Bio-Medical Waste Management
Satish Sinha
History of medical waste
• Medical Waste Tracking Act in US
• I Draft Rules in India–1995
• Final Rules in 1998, 2 amendments and 5
guidelines
• Evolution of Rules and Practices through
National Experiences
• National Guidelines on BMW, Guidelines
on Incineration, CTFs, Immunization
Waste and Mercury
Various networks
NGOs
• Health Care Without Harm (HCWH)
Injection safety:
• SIGN (Safe Injection Global Network)
Anti-incineration:
• GAIA (Global Anti Incinerator Alliance)
Mercury
• Zero Mercury
World Health Assembly
• Patient safety
Stockholm Convention on
Persistent Organic Pollutants
• an international environmental treaty
• aims to eliminate or restrict the
production and use of persistent
organic pollutants (POPs).
• entered into force on 17 May 2004 with
ratification by 128 and 168 signatories.
Basel Convention
• Control of Tran boundary Movement of
Hazardous Wastes and Their Disposal
• Minimize hazardous waste generation
and dispose it nearest to the point of
generation
Environmental Regulations
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Environment Protection Act, 1986
BMW Rules 1998
Municipal Waste (Management and Handling) Rules, 2000
Atomic Energy Act
Hazardous Wastes (Management & Handling) Rules, 1989
E-Waste Rules
Batteries (M&H) Rules 2001
Manufacture, Storage and Import of Hazardous Chemicals
rules, 1989
Patient safety and Bio-medical waste
management
• In 2002 World Health assembly, passed a
resolution calling member states to work
for safety of Patients.
• In Oct. 2004, World alliance for Patient
safety was formed, who have identified
certain challenges in relation to safety of
patients. First Challenge is “Clean care is
Safer Care” (2005)
• A formal pledge committing to address
health care-associated infection in the
country was signed by Government of
India.
Priority areas for Patient safety
• Safe clinical practices and hand
hygiene
• Safe Surgical practices
• Blood Safety
• Safe Injections Practices
• Health Care Waste Management
Rules
and
guidelines
are
available
but
implementation is very poor. Lack of training or
poor training is also a factor. It has not been given
the due priority by most of the states and
dedicated budget is required. All states should
focus on this.
Health care associated infections
• Complicate between 5-10% of
admissions in acute care hospitals
in industrialized countries
• It is estimated that this risk is up
to 20 times higher in developing
world
• At any given time, 1.4 million people
worldwide suffer from HAI, and at least 50%
of HCAI are preventable.
Unsafe injections
• India contributes to 25%-30% of the global
injections (WHO, 1999)
• Annual injection usage ~ 3 – 6 billion, of this
nearly two-thirds (62.9%injections) unsafe India CLEN
Study 2002-04
Why Follow Universal Precautions
• The prevalence rate of blood born diseaseHepatitis B 38/1000, HIV 7/1000 (NACO
1993)
• Difficult to test each patient
• NSI and other sharp injuries are the key
Canadian health issue, affecting 70000 people
per year and costing around dollar 140 million.
• A safety programme at Toronto Hospital
achieved 80% reduction in injuries within an
year.
What is this concern for?
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Infectious waste (solid and liquid)
Sharps waste
Cytotoxic waste
Pharmaceutical waste
Radioactive waste
Chemicals and disinfectants
Pressurised containers
BMW Rules and Key Actors
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Notified in 1998
Concept of PPP model
Identified technologies and standards
CPCB
SPCB
Department of Health
Headline of presentation to come here (on slide master)
Know your waste
80
70
60
50
40
30
20
10
0
Infectios
Hazardous
General
Waste Treatment & Disposal System
Category
Waste category
Treatment
Category 1
Human anatomical waste
Inc/burial
Category 2
Animal waste
Inc/burial
Category 3
Microbiology & biotechnology Inc/alternate
waste
Category 4
Waste sharps
Category 5
Discarded medicines,
cytotoxic drugs
Category 6 & 7
Solid waste
Category 8
Liquid waste
Autoclaving, microwaving &
mutilation for category 7
Disinfection
Category 9
Incineration ash
Landfill
Category 10
Chemical waste
Drain/secured landfill after
treatment
Disinfection &
autoclaving/microwaving/shre
dding & mutilation
Inc/landfill
Schedule II
Colour
coding
Type of Container I
Waste Category
Human, animal,
microbiology, soiled
waste
Treatment options
as per Schedule I
Yellow
Plastic bag
Incineration/deep
burial
Red
Disinfected
Microbiology, solid & Autoclaving/Microwa
container/ plastic bag soiled waste
ving/Chemical
Treatment
Blue/White
translucent
Plastic bag/puncture
proof
container/Sharps
Blaster
Waste sharps & solid
waste
Autoclaving/Microwa
ving/Chemical
Treatment &
destruction/shreddin
g
Black
Plastic bag
Discarded medicine,
cytotoxic drugs,
incineration ash &
Chemical waste
Disposal in secured
landfill
Bio-medical waste and technology
• Technology is only a fraction of the solution.
