Biomedical waste is very important to every person involved in the medical field and for normal lay person too. Without it's knowledge any treatment is incomplete.
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Biomedical waste edited
1. Biomedical Waste Management
Moderator
Dr A.K.Srivastava
Professor
Department of General Surgery
MIMS,Barabanki
Dr Pooja Pandey
PG JR-1
Department of General Surgery
MIMS,Barabanki
2. Let the wastes of "the sick" not
contaminate the lives of "the healthy"
3. On an average, the hospital waste
generation rate ranges from 0.5 to 2.0
kg/bed/day which amounts to about 0.33
million tons annually.
Introduction
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4. Definition
According to Bio-Medical Waste (Management and
Handling) Rules, 1998 of India, "Bio-medical waste" means
any waste, which is generated during the diagnosis,
treatment or immunization of human-beings or animals, or
in research activities pertaining thereto or in the production or
testing of biological.
7. Health-care waste generation
80 per cent general health-care waste, which may be dealt with by
the normal domestic, and urban waste management system
- 15 per cent pathological and infectious waste;
- 1 per cent sharps waste;
- 3 per cent chemical and pharmacological waste;
- Less than 1 per cent special waste, such as radioactive or
cytotoxic waste, pressurized containers, or broken thermometers
and used batteries.
8. Sources of health-care waste
The institutions involved in generation of bio-medical waste are:
Government hospitals
Private hospitals.
Nursing homes.
Physician's office/clinics.
Dentist's office/clinics.
Dispensaries.
Primary health centres.
Medical research and training establishments.
Mortuaries.
Blood banks and collection centres.
Animal houses.
Slaughter houses.
Laboratories.
Research organizations.
Vaccinating centres, and
Bio-technology institutions/production units.
All these health-care establishments generate waste and are therefore, covered under Bio-Medical
Waste (BMW) Rules
9. Health hazards of health-care waste
Exposure to hazardous health-care waste can result
in disease or injury due to one or more of the following
characteristics :
(a)it contains infectious agents;
(b) it contains toxic or hazardous chemicals or pharmaceuticals;
(c) it contains sharps;
(d) it is genotoxic; and
(e) it is radio-active.
10. The main advantages and disadvantages of various
treatment and disposal options
11. The main advantages and disadvantages of various
treatment and disposal options contd….
Treatment advantages disadvantages
12. The United Nations Conference on the Environment and
Development (UNCED) in 1992 recommended the following
measures:
(a) Prevent and minimize waste production
(b) Reuse or recycle the waste to the extent possible
(c) Treat waste by safe and environmentally sound
methods, and
(d) Dispose off the final residue by landfill in confined and
carefully designed sites.
13. Bio-Medical Waste Management in India
Bio-Medical Waste (Management and Handling) Rule 1998,
prescribed by the Ministry of Environment and Forests, Government
of India, came into force on 28th July 1998.
This rule applies to those who generate, collect, receive, store,
dispose, treat or handle bio-medical waste in any manner.
The bio-medical waste should be segregated into containers/bags at
the point of generation of the waste.
20. STEP 1 •Segregation and pretreatment of waste at the site of
generation.
Step 2 •Collection of segregated waste from all areas of hospital .
Step 3 •Transportation of waste from various areas of the hospital to
storage site.
Step 4 •Weighing of bags at storage site .
Step 5 •Transportation for final disposal
21.
22. As per BMW (amendment) rules, 2018, 1% to 2% sodium
hypochlorite should be used.
There is no need of chemical pre-treatment before
incineration, except for microbiological, lab and highly infectious
waste.
Syringes should be either mutilated or needles should be cut
and or stored in tamper proof, leak proof and puncture proof
containers for sharps storage.
Mrs. Sakshi Chaturvedi Assistant professor Banasthali
vidyapith, Jaipur,Rajasthan
23. The frequency of waste collection is:
Emergencies- 3 times/day.
OPDs and Laboratories- 2 times/day.
