BMW Management FC ASMC 21-08-2019

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Foundation Course Session of 21-08-2019, By Dr Vishnu Kumar For MBBS First Professional Students of Government Medical College Shahjahanpur

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Dr . Vishnu Kumar Associate, Department of Biochemistry Time: 9:00 am to 11:00am Date: 21/08/2019 vkawasthi@hotmail.com

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Bio Medical Waste Management SEGREGATION, COLLECTION, STORAGE &TRANSPORT

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Bio-Medical Waste Any waste which is generated during the diagnosis, treatment, or immunization of human beings or animals or in research activities.

BIOMEDICAL WASTE CATEGORIES:

BIOMEDICAL WASTE CATEGORIES 10 WASTE CATEGORIES CAT1 HUMAN ANATOMICAL CAT2 ANIMAL CAT3 MICROBIOLOGY &BIOTECHNOLOGY CAT4 WASTE SHARPS CAT5 CYTOTOXICDRUGS & DISCARDED MEDICINES CAT6 SOILDWASTE CAT7 SOLID WASTE CAT8 LIQUID WASTE CAT9 INCINERATIONASH CAT10 CHEMICAL

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Why to manage BMW? The reasons are: 1. Injuries from sharps leading to infection to all categories of hospital personnel and waste handler. 2. nosocomial infections in patients from poor infection control practices and poor waste management. 3. Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals. 4. Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels. 5. “Disposable” being repacked and sold by unscrupulous elements without even being washed. 6. Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers. 7. Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash.

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APPROACH FOR biomedical WASTE MANAGEMENT 1. Segregation of waste Segregation is the essence of waste management and should be done at the source of generation of Bio-medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labour rooms, treatment rooms etc. The responsibility of segregation should be with the generator of biomedical waste i.e. doctors, nurses, technicians etc. (medical and paramedical personnel). 2. Collection of bio-medical waste Collection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. At ordinary room temperature the collected waste should not be stored for more than 24 hours. 3. Transportation Within hospital, waste routes must be designated to avoid the passage of waste through patient care areas. Separate time should be earmarked for transportation of bio-medical waste to reduce chances of it’s mixing with general waste. Desiccated wheeled containers, trolleys or carts should be used to transport the waste/plastic bags to the site of storage/ treatment .

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4. Treatment of Hospital Waste 4.1 General waste The 85% of the waste generated in the hospital belongs to this category. The, safe disposal of this waste is the responsibility of the local authority. 4.2 bio-medical waste: 15% of hospital waste 1. Deep burial 2. Autoclave and microwave treatment (Annexure II) 3. Shredding (Annexure II) 4. Secured landfill 5. Incineration (Annexure III)

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5. Safety measures 5.1 All the generators of bio–medical waste should adopt universal precautions and appropriate safety measures while doing therapeutic and diagnostic activities and also while handling the bio-medical waste. 5.2 It should be ensured that: 1. Drivers, collectors and other handlers are aware of the nature and risk of the waste. 2. Written instructions, provided regarding the procedures to be adopted in the event of spillage/ accidents. 3. Protective gears provided and instructions regarding their use are given. 4. workers are protected by vaccination against tetanus and hepatitis B 6. Training 1. Each and every hospital must have well planned awareness and training programme for all category of personnel including administrators (medical, paramedical and administrative). 2. All the medical professionals must be made aware of Bio-medical Waste (Management and Handling) Rules 1998. 3. To institute awards for safe hospital waste management and universal precaution practices. 4. Training should be conducted to all categories of staff in appropriate language/medium and in an acceptable manner.

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History and introduction of BMW in India The modern age, in the 21st century with increased use of disposable material and the presence of dreaded disease like Hepatitis – B and AIDS, it is utmost important to take care of the infected and hazardous waste to save the mankind from disasters. The Health care institution or hospitals which are responsible for care of morbid population are emitting voluminous quantity of rubbish, garbage and Bio Medical Waste matter each day from wards, operation theatre and outpatient areas. Proper management of hospital waste is essential to maintain hygiene, aesthetics, cleanliness and control of environmental pollution. The hospital waste like body parts, organs, tissues, blood and body fluids along with soiled linen, cotton, bandage and plaster casts from infected and contaminated areas are very essential to be properly collected, segregated, stored, transported, treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection . Various communicable diseases, which spread through water, sweat, blood, body fluids and contaminated organs, are important to be prevented. The Bio Medical Waste scattered in and around the hospitals invites flies, insects, rodents, cats and dogs that are responsible for the spread of communication disease like plague and rabies. Rag pickers in the hospital, sorting out the garbage are at a risk of getting tetanus and HIV infections. The recycling of disposable syringes, needles, IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis, HIV, and other viral diseases. It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner.

