HOSPITAL WASTE MANAGEMENT

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Let the wastes of “ the sick ” Not contaminate the lives of “ the healthy ” - K. PARK

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BIO-MEDICAL WASTE MANAGEMENT

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BIO-MEDICAL WASTE MANAGEMENT By - Dr. Sandeep Madhukar Wankhede 1 st year MD student Department Of Microbiology

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: Definition : - Any waste,which is generated in the diagnosis, treatment and immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals BIO-MEDICAL WASTE According to Bio-Medical Waste (Management and Handling) Rules, 1998 of india

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CLASSIFICATION OF HEALTH-CARE WASTE Infectious waste Pathological waste Sharps Pharmaceutical waste Genotoxic waste Chemical waste Waste with high contents of heavy metals Pressurized containers Radioactive waste

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CLASSIFICATION OF HEALTH-CARE WASTE Infectious waste Laboratory cultures Waste from isolation wards Tissues(swabs)

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CLASSIFICATION OF HEALTH-CARE WASTE Pathological waste Human tissues or fluids e.g. body parts Blood and other body fluids Fetuses

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CLASSIFICATION OF HEALTH-CARE WASTE Sharps Needles; infusion sets; scalpels Blades Broken glass

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CLASSIFICATION OF HEALTH-CARE WASTE Pharmaceutical waste Pharmaceuticals expired or no longer needed bottles or boxes contaminated by or containing pharmaceuticals

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CLASSIFICATION OF HEALTH-CARE WASTE Genotoxic waste Waste containing cytotoxic drugs (often used in cancer therapy) Genotoxic chemicals

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CLASSIFICATION OF HEALTH-CARE WASTE Chemical waste Laboratory reagents; Film developer; solvents Disinfectants that are Expired or no longer needed

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CLASSIFICATION OF HEALTH-CARE WASTE Waste with high contents of heavy metals Batteries Broken thermometers Blood pressure gauges

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CLASSIFICATION OF HEALTH-CARE WASTE Pressurized containers Gas cylinders gas cartridges aerosol cans

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CLASSIFICATION OF HEALTH-CARE WASTE Radioactive waste Unused liquids from radiotherapy or laboratory research contaminated glassware urine and excreta from patients treated or tested with unsealed radionucleotides

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75%-90% \ 10%-25% Non-risk or general health care waste Mostly from administrative and house keeping functions of health care establishment Hazardous and health risk

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Government hospitals Private hospitals Nursing homes Physician’s office/clinics Dentist’s office/clinics Dispensaries Primary health centres Morturies Medical research & Blood banks & collection centre training establishments Animal houses Slaughter houses Laboratories Research organizations Vaccinating centres Bio-technology institutions (covered under Bio-Medical waste rules) Sources of health-care waste

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Average composition of hospital waste in India Average composition of waste obtained from 10 large hospitals in Mumbai, Kolkata, Delhi and Nagpur Material Percentage Paper 15% Plastics 10% Rags 15% Metal 1% Infectious waste 1.5% Glass 4% General waste 53.5% National Environmental Engineering Research Institute 1997

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Health hazards of health-care waste Infectious agents Toxic or hazardous chemicals or pharmaceuticals Sharps Genotoxic Radio-active

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The Main Groups at Risk Medical doctors nurses health-care auxiliaries and hospital maintenance personnel

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The Main Groups at Risk Patients in Health care establishments Visitors to Health care establishments

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The Main Groups at Risk workers in support services allied to health-care establishments such as laundries, waste handling and transportation

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The Main Groups at Risk Workers in waste disposal facilities such as land fills or incinerators including scavengers

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Potential Health Risks of Bio-medical Waste Hazards from infectious waste and sharps 2. Hazards from chemicals and pharmaceutical waste 3. Hazards from genotoxic waste 4. Hazards from radioactive waste Public sensitivity

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Potential Health Risks of Bio-medical Waste Hazards from infectious waste and sharps through a puncture / abrasion / cut in the skin through the mucous membranes by inhalation by ingestion Sharps - not only cause cuts and punctures but also infect these wounds if they are contaminated with pathogens Double risk of injury and disease transmission sharps are considered as a very hazardous waste class