Wards- Once or twice per day depending on waste generated.
Administrative area, Offices and Support services- Once a day.
24. At the collection/ storage site, bags are weighed before transportation
for final disposal. Waste collected per day from all over the hospital is
approximately:
Yellow waste: 300-400 Kg
Red waste: 80-110 Kg
White waste: 7-8 Kg
Blue waste: 2-3 Kg
General waste: 1500-2000 Kg (3-4 municipal bins)
34. Conclusion
By means of BMW Management Rules, 2016, the Government of India has tried to
simplify the BMW management in our nation.
Final disposal of BMW requiring high-maintenance infrastructure was a vexation for
health-care facilities, which has been done away with by the provision of CBMWTF.
With simpler color-coded categories, updating the knowledge on the same, and on-
ground implementation of BMW, segregation at source by the health-care workers still
remains the biggest challenge.
Widespread publicity, continuous training programs, and audits must be encouraged to
increase the awareness regarding the threats posed by the mismanagement of BMW and
to bring uniformity in practices through all echelons of health-care facilities.
36. Treatment and disposal technologies for
healthcare
waste (2)
Incineration, used to be the method of choice for most
hazardous health-care wastes, and is still widely used.
However, recently developed alternative treatment methods
are becoming increasingly popular. The final choice of
treatment should be made on the basis of factors, many of
which depend on local conditions.
I. Incineration
Incineration is a high temperature dry oxidation process,
that reduces organic and combustible waste to inorganic
incombustible matter and results in a very significant
reduction of waste-volume and weight. The process is
usually selected to treat wastes that cannot be recycled,
reused or disposed off in a land fill site.
The flow diagram of incinerator is as shown in Fig. 1.
37.
38. Incineration requires no pre-treatment, provided that certain waste . types are not included in the matter to be
incinerated. Characteristics of the waste suitable for incineration are :
(a) low heating volume - above
2,000 kcal/kg for single-chamber incinerators, and above
3,500 kcal/kg for pryolytic double-chamber incinerators;
(b) content of combustible matter above 60 per cent;
(c) content of non-combustible solids below 5 per cent;
(d) content of non-combustible fines below 20 per cent; and
(e) moisture content below 30 per cent (2).
Waste types not to be incinerated are : (a) pressurized gas containers; (b) large amount of reactive chemical wastes; (c) silver salts and photographic or radiographic
wastes; (d) Halogenated plastics such as PVC; (e) waste with high mercury or cadmium content, such as broken thermometers,
used batteries, and lead-lined wooden panels; and (f) sealed ampules or ampules containing heavy metals (2).
TYPES OF INCINERATORS
Incinerators can range from very basic combustion unit that operates at much lower temperature to extremely sophisticated, high temperature operating plants. It
should be carefully chosen on the basis of the available resources, the local situation, and the risk-benefit consideration.
Three basic kinds of incineration technology are of interest for treating health-care waste :
(a) Double-chamber pyrolytic incinerators which may be especially designed to burn infectious health-care waste;
(b) Single-chamber furnaces with static grate, which should be used only if pyrolytic incinerators are not affordable; and
(c) Rotary kilns operating at high temperatures, capable of causing decomposition of genotoxic substances and heat-resistant chemicals.
39. II. Chemical disinfection
Chemicals are added to waste to kill or inactivate the pathogens it contains, this treatment usually results in
disinfection rather than sterilization. Chemical disinfection is most suitable for treating liquid waste such as blood,
urine, stools or hospital sewage. However, solid wastes including
microbiological cultures, sharps etc. may also be disinfected chemically with certain limitations.
III. Wet and dry thermal treatment
WET THERMAL TREATMENT : Wet thermal treatment or steam disinfection is based on exposure of shredded
infectious waste to high temperature, high pressure steam,
and is similar to the autoclave sterilization process. The process is inappropriate for the treatment of anatomical waste
and animal carcassess, and will not efficiently treat chemical and pharmaceutical waste.
