Technological advances in bio-medical waste management & disposal

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Technological advances in bio-medical waste
management disposal

• Dr. B. N. Gokul
• Consultant Microbiologist ICO
• Wockhardt Hospital
• Vivus Hospitals
• Mallige Medical Centre
• Prof of Microbiology Infection Control
  In-charge
• SDUMC, Kolar

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What is bio-medical waste?

• Biomedical waste means any waste, which is
  generated during the diagnosis, treatment or
  immunization of human beings or animals, in
  research activities or in the production or
  testing of biologicals and the animal waste from
  slaughter houses or any other similar
  establishment.
• All biomedical waste are hazardous. In hospital
  it comprises of 15 of total hospital waste.

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Bio-medical waste
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Categories of bio-medical waste

• Category No.1- Human Anatomical Waste
• Human tissues, organs, and body parts
• 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 and colleges discharge from
  hospitals and animal houses

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Categories of bio-medical waste (contd..)

• Category No.3 - Microbiology Biotechnology
  Waste
• Waste from laboratory cultures, stocks or
  specimens of micro-organisms, live or attenuated
  vaccines, human and animal cell cultures used in
  research, infectious agents from research and
  industrial laboratories, waste from production of
  biologicals, toxins, dishes and devices used for
  transfer of cultures
• Category No.4 - Sharps waste
• Needles, syringes, scalpels, blades, glass,
  etc. that may cause puncture and cuts, both used
  and unusable

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Categories of bio-medical waste (contd..)

• Category No.5 - Discarded Medicines and Cytotoxic
  drugs
• Waste comprising of outdated, contaminated and
  discarded medicines
• Category No.6 - Soiled waste
• Items contaminated with blood/ body fluids
  including cotton dressings, soiled plaster casts,
  linens, beddings, other material contaminated
  with blood

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Classification of bio-medical waste (contd..)

• Category No. 7- Solid waste
• Waste generated from disposable items, other
  than sharps, such as tubings, catheters,
  intravenous sets, etc
• Category No. 8 - Liquid waste
• Waste generated from laboratory, washing,
  cleaning, housekeeping and disinfecting activities

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Classification of bio-medical waste (contd..)

• Category No.9 - Incineration ash
• Ash from incineration of any bio-medical waste
• Category No.10 - Chemical waste
• Chemicals used in production of biologicals,
  disinfectants, insecticides, etc.

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What is bio-medical waste (BMW) management?

• It is the segregation, collection, treatment,
  transportation and disposal of the hospital waste
• It is a part of hospital hygiene, infection
  control and maintenance activities.

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Rationale of bio-medical waste management

• Only 15 of bio-medical waste is hazardous
• When hazardous waste is not segregated at the
  source of generation and mixed with non-hazardous
  waste, 100 waste becomes hazardous.
• The reasons for BMW management are
• Injuries from sharps leading to infection to all
  categories of HCWs
• Healthcare associated infections in patients from
  poor infection control practices and poor waste
  management

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Rationale of bio-medical waste management
(contd..)

• Risk of infection outside hospital for waste
  handlers and at times general public living in
  the vicinity of hospitals
• Risk associated with hazardous chemicals and
  drugs to persons handling wastes at all levels
• Disposable" being repacked and sold by
  unscrupulous elements without even being washed
• Drugs which have been disposed of, being repacked
  and sold off to unsuspecting buyers
• 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 bio-medical waste management

• Based on Bio-medical Waste (Management and
  Handling) Rules 1998, notified under the
  Environment Protection Act by the Ministry of
  Environment and Forest (Government of India),
  approach comprises of
• Segregation of waste
• Collection of bio-medical waste
• Storage of waste
• Transportation
• Treatment disposal of hospital waste
• Safety measures
• Coordination between hospital and outside
  agencies

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FOCUS ON SEGREGATION FIRST

• Should be done at the site of generation of BMW
  e.g. all patient care activity areas, diagnostic
  service areas, operation theatres, labour rooms,
  treatment rooms etc.
• The responsibility of segregation should be with
  the generator of bio-medical waste i.e. doctors,
  nurses, technicians etc.
• The bio-medical waste should be segregated as per
  categories applicable.

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Type of container and colour for collection of
bio-medical waste
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Type of container and colour for collection of
bio-medical waste
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Type of container and colour for collection of
bio-medical waste

• Those plastics which contains liquid like blood,
  urine, pus, etc., should be put into red colour
  bag for microwaving / autoclaving and other items
  should be put into blue or white bag after
  chemical treatment and mutilation / shredding

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Segregation of bio-medical waste

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Collection of bio-medical waste

• Collection should be done as per BMW Management
  and Handling Rules 1998.
• The collection bags and the containers should be
  labelled as per guidelines, i.e. symbols for
  biohazard and cytotoxic.
• Labels shall be non-washable and prominently
  visible

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Collection of bio-medical waste (contd.)

• Separate container at every point of generation
  for general waste to be disposed of through
  municipal authority
• Trolleys, used to collect hospital waste, be
  designed, there should be no leakage or spillage
  of BMW while transporting

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Collection of bio-medical waste (contd)

• Location of containers- All containers having
  different coloured plastic bags should be located
  at the point of generation of waste
• Waste bags filled up to three-fourth capacity,
  tied securely and removed from the site of
  generation to the storage area regularly
• The colour bags should be replaced, garbage bins,
  cleaned with disinfectant regularly.

