BIO MEDICAL WASTE MANAGEMENT

Presented by Dr. Jitendra saxena Medical Officer Health Bilaspur

2/14/2012

Implementation of BMW rules 1998

High priority to Health & safety of services providers

Environment (Protection) Act, its Regulations & definitions

Ministry of Environment & Forests Notification 20th July 1998. Rules under section 6,8 & 25 of Environment (Protection) Act, 1986 called BMWM & handling rules 1998

 Rules apply to all those who generate ,collect, Receive, store transport, treat, dispose or handle BMW.

MINISTRY OF ENVIRONMENT AND FORESTS NOTIFICATION DEFINITION - I AUTHORISATION MEANS PERMISSION GRANTED BY THE PRESCRIBED AUTHORITY FOR THE GENERATION, COLLECTION, RECEPTION, STORAGE, TRANSPORTATION, TREATMENT, DISPOSAL AND/OR ANY OTHER FORM OF HANDLING OF BIO-MEDICAL WASTE IN ACCORDANCE WITH THESE RULES AND ANY GUIDELINES ISSUED BY THE CENTRAL GOVERNMENT.

2/14/2012

DEFINITIONS CONTD (2)

AUTHORISED PERSON MEANS AN OCCUPIER OR OPERATOR AUTHORISED BY THE PRESCRIBED AUTHORITY TO GENERATE, COLLECT, RECEIVE, STORE, TRANSPORT, TREAT, DISPOSE AND/OR HANDLE BIO-MEDICAL WASTE IN ACCORDANCE WITH THESE RULES AND ANY GUIDELINES ISSUED BY THE CENTRAL GOVERNMENT.
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DEFINITIONS CONTD(3)
OCCUPIER IN RELATION TO ANY INSTITUTION GENERATING BIO-MEDICAL WASTE WHICH INCLUDES A HOSPITAL, NURSING HOME, CLINIC, DISPENSARY, VETERINARY INSTITUTION, ANIMAL HOUSE, PATHOLOGICAL LABORATORY, BLOOD BANK BY WHAT EVER NAME CALLED, MEANS A PERSON WHO HAS CONTROL OVER THAT INSTITUTION AND / OR ITS PERMISES.
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DEFINITIONS CONTINUED (4)

4. DUTY OF OCCUPIER
IT SHALL BE THE DUTY OF EVERY OCCUPIER OF AN INSTITUTION GENERATING BIO-MEDICAL WASTE TO TAKE ALL STEPS TO ENSURE THAT SUCH WASTE IS HANDLED WITHOUT ANY ADVERSE EFFECT TO HUMAN HEALTH (CLIENTS & COMMUNITY) AND THE ENVIRONMENT.
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Definition of BMW
Waste generated out of diagnosis, treatment or immunization procedure carried out to an individual in any health care or related institution

 Operator of BMW Facility

10

 BMW should not be mixed with other waste Segregation - at the point of generation Segregation - responsibility of the generator Transportation- with schedule IV Specialized vehicle under Motor Vehicle Act 1998 Not to be stored for more than 48 hours 11

Prescribed Authority (PCB)

Functions under the supervision & control of State Govt. Applicant applies in Form I to PCB. Authorization granted for three years, then renewal is needed. Refusal with reasons. Decision with in 90 days. May cancel or suspend the authorization. 12

Authorization

Exempted-- less than 1000 pts/month Application in form-I Required fee 13

Advisory committee
Experts form Medical, Veterinary, Environment Depts., Municipal adm, NGO ,PCB Appellate authority with in 30 days

Annual Report

Form II by 31st January to St.PCB. St. PCB to Cent. PCB by 31st March

Maintenance of record
and its Availability for inspection

Accident Reporting

All major accidents in form III to PCB

Punishment

Cases in High courts only Imprisonment 6 months to 1 year Fine up to 1 lac Rs.

