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Bio-medical waste Bio-medical waste managementmanagement inin

General Hospital, General Hospital, SirsaSirsa

Presented by-Dr.JaideepMaster in Public Health (Student)Panjab University, Chandigarh

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I want to give special thanks toI want to give special thanks toDR.S.K.SHARMADR.S.K.SHARMAM.D. (ForensiM.D. (Forensicc medicine) medicine)C.M.O. General Hospital, SirsaC.M.O. General Hospital, Sirsa

DR.S.L.AgarwalDR.S.L.AgarwalMedical SuperintendentMedical Superintendent General Hospital,SirsaGeneral Hospital,Sirsa

DR.VIRESH BHUSHANDR.VIRESH BHUSHAN M.B.B.S.,D.H.A.M.B.B.S.,D.H.A.R.M.O. General Hospital, SirsaR.M.O. General Hospital, Sirsa

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Objective :-To evaluate Bio-medical waste

management in General Hospital ,Sirsa

Methodology :-Study Area :- General Hospital, Sirsa, Haryana. Study Period:- January 2009Study design:-Crossectional & observational studyStudy Tools:-1.Self assessment on Bio-medical waste (management &handling) Rules 1998 2.Interview of Health workers & Synergy waste management (P) ltd. Workers 3.Observation of Bio-medical waste segregation &handling in the Hospital. 4.Information of agreement and other bio-medical waste management measures of General hospital Sirsa were collected through R.T.I. Act 2005.

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I. I. Environmental Environmental Legislation Legislation

The Environment (Protection) Act, 1986The Environment (Protection) Act, 1986 The Biomedical Waste (Management & The Biomedical Waste (Management &

Handling) Rules, 1998Handling) Rules, 1998 The Municipal Solid Waste (Management & The Municipal Solid Waste (Management &

Handling) Rules, 2000Handling) Rules, 2000 The Hazardous Waste (Management & The Hazardous Waste (Management &

Handling) Rules, 1989Handling) Rules, 1989 The National Environmental Tribunal Act, The National Environmental Tribunal Act,

19951995 The Air (Prevention and Control of Pollution) The Air (Prevention and Control of Pollution)

Act, 1981Act, 1981

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BIOMEDICAL WASTE(MANAGEMENT & HANDLING) RULES 1998

Amended on 2000

 

 

 

 

 

 

 

•Bio-medical waste shall not be mixed with other wastes.

• Bio-medical waste shall be segregated into containers/bags at the point of generation in accordance with Schedule II (next slide) prior to its storage, transportation, treatment and disposal. The containers shall be labeled according to Schedule III .

Rules for Segregation & Packing of BMW

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Option Waste Category Treatment & Disposal

Category No. 1 Human Anatomical Waste(human tissues, organs, body parts)

incineration @/deep burial*

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, colleges, discharge from hospitals, animal houses)

incineration@/deep burial*

Category No. 3 Microbiology & Biotechnology Waste(Wastes from laboratory cultures, stocks or micro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures)

local autoclaving/micro-waving/incineration@

Category No. 4 Waste Sharps(needles, syringes, scalpels, blade, glass, etc. that may cause punture and cuts. This includes both used and unused sharps)

disinfection (chemical treatment @@@/auto claving/microwaving and mutilation/shredding##

Category No. 5 Discarded Medicines and Cytotoxic drugs(Waste comprising of outdated, contaminated and discarded medicines)

incineration@/destruction and drugs disposal in secured landfills

Schedule-ICATEGORIES OF BIO-MEDICAL WASTE

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Category No. 6 Soiled Waste(items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood)

incineration@autoclaving/microwaving

Category No. 7 Solid Waste(Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.)

disinfection by chemical treatment@@ autoclaving/microwaving and mutilation/shredding##

Category No. 8 Liquid Waste(Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities)

disinfection by chemical treatment@@ and discharge into drains

Category No. 9 Incineration AshAsh from incineration of any bio-medical waste)

disposal in municipal landfill

Category No. 10 Chemical Waste(Chemicals used in production of biologicals, chemicals used in production of biologicals, chemicals used in  disinfection, as insectricides, etc.)

chemical treatment@@ and discharge into drains for liquids and secured landfill for solids

Schedule-ICATEGORIES OF BIO-MEDICAL WASTE (continue)

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Note :@ There will be no chemical pretreatment

before incineration. Chlorinated plastics shall not be incinerated.

* Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas.

@@ Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It musts be ensured that chemical treatment ensures disinfection.

## Multilation/shredding must be such so as to prevent unauthorised reuse.

Schedule-ICATEGORIES OF BIO-MEDICAL WASTE (continue)

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Schedule-IICOLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIO

MEDICAL WASTESColour Coding

Type of Container

Waste Category Treatment options

Yellow Plastic Bag Categories 1, 2, 3 & 6. Incineration/ deep burial

 Red Disinfected container/Plastic bag

Categories 3, 6, 7

Autoclaving/Micro-waving/Chemical Treatment

Blue/White Translucent

Plastic Bag /punctproof containers

Cat. 4, Cat. 7

Autoclaving/Micro-waving/ Chemical Treatment & Destruction / shredding

Black Plastic Bag Categories 5, 9, 10 Disposal in secured landfill.

Notes:1. Colour coding of waste categories with multiple treatment options as defined in schedule 1, shall be selected depending on treatment option chosen, which shall be as specified in Schedule I.2. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics.3. Categories 8 and 10 (liquid) do not require containers/bags.4. Category 3, if disinfected locally need not be put in containers/bags.

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•If a container is transported from the premises where bio-medical waste is generated to any waste treatment facility outside the premises, the container shall, apart from the label prescribed in Schedule III, also carry information prescribed in Schedule IV.

•Notwithstanding anything contained in the Motor Vehicle Act, 1988, or rules there under, untreated biomedical waste shall be transported only in such vehicles as may be authorized for the purpose by the competent authority as specified by the government.

•No untreated bio-medical waste shall be kept/stored beyond a period of 48 hours.

•Provided that if for any reason it becomes necessary to store the waste beyond such period, the authorized person must take permission of the prescribed authority and take measures to ensure that the waste does not adversely affect human health and the environment.

Rules for Transportation & Storage of BMW

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Schedule-IIILABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

BIOHAZARD SYMBOL

CYTOTOXIC HAZARD SYMBOL

                                        

BIOHAZARD

                         CYTOTOXIC

HANDLE WITH CARE Note : Lable shall be non-washable and prominently visible.

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HARYANA GOVERNMENT(ENVIRONMENT DEPARTMENT)

In exercise of the powers conferred by rule 9 of the Bio-Medical Waste (Management and Handling) Rules, 1998, the Governor of Haryana hereby constitutes an Advisory Committee for the purpose of the said rule 9 consisting of the following members, namely :-1. Commissioner and Secretary to Government, Haryana Environment Department Chairman

2. Chairman, Haryana State Pollution Control Board, Chandigarh Member3. Engineer-in-Chief, PW (Public Health) Department, Haryana, Chandigarh Member4. Director General, Health Services, Haryana Chandigarh ,Member5. Director, Animal Husbandry Haryana, Chandigarh, Member6. Dean, College of Veterinary Sciences, Chaudhry Charan Singh, Haryana Agriculture University, Hisar Member7. Dean, Medical College, Rohtak, Member8. President, Indian, Medical Association Haryana Branch, Member9. Director Environment, Haryana Member-Secretary

The 23rd July, 1999

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NODAL AGENCY FOR AUTHORISATION Haryana State Pollution Control Board

PENALTY:-Defaulters to be penalised as per provisions of Environment (Protection) Act 1986 and other Pollution Control Acts.Punishment – imprisonment for a term which may extend for 5 years with fine which may extend to Rs. one lakh, or with both.If failure or contravention of the provisions of the Act continues, additional fine which may extend to Rs.5000/- per day is levied upto the date the contravention is removed.If the failure or contravention continues beyond a period of one year after the date of conviction, the offender shall be punished with imprisonment for a term which may extend upto 7 years.

