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
·
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
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