Sources of BMW

Why we need BMWM

Harmful to humans ,animals & environment

Type of Hazards
Infectious agents Genotoxic material Hazardous chemicals Radio-active Materials May contain sharps

Nature of Hazards
Injuries by sharps Nosocomial infections Injuries to scavengers Change in microbial ecology Antibiotic resistance Due to chemicals

Persons at Risk
Staff Patients Visitors Support Staff S. Karamcharis

Hazards to Animals
Vultures Dogs & wild animals Grazing animals

Hazards to Public

Rag Pickers Garbage Workers Animals Grazers

 Hazards to Environment-Ozone Layer

Micro biology of Health Care Waste

TYPE OF INFECTION Gastroenteric infections EXAMPLES OF CAUSATIVE ORGANISMS Enterobacteria e.g. Salmonella, Shigella sp; Vibrio cholerae; Helminths TRANSMISSION VEHICLES Faeces and / or vomit

Respiratory infections

Mycobacterium tuberculosis; Inhaled secretions; measles virus; saliva streptococcus pneumoniae Herpes virus Neisseria gonorrhoeae; herpes virus Streptococcus sp Bacillus anthracis Neisseria meningitis Human immunodeficiency virus (HIV) Eye secretions Genital secretions Pus Skin secretions Cerebrospinal fluid Blood, genital secretions

Ocular infection Genital infections Skin infections Anthrax Meningitis Acquired immunodeficiency syndrome (AIDS)

TYPE OF INFECTION
Haemorrhagic fevers Septicaemia Bacteraemia

EXAMPLES OF CAUSATIVE ORGANISMS

Junin, Lassa, Ebola and Marburg viruses Staphylococcus spp Coagulase-negative Staphylo coccus sp. Staphylococcus aureus; Enterobacter, Enterococcus, Klebsiella, and Streptococcus sp Candida albicans

TRANSMISSIO N VEHICLES
All bloody products and Secretions Blood

Candidaemia

Blood Faeces

Viral hepatitis A Hepatitis A virus

Viral Hepatitis B Hepatitis B and C viruses Blood and Body and C fluids

CATEGORIZATION OF BIO-MEDICAL WASTE BIOSCHEDULE I (SEE RULE - 5)

OPTION
CATEGORY NO.1 CATEGORY NO. 2

WASTE CATEGORY
HUMAN ANTATOMICAL WASTE (HUMAN TISSUES ORGANS BODY PARTS) ANIMAL WASTE (ANIMAL TISSUES, ORGANS, BODY PARTS, CARCASSES, BLEEDING PARTS, FLUIDS, BLOOD AND EXPERIMENTAL ANIMAL USED IN RESEARCH WASTE GENERATED BY VETERINARY HOSPITALS/ COLLEGES, DISCHARGE FROM ANIMAL HOUSES) MICROBIOLOGY AND BIOTECHNOLOGY WASTE (WASTES FROM LABORATORY CULTURES STOCKS OR SPECIMENS OF MICRO OPGANISMS LIVE OR ATTENUATED VACCINES, HUMAN AND ANIMAL CELL CULTURE USED IN RESEARCH AND INFECTIOUS AGENTS FROM RESEARCH AND INDUSTRIAL LABORATORIES, BIOLOGICALS, TOXINS, DISHES AND DEVICES USED FOR TRANSFER OF CULTURES)

TREATMENT & DISPOSAL

INCINERATION/ DEEP BURIAL, NO DISINFECTION INCINERATION/DEE P DUMPING, NO DISINFECTION

CATEGORY NO. 3

INCINERATION OR DEEP DUMPING

OPTION
CATEGORY NO.4

WASTE CATEGORY
WASTE SHARPS (NEEDLES, SYRINGES, SCALPEL BLADES, GLASS ETC. THAT MAY CAUSE PUNCTURE AND CUTS. THIS INCLUDES BOTH USED AND UNUSED SHARPS) DISCARDED MEDICINES AND CYTOTOXIC DRUGS(WASTES COMPRISING OF OUTDATED ,CONTAMINATED AND DISCARDED MEDICINES) SOLID WASTE- ITEMS CONTAMINATED WITH BLOOD, BODY FLUIDS INCL. COTTON, DRESSINGS, SOILED PLASTER CASTS, LINEN, BEDDINGS, OTHER MATERIAL CONTAMINATED WITH BLOOD SOLID WASTE- WASTE GENERATED FROM DISPOSABLE ITEMS OTHER THAN WASTE SHARPS (TUBINGS/CATHETERS/INTRA VENOUS SETS ETC.)

