No. 9

Solid Waste (Waste generated from

Disinfecting by chemical

disposable items other than the waste

treatment/ autoclaving /

sharps such as tubing, catheters,

microwaving and mutilation /

intravenous sets, etc.)

shredding

Liquid Waste (Waste generated from the

Disinfecting by chemical

laboratory and washing, cleaning, house

Treatment and discharge

keeping and disinfecting activities)

into drains

Incineration Ash (Ash from

Disposal in municipal landfill

incineration of any biomedical waste)

Category

Chemical Waste (Chemicals used in

Chemical treatment and

No.10

production of biological, chemicals used

discharge into drains for liquids

in disinfecting, as insecticides, etc.)

and secured landfill for solids.

Segregation Segregation of b iomedical waste Creating a system for segregation of waste is the first step. Segregation at source of different types of biomedical wastes and their appropriate storage and/or disinfections sterilization, etc. would ensure that infectious wastes do not get mixed with non- infectious wastes as this would infect the entire waste. Only a small fraction of waste generated by health care institutions is actually infectious or hazardous. It is estimated that 80-85 per cent is non-infectious, 10 per cent is infectious and 5 per cent is hazardous. Segregation of waste into infected or contaminated waste and non-infected waste is mandatory and is a prerequisite for safe and hygienic waste management. Segregation at source makes it easier to prevent spread of infection, help it easier to choose among the options of disposal, and can reduce the load on the waste treatment system and prevent injuries.

 

The Schedule 1 of the Rules has laid down certain directions regarding segregation and storage to ensure safe and hygienic handling of infectious and non-infectious waste. The segregation of biomedical waste into various categories and storage in four different coloured containers are taking into account the treatment and disposal facilities available (see Table 2). The Biomedical waste shall be segregated into containers/bags at the point of generation in accordance with Schedule  Schedule   II II prior  prior to its storage, transportation, treatment and disposal. The containers shall be labelled according to Schedule III Schedule  III of  of the rule. Apart from the biomedical waste the general waste or the garbage generated in health care establishments such as office waste, food waste and garden waste is advisable to be stored in green coloured containers. The local bodies are duty bound to collect such general waste stored in green coloured containers. The Rules recommend different colour codes for waste containers in which different types of wastes needs to be stored. Clinical and general wastes should be segregated at source and placed in colour coded plastic bags and containers of definite specifications prior to collection and disposal. The container should comprise of an inner plastic bag of varied colour depending on the type of waste. It should be of a minimum gauge of 55 micron (if of low density) or 25 micron (if of high density), leak proof and puncture proof, and should match the chosen outer container. The outer container is a plastic bin with handles, and of a size which will depend on the amount of waste generated. The inner polythene bag should fit into the container with one-fourth of the polythene bag turned over the rim. Labelling has been recommended to indicate the type type of waste, site of generation, name of generating generating hospital or facility. This will allow the waste to be traced from the point of generation to the disposal area. The containers are then to be transported in closed trolleys or wheeled containers that should be designed for easy cleaning and draining. If for any reasons, it becomes necessary to store the waste beyond such period, permission from the prescribed authority (established by the government of every State and Union Territory) must be taken, and it must be ensured that it does not adversely affect human health and the environment. Once collection occurs, then biomedical waste is stored in a proper place. No untreated biomedical waste shall be stored beyond a period of 48 hours. Segregated wastes of different categories need to be collected in identifiable containers. The duration of storage should not exceed for 8-10 hours in big hospitals and 24 hours in other health care institutions. Each container may be clearly labelled to show the ward or room where it is kept. The reason for this labelling is that it may be necessary to trace the waste back to its source. Besides this, storage area should be marked with a caution sign.

 

Table 2

Colour Coding and Type of Container   Type of

Colour Coding Yellow

Container Plastic bag

Waste Cate Category gory Cat.1,Cat.2, Cat.3

Treatment opti ons (Schedule I) Incineration/ deep burial

and Cat.6 Red

Disinfected

Cat.3, Cat.6, and

 Autoclaving/Micro waving/

container/plastic

Cat.7

Chemical treatment

Cat.4 and Cat.7

Autoclaving/Micro waving/

bag Blue/ White

Plastic bag/

Translucent

puncture proof

Chemical treatment and

container

destruction/ shredding

Black Blac k

Plastic bag

Cat.5, Cat.9, and

Disposal in secured landfill

Cat.10 (solid)

Transportation Untreated biomedical waste shall be transported only in specially designed vehicles. The waste should be transported for treatment either in trolleys or in covered wheelbarrows. Manual loading should be avoided as far as possible. The bags / container containing biomedical wastes should be tied/ lidded before transportation. Before transporting the bag containing biomedical wastes, it should be accompanied with a signed document by Nurse/ Doctor mentioning date, shift, quantity and destination. Special vehicles must be used so as to prevent access to, and direct contact with, the waste by the transportation operators, the scavengers and the public. The transport containers should be properly enclosed. The effects of traffic accidents should be considered in the design, and the driver must be trained in the procedures he must follow in case of an accidental spillage. It should also be possible to wash the interior of the containers thoroughly

Personnel Personnel safety devices The use of protective gears should be made mandatory for all the personnel handling waste. Gloves::   Heavy-duty rubber gloves should be used for waste handling by the waste retrievers. This Gloves should be bright yellow in colour. After handling the waste, the gloves should be washed twice. The gloves should be washed after every use with carbolic soap and a disinfectant. The size should fit the operator.

