BIOMEDICAL WASTE

MANAGEMENT Dr. Sukhwant Singh

BIO-MEDICAL WASTE ( MANAGEMENT & HANDLING ) RULE, 1998.* Came in to force on 28th July, 1998.* Prescribed by Ministry of Environment & Forests, under the Environment Protection Act of India.* Proper management of biomedical waste

is a statutory requirement.* This rule applies to those who generate, collect, receive, store, dispose, treat or handle bio-medical waste in any manner.

BIO – MEDICAL WASTE COULD BE DEFINED AS

“any solid, fluid or liquid waste, including its container and any

intermediateproduct, which is generated

during the diagnosis, treatment or immunization of human

beings or animals, in research pertaining thereto,

or in the production or testing of biologicals

and the animal waste from slaughter houses or any other like establishments”.

Why it is essential to have safe & reliable

treatment of “Bio-Medical Waste”-

Bio-Medical Waste may have serious public

health consequences and a significant impact on

the environment.

Hazards from infectious waste and sharps-

* Pathogens in infectious waste may

enter the human body through a

puncture, abrasion or cut in the

skin, through mucus membrane

by inhalation or ingestion.

Chemical and Pharmaceutical waste* They may be toxic, genotoxic, corrosive, flammable, reactive or explosive. Radioactive waste* The possible effects can range from headache, dizziness, vomiting to affecting genetic material. Public Sensitivity* The general public is very sensitive to visual impact of health care waste, esp. anatomical waste.

As per WHO, the biomedical wastes could be classified into eight categories on the basis of the type of waste and the risk of transmission of infectious material in them.

1. General waste (domestic)2. Pathological3. Radioactive4. Chemical5. Infectious6. Pharmaceutical wastes7. Sharps and 8. Pressurised containers.

Cat- 1 Human Anatomical Wastes

Cat- 2 Animal Anatomical Wastes

Cat- 3 Microbiology and Biotechnology wastes

Cat- 4 Waste Sharps

Cat- 5 Discarded medicines and Cytotoxic drugs

CLASSIFICATION OF WASTE CATEGORY

Cat- 6 Soiled wastes include items contaminated with blood, body fluids such as cotton, dressings, linen, beddings etc.

Cat- 7 Solid wastes i.e. waste generated from disposable items other than sharps such as tubing, catheters, IV sets.

Cat- 8 Liquid wastes ( washing, cleaning )

Cat- 9 Incineration ash

Cat- 10 Chemical wastes ( disinfectants, insecticides )

COLOR CODING FOR SEGGREGATION OF BMW

COLOR WASTE TREATMENT

Yellow Human & Animal anatomical waste / Micro-biology waste and soiled cotton/dressings/linen/beddings etc.

Incineration / Deep burial

Red Tubings, Catheters, IV sets. Autolaving / Microwaving / Chemical treatment

Blue / White

Waste sharps ( Needles, Syringes, Scalpels, blades etc. )

Autolaving / Microwaving / Chemical treatment & Destruction / Shredding

Black Discarded medicines/cytotoxic drugs,Incineration ash, Chemical waste.

Disposal in secured landfill

QUANTITY OF BIOMEDICAL WASTE GENERATED IN HEALTH CARE SETTINGS –

Developed Countries- 1-5 kg/bed/day, with variations among countries. In India- 1-2 kg/bed/day with variation among Govt. and Private establishments. * 80 percent waste generated in a hospital is non hazardous and can be dealt with normal domestic waste management system. * 15 percent pathological & infectious waste. * 3 percent chemical & pharmaceutical waste. * 1 percent sharps. * 1 percent radioactive, cytotoxic and heavy metals.

PRINCIPLES OF CONTROL OF HAZARDS OF BIOMEDICAL WASTE IN HEALTH CARE ESTABLISHMENTS

* Each institution should develop its own bio waste management policy and ensure that the health care workers are adequately trained to handle biological waste.* Measures such as universal safety precautions, hand washing and proper segregation of waste material should be encouraged.* Rationale patient management policy should be followed and admissions restricted to those for whom it is felt absolutely necessary.* Proper house-keeping is essential and the hospital premises should be kept clean and well-ventilated.* Use of disinfectants should be rationalised.

STEPS IN THE MANAGEMENT OF BIOMEDICAL WASTE

1. Survey of waste generated.2. Segregation of hospital waste.3. Collection & Categorization of waste.4. Storage of waste.( Not beyond 48 hrs. )5. Transportation of waste.6. Treatment of waste.

