1. BIOMEDICAL WASTE MANAGEMENT Dr. Sukhwant Singh

2. BIO-MEDICAL WASTE ( MANAGEMENT & HANDLING ) RULE, 1998.* Came in to force on 28th July, 1998.* Prescribed by Ministry of Environment & Forests, under the Environment Protection Act of India.* Proper management of biomedical waste is a statutory requirement.* This rule applies to those who generate, collect, receive, store, dispose, treat or handle bio-medical waste in any manner.

3. Bio – Medical Waste could be defined as “any solid, fluid or liquid waste, including its container and any intermediate product, which is generated during the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals and the animal waste from slaughter houses or any other like establishments”.

4. Why it is essential to have safe & reliable treatment of “Bio-Medical Waste”-Bio-Medical Waste may have serious public health consequences and a significant impact on the environment.

5. 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 mucus membrane by inhalation or ingestion.

6. Chemical and Pharmaceutical waste* They may be toxic, genotoxic, corrosive, flammable, reactive or explosive.Radioactive waste* The possible effects can range from headache, dizziness, vomiting to affecting genetic material.Public Sensitivity* The general public is very sensitive to visual impact of health care waste, esp. anatomical waste.

7. As per WHO, the biomedical wastes could be classified into eight categories on the basis of the type of waste and the risk of transmission of infectious material in them. 1. General waste (domestic)2. Pathological3. Radioactive4. Chemical 5. Infectious6. Pharmaceutical wastes7. Sharps and 8. Pressurised containers.

8. CLASSIFICATION OF WASTE CATEGORY

10. COLOR CODING FOR SEGGREGATION OF BMW

11. Quantity of Biomedical WasteGenerated in HealthCare Settings –Developed Countries- 1-5 kg/bed/day, with variations among countries.In India- 1-2 kg/bed/day with variation among Govt. and Private establishments. * 80 percent waste generated in a hospital is non hazardous and can be dealt with normal domestic waste management system.* 15 percent pathological & infectious waste. * 3 percent chemical & pharmaceutical waste. * 1 percent sharps. * 1 percent radioactive, cytotoxic and heavy metals.

12. Principles of Control of Hazards of Biomedical Wastein Health Care Establishments* Each institution should develop its own bio wastemanagement policy and ensure that the health care workersare adequately trained to handle biological waste. * Measures such as universal safety precautions, handwashing and proper segregation of waste material shouldbe encouraged. * Rationale patient management policy should be followed and admissions restricted to those for whom it is felt absolutely necessary. * Proper house-keeping is essential and the hospital premises should be kept clean and well-ventilated. * Use of disinfectants should be rationalised.

13. Steps in the Management of Biomedical Waste1. Survey of waste generated.2. Segregation of hospital waste.3. Collection & Categorization of waste.4. Storage of waste.( Not beyond 48 hrs. )5. Transportation of waste.6. Treatment of waste.

14. Technologies for waste treatmentChemical disinfection Technology It uses chemicalsto destroy pathogenic organisms from any inanimate object. ● Sharps contaminated with blood and body fluids. ● Instruments, equipment that are used to cut, pierce or enterthe natural orifices like needles, syringes and endoscopes ● Contaminated floors, surfaces, clothes, beds, beddings,enamel, crockery and bed pans ● Wet mopping of intensive care units, operation theatres,wards and patient waiting areas.

16. Thermal technology *It uses heat to decontaminateinstruments and equipment and the temperatures in this processmay rise to extremely high levels. *Most of the microbes aredestroyed at temperatures below 100°C.1. Autoclave 2. Hydroclave3. Incinerator4. Microwave

17. AUTOCLAVEGravity displacement type – -where air is pushed out of the autoclave by steam under pressure. -This system operates at temperatures of 121°C and has a cycle time of approximately 60 - 90 minutes. Pre vacuum type –Here vacuum pumps are utilized to evacuate the air in the chamber of autoclave and steam under pressure is pushed in, which is able to penetrate the waste material more thoroughly. This technology thus reduces the cycle time to 30 - 60 minutes and the temperatures attained are 132°C.

18. Hydroclave- This is a steam sterilization technology in which the steam is used as an indirect heating source thus allowing total dehydration of waste material. - The holding time for waste is 15 minutes at 132°C or 30 minutes at 121°C. - The organic components of the waste are hydrolyzed and the waste matter is reduced by weight and volume.

19. Incinerator - Incineration is a high heat system process of burning combustible solids at very high temperature in a furnace.- It employs combustion of waste material in stages, followed by cleaning of the flue gas through a number of pollution control devices. - The end product is devoid of infectious organisms and organic compounds of waste, which is aesthetically acceptable. - Based on the type of fuel consumed the division could be- ● Conventional incinerator using wood/charcoal ● Electrical incinerator ● Oil fired incinerator using electricity and diesel oil

20. Microwave -This low heat system uses microwaves to heat up the waste material from inside, unlike the external heat given in autoclave and hydro clave. -Microwaves are electromagnetic waves that lie between the 300 to 300,000 mega hertz range in the electromagnetic radiation spectrum. -They are able to penetrate materials and create vibrations in all the dipole molecules such as water in the waste materials. -This vibration generates friction, which in turn produces heat to disinfect the waste material. -The heat produced at 95 - 100°C for a holding period of 25 minutes

21. MECHANICAL TECHNOLOGY1. Compaction: Compacting is carried out by a hydraulic ram against a hard surface.2. Grinding / Shredding:Waste material is broken down into smaller particles under negative pressure to avoid any spillage outside the chamber.3. Pulverization: Waste is mixed with large volume of water and bleach solution. The waste is torn to shreds and then fed to an ultra high speed hammer mill with large spin blades which pulverize the matter into small, safe particles.

22. Irradiation technology *This involves exposing thewaste matter to ultraviolet or ionizing radiation in an enclosedchamber. *Decontamination occurs when nucleic acids in theliving cells are irradiated.* The advantage with this technology is that energy input isminimal and it is used to treat items, which cannot be heated.* Source of radiation needs to be properly disposed off after its decay.