SCREW-FEED TECHNOLOGY : Screw-feed technology is the basis of a non-burn, dry thermal disinfection process
in which waste is shredded and heated in a rotating auger.
The waste is reduced by 80 per cent in volume and by 20-35 per cent in weight. This process is suitable for treating
infectious waste and sharps, but it should not be used to
process pathological, cytotoxic or radio-active waste.
IV. Microwave irradiation
Most microorganisms are destroyed by the action of microwave of a frequency of about 2450 MHz and a wave length
of 12.24 nm. The water contained within the waste is rapidly heated by the microwaves and the infectious .
components are destroyed by heat conduction. The efficiency of the microwave disinfection should be checked
routinely through bacteriological and virological tests.
40. V. Land disposal
MUNICIPAL DISPOSAL SITES : If a municipality or
medical authority genuinely lacks the means to treat waste
before disposal, the use of a landfill has to be regarded as an
acceptable disposal route. There are two types of disposal
land-open dumps and sanitary landfills. Health-care waste
should not be deposited on or around open dumps. The risk
of either people or animals coming into contact with
infectious pathogens is obvious.
Sanitary landfills are designed to have at least four
advantages over open dumps : geological isolation of waste
from the environment, appropriate engineering preparation
before the site is ready to accept waste, staff present on site
to control operations, and organized deposit and daily
coverage of waste.
41. VI. Inertization
The process of "inertization" involves mixing waste with
cement and other substances before disposal, in order to
minimize the risk of toxic substances contained in the wastes
migrating into the surface water or ground water. A typical
proportion of the mixture is: 65 per cent pharmaceutical waste,
15 per cent lime, 15 per cent cement and 5 per cent water. A
homogeneous mass is formed and cubes or pellets are
produced on site and then transported to suitable storage sites.
The main advantages and disadvantages of various
treatment and disposal options are listed in Table 3.
National legislation is the basis for improving health-care
waste disposal practices in any country. It establishes legalcontrol, and permits the
national agency responsible for the
disposal of health-care waste, usually the Ministry of Health,
to apply pressure for their implementation. The Ministry of
Environment may also be involved. There should be a clear
designation of responsibilities before the law is enacted.
Notas del editor
The waste produced in the course of health-care
activities carries a higher potential for infection and injury
than any other type of waste. Therefore, it is essential to
have safe and reliable method for its handling. Inadequate
and inappropriate handling of health-care waste may have
serious public health consequences and a significant impact
on the environment.
Of the total BMW, about 75% and 90% of the waste is nonhazardous or general healthcare waste.
The remaining 10% - 25% of BMW is regarded as hazardous, and if not managed properly, it can spread highly contagious diseases of which
the most dangerous ones are hepatitis B, HIV-AIDS, and hepatitis C, thus a grave health hazard for current and future
generations.
It is also a threat to the environment, causing air,
water, and soil pollution
All individuals exposed to such hazardous health-care
waste are potentially at risk, including those who generate
the waste or those who either handle such waste or are
exposed to it as a consequence of careless management. The
main groups at risk are :
- medical doctors, nurses, health-care auxilliaries, and
hospital maintenance personnel;
patients in health:..care establishments;
visitors to health-care establishments;
workers in support service allied to health-care
establishments such as laundries, waste handling and
transportation; and workers in waste disposal facilities such as land-fills or
incinerators including scavengers.
1. 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
mucous membranes by inhalation or by ingestion. There is
particular concern about infection with HIV and hepatitis
virus B and C, for which there is a strong evidence of
transmission via health-care waste. Bacterias resistant to
antibiotics and chemical disinfectants, may also contribute
to the hazards created by poorly managed waste.
2. Hazards from chemical and pharmaceutical waste
Many of the chemicals and pharmaceuticals used in
health-care establishments are toxic, genotoxic, corrosive,
flammable, reactive, explosive or shock-sensitive. Although
present in small quantity they may cause intoxication, either
by acute or chronic exposure, and injuries, including burns.