TREATMENT & DISPOSAL

DISINFECTION (CHEMICAL TREATMENT AUTOCAVING/MICROWAVING AND MUTILATION AND DEEP DUMPING / SHREDDING INCINERATION OR / DESTRUCTION AND DRUGS DISPOSAL IN SECURED LANDFILLS INCINERATION, AUTOCLAVING/DEEP BURIAL NO CHEMICAL TREATMENT

CATEGORY NO. 5

CATEGORY NO. 6

CATEGORY NO.7

DISINFECTION BY CHEMICAL TREATMENT/AUTOCLAVING

OPTION
CATEGORY NO.8

WASTE CATEGORY
LIQUID WASTE GENERATED FROM LABORATORY AND WASHING, CLEANING, HOUSEKEEPING AND DISINFECTING ACTIVITIES.

TREATMENT & DISPOSAL

DISINFECTION BY CHEMICAL TREATMENT AND DISCHARGE INTO DRAINS

All

antiseptics.
CATEGORY NO. 9
INCINERATION ASH (ASH FROM INCINERATION OF ANY BIOMEDICAL WASTE ). DISPOSAL IN MUNICIPAL LANDFILL

CATEGORY NO. 10

CHEMICAL WASTE (CHEMICAL USED IN PRODUCTION OF BIOLOGICALS, CHEMICALS USED IN DISINFECTION, INSECTICIDES, DEVELOPER/FIXER FROM X-RAY ,un-used reagents.DDT)

CHEMICAL TREATMENT AND DISCHARGE INTO DRAINS FOR LIQUIDS AND SECURED LANDFILL FOR SOLIDS.FIXER TO BE SOLD.DEVELOPER INTO THE DRAINS

CLASSIFICATION OF BMW AND COLOUR CODING

CLASSIFICATION OF BMW AND COLOUR CODING Schedule II (See Rule 6) Category wise storage of BMW in the colour coded bins after segregation: Yellow Cat.1,2,3,&6 Incineration/deep burial All type of tissue ( body parts, pus, blood, body fluids, sputum, lab culture ,vaccines ) Red Cat.7 Autoclaving/chem. treatment Tubings, catheter, I.V. sets, plastic syringes and other plastic material.

 Blue Cat.4 (puncture proof containers) Shredding/autoclaving/chem. treatment Blades, needles, slides, ampoules, glass vials, foils of the tablets and capsules. Black Cat. 5, 9 & 10. Disposal in secured landfill General (household) waste, fixer from radiology dept., incineration ash.

 A few examples of waste: Infectious waste: Contaminated dressings, body parts, placenta, disposable specimens/containers/wood/paper/plastic/glass etc, sharp object-- blades/needles, broken glass, pieces of bones, nails, disposable syringes ,used catheters/I.V. sets/rubber tubing's, microbiological waste, culture plates, specimen containers. It also includes the BMW being generated from minor or scattered sources such as that produced in the course of healthcare undertaken in home (dialysis, insulin injections). General waste: Kitchen garbage, laundry waste, general washing, disposable wrappers & packing material like paper, plastic and wood.

 Hazardous waste: Radioactive materials & radiations, cytotoxic drugs, pressurized containers, mercury. Chemical waste: Reagents, developer, savlon, Lysol, gluteraldehyde, expired drugs. Genotoxic waste: It is highly hazardous and may have mutagenic, teratogenic or carcinogenic effects. It has the ability to kill or stop the growth of certain living cells and is used in chemotherapy of cancer

How to minimize BMW

AV. Qty. 1.5 to 2.2 kg/day/bed Remember 3 Rs reduce, reuse, recycle

Reduce
Less prescription of injections Proper segregation 15-20% BMW-1%sharp, 4%chemical, 10 -15%infectious & pathological 80-85% general waste All colour coded bins at the point of generation Sieved containers

Reuse
Linen ,glass syringes, sheets, gowns instruments, glass slides. Use of tooth brushes Slides in RNTCP programme are not re-used.