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Potential Health Risks of Bio-medical Waste Hazards from infectious waste and sharps through a puncture / abrasion / cut in the skin through the mucous membranes by inhalation by ingestion Sharps - not only cause cuts and punctures but also infect these wounds if they are contaminated with pathogens Double risk of injury and disease transmission sharps are considered as a very hazardous waste class Needles – important sharps waste category particularly hazardous because often contaminated with patient’s blood

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Potential Health Risks of Bio-medical Waste Hazards from infectious waste and sharps Human immunodeficiency virus (HIV) Hepatitis viruses B and C Bacteria resistant to antibiotics & chemical disinfectants

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Potential Health Risks of Bio-medical Waste Hazards from infectious waste and sharps Risk of infection after needle puncture Infection Risk of infection HIV 0.3% Viral hepatitis B 3% Viral hepatitis C 3–5%

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Potential Health Risks of Bio-medical Waste Hazards from chemicals and pharmaceutical waste toxic, genotoxic, corrosive, flammable, reactive, explosive, shock-sensitive Intoxication - acute or by chronic exposure and injuries including burns absorption through the skin or mucous membrane inhalation or ingestion Formaldehyde and other volatile substances

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Potential Health Risks of Bio-medical Waste Hazards from chemicals and pharmaceutical waste toxic, genotoxic, corrosive, flammable, reactive, explosive, shock-sensitive Intoxication - acute or by chronic exposure and injuries including burns absorption through the skin or mucous membrane inhalation or ingest Formaldehyde and other volatile substances Disinfectants - important members of this group large quantities & often corrosive

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Potential Health Risks of Bio-medical Waste Hazards from genotoxic waste substance toxicity itself and the extent and duration of exposure inhalation of dust or aerosols, absorption through the skin, ingestion of food accidentally contaminated with cytotoxic drugs, chemicals, or waste Cytotoxicity ( antineoplastic drugs ) - cell-cycle-specific,targeted on specific intracellular processes such as DNA synthesis and mitosis Alkylating agents - not phase specific, but cytotoxic at any point in the cell cycle irritant and have harmful local effects after direct contact with skin or eyes also cause dizziness, nausea, headache, or dermatitis

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Potential Health Risks of Bio-medical Waste Hazards from radioactive waste Type and extent of exposure Headache, dizziness, and vomiting to much more serious problems As certain radioactive waste - genotoxic, it may also affect genetic material

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Potential Health Risks of Bio-medical Waste Public sensitivity visual impact of anatomical waste that is recognisable human body parts including fetuses

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National legislation is the basis for improving health-care waste disposal practices in any country. It establishes legal controls and permits the national agency responsible for the disposal of health-care waste, usually the ministry of health, to apply pressure for their implementation. The ministry of environment or national environmental protection agency may also be involved; there should be a clear designation of responsibilities before the law is enacted. Legal Provisions

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Bio-Medical waste management in India Bio-Medical waste ( management and handling) rule 1998 Ministry of Environment and Forests, Government of india 28 th July 1998 Applies to those who – Generate Collect Receive Store Dispose Treat Or Handle Bio-medical waste in any manner

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Schedule – I Categories of Biomedical Waste in India Category no. 1 Human Anatomical Waste human tissues Organs body parts

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Schedule – I Categories of Biomedical Waste in India Category No. 2 Animal Waste animal tissues Organs body parts carcasses bleeding parts Fluid blood experimental animals used in research waste generated by veterinary hospitals, colleges discharge from hospitals, animal houses

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Schedule – I Categories of Biomedical Waste in India Category no. 3 Microbiology & Biotechnology Waste Wastes from laboratory cultures human and animal cell culture infectious agents from research and industrial laboratories wastes from production of biological, etc

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Schedule – I Categories of Biomedical Waste in India Category no. 4 Waste Sharps Needles Syringes Scalpels Blade Glass etc. that may cause puncture and cuts includes both used and unused sharps

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Schedule – I Categories of Biomedical Waste in India Category no. 5 Discarded Medicines and Cytotoxic drugs Waste comprising of Outdated contaminated & discarded medicines

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Schedule – I Categories of Biomedical Waste in India Category no. 6 Solid waste Items contaminated with blood and body fluids including cotton Dressings soiled plaster casts Linens Bedding & other material contaminated with blood

