Bio Medical Waste Management

BIO MEDICAL WASTE MANAGEMENT

        Description also available in video format (attached below), for better experience use your desktop.

Introduction

·       BMWM is the management of the waste that is generated during the diagnosis and treatment of a patient

·       Hospital Waste entirely divide into the below mentioned categories

o   Non Hazardous (80%)

o   Hazardous (20%)

§  Infectious (15%)

§  Other Hazardous (5%)

·       Non sharps

·       Sharps

·       BMW can easily affect out the entire community such as

o   Patients

o   Healthcare Workers

o   Municipal Workers

o   Rag pickers

o   Workers in recycling industries

 

BMW Handling & Management Rules 1998

·       RULE 1 (SHORT TITLE AND COMMENCEMENT)

o   Bio-Medical Waste Management Rules, 1998

o   Came into force on the 20th July 1998

·       RULE 2 (APPLICATION)

o   Rules apply to all persons who

§  Generates, Collect, Receive, Store

§  Transport, Treat, Dispose & Handle the BMW

o   Rules shall not apply to

§  Radioactive Waste

§  Hazardous Chemicals

§  Lead acid batteries

§  E-waste

·       RULE 3 (IMPORTANT DEFINITIONS)

o   BMW:- Waste that is generated during

§  The diagnosis, treatment or immunization of human being or animals

§  In research activities 

§  In the production or testing of biological

§  In health camps

o   Occupier

§  Person having control on an institution generating BMW

o   Authorization

§  Permission granted by the prescribed authority

o   BMW treatment facility

§  Facility that is used to treat and dispose the BMW

·       RULE 4 (DUTIES OF OCCUPIER)

o   Immunize all its healthcare workers

o   Establish a GPS enabled barcode system for bags carrying BMW to outside the primises

o   Reports major accidents relating to BMW to the SPCB (State Pollution Control Board)

o   Maintain the BMWM register

o   Display the BMWM monthly data on its website

o   ETP & STP installation

o   Form a committee to monitor and implement the rules in his healthcare facility

·       RULE 5 (DUTIES OF OPERATOR)

o   Ensure the timely collection of BMW

o   Assist the occupier in conduct of training

·       RULE 6 (AUTHORITIES)

o   Ministry of Environment, Forest and Climate Change

o   Government of India

o   Ministry of Health & Family Welfare

o   Ministry of Animal Husbandry and Veterinary

o   Ministry of Defence

o   Central Pollution Control Board

o   State Pollution Control Board

o   Municipalities, Urban local bodies and Gram Panchayts

·       RULE 7 (TREATMENT AND DISPOSAL)

o   Common treatment & disposal service will be given with the range of 75km radius for all the healthcare facilities

o   If the service is not available, the occupier can establish its own treatment & disposal facility by using

§  Incinerator

§  Autoclave

§  Microwave

§  Shreder

·       RULE 8 (SEGRIGATION, PACKAGING, TRANSPORTATION & STORAGE)

o   Segregation should be done in containers or bags at the point of generation

o   Then bags should be labelled as specific during their packaging

o   The operator of the common facility shall transport the BMW from the premises of the occupier

o   BMW shall not be stored beyond 48 hours and if that is happen in any case of urgency, the occupier must inform it to the SPCB

·       RULE 9 (PRESCRIBED AUTHORITY)

o   The prescribed authority shall be the SPCB & Pollution Control Committees

·       RULE 10 (PROCEDURE OF AUTHORIZATION)

o   Application shall be made by the Occupier in Form II to the Prescribed authority

o   Prescribed Authority will grant the authorization in Form III

·       RULE 11 (ADVISORY BOARD)

o   For the State government a committee shall be constituted under the chairman ship of Health Secretariat

o   For the Ministry of Defence a committee shall be constituted under the Director General of Health services

·       RULE 12 (MONITORING OF IMPLEMENTATION)

o   Ministry of Environment, Forest & Climate change shall review the implementation of rules in the country

o   State government shall constitute a District Level Monitoring Committee under the chairmanship of DM

o   This committee shall report to the SPCB for taking further necessary actions

·       RULE 13 (ANNUAL REPORT)

o   Submitted by the occupier to the Prescribed authority in Form IV on or before the 30th June of every year

o   Prescribed authority shall compile, review and analyze the information received and send this information to CPCB on or before the 31st July of every year

o   CPCB to MOEF on or before 31st August every year

·       RULE 14 (MAINTENANCE OF RECORDS)

o   Records will be maintained by the authorized person of

§  BMW generation

§  BMW collection

§  BMW receiving

§  BMW storage & transportation

§  BMW treatment & disposal

·       RULE 15 (ACCIDENT REPORTING)

o   Informed by the authorized person to the Prescribed authority

o   The accident report must be forwarded within 24hrs along with the remedial steps taken in Form-V