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IMPLEMENTATION OF BIO-MEDICAL WASTE RULES 1998• BMW Rules have been adopted and notified in Haryana State with the objective to Stop the indiscriminate disposal of hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment.•Survey of Health institutions in the private sector has been completed.•All government institutions including hospitals/ CHCs/ PHCs /Laboratories/Blood Banks have applied for authorisation under the Act. •Incineration facilities installed at 11 District hospitals Ambala, Panchkula, Kurukshetra, Bhiwani, Faridabad, Hisar, Sirsa, Jind, Sonipat, Karnal & Panipat have been offered to the health institutions working in private sector on the payment of nominal charges.

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•Notification regarding the use of incineration facilities of Govt. by private doctors on the payment of prescribed amount and creation of district Bio-Medical waste Management Societies have been issued.•Segregation and disposal of Bio-medical waste has been started in hospitals.•Sensitization of all Civil Surgeons about BMW Rules have been done at State Headquarter.•24 Senior Officers from various districts have been got trained in Bio-Medical Waste (Management & Handling) Rules at National Institute of Management at Jaipur from 26.12.2000 to 4.1.2001.•Civil Surgeons have completed the training for medical and paramedical personals in these respective Districts.•Tenders for proper Bio-Medical Waste Disposal according to guidelines have been floated by the Department. Private Firms have submitted the tenders and they are under active consideration of the Govt.

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SirsaSirsa Total Population Total Population

(NAMP) Jan.,2000 (NAMP) Jan.,2000 1082651 1082651

Rural - 952209 Rural - 952209 Urban - 130442 Urban - 130442

Gen. HospitalGen. Hospital 100 bedded Hospital 100 bedded Hospital Daily OPD:-600 Daily OPD:-600 Bed occupancy rate :-Bed occupancy rate :-

85 85

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Bio-medical waste management in Bio-medical waste management in General HospitalGeneral Hospital

Contract is given to Pvt.Agency:- Contract is given to Pvt.Agency:- Synergy waste Synergy waste management (P) ltd.management (P) ltd. Delhi Delhi

Agency NameAgency Name:-:- M. Synergy waste management private limited, M. Synergy waste management private limited,

Delhi Delhi Charges:-Charges:- 15000/- per month 15000/- per month Collection of BMWCollection of BMW:-:-Daily except holiday.Daily except holiday. BMW generated per day:-BMW generated per day:- 20 kg (average) 20 kg (average)

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Medical waste segregation awareness boards presents in different wards of hospital

19 Availability and position of dustbins in wards

Card box was used as dustbin

20 Medical Ward

Card box was used as dustbin

21Surgical Ward

22Ortho Ward

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Gyn.Ward

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EMERGENCY WARD

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Guidelines for use of Red dustbin

Red dustbins in General Hospital

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Red dustbins in General Hospital

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Yellow dustbins in General hospital

Guidelines for use of yellow dustbin

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Yellow dustbins in General Hospital

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Yellow dustbins in General hospital

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Guidelines for use of blue dustbin Blue dustbins in General Hospital

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Disposable Syringe Prepared for re use

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Disposable Syringe Prepared for re use

Disposable Syringe in Wash basin

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Bio-medical waste mixed with Municipal waste in G.H.Sirsa campus

Human Placent

a

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Medical waste

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Rag pickers with BMW

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Transportation of BMW from G.H.Sirsa

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Incinerator of hospitalStarted in 1998,Cost 9 lakh 19 thousand.

(Not used by hospital authority)

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ResultsResultsStrengths:Strengths: Medical waste segregation Medical waste segregation

awareness boards presents awareness boards presents in different wards of in different wards of hospital.hospital.

Contract is given to private Contract is given to private agency for collection of agency for collection of BMW.BMW.

Weaknesses:•BMW was not segregated, collected according to rules. •No Quality assessment of bio-medical waste management be done from time to time.• Unavailability of all types of Unavailability of all types of dustbins(i.eRed,Blue, Yellow dustbins(i.eRed,Blue, Yellow and Black) in all wards.and Black) in all wards.•Unavailability of plastic bags Unavailability of plastic bags for medical waste segregation.for medical waste segregation...