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Storage of waste

• Refers to holding BMW for a certain period of
  time at the site of generation till transit for
  treatment and final disposal.
• No untreated BMW stored beyond a period of 48
  hours
• Requires permission of the prescribed authority
  if for any reason becomes necessary to store the
  waste beyond 48 hours

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Transportation

• Transportation of waste within the hospital
• Avoid passage of waste through patient care areas
  as far as possible
• Separate time schedules for transportation of
  bio-medical waste and general waste
• Dedicated wheeled containers, trolleys or carts
  with proper label
• Trolleys or carts cleansed and disinfected in
  the event of any spillage

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Transportation

• Transportation of waste for disposal outside the
  hospital
• through desiccated vehicles specially constructed
  for the purpose having fully enclosed body, lined
  internally with stainless steel or aluminium to
  provide smooth and impervious surface which can
  be cleaned
• The drivers compartment separate from the load
  compartment with a bulkhead
• The load compartment provided with roof vents
  for ventilation.

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Treatment disposal of bio-medical waste

• Yellow bags- (Cat. 1, 2, 3, 6) Incineration /
• deep burial 
• Red bags (Cat. 3,6) microwave / autoclave
  treatment
• Blue/ White translucent bag (Cat. 4,7) - should
  be sent to shredder after autoclaving /
  microwaving / chemical treatment
• Black Cat. 5, Cat. 9 and Cat.10 (solid)
  Disposal in secured landfill
• Liquid waste 1 part bleach to 9 parts
  contaminated liquid let stand for 20 to 30
  minutes. After treating, dispose down drain with
  lots of H2O

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Disposal of bio-medical waste

• General waste (non-hazardous, non-toxic,
  non-infectious
• Through local municipal authority
• Bio-medical waste
• Incineration
• should be installed and made operational as per
  specification under the BMW rules 1998 regarding
  the incinerator and norms of combustion
  efficiency and emission levels
• The temperature of the primary chamber shall be
  800 /- 50 deg.C
• secondary chamber temperature at 1050 /- 50
  deg.C
• Minimum stack height shall be 30 meters above
  ground
• Note
• Waste to be incinerated shall not be chemically
  treated with chlorinated disinfectants
• Chlorinated plastics shall not be incinerated

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Disposal of bio-medical waste-Deep burial

• Option in towns with population less than five
  lakhs
• A pit or trench should be dug about 2 meters
  deep. It should be half filled with waste, then
  covered with lime within 50 cm of the surface,
  before filling the rest of the pit with soil.
• Animals should not have any access to burial site
• On each occasion when wastes are added to the
  pit, layer of 10 cm of soil shall be added to
  cover the wastes
• Burial must be performed under close and
  dedicated supervision
• The deep burial site should be relatively
  impermeable and no shallow well should be close
  to the site.
• The pits should be distant from habitation so as
  to ensure that no contamination occurs of any
  surface water or ground water. The area should
  not be prone to flooding or erosion
• The location of the deep burial site will be
  authorized by the prescribed authority
• The institution shall maintain a record of all
  pits for deep burial.

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Treatment of Bio-medical waste (Category 3,4,6,7)
- Autoclave
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Treatment of Bio-medical waste- (Category
3,4,6,7) Microwaving

• Should not be used for cytotoxic, hazardous or
  radioactive waste, contaminated animal parts and
  large metal parts
• Should completely and consistently kill bacteria
  and other pathogenic organisms. Biological
  indicators of Bacillus subtilis spores be used to
  monitor

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Treatment of bio-medical waste

• Shredding- The plastics (IV bottle, IV sets,
  syringes, catheters, etc.), sharps (needles,
  blades, glass, etc) should be shredded but only
  after chemical treatment / microwaving/
  autoclaving, ensuring disinfection
• Needle destroyers can be used for disposal of
  needles directly without chemical treatment

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Treatment of bio-medical waste

• Secured land fill
• The incinerator ash, discarded medicines,
  cytotoxic substances and solid chemical waste
  should be treated by this option

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Treatment of bio-medical waste

• It may be noted that there are multiple options
  available for certain category of waste
• The individual hospital can choose the best
  option depending upon treatment facilities
  available
• The management of radioactive waste should be
  undertaken as per the guidelines of BARC

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Safety Measures

• Required for
• Clinical workers generating waste
• Workers collecting and transporting wastes
• -- Staff operating hospital incinerator
• Staff taking waste to municipal bins
• Municipal worker collecting waste at the
  municipal bins and transporting to dumping sites
• Rag pickers
• Education and training programs must be developed
  to
• speak to each category in a way that will
  best meet the needs, build understanding and
  change behavior in that population

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Coordination between hospital outside agencies

• Hospital authorities should have constant
  interaction with the municipal authorities so
  that the general category of waste is regularly
  taken out of the hospital premises for further
  disposal
• Involvement of private sector / NGOs for
  creation of common facilities for treatment
• Coordination with NGOs and environmental groups,
  for public awareness education

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Coordination between hospital outside agencies

• Sharing of facility by hospitals which do not
  have their own facility for treatment
• Hospitals having additional capacity may extend
  their facility to nearby smaller hospital or
  healthcare units
• Coordinated agencies required to take care of
  disruption of waste treatment equipment in a unit

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THANK YOU