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Schedule – I Categories of Biomedical Waste in India Category no. 7 Solid Waste Waste generated from disposable items other than the sharps such as Tubings Catheters Intravenous sets, etc

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Schedule – I Categories of Biomedical Waste in India Category no. 8 Liquid Waste Waste generated from laboratory and washing, Cleaning Housekeeping disinfecting activities

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Schedule – I Categories of Biomedical Waste in India Category no. 9 Incineration Ash Ash from incineration of any bio-medical waste

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Schedule – I Categories of Biomedical Waste in India Category no. 10 Chemical waste Chemicals used in production of biologicals Chemicals used in disinfection, as insecticides, etc

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Segregation of Biomedical Waste key to successful Biomedical waste management Biomedical waste should not be mixed with any other kind of waste It should be separated/segregated at the point of generation before storage or transport. The container should be labelled according to the schedule -III

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SCHEDULE – II COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIO-MEDICAL WASTES RED BLUE BLACK YELLOW

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Yellow Bag category 1 Human anatomical waste category 2 animal waste category 3 microbiological & biotechnology waste category 6 solid waste

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Yellow Bag Category 1,2,3 & 6 Incineration Deep burial

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Red Bag Category 3 microbiological waste Category 6 solid waste Category 7 solid waste

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Red Bag Category 3,6 & 7 Autoclaving Microwaving Chemical treatment

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Blue Bag Category 7 solid waste Category 4 waste sharps

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Blue Bag Autoclaving Microwaving Chemical treatment & Destruction or shredding Category 4 & 7

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Black Bag Category 5 Discarded medicines & cytotoxic drugs Category 10 (solid waste) Chemicals used in production of biologicals, chemicals used in disinfection, as insecticides, etc Category 9 incineration ash

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Black Bag Category 5, 9 & 10 Disposal in Secured landfill

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SEGREGATION MUST ! MUST ! MUST !

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DISPOSAL OF RADIOACTIVE WASTES Disposal as a final step in the management of radioactive waste involves confinement or isolation of these wastes from biosphere in the repositories. www.barc.ernet.in/publications/eb/golden/nfc/toc/.../17.pdf Based on the longevity and concentration of the radionuclide present in the waste, the repository could be either near-surface or in deep geological formation.

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COLLECTION AND TRANSPORTATION OF BIO- MEDICAL WASTES chances of segregated bio-medical waste coming in contact with the public, rag pickers, animals / birds etc are high. Therefore, All care shall be taken to ensure that the segregated bio-medical waste handed over by the healthcare units reach CBWTF without any damage CBWTF – COMMON BIO-MEDICAL WASTE TREATMENT FACILITY (governed by Delhi Pollution Control Committee)

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COLLECTION AND TRANSPORTATION OF BIO- MEDICAL WASTES Common Bio-medical Waste Treatment Facilities (CBWTFs) in NCR Region M/s SembRamky Environmental Management (P) Ltd. at Ghaziabad, UP, M/s Synergy Waste Management (P) Ltd., Delhi and M/s Bio-Care Technological Services, Delhi. www.dpcc.delhigovt.nic.in

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COLLECTION AND TRANSPORTATION OF BIO- MEDICAL WASTES Near NDMC Composite Plant, Okhla Tank, Mathura Road, New Delhi-110020 India. Phone.   : +91-11-26933371, 72 Fax No.  : +91-11-26933373 E-mail.   : info@synergyworld.co.in

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COLLECTION AND TRANSPORTATION OF BIO- MEDICAL WASTES

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COLLECTION AND TRANSPORTATION OF BIO- MEDICAL WASTES Separate cabins for driver/ staff and the bio-medical waste containers. ii) The base of the waste cabin - leak proof to avoid pilferage of liquid during transportation. iii) The waste cabin - designed for storing waste containers in tiers. iv) The waste cabin - designed that it is easy to wash and disinfect. v) The inner surface of the waste cabin - made of smooth surface to minimize water retention. vi) The waste cabin - provisions for sufficient openings in the rear and / or sides so that waste containers can be easily loaded and unloaded. vii) The vehicle - labeled with the bio-medical waste symbol Transportation of Bio-Medical Waste to CBWTF transported to the CBWTF in a fully covered vehicle