BioMedical Waste Management Issues Challenges

 

Bio-medical Waste Management Issues and Challenges

Dr. Selwyn A Colaco Chief Operating Officer Narayana Hrudayalaya Hospitals, Bangalore

 

I. Environmental Legislation    

 

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The Air (Prevent (Prevention ion and Control of Pollution) Act, 1981 The Environment (Protection) Act, 1986 The Hazardous Waste (Management (Management & Handling) Rules, 1989 The National Environmental Tribunal Act, 1995  1995  The Biomedical Waste (Management & Handling) Rules, 1998  The Municipal Solid Waste (Management & Handling)  Rules, 2000  

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Implementation of  BIO-MEDICAL BIO-MEDIC AL WASTE WASTE RULES 1998

BMW Rules have been adopted and notified with the  objective to stopbio-medical the indiscriminate disposal of that  hospital waste/ waste and ensure such waste is handled without any adverse effect on  the human health and environment.  environment. 

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Implementation of  BIO-MEDICAL BIO-MEDIC AL WASTE WASTE RULES 1998 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

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Basic Principles 

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Segregation and safe containment of waste at the Segregation health facility level Processing and storage for terminal disposal

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Basic Principles    

Bio-medical waste shall not be mixed with other wastes. Segregation Segregat ion 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 generat generation ion in accordance with Schedule II (BMW Rules 1998) prior to its storage, transportation, treatment and disposal.  disposal. 

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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 

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 Transporta  T ransportation tion & Storage Storag e of BMW 

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Untreated biomedical biomedical waste shall be transported only in   vehicles authorized for the purpose by the competent authority as specified by the government government.. 

bio-medical waste shall not be kept/stored beyond a Untreated period of 48 hours. 

If for any reason it becomes necessary to store the waste

beyond such period, measuresaffect musthuman be taken to ensure that the waste does not adversely health and the environment.   environment.

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Biomedical

Waste Management Waste Manag ement - Issues

Use/Reuse of  equipment 

Unsafe collection

Unsafe disposal

 

Biomedical

•

Waste Management Waste Manag ement - Issues

Not considered important Lack of interest from senior management  –   –   –   – 

No ownership of the process  Awareness  Awarene ss of problems  Appreciate the need for for constant monitoring

 

Biomedical

Waste Management Waste Manag ement - Issues

Segregation S egregation of waste not taken seriously at user us er level Non compliance with color coding Non Monitoring segregation at source low budgets allocated   Monitoring

 –   –   – 

 – 

 – 

costs are not always known Cost of color coding, staff, transport and disposal Cost Quantification of waste generated is not accurately done Quantification

 –   – 

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Biomedical

Waste Management Waste Manag ement - Issues

Protection P rotection of healthcare workers not given adequate thought Clinical waste dumped with non infectious waste - Risk for Clinical

 – 

 – 

healthcare workers and public Waste disposal not effective, effective, often dumped in open landfills

 – 

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Biomedical

Waste Management Waste Management - responsibilities

Responsibility R esponsibility for waste disposal head of facility, but devolved to members of the waste management team Each healthcare worker segregat Each segregation ion and appropriate

 – 

 – 

 – 

 – 

disposal Private companies from collection point in hospital to Private disposal Medical waste segregation awareness and Information Medical

 – 

 – 

 – 

should be available in all areas of hospital

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Challenges: Need for protocol and policies… To provide protection for Healthcare workers Patients  –   –   –  • •

Community atstatutory large - from the risk of infections inf ections Compliance with requirements Government of India India -1998 -1998 biomedical biomedical waste management and handling rules under EPA   (compels hospitals, hospitals, clinics, labs to ensure safe safe and environmentally  sound management management of waste generated at their establishments) establishments)

 

Challenges Establishing robust waste management policies within the organization  Organization wide awareness about the health hazards 

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Sufficient and human Monitoringfinancial and control of wasteresources disposal  Clear responsibility for appropriate handling and disposal of  waste.  

