Bio-medical Waste Management (BMW)

Implementation of BIO-MEDICAL WASTE (Management & Handling) Rules, 1998

BMW Rules have been adopted and notified with the objective to stop the indiscriminate disposal of hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment. Health care waste includes Waste generated by the health care facilities Research facilities Laboratories

Biomedical waste in hospitals 85% are non-infectious 10% are infectious 5% are hazardous

Basic Principles
Segregation and safe containment of waste at the health facility level Processing and storage for terminal disposal Bio-medical waste shall not be mixed with other wastes. Segregation at source both at ward and unit level Color coding to support segregation at source

Bio-medical waste shall be segregated into containers/ bags at the point of generation in accordance with Schedule II (BMW Rules 1998) prior to its storage, transportation, treatment and disposal. The containers shall be labeled according to Schedule III (BMW Rules 1998) Transport waste safely to pick up site Identify destination for each type of waste and ensure safe disposal Keep track of usage

Transportation & Storage of BMW

Untreated biomedical waste shall be transported only in vehicles authorized for the purpose by the competent authority as specified by the government. Untreated bio-medical waste shall not be kept/stored beyond a period of 48 hours. If for any reason it becomes necessary to store the waste beyond such period, measures must be taken to ensure that the waste does not adversely affect human health and the environment.

Biomedical Waste Management Issues Lack of interest from senior management No ownership of the process Awareness of problems Appreciate the need for constant monitoring Segregation of waste not taken seriously at user level Monitoring segregation at source low budgets allocated costs are not always known

Quantification of waste generated is not accurately done Protection of healthcare workers not given adequate thought Clinical waste dumped with non infectious waste - Risk for healthcare workers and public Waste disposal not effective, often dumped in open landfills

Biomedical Waste Management responsibilities Responsibility for waste disposal head of facility, but devolved to members of the waste management team Each healthcare worker segregation and appropriate disposal Private companies from collection point in hospital to disposal Medical waste segregation awareness and Information should be available in all areas of hospital

Challenges To provide protection for o o o Healthcare workers Patients Community at large - from the risk of infections

Establishing robust waste management policies within the organization Organization wide awareness about the health hazards Sufficient financial and human resources Monitoring and control of waste disposal Clear responsibility for appropriate handling and disposal of waste.

ADRESSING THE ISSUES 1. Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal 2. This is a long-term process, sustained by gradual improvements. 3. Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital. 4. Man power needs and other resources for the BMWM of hospital to be addressed. 5. Quality assessment of bio-medical waste management should be done from time to time. 6. Segregated collection and transportation - The use of color coding and labeling of hazardous waste. 7. Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages. 8. Safety of handlers. 9. Raising Awareness about risks related to health-care waste; training staff and HCW on safe practices. 10. Selection of safe and environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.

Table1. Schedule I of the Bio- Medical Waste Rules (category, treatment and disposal, waste category)
Option Cat. No. 1 Treatment & Disposal Waste Waste Category Category Incineration /deep burial Human Anatomical Waste (human tissues, organs, body parts) Anatomical Waste tissues, organs, body parts) (human Animal Waste Animal tissues, organs, Body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals/ colleges, discharge from hospitals, animal houses) Local autoclaving/ micro waving/ Microbiology & Biotechnology waste (wastes incineration from laboratory cultures, stocks or specimens of micro-organisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biological, toxins, dishes and devices used for transfer of cultures) Disinfections (chemical treatment Waste Sharps (needles, syringes, scalpels /autoclaving/micro waving and blades, glass etc. that may cause puncture and mutilation cuts. This includes both used & unused sharps) Shredding Incineration / destruction & drugs Discarded Medicines and Cytotoxic drugs disposal in secured landfills (wastes comprising of outdated, contaminated and discarded medicines) Incineration, autoclaving/micro Solid Waste (Items contaminated with blood waving and body fluids including cotton, dressings, soiled plaster casts, line beddings, other material contaminated with blood) Disinfections by chemical Solid Waste (waste generated from disposable treatment autoclaving/micro items other than the waste sharps such as waving& mutilation tubing, catheters, intravenous sets etc.) shredding. Disinfections by chemical Liquid Waste (waste generated from laboratory treatment and & washing, cleaning , house-keeping and discharge into drain disinfecting activities) Disposal in municipal landfill Incineration Ash (ash from incineration of any bio-medical waste) Chemical treatment & discharge Chemical Waste (chemicals used in production into drain for liquid & secured of biological, chemicals, used in disinfect ion, landfill for solids as insecticides, etc)

Cat. No. 2

Cat. No. 3

Cat. No. 4

Cat. No. 5

Cat. No. 6

Cat. No. 7

Cat. No. 8

Cat. No. 9 Cat. No. 10

Table2. Schedule II of the Bio-Medical Waste Rules

Colour Coding

Type of Containers

Waste Category

Treatment Options as per Schedule 1 Incineration/deep burial Autoclaving/Micro waving/ Chemical Treatment

Yellow Red

Plastic bag Disinfected Container/ Plastic bag

1,2,3,6 3,6, 7

Blue/ White translucent

Plastic bag/ puncture proof container

4,7

Autoclaving/Micro waving/chemical treatment and destruction/shredding

Black

Plastic bag

5,9,10 (Solid)

Disposal in secured landfill