bm waste mgmt_issues_challenges040609 (1)

Bio-medical Waste Bio-medical Waste Management Management

Issues and ChallengesIssues and Challenges

Dr. Selwyn A ColacoDr. Selwyn A ColacoChief Operating OfficerChief Operating OfficerNarayana Hrudayalaya Hospitals, Narayana Hrudayalaya Hospitals, BangaloreBangalore

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I. Environmental LegislationI. Environmental Legislation

The Air (Prevention and Control of Pollution) Act, The Air (Prevention and Control of Pollution) Act, 19811981

The Environment (Protection) Act, 1986The Environment (Protection) Act, 1986 The Hazardous Waste (Management & Handling) The Hazardous Waste (Management & Handling)

Rules, 1989Rules, 1989 The National Environmental Tribunal Act, 1995The National Environmental Tribunal Act, 1995 The Biomedical Waste (Management & Handling) The Biomedical Waste (Management & Handling)

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

Handling) Rules, 2000Handling) Rules, 2000

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BMW Rules have been adopted and notified 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.

Implementation of Implementation of BIO-MEDICAL WASTE RULES 1998BIO-MEDICAL WASTE RULES 1998

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Health care waste includes Health care waste includes Waste generated by the health care facilities Waste generated by the health care facilities Research facilitiesResearch facilities LaboratoriesLaboratories

Biomedical waste in hospitalsBiomedical waste in hospitals 85% are non-infectious85% are non-infectious 10% are infectious10% are infectious 5% are hazardous5% are hazardous

Implementation of Implementation of BIO-MEDICAL WASTE RULES 1998BIO-MEDICAL WASTE RULES 1998

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Segregation and safe containment of waste at Segregation and safe containment of waste at the health facility level the health facility level

Processing and storage for terminal disposalProcessing and storage for terminal disposal

Basic PrinciplesBasic Principles

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Bio-medical waste shall not be mixed with other Bio-medical waste shall not be mixed with other wastes.wastes. Segregation at source – both at ward and unit levelSegregation at source – both at ward and unit level Color coding to support segregation at sourceColor coding to support segregation at source Bio-medical waste shall be segregated into Bio-medical waste shall be segregated into containers/ bags at the point of generation in containers/ bags at the point of generation in accordance with Schedule II (BMW Rules 1998) prior accordance with Schedule II (BMW Rules 1998) prior to its storage, transportation, treatment and to its storage, transportation, treatment and disposal.disposal.


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The containers shall be labeled according to The containers shall be labeled according to Schedule III (BMW Rules 1998)Schedule III (BMW Rules 1998) Transport waste safely to pick up siteTransport waste safely to pick up site Identify destination for each type of waste and Identify destination for each type of waste and ensure safe disposalensure safe disposal Keep track of usageKeep track of usage


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Untreated biomedical waste shall be transported only Untreated biomedical waste shall be transported only in vehicles authorized for the purpose by the in vehicles authorized for the purpose by the competent authority as specified by the government.competent authority as specified by the government.

Untreated bio-medical waste shall not be kept/stored Untreated bio-medical waste shall not be kept/stored beyond a period of 48 hours.beyond a period of 48 hours.

If for any reason it becomes necessary to store the If for any reason it becomes necessary to store the waste beyond such period, measures must be taken to waste beyond such period, measures must be taken to ensure that the waste does not adversely affect human ensure that the waste does not adversely affect human health and the environment.health and the environment.

Transportation & Storage of BMWTransportation & Storage of BMW

Use/Reuse of equipment

Unsafe collection

Unsafe disposal

Biomedical Waste Management - Biomedical Waste Management - IssuesIssues


• Not considered important Not considered important – Lack of interest from senior management Lack of interest from senior management

– No ownership of the processNo ownership of the process– Awareness of problems Awareness of problems – Appreciate the need for constant monitoringAppreciate the need for constant monitoring

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–Segregation of waste not taken seriously at user Segregation of waste not taken seriously at user level level –Non compliance with color codingNon compliance with color coding–Monitoring segregation at source – low budgets Monitoring segregation at source – low budgets allocated – costs are not always knownallocated – costs are not always known–Cost of color coding, staff, transport and disposalCost of color coding, staff, transport and disposal–Quantification of waste generated is not accurately Quantification of waste generated is not accurately donedone


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–Protection of healthcare workers not given adequate Protection of healthcare workers not given adequate thoughtthought–Clinical waste dumped with non infectious waste - Clinical waste dumped with non infectious waste - Risk for healthcare workers and publicRisk for healthcare workers and public–Waste disposal not effective, often dumped in open Waste disposal not effective, often dumped in open landfillslandfills


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–Responsibility for waste disposal – head of facility, Responsibility for waste disposal – head of facility, but devolved to members of the waste management but devolved to members of the waste management teamteam–Each healthcare worker – segregation and Each healthcare worker – segregation and appropriate disposalappropriate disposal–Private companies – from collection point in hospital Private companies – from collection point in hospital to disposalto disposal–Medical waste segregation awareness and Medical waste segregation awareness and Information should be available in all areas of Information should be available in all areas of hospitalhospital