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 ADRESSING  ADRES SING THE ISSUES ISSUES 1. Nee Need d to build-up of a comprehe comprehensive nsive system, system, address address responsibilities, resource allocation, handling and disposal 2. This is a long-term long-term process, process, sustaine sustained d by gradual gradual improvements. 3. Spec Specific ific personnel personnel need need to be assigned to monitor 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. Qualit Quality y assessment assessment of bio-medical bio-medical waste manageme management nt should be done from time to time. 

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 ADRESSING  ADRESS ING THE ISSUES 6. Segregate Segregated d collection and transportation transportation - The use of  color coding and labeling of hazardous waste. 7. Clear direct directives ives in the form form of a posters posters and notice notice to be displayed in all concerned areas in English and local languages. 8. Saf Safet ety y of handl handlers ers.. 9. Raising Aware Awareness ness about risks related related to health-care waste; training staff and HCW on safe practices. 10.Selection 10.Select ion of safe and environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.

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 ADRESSING  ADRES SING THE ISSUES 11.Issue of all protectiv protective e 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 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 treatment and final disposal.

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Thank you  Any Questions? Questions?

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Schedule-I CATEGORIES OF BIO-MEDICAL WASTE Option

Waste Categor Category y

Treatment & Disposal

Category No. 1 

Human Anatomical Waste  Waste 

incineration @/deep burial*

(human tissues, organs, body parts)  parts)   Category No. 2 

Animal Waste  Waste  (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals,

incineration@/deep burial*

colleges, houses)   discharge from hospitals, animal houses) Category No. 3 

Microbiology & Biotechnology Waste  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

local autoclaving/microwaving/incineration@

industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures)  cultures)  Category No. 4 

Waste Sharps  Sharps  (needles, syringes, scalpels, blade, glass, etc. that may cause punture and cuts. This includes both used and unused sharps)  sharps) 

disinfection (chemical treatment @@@/auto claving/microwaving and mutilation/shredding# mutilation/shredding## #

Category No. 5 

Discarded Medicines and Cytotoxic drugs  drugs  incineration@/destruction and (Waste comprising of outdated, drugs disposal in secured 20 contaminated and discarded medicines) landfills

contaminated and discarded medicines)  medicines) 

landfills

 

Schedule-I CATEGORIES OF BIO-MEDICAL WASTE (continued) Soiled Waste  Waste 

incineration@autoclaving/micro

(items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood)  blood) 

waving

Category No. 7 

Solid Waste  Waste  (Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.)  etc.) 

disinfection by chemical treatment@@ autoclaving/microwaving autoclaving/microwav ing and mutilation/shredding##

Category No. 8 

Liquid Waste  Waste  (Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities)   activities)

disinfection by chemical treatment@@ and discharge into drains

Category No. 6 

Category No. 9 

Category No. 10 

Incineration Ash  Ash   Ash from incineration incineration of any biomedical waste)  waste)  Chemical Waste  Waste  (Chemicals used in production of  biologicals, chemicals used in production of biologicals, chemicals used in disinfection, as

disposal in municipal landfill

chemical treatment@@ and discharge into drains for liquids and secured landfill for solids 21

insectricides, etc.)  etc.)   

Schedule-I CATEGORIES OF BIO-MEDICAL WASTE (continue) 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% hypoch hypochlorite lorite 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.

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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 

 Yellow

Plastic Bag

Categories 1, 2, 3 & 6.

Disinfected container/Plastic

Red   Red

Blue/White Translucent Black

bag Plastic Bag /puncture proof  containers Plastic Bag

Categories 3, 6, 7

Treatment options  Incineration/ Incineration / deep burial  Autoclaving/Micro-waving/Chemical  Autoclaving/Micro-waving/Chemical Treatment

Cat. 4, Cat. 7

 Autoclaving/Micro-waving/ Chemical Treatment & Destruction / shredding

Categories 5, 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.