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Presentation Outline
Introduction to Biomedical Waste
Indian Scenario
Laws regarding BMW Management Issues concerning BMW Group Work
Consider A Scenario
You have got an opportunity to work in a trauma center at a newly established hospital at Gangtok. As your first assignment you have to take care of a patient named Joseph, male aged 45 yrs, who has met an accident 7 days back and is suffering form multiple fractures and injuries, also he has lost his right foot because of trauma induced sepsis, and is still on multiple IV antibiotic and pain killers, his MRI has revealed concussion injuries, and whole body CT revealed fracture shaft femur, ribs, and vertebral dislocation. Also, the patient had gone into Nosocomial infection induced sepsis. You have been given the task to establish the Infection control and waste management system for the trauma center as it is assumed that the hospital infection rates are soaring because of their absence.
Biomedical Waste
Infectious Wastes sufficient concentration of bacteria, virus, parasites and fungi to cause diseases. Sharps items that can cause cuts or puncture wounds. E.g. needles, scalpels, blades, knifes, broken glass. Cytotoxic Drugs have the ability to stop growth of certain living cells and are used as chemotherapeutic agents.
Biomedical Waste
Pharmaceutical Waste expired drugs, spilled pharma products, vaccines which are not useful. Radioactive Waste produced during in vitro analysis of body tissue, organ imaging and tumour localization. Chemicals formaldehyde, glutaraldehyde and photographic chemicals. Used in diagnostic, experimental work and during cleaning and disinfecting.
Historical Perspective
Quantum jump in technological field applicable to us since last two decades .Synergized by increasing clientele Increased awareness in health professionals & public. Florida Beach Wash-up or Syringe Tides , awakening in USA. Dr. B.L.Wadhera Vs Union of India Honable Supreme Court of India 1996 Bio Medical Waste ( Management and Handling ) Rules , 1998 ( Min. of Environment & Forest)
Sharps Waste
Radioactive Waste
Spread HIV infection, Hepatitis B and C Globally 2% of HIV infections (96000) are caused due to unsafe injection practices
Causes radiation burns, headache, dizziness, vomiting, genotoxicity. Goiania, Brazil (1988), Mexico City (1962), Algeria (1978), Morocco (1983)
Cytotoxic Drugs
Glutaraldehyde
Vulnerable Populations
Doctors Nurses Patients Visitors to the patient Workers in waste handling facilities Ragpickers
Networks
Safe Injection Global Network (SIGN)
Snapshots
The law prescribes a maximum time limit of 48 hours for storing waste. Chlorinated plastics are not be incinerated. No chemical pretreatment of waste is allowed before incineration.
The label shall be non-washable and visible prominently. It should have details such as the date, category, class and description of waste. If transported off-site, the contact details of the sender and receiver should also be mentioned on the label. For use of treatment options not specified in the rules, one shall approach CPCB to get the standards laid down.
Section 6
Section 8 Section 10
This section empowers the Central Government to make rules in respect of all or any environmental issues.
no person shall handle, or cause to be handled, any hazardous substance except in accordance with such procedure and after complying with such safeguards as may be prescribed.
Penalty for contravention of the provisions of the Act and the Rules, Orders and Directions
Offences by companies
Type of Waste
Human anatomical wastes
Animal wastes Microbiology and biotechnology wastes Sharps waste
Disposal
Incineration /deep burial
Incineration /deep burial Local autoclaving/ micro waving/ incineration Disinfections (chemical treatment /autoclaving/micro waving and mutilation shredding Incineration / destruction & drugs disposal in secured landfills
Category 5
Category
Type of Waste
Disposal
Category 8
Category 9 Category 10
Colour
Type of Container
Waste Category
Disposal
Red
Blue/White
Black
Plastic Bag
Encapsulation
Way of disposing sharps. Sharps collected in leak/puncture proof containers and filled up to half level. Cement mortar or clay filled in the remaining half. Once it is completely filled, sealed and disposed in landfills.
Segregation
Segregation refers to the storing of waste in separate containers. Segregation of waste is always done at the point of its generation and as soon as it is generated. Segregation not only reduces the chances of spreading infection, but also prevents occupational hazards. Segregation also reduces the investment in waste disposal.
Incineration
INCINERATION IS THE PROCESS OF BURNING HOSPITAL WASTE AT A MINIMUM TEMPERATURE OF 800-1000 degrees C ADVANTAGES : REDUCES WASTE/ORGANIC WASTE TO ASHES DISADVANTAGES: NOT ALL WASTE CAN BE INCINERATED INVESTMENT OPTION COST HIGH RUNNING EXPENSES ARE VERY HIGH COMBUSTION GASES- DIOXIN AND FURAN KNOWN CARCINOGENIC METHOD FOR MONITORING IS COMPLEX AND EXPENSIVE
Autoclaving
ADVANTAGES : LOW INVESTMENT COST/OPERATING COST ENVIRONMENT FRIENDLY DISADVANTAGES : WASTE REDUCTION MINIMAL WASTE MAY NEED TO BE SHREDDED AS IT IS RECOGNISABLE NOT FOR HUMAN WASTE
Microwave Irradiation
WASTE TREATMENT BY HEAT CONDUCTION RADIATION ADVANTAGES : WASTE SHREDDED, UNRECOGNIZABLE DISADVANTAGES : NOT FOR HUMAN TISSUE/CARCASS EXPENSIVE INVESTMENT/OPERATING COST HIGH TECH. APPARATUS HIGHLY TRAINED PERSONNEL FOR OPERATION/ MAINTENANCE NOT FOR CATEGORY 1& 2
Chemical Disinfection
AVAILABLE CHLORINE REQUIRED (1-5gm/l) HYPOCHLORITE SOLUTION-20ml-100ml/l) NADCC tablets(1-4 tablet/l) CHLORAMINE20gm/l MUTILATION / SHREDDING RECOMMENDED TO PREVENT REUSE. WASTE TYPE CATEGORY 4- SHARPS CATEGORY 7- PLASTICS
Collection
Proper training imparted to hospital staff. Specific staff can be trained to collect specific waste category. Waste bags should be 3/4th full. Different waste streams should be collected at different times (to avoid wastage) Closed container are aesthetic and prevents spillage.
Storage
Indian Laws 48 hour storage Storage within the hospital should be done in labelled, colour-coded bins and bags in secured, balanced, easily washable containers that do not have any sharp edges. The main storage site of the hospital should be accessible to vehicles so that the collection vans can reach it. The hospital should ensure that there are written instructions to handle spills
Waste Audit
A waste audit is the complete survey of a hospitals waste management practices. Aims Differentiate types of waste Quantify waste generated Determine point of generation and type of waste generated at each point. Determine level of generation and disinfection within the hospital. Find out type of disposal mechanism carried out.
Conclusions
Developing an action plan
Waste Auditing Training Collection Segregation
Storage
Transport to land fill/recycling