2. “There is no such thing as away when we
throw any thing ‘away’ it must go
somewhere”
3. Introduction
Health-care activities protect and restore health and save lives. But what about the waste
and by-products they generate?
Hospital waste is a potential reservoir of pathogenic microorganisms and
requires appropriate, safe and reliable handling.
BMW has been emerged as issue of concern and day to day challenge
faced by healthcare providers world over.
BMW is a real problem for Man, community and environment.
BMW Management is a need of an hour to help providers to become
better providers.
4. Wastes
“Something which is not put into proper usage at a given time”
WASTES
Municipal waste
Biomedical
waste
Infectious waste
Non-Infectious
Hazardous waste
5. Historical aspect
In the late 1980’s – Items such as used syringes washed up on several East
Coast beaches of USA and Concerned about HIV and HBV virus infection
which Leads to development of Biomedical Waste Management Law in USA.
However, in India the seriousness about the management came into lime
light only after 1990’s.
6. Definition
Biomedical 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.
-According to Biomedical waste (Management and handling) rules,1998 of India
7. Classification
Infectious waste: waste contaminated with blood and other bodily fluids
(e.g. from discarded diagnostic samples), cultures and stocks of infectious
agents from laboratory work (e.g. waste from autopsies and infected animals
from laboratories), or waste from patients with infections (e.g. swabs,
bandages and disposable medical devices).
Pathological waste: Human tissues, organs or fluids, body parts and
contaminated animal carcasses.
Sharps waste: Needles, disposable scalpels and blades, etc.
8. Classification
Chemical waste: Solvents and reagents used for laboratory
preparations, disinfectants, sterilant and heavy metals contained in
medical devices (e.g. mercury in broken thermometers) and batteries.
Pharmaceutical waste: Expired, unused and contaminated drugs and
vaccines.
Genotoxic/Cytotoxic waste: waste containing substances with
genotoxic properties (i.e. highly hazardous substances that are,
mutagenic, teratogenic or carcinogenic), such as cytotoxic drugs used in
cancer treatment and their metabolites.
9. Classification
Radioactive waste: such as products contaminated by radionuclides including
radioactive diagnostic material or radiotherapeutic materials.
Non-hazardous or general waste: waste that does not pose any biological,
chemical, radioactive or physical hazard.
Pressurized waste: Gas cylinders, gas cartridges, aerosol cans.
10. Need of Biomedical waste
Management
Within the domain of municipal solid waste, biomedical waste acquires a
special dimension, since it is infectious and hazardous and capable of
spreading disease or be harmful to individuals.
In the absence of proper segregation, packaging, segregation, treatment and
disposal of bio medical waste, the non-infectious waste becomes infectious and
poses environmental threat to the society.
11. Every year an estimated 16 billion
injections are administered worldwide,
but not all of the needles and syringes
are properly disposed of afterwards.
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.
Approximately 506.74 tons/ day wastes
generated.
Out of which only 57% waste
undergoes proper disposal Biomedical
waste Statistics.
12. Legislation
Recognizing the deadliest nature of the Bio-Medical Waste, the Government and
Pollution Control Boards under the guidelines of Ministry of Environment and
Forests (MOEF).
Promptly designed and issued guidelines to the hospitals to ensure a proper
and safe disposal of bio-medical waste
“BIO-MEDICAL WASTE Management & Handling RULE 1998 came into effect.
Provides uniform guidelines and code of practice for Bio-medical waste
management.
13. Principles of Biomedical
Management
Biomedical wastes ,1998 The Government of India as contemplated under
Section 6,8 and 25 of the Environment (Protection) Act,1986, has made the
Biomedical Wastes (Management & Handling) Rules, 1998. The rules are
applicable to every institution generating biomedical waste.
14. Principles of Biomedical
Management
Biomedical Wastes (Management & Handling) Rules, 1998. revised in
2011, Now known as BMW Rules, 2011.It includes-
Develop a waste management plan that is based on an assessment of the current
situation and which minimizes the amount of waste generated.
Segregate clinical (infectious) waste from non-clinical waste in dedicated
containers.
Transport waste in dedicated trolleys.
Store waste in specified areas with restricted access.
15. Principles of Biomedical
Management
Collect and store sharps in sharps containers. Sharps containers should be
made of plastic or metal and have a lid that can be closed. Mark the storage
areas with a biohazard symbol.