Recycle

Proper shredding of plastic material

Universal Precautions
All waste hazardous Handling of mercury Segregation -early & proper Color coded bins Training of staff PPE Proper Handling of BMW Proper transportation Accident reporting Immunization of staff B.P. not in pits Careful handling of sharps Puncture Proof container - sharps Sieved containers Disinfection of reusable items No direct touch Bags/ bins dont drag Proper hand washing Don't. correct errors of segregation Chemical & pharma waste if small then collect with infections waste Proper disposal of large quantity of expired drugs Disposal of chemical waste

Response to accidents/exposures
Care of wound Antibiotics if needed HIV testing & PEPT Inform Infection control officer

Material and supplies

PPES--- cap, gown, goggles ,gum boots, gloves, aprons, masks Color coded bins Weighing machine Syringe cutters B.Powder Wheeled trolley Scissors Savlon Polythene bags-- color coded Sieved containers

Polythene bags
Leak resistant Impervious to moisture Strong. Thickness- 55 microns Sealing facility Color coded

 Bins-swing covers/foot operated

Carts/trolley
Properly designed Stable Do not produce noise No sharp edges Easy to disinfect, drain & handle

Segregation
Why we need it Reduce the quantity of BMW Ensure proper disposal At the point of generation Color coded bins Empty it-- when 2/3 full

Shredding
Syringe cutters At workable height Away from kids Scissors for BMWM Proper shredding

Disinfection
1% B.P. solution-1% available chlorine. 35 gms./ litre 1/2kg or less pack Stability-- 3 hours Contact time-- 1/2hr. Air-tight container

 If deep dumping Tissue should not be disinfected

 Treatment of spills

 Disinfection of sputum cups 5% phenol for 18 hours. And then shredding.

 Decontamination of blankets , mattresses, OT table & labour Table

Autoclaving
Temp 1210 c, Pressure 15 lbs/sq. inch for 60 mint 1350 c 31 45 1490 c 35 30

 MICROWAVING

 Validation Test -Sterilables

Storage
Bins are emptied after every 3 Hours

Storage Room
Near the parking point Floor elevated, Impermeable Hand washing facility Room washing facility One Exhaust Fan Locking of Doors No entry for rats & reptiles

Handling of
Dont Touch Use Syringe Store in water Sale it out

Mercury

Transportation
2/3 Filled bag, Tied up, Removed and replaced Bag once closed should not be opened Dont drag Dont Store for more then 48 hours Vehicle-closed ban with logo Scheduled IV

Disposal
Deep burial
No. Bleaching Powder inside BMW then 10 cm Soil 2 X 2 X 2 meter 2/3 Filled then lime & Soil

Incineration
Reduces organic , Combustible waste to inorganic, non-combustible waste Reduces Volume and weight Two chambers Temp 800 +- 500c 1050+- 500c

Incineration contd.
Steam , CO2 and some other gases are produced Nitrogen oxides Metals , halogenic acids ash - Incomplete incineration Carb.mono-oxide, di-oxins, furans, co-planar Affect immune system Development of Nervous, endocrine and reproductive system Skin lesion Chimney 30 mtrs. height Ash--- deep dumping

Not to be incinerated
Pressurized containers Reactive chemical waste Silver Salts Radiographic waste Sealed ampouls /vials Halogenated Plastic Thermometers Used batteries Lead lined panels

Construction of Pits

One pucca pit with concrete roof One Kuchcha pit with steel structure

 Sub centre level 2 X 2 feet are sufficient

Contract with the operator

Written agreement between M.O. I/C and operator Operator empanelled by PCB Rates by negotiation May be tenders in future

 Procedure for authorization Application From No. I Fee Structure

>> 500 beds---10,000/yr

200-500 beds -5000/Yr 50-199 beds -3000/Yr Less then 50 beds-1000/Yr No beds -500/Yr (OPD more than 1000/months) Permission with in 90 days Appeal with 30 days

Record Keeping Daily Log Book st Jan Report Form II by 31 Accident reporting Transportation Schedule IV

 Management at Institutional Level Incineration is the choice Deep dumping-- second best Level I & II --deep burial Level III /CHC/CH/RH-- either Level IV and above-- Incineration

Responsibility and supervision Segregation Generator Supervision by Deptt. In charges Q.C. Sanitation, MO I/C

 Handling of BMW in field campus deep burial or Transportation & disposal by incineration