 

 Ap ro ns , go wn s, su it s or ot her app are arels ls :  Apparel is worn to prevent contamination of clothing and protect skin. It could be made of cloth or impermeable material such as plastic. People working in incinerator chambers should have gowns or suits made of non-inflammable material. Masks::   Various types of masks, goggles, and face shields are worn alone or in combination, to Masks provide a protective barrier. It is mandatory for personnel working in the incinerator chamber to wear a mask covering both nose and mouth, preferably a gas mask with filters. Boots::  Leg coverings, boots or shoe-covers provide greater protection to the skin when splashes or Boots large quantities of infected waste have to be handled. The boots should be rubber-soled and anti-skid type. They should cover c over the leg up to the ankle.

Biomedical waste treatment system The Biomedical waste treatment and disposal are to be done very carefully, as it is infectious in nature. Considering the then level of information and knowledge, the Government of India has specifically laid down the treatment and disposal options. All health care institutions are required to follow this without fail. As per the Rule, the biomedical waste has to be treated and disposed of in accordance with options suggested under Schedule I Schedule I,, and in compliance with the standards prescribed in Schedule V of the Rule.  Any biomedic biomedical al waste treatment system should comprise of segregation segregati on at source, storage in colourcoded containers, systematic collection, transportation to treatment site, treatment considering the type of waste and disposal considering the type of waste. Segregation of biomedical waste is based on the category of waste. Storage and collection of waste in colour-coded containers is based on the treatment adopted. The treatment options for biomedical waste as per the schedule I of the Rules are incineration, deep burial, autoclave, microwave, chemical treatment, destruction and shredding, and disposal in secured land fills. Disinfection refers to procedures, which reduce the number of microorganisms on an object or surface but not the complete destruction of all microorganisms or spores. Sterilisation on the other hand, refers to procedures, which would remove all microorganisms, including spores, from an object. Sterilisation is undertaken either by dry heat (for 2 hours at 170oC in an electric oven - method of choice for glass ware and sharps) or by various forms of moist heat (i.e. boiling in water for an effective contact contact time of 20 minutes or steam sterilization in an autoclave at 15 lb/ lb/sq sq inch at 121oC for 20 minute)

Specifications of equipments Incinerator:   The biomedical waste incinerator shall meet the following operating and emission standards: (i) Operating standards

 

1. Combustion efficiency (CE) shall be at least 99.00 %. 2. The combustion efficiency is computed as follows:

%CO %C O2 x 100 CE = % CO2 + % CO O

3. The temperature of the primary chamber shall be 800 +/-50 c O

4. The secondary chamber gas residence time shall be at least 1 (one) second at 1050 +/- 50 c

(ii) Emission standards: Waste to be incinerated not to be disinfected with chlorine containing substances. Chlorinated plastics should not be incinerated. Toxic metals in incineration ash should be limited to within regulatory quantities. Only low sulphur fuels like LDO/LSHS to be used as fuel

Deep Burial  

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A pit or trench should be dug about 2 m deep. It should be half filled with waste, and then covered with lime within 50 cm of the surface, before filling the rest of the pit with soil.

 

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It must be ensured that animals do not have access to burial sites. Covers of galvanized iron/wire meshes may be used.

 

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On each o occasion, ccasion, when when wastes are added to the pit, a layer of 10cm of soil be added 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

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•

site.  

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The pits should be distant from from habitation, and sited so as to ensure that no contami contamination nation occurs of any surface water or ground water. The area should not be prone to flooding or erosion.

 

The location of the deep burial site will be authorised by the prescribed authority.

 

The in institution stitution shall maintain a record of all pits pits ffor or deep b burial. urial.

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 Auto  Au to cl avi ng The basic objective of autoclaving is to disinfection and treating biomedical waste. 1. When operating operating a gravity gravity flow autoclave, medical waste waste shall be subjected to: a.

0

A temperature of not less than 121 C and pressure of 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes; or

b.

0

A temperature of not less than 135 C and a pressure of 31 psi for an autoclave

 

residence time of not less than 45 minutes; or c.

0

A temperature of not less than 149 C and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes.

2. When operating a vacuum autoclave, m medical edical waste shall be subjected to a minimum of one pre vacuum pulse to purge the autoclave of all air. The waste shall be subjected to the following a.

0

A temperature of not less than 121 C and a pressure of 15 psi for an autoclave residence time of not less than 45 minutes; or

b.

0

A temperature of not less than 135 C and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes.

3. Medical waste shall not be considered properly treated unless the time, 4.

Temperature and pressure indicators indicate that the required time, temperature and pressure are reached during the autoclave process. If for any reason, time, temperature or pressure indicator indicates that the required temperature, pressure or residence time was not reached, reached, the entire load of medical waste must be autoclaved again until the proper temperature, pressure and residence time were achieved.