• Major components of waste management are:
o Segregation of waste
o Waste minimisation
o Reducing use of hazardous substances or processes
o Waste Audit
Approved treatment methods
• Autoclave
• Chemical disinfection
• Hydroclave
• Microwave
• Incineration
• Any other technology after CPCB approval
In house management of waste
• 1.Survey
2.Meeting with the heads of all the departments
3.Forming a waste management committee
4.Rounds of wards to see the functioning
5.Creating a model ward
6.Suggest equipment procurement
7.Formal training for all the nursing staff
8.Implementing the system throughout the hospital
Right Technology
Medical waste management is 80% segregation and
20% technology
• Incineration: Pathological Waste and Body Parts ,
no chlorinated plastics
• Autoclaving: All except body parts and
pathological waste
• Microwaving: All except pathological waste and
metals
• Chemical: Mainly plastics
Of site management of wasteCentralized Facilities
Draft Guidelines on Common facilities•Treatment facilities- 90% non-burn, 10% waste- burn
•Limits incineration to Categories 1&2
•Atleast 1 Km from residential areas. Acceptable in
industrial area
•One operator allowed to cater upto 10,000 beds, situated
within 150 km radius
•Segregation is the role of generator; operator can report
mixing of waste to the prescribed authority
Medical waste in India: 2006-2009
2006
HCF
Waste
Incinerator
2008
2009
Total Number of Healthcare facilities
73975
129511
Number of HCFs linked to CTFs / own facility
34001
116080
Number of facilities where waste is not being
treated
39974
13431
Percentage of total facilities with no type of
treatment mechanism
54%
10%
Bio-medical waste generated /day
319453 kgs
413500#
414956#
Bio-medical waste treated /day
143952 kgs
295270
291983
Bio-medical waste not treated /day-
175501 kgs
113719
Percentage of Bio-medical waste untreated
/day
55%
28%
Total incinerators in the country
436
547
Incinerators with APCDs
207
250
Incinerators without APCDs
229
297
Total Number of Violations
24,412
13037
HCF issued Show cause notices
14898
Hurdles in Implementation
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Issues of Capacity
Low priority
Resource Allocation
Fixed Mindset
Injection safety, chemical safety and waste
management issues yet to find space in
development planning
At the SPCB level
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Capacity and resource
Monitoring and control
Transparency of processes
Hierarchy of control
Independent audits
Awareness of community
Increasing outreach of centralized facility to rural
areas
At the Hospital level
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Mindset issues
Involvement of senior management
Resource availability and prioritising
Government Hospitals biggest defaulters
Capacity Building
Implementation bottlenecks
Responsibility fixing
Monitoring and Accreditation
Periodic Waste audits wrt economics
At the CTF level
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Untrained Staff
Poor maintenance of equipment
Effluent Treatment Plants
Maintenance of records
No power back ups
Closed door, non transparent
Differential charges
Flawed systems
Profit driver
Need for accreditation
Way Forward
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Resource allocation for waste management
Maintaining a pool of trainers at block/ district levels
Stakeholders involvement
Incorporation into curricula of medical, nursing and
paramedical colleges
Up gradation to latest developments in BMW
management
Waste minimizations policy
Appropriate technology selection
Pro-environment procurement policy
Emerging Issues
Mercury
 First mercury documentation in healthcare in
2004: 3 kg/ hospital/year
 Public notices by DPCC
 Mercury phase-out committee formed by DHS
 Delhi hospitals to phase out mercury
 No new mercury equipment procurement in
Delhi government hospitals
 HCEs aiming for ISO/ NABH to phase out
mercury
Emerging Issues
Injection Safety
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Increased attention by hospitals
Fines on unattended needles
No to recapping
Reporting of needle stick injury and follow up
Chemical Safety
 Monitored
use
of
Glutaraldehyde,
formaldehyde, benzene, cytotoxic drugs etc.
Thank You
Toxics Link
H-2, Jungpura Ext.
New Delhi 110014
011-24328006, 24320711
info@toxicslink.org
www.toxicslink.org