Health & Safety Protections

PPEs Proper handling of BMW Immunization Dont touch directly Behavioral change Management practices

Training programme of Staff

All categories of staff Behavioral Change Training & supervision

Object of Training
Awareness regarding health safety & environment Awareness regarding safety at work place Awareness regarding role of each staff member

Training of the community

Prevent exposure to BMW Risk of BMW

Monitoring and Evaluation

Supervision of the record Decrease in the number of accidents Campus looks clean

FORM I
(See Rule 8) APPLICATION FOR AUTHORIZATION (To be submitted in duplicate) To The Prescribed Authority (Name of the State Govt/UT Administration) Address: 1. Particulars of Application i) Name of the Applicant (Block letter & in full) ii) Name of the Institution: Address: Tel No. Fax No. Telex No.

Activity for which authorization is sought: i) Generation ii) Collection iii) Reception iv) Storage v) Transportation vi) Treatment vii) Disposal viii) Any other form of handling 3. Please state whether applying for fresh authorization or for renewal: (In case renewal previous authorization number and date) 4. i) Address of the institution handling bio-medical waste: ii) Address of the place of the treatment facility. iii) Address of the place of disposal of the waste. 5. i) Mode of transpiration (in any) of bio-medical waste: ii) Mode(s) of treatment.

2.

 6. Brief description of method of treatment and disposal (attach details): 7. i) Category (See Schedule I) of waste to be handled. ii) Quantity of waste (category wise) to be handled per month. 8. Declaration I do hereby declare that the statements made and information given above are true to the best of my knowledge and belief and that I have not concealed any information. I do also, hereby, undertake to provide any further information sought by the prescribed authority in relation to these rules and to fulfil any conditions stipulated by the prescribed authority. Date: Place: Signature of applicant: Designation of applicant

FORM II
(See Rule 10) ANNUAL REPORT (To be submitted to the prescribed authority by 31 January every year) 1. Particulars of the application: i). Name of the authorized person (occupier / operator): ii). Name of the institution: Address Tel No Fax No. Categories of waste generated and quantity on a monthly average basis: Brief details of the treatment facility: In case of off site facility. i). Name of the operator. ii). Name and address of the facility:

2. 3.

Tel No. Telex No. Fax No. 4. Category-wise quantity of waste treated. 5. Mode of treatment with details: 6. Any other information: 7. Certified that the above report is for the period from

Date: Signature Place: Designation NAME OF THE HEALTH CARE FACILITY:

FORM III
(See Rule 12) ACCIDENT REPORTING 1. Date and time of accident. 2. Sequence of events leading to accident. 3. The waste involved in accident. 4. Assessment of the effects of the accidents on human health and the environment: 5. Emergency measures taken. 6. Steps taken to alleviate the effects of accidents: 7. Steps taken to prevent the recurrence of such an accident: Date: Signature: Place: Designation:

SCHEDULE V (See Rule 5)

SCHEDULE FOR WASTE TREATMENT FACILITIES LIKE INCINERATOR / AUTO CLAVE/MICROWAVE SYSTEM
A.

Hospital and nursing homes in towns with population of 30 lakhs and above

By 31st December, 1999 or earlier

B.

Hospitals and nursing homes in towns with population of below 30 lakhs. I with 500 beds and above II with 200 beds and above but less than 500 beds. III With 50 beds and above but less than 200 beds IV With less than 50 beds. All other institutions generating bio-medical waste not included in A and B above.

By 31st Dec., 1999 or earlier. By 31st Dec., 2000 or earlier. By 31st Dec., 2001 or earlier. By 31st Dec., 2002 or earlier. By 31st Dec., 2002 or earlier.

C.

SCHEDULE III (SEE RULE 6) LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

SCHEDULE IV
(SEE RULE 6)
Level for transport of Bio-Medical Waste Containers /Bags Day.. Month. Year. Date of Generation Waste category No. . Waste class: Waste description: Senders Name & Address: Receivers Name & Address; Phone No.. Phone No.. Telex No. . Telex No. . Fax No. Fax No. Contact Person Contact Person In case of emergency please contact: Name & Address: Phone No: Note: Label shall be non-washable and prominently visible.