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Biomedical waste management. Presenter: Dr.L.Karthiyayini Moderator: Dr. A.Mehendale . Framework. Definition Burden of biomedical waste Sources of waste Types of health care waste & its health hazards Legislations Waste generation Principles of managing waste Waste minimization
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Biomedical waste management Presenter: Dr.L.Karthiyayini Moderator: Dr. A.Mehendale
Framework • Definition • Burden of biomedical waste • Sources of waste • Types of health care waste & its health hazards • Legislations • Waste generation • Principles of managing waste • Waste minimization • Managing sharps • Chemical disinfectants • Handling of health care waste • Waste segregation & labeling • Waste storage & transport • Waste treatment & disposal • Infection control • BWM at MGIMS • BMWM in national programs • Biomedical waste audit
Definition “Any waste which 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” [Source: Biomedical Waste (Management and Handling) Rules, 1998 of India]
MAGNITUDE OF THE PROBLEM GLOBALLY: • Developed countries generate 1 to 5 kg/bed/day • Developing countries: 1-2kg/pt/day WHO Report: • 85% non hazardous waste • 10% infective waste • 5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive) • 2002, 22 countries, health care facilities not using proper disposal 18%-64%
INDIA: • No national level study • Hospitals generate 1-2 kg/bed/day • BMW generation : • 4,05,702 kg/day • 2,91,983 kg/day is disposed • 28% of the wastes is untreated • 53.25% HCE – not authorized
Sources of biomedical wastes Major Sources: • Govt. hospitals/private hospitals/nursing homes/ dispensaries. • Primary health centres. • Medical colleges and research centres/ paramedic services. • Veterinary colleges and animal research centres. • Blood banks/mortuaries/autopsy centres. • Biotechnology institutions.
Minor Sources: • Physician’s/ dentist’s clinics • Animal houses/slaughter houses. • Blood donation camps. • Vaccination centres. • Acupuncturists/psychiatric clinics/cosmetic piercing. • Funeral services. • Institutions for disabled persons
LEGISLATIONS ENVIRONMENTAL REGULATIONS FROM MoEF: • Environment protection act,1986: • Bio-medical waste management rules,1998(RENEWED 2011) • Municipal solid waste rules,2000 • Hazardous waste rules,1989 • EIA Notification, July 2004
Bio-Medical Waste Rules 2011 • Elaborate, stringent and several new provisions have been added • Not applicable: • Radioactive waste, • Hazardous waste, • Municipal solid waste • Battery waste
Accident reporting must • HCE- BMWM unit & meetings • Mandatory treatment & disposal • Adequate treatment facilities • Promote new technologies • Omitted- Incinerator & deep burial • District level monitoring committee • Allocation : Funds & Equipments • Lacking: guidelines for linen & mattress, blood bags & pressurized containers
Schedules • Schedule I :Categories of Biomedical waste • Schedule II :Color coding • Schedule III :Labels for Hazardous waste • Schedule IV :Label for transport of BMW container/bags • Schedule V :Standards for – incineration , autoclaving, sewerage, deep burial • Schedule VI :Deadlines for implementation
SCHEDULE IIILABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS BAGS
SCHEDULE-IV LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS BAGS • Day... ...Month ….……. Year…………Date of generation • Waste category No ... Waste Class ……… • Waste description …………………………………………………. • Sender's Name & Address • Receiver's Name & Address . • In case of emergency please contact……….
Forms • FORM-I : Application for authorization/ renewal of authorization • FORM II : Annual report(To be submitted to the prescribed authority by 31 January every year • FORM III :- Accident reporting • FORM IV: Authorization granting format • FORM V : Application for filing appeal against order passed by the prescribed authority • FORM VI: Operator of CBMWTF filing against HCE- if no proper segregation
ANNEXURE-II • GUIDELINES FOR DESIGN AND CONSTRUCTION OF BIO-MEDICAL WASTE INCINERATOR • Air Pollution Control Device (APCD) • Emission limit - 150 mg/Nm3 (corrected to 12% CO2) for Particulate Matter
COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTES
PRINCIPLES OF MANAGING HEALTH CARE WASTE • Waste minimization • Safe reuse & recycling • Managing sharps
Waste minimization • Source reduction • Management and control measures at hospital level • Stock management of chemical and pharmaceutical products
SAFE REUSE & RECYCLING Sterilization methods for reusable items: Thermal sterilization • Dry sterilization - Exposure to 160 °C for 120 minutes or 170 °C for 60 minutes in a “Poupinel” oven. • Wet sterilization - Exposure to saturated steam at 121°C for 30 minutes in an autoclave. Chemical sterilization • Ethylene oxide - Exposure to an atmosphere saturated with ethylene oxide for 3–8 hours, at 50–60°C, in a reactor tank • Glutaraldehyde - Exposure to a glutaraldehyde solution for 30 minutes
Managing sharps Auto disable syringes
In 2000, WHO estimation-injections with contaminated syringes caused: • 21 million hepatitis B virus (HBV) infections (32% of all new infections) • two million hepatitis C virus (HCV) infections (40% of all new infections) • 260 000 HIV infections (5% of all new infections). • One needle stick injury risks: • 30% -HBV • 1.8% -HCV • 0.3% -HIV.
Disinfectants commonly used for disinfection of materials contaminated with blood & body fluids
Infection control • Hand washing • Personnel protective equipment • Safe handling of waste • Prevention of needle stick injuries • Environmental cleaning & spillage management • Proper training to health care workers • Immunization of health care workers