Ensure that the carts or trolleys used for the transport of segregated waste
collection are not used for any other purpose – they should be cleaned
regularly.
Identify a storage area for waste prior to treatment or being taken to final
disposal area.
16. Principles of Biomedical
Management
The Central Government vide notification on 19th March 2019, has published
in the e-gazette, the Bio-Medical Waste Management (Amendment) Rules,
2019.
The key highlights of the amended Rules (2019) are as follows:
The occupier of all bedded health care units shall maintain and update on a day to
day basis the bio-medical waste management register.
All bedded healthcare units shall display the monthly record of waste disposal
management on its website.
Such health care facilities (irrespective of any number of beds), shall make the Annual
Report available on its website before 19 Mach 2021.
17. Principles of Biomedical
Management
Health Care Facilities having less than ten beds shall have to comply with the output discharge
standard for liquid waste by 31st December 2019.
PENALTIES AS PER RULES
The PENALTIES are as specified in Environment (Protection) Act 1986.
Imprisonment for up to five years with fine up to one lakh rupees, or both.
In case the failure additional fine up to five thousand rupees for every day.
19. Health Hazards of Biomedical
waste
Health-care waste contains potentially harmful microorganisms that can infect
hospital patients, health workers and the general public.
21. Treatment and disposal technologies for biomedical
waste
Incineration
Incineration
Inertization
Land
Disposal
Wet and dry
thermal
Treatment
Chemical
Disinfection
23. Color coding of Biomedical
wastes
Colour coding Types of Containers Waste Category Treatment Options Based
on the Category
YELLOW Plastic bag 1, 2, 3 and 6 Incineration/Deep Burial
RED
Disinfected container/plastic bag 3,6 and 7 Autoclaving/Microwaving
Chemical treatment
BLUE/WHITE
TRANSLUCENT
Plastic bag/puncture proof container 4 and 7 Autoclaving/Microwaving
Chemical treatment and
destruction/Shredding
BLACK
Plastic bag 5, 9 and 10 (solid) Disposal in secured
landfills
24. Steps in the management of
hospital waste
GENERATION
SEGREGATION
COLLECTION AND STORAGE
TRANSPORTATION
TREATMENT AND DISPOSAL
31. CDC Guidelines, 2016
Categories of Regulated Medical Waste.
Disposal Plan for Regulated Medical Wastes.
Handling, Transporting, and Storing Regulated Medical Wastes.
Treatment and Disposal of Regulated Medical Wastes.
33. Reason for failure of
Biomedical waste Management
Lack of awareness about the health hazards related to health-care waste.
Inadequate training in proper waste management, absence of waste
management and disposal systems.
Insufficient financial and human resources and the low priority given to
the topic are the most common problems connected with health-care
waste.
Many countries either do not have appropriate regulations, or do not
enforce them.
34. Ways to Improve Biomedical
waste Management
Generate waste when it is essential.
Segregate waste as soon as it is generated and segregate at the point of
generation into specific categories of waste.
Clean the bins regularly with soap and water or disinfectant.
Collect the domestic waste/eatables, wrappers, fruit peels, papers etc., in
green bin.
Carry/transport the waste in closed containers.
Transport waste through a pre-defined route within the hospital.
35. Ways to Improve Biomedical
waste Management
Mutilate needle and plastic waste soon after generation.
Dispose body parts in yellow bin. If Common Bio-Medical Waste Treatment
Facility is available, hand over to them within 48 hours, otherwise dispose by
incineration or deep burial where population is less than five lakhs people.
Waste sharps should be kept in white translucent bin.
37. A nurse plays a significant role in bio-
medical waste management.
A nurse has to determine and implement
the desired standards in coordination
with waste management programme of
the healthcare facilities.
The head nurse should keep an inventory
of materials required such as bags, bins,
containers, mutilating aids, protective
aids etc. and check for the adequate
supply.
38. She should see that the reusable items
must be disinfected, cleaned, repacked
and sent for sterilisation.
Infected material should be discarded and
incinerated wherever possible.
Floor wise, one nursing supervisor is
responsible for supervision of
segregation.
Matron or senior nursing officer is
responsible for training new nurses in
good bio-medical waste handling.
39. The nursing staff must be trained in safe
handling of waste and its procedures.
Biomedical waste generated by the
Nurses should be disposed of according
to the hospital policies.
Nursing staff should ensure that waste
bags are tightly closed or sealed when
they are about 3/4 full.