BM_Waste_mgmt_issues_challenges

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Bio-medical Waste Management Issues and Challenges Dr. Selwyn A Colaco Chief Operating Officer Narayana Hrudayalaya Hospitals, Bangalore

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

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3 BMW Rules have been adopted and notified with the objective to stop the indiscriminate disposal of hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment. Implementation of BIO-MEDICAL WASTE RULES 1998

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4 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 Implementation of BIO-MEDICAL WASTE RULES 1998

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

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

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7 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 Basic Principles

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8 Untreated biomedical waste shall be transported only in vehicles authorized for the purpose by the competent authority as specified by the government. Untreated bio-medical waste shall not be kept/stored beyond a period of 48 hours. If for any reason it becomes necessary to store the waste beyond such period, measures must be taken to ensure that the waste does not adversely affect human health and the environment. Transportation & Storage of BMW

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Use/Reuse of equipment Unsafe collection Unsafe disposal Biomedical Waste Management - Issues

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Biomedical Waste Management - Issues Not considered important Lack of interest from senior management No ownership of the process Awareness of problems Appreciate the need for constant monitoring

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11 Segregation of waste not taken seriously at user level Non compliance with color coding Monitoring segregation at source – low budgets allocated – costs are not always known Cost of color coding, staff, transport and disposal Quantification of waste generated is not accurately done Biomedical Waste Management - Issues

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12 Protection of healthcare workers not given adequate thought Clinical waste dumped with non infectious waste - Risk for healthcare workers and public Waste disposal not effective, often dumped in open landfills Biomedical Waste Management - Issues

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13 Responsibility for waste disposal – head of facility, but devolved to members of the waste management team Each healthcare worker – segregation and appropriate disposal Private companies – from collection point in hospital to disposal Medical waste segregation awareness and Information should be available in all areas of hospital Biomedical Waste Management - responsibilities

Challenges: Need for protocol and policies… :

Challenges: Need for protocol and policies … To provide protection for Healthcare workers Patients Community at large - from the risk of infections Compliance with statutory requirements Government of India -1998 biomedical waste management and handling rules under EPA (compels hospitals, clinics, labs to ensure safe and environmentally sound management of waste generated at their establishments)

Challenges:

15 Challenges Establishing robust waste management policies within the organization Organization wide awareness about the health hazards Sufficient financial and human resources Monitoring and control of waste disposal Clear responsibility for appropriate handling and disposal of waste.

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16 ADRESSING THE ISSUES Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal This is a long-term process, sustained by gradual improvements. Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital. Man power needs and other resources for the BMWM of hospital to be addressed. Quality assessment of bio-medical waste management should be done from time to time.

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17 ADRESSING THE ISSUES Segregated collection and transportation - The use of color coding and labeling of hazardous waste. Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages. Safety of handlers. Raising Awareness about risks related to health-care waste; training staff and HCW on safe practices. Selection 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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18 ADRESSING THE ISSUES Issue of all protective clothes such as, gloves, aprons, masks etc. to all HCW. Regular medical check-up (half-yearly) of staff associated with BMWM. Maintenance of Record registers for this purpose. Containers should be robust and leak proof Tracking of Bio Medical Waste upto point of Disposal. Proper treatment and final disposal.

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19 Thank you Any Questions?

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20 Option Waste Category Treatment & Disposal Category No. 1 Human Anatomical Waste (human tissues, organs, body parts) incineration @/deep burial* Category No. 2 Animal Waste (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses) incineration@/deep burial* Category No. 3 Microbiology & Biotechnology 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 industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures) local autoclaving/micro-waving/incineration@ Category No. 4 Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause punture and cuts. This includes both used and unused sharps) disinfection (chemical treatment @@@/auto claving/microwaving and mutilation/shredding## Category No. 5 Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines) incineration@/destruction and drugs disposal in secured landfills Schedule-I CATEGORIES OF BIO-MEDICAL WASTE

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21 Category No. 6 Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood) incineration@autoclaving/microwaving Category No. 7 Solid Waste (Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.) disinfection by chemical treatment@@ autoclaving/microwaving and mutilation/shredding## Category No. 8 Liquid Waste (Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities) disinfection by chemical treatment@@ and discharge into drains Category No. 9 Incineration Ash Ash from incineration of any bio-medical waste) disposal in municipal landfill Category No. 10 Chemical Waste (Chemicals used in production of biologicals, chemicals used in production of biologicals, chemicals used in  disinfection, as insectricides, etc.) chemical treatment@@ and discharge into drains for liquids and secured landfill for solids Schedule-I CATEGORIES OF BIO-MEDICAL WASTE (continued)

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

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23 Schedule-II COLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIO MEDICAL WASTES Colour Coding Type of Container Waste Category Treatment options Yellow Plastic Bag Categories 1, 2, 3 & 6. Incineration/ deep burial Red Disinfected container/Plastic bag Categories 3, 6, 7 Autoclaving/Micro-waving/Chemical Treatment Blue/White Translucent Plastic Bag /puncture proof containers Cat. 4, Cat. 7 Autoclaving/Micro-waving/ Chemical Treatment & Destruction / shredding Black Plastic Bag 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.

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