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1. Supreme Court judgment dated 1st March 1996 in connection with safe disposal of hospital waste ordered that (a) All hospitals with 50 beds and above should install either their own incinerator or an equally effective alternative method before 30th November 1996. (b) The incinerator or the alternative method should be installed with a necessary pollution control mechanism conforming to the standard laid down by Central Pollution Control Board (CPCB). (c) Hazardous medical waste should be segregated as source and disinfected before final disposal. 2. Ministry of Environment & Forest, Govt. of India issued a notification for Biomedical Waste(Management & Handling) Rules 1998 in exercise of powers conferred by Section 6, 8 & 25 of the Environment (Protection) Act, 1986 that was published in The Gazette of India Extraordinary, Part-II, Section 3-Sub-Section (ii) New Delhi, July 27, 1998 .

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General Description and Quantity Hospital waste refers to all waste generated, discarded and not intended for further use in the hospital. It is broadly categorized into the following categories: 1. General Waste 2. Pathological Waste 3. Infectious Waste 4. Sharps 5. Pharmaceutical Waste 6. Chemical Waste 7. Radioactive Waste AMOUNT AND COMPOSITION OF HOSPITAL WASTE GENERATED (a) Amount Country Quantity (kg/bed/day) U. K. 2.5 U.S.A. 4.5 France 2.5 Spain 3.0 India 1.5

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(b) Hazardous/non-hazardous Hazardous 15% a) Hazardous but non-infective 5% b) Hazardous and infective 10% Non-hazardous 85% (c) Composition By weight Plastic 14% Combustible Dry cellublostic solid 45% Wet cellublostic solid 18% Non-combustible 20%

Collection & storage (within the hospital):

Collection & storage (within the hospital) Waste collected and stored in thick non-corrosive disposable plastic bags or containers of specific colour code. • The waste in bags or containers should be stored in a separate area, room, or building of a size appropriate to the quantities of waste produced and the frequency of collection.

Container should bear 'Biohazard' symbol and appropriate wording Container should never be completely filled:

Container should bear 'Biohazard' symbol and appropriate wording Container should never be completely filled

In a color coded leak-proof container :

In a color coded leak-proof container • Health care waste should be transported within the hospital or other facility by means of hand cart wheeled trolley

PACKAGING & LABELING::

PACKAGING & LABELING: Bags 3/4th filled should be tied • be supervised Name of Ward • Date of Packaging • Destination (Treatment Site) • Bio Hazard/ Cytotoxic Symbol • Weighing & Recording • Separate Register and Weighing Machine • Daily recording is mandatory

LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS:

LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS Date of generation ................... • Waste category No ........ • Waste class…………… • Waste description…………. • Sender's Name & Address……….. Contact Person…………..

Attention !!:

Attention !! Do not allow the containers to overfill Arrange containers near the operation area at accessible distance Ensure that the disposed item is inside the container and not hanging at the edge

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• Receiver's Name & Address……… Contact Person………….. • In case of emergency please contact, Name & address………. Label shall be non-washable and prominently visible.

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LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS/BAGS Day ............ Month .............. Year ........... Date of generation ...................

OVERVIEW OF BIOMEDICAL RULES:

OVERVIEW OF BIOMEDICAL RULES The Rules apply to all persons who generate, collect, receive, store, transport, treat, dispose or handle bio-medical waste in any form Rules under the Environment (Protection) Act, 1986 I draft-1995, II draft- 1997 Final rules notified on 27 th July 1998, Bio Medical Waste (Management & Handling) Rules, 1998 Amendments-2003 latest New Rules Notified on 28.3.16, Bio medical Waste Management Rules,2016, 2018.

Advisory Committee:

Advisory Committee Every State Government shall constitute an Advisory Committee under the chairmanship of the Health Secretary to oversee the implementation of the rules Representatives from the Departments of Health, Environment, Urban Development, local bodies or Municipal Corporation, representatives from IMA and NGOs The Advisory Committee constituted shall meet at least once in six months and review all matters related to implementation

WASTE COLLECTION:

WASTE COLLECTION Color of Bin Waste collection Treatment Yellow Bin Soiled waste, Infectious waste Swabs, Gauze, Bandages, Linen, Body parts, Discarded Medicines etc Incineration Red Bin Infected plastics Catheters, tubing's, IV bottles, Gloves, Blood Bags etc Autoclaving & recycling White Bin Needles with or without syringes, scalpels, blades etc Autoclaving & recycling to foundries Blue Bin broken glass, vials & ampoules etc Autoclaving and recycling Green/ blck Bin Food waste , Fruit peels/seeds with no polythenes etc Composting

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INCINERATION Waste collected in yellow containers is incinerated. Waste categorized as Human Anatomical Waste and Animal Waste is incinerated. Human Anatomical Waste includes human tissues, organs, and body parts. Animal waste includes animal tissues, organs, body parts, carcasses, bleeding parts, experimental animals used in research, and waste generated by veterinary hospitals and colleges, and animal houses .

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Primary Chamber is designed to burn the waste at 800 Deg C. Secondary Chamber is designed to burn the waste at 1050 Deg C. The incinerator has oil fired burners. The incinerator is designed for operation under excess air conditions . Combustion under excess air conditions ensures complete destruction of dioxins and furans and produces smokeless flue gases.

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