·       RULE 16 (APPEAL)

o   In Form V, any person can appeal against the prescribed authority to the State Secretary within 30 days

·       RULE 17 (SITE FOR COMMON BMW TREATMENT AND DISPOSAL FACILITY)

o   The department in the business allocation of land assignment shall be responsible for providing suitable site for it to the State government

·       RULE 18 (LIABILITY OF AN OCCUPIER OF COMMON FACILITY)

o   All the damages caused to the environment or public because of improper BMW handling

o   The actions will be taken under section 5 & 15 of this Act (1 Lakh fine/5years Imprisonment)

 

Classification of BMW


Categorization of BMW

 

 BMW Segregation, Collection, Transportation & Disposal

·       Segregation

o   


·       Collection

o   Segregated BMW in small bins get collected by the housekeepers in the large size color coded bags

o   The bags get tied up and placed on a common trolley to transport them at the storage site

o   Bags also have a bar code on it, to get scanned

o   Bags must have the symbols of Biohazard & Cytotoxic on it

o   Then these bags moves from the site of generation & segregation to the site of storage from a separate route

o   At the storage site, these bags get stored in the separated chambers made as per the instruction of BMW Act

·       Transportation

o   Special vehicles shall be used to transport untreated wastes

o   The medium of transportation should be covered

o   Avoid manual loading

o   Ensures the availability of signed document by Nurse/Doctor before transportation having

§  Date

§  Shift

§  Quantity

§  Destination

o   Driver must be trained to accidental cases

·       Disposal/Treatment


Deep Burial Standards

·       Dug a pit of about a 2meter deep

·       Should be half filled with waste and covered with lime upto the 50cm of space

·       Ensures that animals don’t have any access to the burial sites

·       Use galvanized iron or wire meshes

·       Every time whenever waste is added to the pit, a layer of 10cm of soil shall be added to cover the wastes

·       Burial site should be

o   Impermeable

o   Non shallow

o   Distant from habitation

o   Away from surface water

o   Away from prone, flooding and erosion area

·       Location shall be authorized by the prescribed authority

·       Institution should maintain a record of all pits used for deep burial

·       Ground water level should be a minimum of six meters below the lower level of deep burial pit  


BMW Management Process

·       .


 

Methods of Disinfection

·       Incineration

o   High temperature dry oxidation process

o   Reduces organic and combustible waste into inorganic incombustible matter like

§  Heat

§  Fuel gas

§  Ash

o   Results in significant reduction in waste volume and weight

o   Generally selected to treat the waste that cannot be

§  Recycled

§  Reused

§  Disposed in land

o   Basically of 3 types

§  Double Chambered (for infectious waste)

§  Single Chambered (when double chambered not affordable)

§  Rotator kilns (for toxic waste)

·       Chemical Disinfection

o   Used to treat liquid infectious waste like

§  Blood

§  Urine

§  Stool

§  Hospital Sewage

o   Chemicals are added in waste for killing or inactivate the pathogen it contains

·       Wet & Dry Thermal Treatment

o   Wet thermal disinfection is based on the exposure of waste to the high temperature by using steam

o   Wet disinfection cannot be used to treat

§  Anatomical Waste

§  Chemical Waste

§  Pharmaceutical Waste

o   In dry disinfection the waste is shredded and heated in rotating auger

o   It can reduce 80% volume and 20-35 weight of the waste

o   Suitable for infectious waste and sharps

·       Microwave Irradiation

o   Used to treat the waste by using

§  Frequency of 2450MHZ

§  Wave length 12.24cm

o   Destroy the microbes up to 99.99%

o   Rapidly destroyed the water contained infectious waste by heat conduction

·       Land Disposal

o   Use of Open Dumps to treat the waste

o   A risk for public health in Open Dumps

o   Another way of land disposal is Sanitary landfills

§  Design and constructed to prevent contamination of

·       Soil

·       Surface

·       Ground

·       Water

·       Direct contact with public

·       Inertization

o   Process of mixing waste with cement before disposal

o   It minimizes the risk of toxic substance migrating into the water surface

o   It prevents scavenging

o   The proportion that is generally used is

§  Waste 65%

§  Lime 15%

§  Cement 15%

§  Water 5%

Modern Technology for Handing BMW

·       Steam Sterilization

o   Also known as autoclaving

o   Most common alternative treatment method

o   Worked on the principle of doing steam sterilization in closed chamber where both heat and pressure are applied over a period of time to destroy all microorganisms