Disinfectants are particularly important members of this
group. They are used in large quantities and are often
corrosive, reactive chemicals may form highly toxic
secondary compounds.
3. Hazards from genotoxic waste
The severity of the hazards for health-care worker
responsible for handling or disposal of genotoxic waste is
governed by a combination of the substance toxicity itself
and the extent and duration of exposure. Exposure may also
occur during the preparation of or treatment with particular
drug or chemical. The main pathway of exposure is
inhalation of dust or aerosols, absorption through the skin,
ingestion of food accidentally contaminated with cytotoxic
drugs, chemicals or wastes etc.
4. Hazards from radio-active waste
The type of disease caused by radio-active waste is
determined by the type and extent of exposure. It can range
from headache, dizziness and vomiting to much more
serious problems. Because it is genotoxic, it may also affect
genetic material.
5. Public sensitivity
Apart from health hazards, the general public is very
sensitive to visual impact of health-care waste particularly
anatomical waste.
Schedule 1
@ @ Chemical treatment using at least 1 % hypochlorine solution or any other equipment chemical reagent. It must be ensured that
chemical treatment ensures disinfection.
## Mutilation I shredding must be such so as to prevent unauthorized reuse.
@ There will be no chemical pre-treatment 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.
Notes:
1. Colour coding of waste categories with multiple treatment options as defined in Schedule I, shall be selected depending on the
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 in containers/bags.
Waste collected from all over the hospital is transported to collection site in color coded waste trolleys.
Waste collected from all over the hospital is transported to collection site in color coded waste trolleys.
The workers transporting the waste use PPEs like boots, gloves, masks and aprons.
The collected waste is not stored for more than 48hrs. at collection site.
The workers transporting the waste use PPEs like boots, gloves, masks and aprons.
The collected waste is not stored for more than 48hrs. at collection site.
m e d i c a l journal armed forc e s i n d i a 7 5 ( 2 0 1 9 ) 2 4 0e2 4 5
Keeping in pace with the new Biomedical Waste
Management Rules: What we need to know!
Gurpreet Singh Bhalla a, Kuntal Bandyopadhyay b,*, Kavita Sahai c
a Graded Specialist (Microbiology), O I/C Biomedical Waste Management, Army Hospital (R&R), New Delhi, India
b Graded Specialist (Community Medicine) & Officer Commanding, SHO, Amritsar Cantt, India
c DDG (Pension), Office of DGAFMS, Ministry of Defence, New Delhi, India
https://doi.org/10.1016/j.mjafi.2018.12.003
WHO: World Health Organization, CBMWTF: common biomedical waste treatment facility, BMW: biomedical waste, ETP: effluent treatment
plant, BMWM: Biomedical Waste Management, HCW: Healthcare Workers, TT: Tetanus Toxoid, HBV: Hepatitis B Virus.
HCF: health-care facility, ETP: effluent treatment plant, CBMWTF: common BMW treatment facility, PVC: polyvinyl chloride, LAT: latex-agglutination test, ICMR: Indian Council of Medical Research,
ICT: immuno-chromatographic tests, BMD: broth microdilution, IABP: intra-aortic balloon pump, SPCB: State Pollution Control Board.
a Cytotoxic drugs: ICMR is formulating cytotoxic guidelines.
b The articles which require pretreatment of autoclaving/microwaving at HCF include culture media with growth of microorganisms, broth with live cultures, live and attenuated vaccines, positive
control of kits, pipette tips/articles used in processing of culture of organisms, and blood bags. The specimens received from patients need to be autoclaved or disinfected.
c Not all sharps can be mutilated (blades and thick needles, knife, suture needles, lumbar puncture needles, etc.), therefore, they go directly in white containers to prevent injury or health hazard to
the health-care workers. Needle cutters are preferred over needle destroyers.
d The articles such as robotic instruments, large combination articles with plastic and/or glass and or metal are gray areas as rules do not specify their disposal.