TECHNOLOGIES FOR WASTE TREATMENT

CHEMICAL DISINFECTION TECHNOLOGY It uses chemicals to destroy pathogenic organisms from any inanimate object.● Sharps contaminated with blood and body fluids.● Instruments, equipment that are used to cut, pierce or enter the natural orifices like needles, syringes and endoscopes● Contaminated floors, surfaces, clothes, beds, beddings, enamel, crockery and bed pans● Wet mopping of intensive care units, operation theatres, wards and patient waiting areas.

Recommended concentration/dilution of Chemical disinfectants

DISINFECTANT( A contact period 0f 30 minutes is required for effective disinfection )

CONTAMINATED CONDITION

GROSSLY CONTAMINATED

CONDITION

Sodium hypochlorite 5% available chlorine as liquid bleach

20 ml / L 200 ml /L

Tincture of Iodine/Povidone Iodine 2.5 % 2.5 %

Ethyl Alcohol 70 % 70 %

Isopropyl Alcohol 70 % 70 %

Gluteraldehyde 2 % 2.5 % 2.5 %

Formaldehyde 40 % 5 % 10 %

Savlon 5 % 10 %

Dettol 4.8 % v/v 4 % 10 %

Cresol 2.5 % 5 %

THERMAL TECHNOLOGY *It uses heat to decontaminate instruments and equipment and the temperatures in this process may rise to extremely high levels. *Most of the microbes are destroyed at temperatures below 100°C.1. Autoclave 2. Hydroclave3. Incinerator4. Microwave

AUTOCLAVE Gravity displacement type – -where air is pushed out of the autoclave by steam under pressure. -This system operates at temperatures of 121°C and has a cycle time of approximately 60 - 90 minutes. Pre vacuum type – Here vacuum pumps are utilized toevacuate the air in the chamber of autoclave and steam under pressure is pushed in, which is able to penetrate the waste material more thoroughly. This technology thus reduces the cycle time to 30 - 60 minutes and the temperatures attained are 132°C.

HYDROCLAVE

- This is a steam sterilization technology in which the steam is used as an indirect heating source thus allowing total dehydration of waste material.- The holding time for waste is 15 minutes at 132°C or 30 minutes at 121°C.

- The organic components of the waste are hydrolyzed and the waste matter is reduced by weight and volume.

INCINERATOR - Incineration is a high heat system process of burning combustible solids at very high temperature in a furnace.- It employs combustion of waste material in stages, followed by cleaning of the flue gas through a number of pollution control devices. - The end product is devoid of infectious organisms and organic compounds of waste, which is aesthetically acceptable.

- Based on the type of fuel consumed the division could be- ● Conventional incinerator using wood/charcoal● Electrical incinerator● Oil fired incinerator using electricity and diesel oil

MICROWAVE -This low heat system uses microwaves to heat up the waste material from inside, unlike the external heat given in autoclave and hydro clave. -Microwaves are electromagnetic waves that lie between the 300 to 300,000 mega hertz range in the electromagnetic radiation spectrum.

-The heat produced at 95 - 100°C for a holding period of 25 minutes

-They are able to penetrate materials and create vibrations in all the dipole molecules such as water in the waste materials. -This vibration generates friction, which in turn produces heat to disinfect the waste material.

MECHANICAL TECHNOLOGY

1. Compaction: Compacting is carried out by a hydraulic ram against a hard surface.2. Grinding / Shredding: Waste material is broken down into smaller particles under negative pressure to avoid any spillage outside the chamber.3. Pulverization: Waste is mixed with large volume of water and bleach solution. The waste is torn to shreds and then fed to an ultra high speed hammer mill with large spin blades which pulverize the matter into small, safe particles.

IRRADIATION TECHNOLOGY

*This involves exposing the waste matter to ultraviolet or ionizing radiation in an

enclosed chamber. *Decontamination occurs when nucleic acids in the living cells are irradiated.* The advantage with this technology is that energy input is minimal and it is used to treat items, which cannot be heated.* Source of radiation needs to be properly disposed off after its decay.

FINAL DISPOSAL METHODS

General non hazardous waste Secured landfills

Liquid wastes Chemical disinfectant F/b neutralization with reagent, and discharged into the sewerage system.

Human anatomical wastes Incinerated and sent to landfill sites.

Sharps Needles can be cut by needle cutter and contained in 1% bleach solution, and sent to landfill for disposal.

Microbiology waste Autoclave/Microwave/Incineration F/b landfill disposal.

Infectious solid waste Autoclave/Microwave/Incineration F/blandfill disposal.

Radioactive waste The solid wastes are disposed by concentration and storage, while liquids by dilution and dispersal

Pressurised containers Disposed off with general waste in secured landfills.