o   Always performed before the landfill disposal of BMW

o   This process has the

§  Lowest capital cost

§  Used to process 90% of medical waste

§  Easily scaled to meet the needs of any medical organizations

·       Advanced Autoclaves

o   A combine steam treatment with

§  Vacuuming

§   Internal mixing

§  Fragmentation

§  Internal Shredding

§  Drying

§  Compaction

o   It leads to the 90% volume reduction of the waste

o   Have higher capital cost

·       Microwaves

o   A promising medical waste disposal technology

o   Treatment of waste occurs through the use of moist heat and steam generated from microwave energy

o   It consist of a treatment chamber inside which the microwave energy is directed from a microwave generator

o   Have higher capital cost

o   Can be batch or semi-continuous in nature

·       Chemical Process

o   Use disinfectants such as lime or peracetic acid to treat the waste

o   The heated alkali easily digests the

§  Tissues

§  Pathological waste

§  Anatomical parts

§  Animal Carcasses

o   The whole process takes place inside a stainless steel chamber

o   Have a low capital cost

·       Plasma Gasification

o   An emerging and promising option to dispose medical waste

o   It uses an oxygen starved reactor that is operated at a high temperature and results in the breakdown of waste into

§  Hydrogen

§  Carbon monoxide

§  Water etc

o   Main product of Plasma gasification is Energy rich gases

o   These gases can be converted into

§  Heat

§  Electricity

§  Liquid fuels

Monitoring & Controlling Cross Infection

·       Monitoring Techniques

o   Designate an Infection Control Owner

§  The basic and compulsory need for any monitoring is a supervisor

§  She/he is responsible to monitor the each and every aspect that contributes to control the cross infection

§  The controlling officer can be the Infection Control Nurse

§  She is used for the distribution of specific task to a specific person

§  It increases the chances of staying compliant

o   Dedicate the Necessary Resources

§  Like every other area of hospital, infection control area also needs proper resources like

·       Time

·       Money

·       Material etc

§  For an effective monitoring we need the resources to implement the policies and to decrease the cross infection

o   By developing an Infection Control Committee

§  Responsible for the monitoring program and policies

§  Used to implement the SOPs

§  Recommend the corrective actions

·       Controlling Methods

o   Hand hygiene

o   Environmental hygiene

o   Patient screening

o   Cohorting patients

o   Surveillance

o   Antibiotic stewardship

o   Follow guidelines

o   Safety culture

o   Use of Personnel Protective Equipments

§  Mask

§  Face shield

§  Gloves

§  PPE kit

§  Gown

§  Utility gloves

o   Immunization against communicable diseases

o   Restrict visitors

o   Isolation

o   Proper ventilation

Waste Reduction Activities for a Hospital

·       Develop a formal waste disposal management plan

·       Give thorough & consistent employee training

·       Clearly understand the rules & norms of BMW

·       Restrict access whenever possible

·       Maintain physical separation between different waste bins

·       Use color code containers to ensure appropriate sorting

·       Post strategic signage

·       Conduct waste audits

·       Keep an eye on pharmaceutical agents

·       Recycling & Reuse

BMW Awareness & Education

·       At present the awareness and education about the BMW is a compulsion for the entire community

·       Not even the hospital but the whole community must have to understand that the medical waste is directly or indirectly related to their health

·       BMW affects the entire community but the population which are at greatest risk

o   Patients

o   Healthcare workers

o   Municipal workers

o   Rag pickers

o   Workers at recycling industries

o   Workers at treatment facilities

·       The awareness and education on BMW can be conducted out via

o   Training on regular basis

o   Run social media contest

o   Pursue local partnership

o   Create info graphics

o   Nukkad Natak

o   Publishing articles on BMW in newspapers

Video Description

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Comments

Chris Taylor said…
This caught my attention instantly. Well executed and worth sharing! I appreciate the effort behind this.
Telemedicine App Development Company
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