Biomedical Waste Management - Biomedical Waste Management - responsibilitiesresponsibilities

Challenges: Need for protocol and Challenges: Need for protocol and policies…policies… To provide protection forTo provide protection for

– Healthcare workers Healthcare workers – PatientsPatients– Community at large - from the risk of infectionsCommunity at large - from the risk of infections

• Compliance with statutory requirementsCompliance with statutory requirements• Government of India -1998 biomedical waste Government of India -1998 biomedical waste

management and handling rules under EPAmanagement and handling rules under EPA

(compels hospitals, clinics, labs to ensure safe and (compels hospitals, clinics, labs to ensure safe and environmentally sound management of waste environmentally sound management of waste generated at their establishments)generated at their establishments)

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ChallengesChallenges

Establishing robust waste management policies Establishing robust waste management policies within the organizationwithin the organization Organization wide awareness about the health Organization wide awareness about the health hazardshazards Sufficient financial and human resourcesSufficient financial and human resources Monitoring and control of waste disposal Monitoring and control of waste disposal Clear responsibility for appropriate handling and Clear responsibility for appropriate handling and disposal of waste.disposal of waste.

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ADRESSING THE ISSUES

1. Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal

2. This is a long-term process, sustained by gradual improvements.

3. Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital.

4. Man power needs and other resources for the BMWM of hospital to be addressed.

5. Quality assessment of bio-medical waste management should be done from time to time.

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6. Segregated collection and transportation - The use of color coding and labeling of hazardous waste.

7. Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages.

8. Safety of handlers.9. Raising Awareness about risks related to health-

care waste; training staff and HCW on safe practices.

10.Selection of safe and environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.

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11.Issue of all protective clothes such as, gloves, aprons, masks etc. to all HCW.

12.Regular medical check-up (half-yearly) of staff associated with BMWM.

13.Maintenance of Record registers for this purpose.

14.Containers should be robust and leak proof 15.Tracking of Bio Medical Waste upto point of

Disposal.16.Proper treatment and final disposal.

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Thank you

Any Questions?

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OptionOption Waste CategoryWaste Category Treatment & DisposalTreatment & Disposal

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

incineration @/deep burial*incineration @/deep burial*

Category No. 2Category No. 2 Animal WasteAnimal Waste(animal tissues, organs, body parts (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and carcasses, bleeding parts, fluid, blood and experimental animals used in research, experimental animals used in research, waste generated by veterinary hospitals, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal colleges, discharge from hospitals, animal houses)houses)

incineration@/deep burial*incineration@/deep burial*

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

local local autoclaving/micro-waving/incinerautoclaving/micro-waving/incineration@ation@

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

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

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

incineration@/destruction and incineration@/destruction and drugs disposal in secured drugs disposal in secured landfillslandfills

Schedule-ISchedule-ICATEGORIES OF BIO-MEDICAL WASTECATEGORIES OF BIO-MEDICAL WASTE

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

incineration@autoclaving/incineration@autoclaving/microwavingmicrowaving

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

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

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

disinfection by chemical disinfection by chemical treatment@@ and discharge treatment@@ and discharge into drainsinto drains

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

disposal in municipal landfilldisposal in municipal landfill

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

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

Schedule-ISchedule-ICATEGORIES OF BIO-MEDICAL WASTE (continued)CATEGORIES OF BIO-MEDICAL WASTE (continued)

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Note :Note :

@@ There will be no chemical pretreatment before incineration. Chlorinated There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated.plastics shall not be incinerated.

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

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

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

Schedule-ISchedule-ICATEGORIES OF BIO-MEDICAL WASTE (continue)CATEGORIES OF BIO-MEDICAL WASTE (continue)

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Schedule-IISchedule-IICOLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL COLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL

OF BIO MEDICAL WASTESOF BIO MEDICAL WASTES

Colour Colour CodingCoding

Type of Type of ContainerContainer

Waste Waste CategoryCategory Treatment optionsTreatment options

YellowYellow Plastic BagPlastic BagCategorieCategories 1, 2, 3 s 1, 2, 3 & 6.& 6.

Incineration/ deep burialIncineration/ deep burial

RedRed Disinfected Disinfected container/Plasticontainer/Plastic bagc bag

CategorieCategories 3, 6, 7s 3, 6, 7

Autoclaving/Micro-waving/Autoclaving/Micro-waving/Chemical TreatmentChemical Treatment

Blue/Blue/White White TransluceTranslucentnt

Plastic Bag Plastic Bag /puncture proof /puncture proof containers containers

Cat. 4, Cat. 4, Cat. 7Cat. 7

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

Black Black Plastic BagPlastic Bag CategorieCategories 5, 9, 10s 5, 9, 10 Disposal in secured landfill.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.

bm waste mgmt_issues_challenges040609 (1)

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