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ConclusionsConclusionsThe absence of waste management, lack of awareness about The absence of waste management, lack of awareness about the health hazards, insufficient financial and human the health hazards, insufficient financial and human resources and poor control of waste disposal are the most resources and poor control of waste disposal are the most common problems connected with health-care wastes. An common problems connected with health-care wastes. An essential issue is the clear attribution of responsibility of essential issue is the clear attribution of responsibility of appropriate handling and disposal of waste. According to the appropriate handling and disposal of waste. According to the 'polluter pays' principle, this responsibility lies with the 'polluter pays' principle, this responsibility lies with the waste producer, usually being the health-care provider, or waste producer, usually being the health-care provider, or the establishment involved in related activities. the establishment involved in related activities. We need We need innovative and radical measures to clean up the distressing picture innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules, as waste government implementation of bare minimum of rules, as waste generation particularly biomedical waste imposes increasing direct generation particularly biomedical waste imposes increasing direct and indirect costs on society. The challenge before us, therefore, is and indirect costs on society. The challenge before us, therefore, is to scientifically manage growing quantities of biomedical waste that to scientifically manage growing quantities of biomedical waste that go beyond past practices. If we want to protect our environment and go beyond past practices. If we want to protect our environment and health of community we must sensitize our selves to this important health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the issue not only in the interest of health managers but also in the interest of community.interest of community.

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Recommendations Some suggestions which would act as remedial

measures for the Improvements in health-care waste management are given below :-

1. Specific personnel need to be deputed to monitor the bio-medical

waste management.2. By assessing the need of man power and other things for the BMWM

of hospital and by fulfilling of all the requirements.3. Quality assessment of bio-medical waste management be done from

time to time. Regular quality analysis by independent authorities.4. The build-up of a comprehensive system, addressing responsibilities,

resource allocation, handling and disposal. This is a long-term process, sustained by gradual improvements;

5. Awareness raising and training about risks related to health-care waste, and safe and sound practices.

6. Clear directives in the form of a notice to be displayed in all concerned areas in local languages.

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8.Issuance of all protective clothes such as, gloves, aprons, masks etc. without fail.

9.Maintenance of Record registers for this purpose.10.Regular medical check-up (half-early) of staff associated

with BMWM.11.Tracking of Bio Medical Waste upto point of Disposal.12.Segregated collection and transportation - The use of

colour coding and labelling of hazardous waste including local language.

13.Safety of handling.14.Selection of safe and environmentally-friendly

management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.

15.Proper treatment and final disposal.

Government commitment and support is needed to reach an overall and long-term improvement of the situation, although immediate action can be taken locally.

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References:- 1.Wastes from health-care activities(WHO Media centre) .2.“Bio-medical waste management”, Environmental Management and Policy Research Institute, Bangalore, 2004. .3.“Southern regional conference on bio-medical waste management” Tamilnadu Pollution Control Board, Chennai, 1999. .4.“Manual on hospital waste management”, Central Pollution Control Board, Delhi, 2000. 5.Report: Biomedical waste management practices at Balrampur Hospital, Lucknow, India (Saurabh Gupta ,Ram Boojh)6.Biomedical waste management in nursing homes and smaller hospitals in Delhi( Lalji K. Verma, Shyamala Mania, Nitu Sinha and Sunita Rana)7.Biomedical solid waste management in an Indian hospital: a case study(Gayathri V. Patil and Kamala Pokhrel) Knowledge, Attitude and Practices of Bio-Medical Waste Management Amongst Staff of a Tertiary Level Hospital in India (S. Saini, S.S. Nagarajan, R.K. Sarma)8.Park’s Text Book,.gov,who.org9.Profile of Health Department Haryana 10.The Gazette of India. Biomedical Waste (Management & Handling) Rule 1998. No 460 July 27th 1998 and Amended No. 375, June 2nd 2000Web sites: a. http://www.expresshealthcaremgmt.comb. http://www.who.ch/

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Thanks !!Thanks !!

HPH (Health Promoting Hospital) indicator