5. Recording of operational parameters: Each autoclave autoclave shall have graphic or computer recording devices which will automatically and continuously monitor and record dates, time of day, load identification number and operating parameters through out the entire length of the autoclave cycle. 6. Validation test: 7.

Spore testing: testing: The autoclave should completely and consistently kill the approved biological indicator at the maximum design capacity of each autoclave unit. Biological indicator for autoclave shall be Bacillus stearothermophilus spores using vials or spore strips, with at least 4

1*10  spores per million. Under no circumstances will an autoclave have minimum operating parameters less than a residence time of 30 minutes, regardless of temperature and pressure, a temperature less than 121  0C or a pressure less than 15 psi. 8.

Routine tests: A chemical indicator strip/tape that changes colour when a certain temperature temperat ure is reached can be used to verify that a specific temperature has been achieved. It may be necessary to use more than one strip over the waste package at different location to ensure that the inner content of the package has been adequately autoclaved.

Microwave Treatment 1. Microwave treatment shall not be used for cytotoxic, hazardous or radioactive wastes, contaminated animal carcasses, body parts and large metal items. 2. The microwave system shall comply with the efficacy tests/routine tests and a performance

 

guarantee, may be provided by the supplier before operation of the unit. 3. The microwave should completely and consistently kill bacteria and other pathogenic organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit. Biological indicators indica tors for microwave shall be Bacillus subtilis spores using vials or spore strips with 4

a least 1*10  spores per ml.

Chemical Treatment 1 % hypochlorite solution can be used for chemical disinfection.

Destruction and Shredding The discarded medicine shall be destructed before disposal. It is advisable that the discarded medicines are returned to the manufacturer for destruction. The solid materials, particularly plastic shall be shredded before sending to the recyclers. These materials are to be disinfected before shredding.

Disposal in Secured Land fills This is an arrangement for disposal of discarded medicine and chemical waste.

BIOMEDICAL WASTE MANAGEMENT BY IMAGE The management of biomedical wastes in individual health care institutions is economically not feasible. IMAGE was conceived and launched to support healthcare providers to face the challenges and responsibilities of the Biomedical Waste (Management and Handling) Rules 1998. Indian Medical  Association  Associ ation Kerala State Branch established establ ished a Common Biomedical Waste Treatment and Disposal th

Facility at Palakkad was dedicated to the nation on 14 December 2003. IMAGE (Indian Medical Association Goes Eco-friendly)  Eco-friendly)   the biomedical waste treatment and disposal scheme of Indian Indian Medical Association Association has been a different cup of o f tea altogether, uni unique que in conception and execution. The scheme is a testimony to what IMA is capable of. The brand IMA has withstood the difficulties in dealing with an issue concerned with waste. The story of IMAGE is the story of public trust in IMA. It is the unshakable faith in IMA's credentials that has sustained IMAGE.

IMA has invested in IMAGE around Rs 3 crore for the project. This liability is being shared on a cooperative basis by the affiliated institutions. However, this expenditure will amount to only one tenth of the cost the institutions would incur if they choose an individual facility. Health care institutions can affiliate with IMAGE by paying a non-refundable one time affiliation fee along with the duly filled up prescribed application form. The affiliation fee is Rs. 1000/- per bed. The minimum affiliation fee for clinics, laboratory, and diagnosis centre, dental clinics with two chairs, etc will be Rs. 5000/- only.

 

Government hospitals have been exempted from paying affiliation fee. IMAGE provides comprehensive service to health care institutions by training hospital staff, advice and assistance in procuring materials for installing a waste management system, collection of biomedical waste from hospitals in colour coded bags, transportation in specially designed vehicles, treatment and final disposal in the common facility. Thus infectious waste generated from hospitals is disposed off most scientifically within 48 hours. The expenditure for service is by collecting daily charges.  As of today IMAGE serves in i n all the 14 districts of the state. More than 2500 health care establishments esta blishments are affiliated to IMAGE. This amounts to total bed strength of about 65000. Today IMAGE handles more than half of the biomedical waste generated in Kerala. IMAGE consists of a common treatment and disposal facility and a fleet of 28 specially designed vehicles which collect and transport biomedical waste from all the affiliated hospitals everyday conforming to all the legal regulations. The treatment facilities consist of three incinerators, two autoclaves, a plastic shredder, sharp pits, facility for storage of incineration ash, waste water treatment plant, etc. The IMAGE has made an agreement with the KEIL (Kerala Environmental Infrastructure Limited) Ernakulum for collecting and transporting to their common facility all incineration ash and waste water treatment plant sludge. This is an institution of excellence. This model is unique to Kerala and has propelled the state ahead of other states. Training the staff of the institutions for scientific segregation of biomedical waste; provision to make available colour coded bags and containers with emblem; daily collection of segregated and contained biomedical waste from institutions; safe disposal of the biomedical waste in the plant as per the rules; to make available monthly statement regarding the quantity of biomedical waste collected and disposed on behalf of the institutions and facilitate to obtain Authorization from the State Pollution Control Board, these are some of the services extended to health care facilities in the state by the IMAGE. IMAGE.