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Bio medical waste management 13-1
India accounts for 86% of oral cancer cases worldwide, which is the most common cancer among Indian men. Biomedical waste is any waste that is produced during diagnosis, treatment, or immunization of humans or animals in research activities. It is classified into 10 categories by the WHO based on type of waste such as infectious, sharps, pharmaceutical, etc. The key steps to manage biomedical waste are segregation, collection, storage, transportation and final treatment like incineration depending on the waste category. Proper waste management is important to prevent infections and protect public health.
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Bio medical waste management 13-1
- 1. Bio-Medical Waste Management AnjiAnura School of Medical Science and Technology IIT Kharagpur
- 2. My research Oral Cancer Indiaaccounts for 86% of the world's oral cancer cases Prevalence of oral cancer Ranked 1st among male (12% of all cancer Ranked 3rd among female (8% of all cancer) Cause The habit of betel quid chewing incorporating tobacco Human papiloma virus (HPV) Histopathology Diagnosis of cancer Oral lesions Tissue Biopsy
- 3. WASTES Wastes Solid waste Household waste Industrial waste Biomedical waste or hospitalwaste Liquid Waste Gaseous Waste WASTES “Something which is not put into proper usage at a given time”.
- 4. What is Bio-medicalwaste ?? Definition – Anything tested or used on an individual, or any trash from biological experiments are medical waste Generated from – Waste generated by health care facility – Research facility – Laboratories Hazardous health care waste – 85% waste is non infectious – 10% are infectious – 5% are hazardous
- 5. History • In thelate 1980’s – Items such as used syringes washed up on several East Coast beaches USA – HIV and HPV virus infection – Lead 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. WHO has estimatedthat • in 2000 • injections with contaminated syringes caused: • 21 million hepatitis B virus (HBV) infections (32% of all new infections); • Two million hepatitis C virus (HCV) infections (40% of all new infections); • 260 000 HIV infections (5% of all new)
- 7. Laws of BiomedicalWaste Management On 20th July 1998 • Ministry of Environment and Forests (MoEF), Govt. of India, Framed a rule known as ‘Bio-medical Waste (Management and Handling) Rules, 1998,’ • Provides uniform guidelines and code of practice for Bio-medical waste management. According to this rule Bio-Medical Waste “Any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining there to or in the production of testing of biological”
- 8. Developed Countries- 1-5kg/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
- 9. Non-Infectious waste, 80% Pathological and Infectious waste,15% Chemical and Pharmaceutical waste, 3% Sharps, 1% Radioactive, Cytotoxic and heavy metals, 1% Categories of Bio-Medical Wastes
- 10. • Human anatomicalwaste • Animal waste • Microbiology and biotechnology waste • Waste sharps • Liquid waste • Tissues, organs, body parts • Generated during research/experimentation, f rom veterinary hospitals • Laboratory cultures, micro- organisms, human and animal cell cultures, toxins • hypodermic needles, syringes, scalpels, b roken glass • Generated from any of the infected areas Components of Bio-medical waste
- 11. • Dressing, bandages,plaster casts, material contaminated with blood • Alcohol, Sulphuric acid, chlorine powder, Glutaraldehyde, Picric acid, fertiliser, ammonia • Barium enema, X-rays, Cancer chemotherapy, tar-based products • EtBr, Radioactive components Soiled waste Chemical waste Discarded medicines and cyto- toxic drugs Radioactive Components Incineration ash Components of Bio-medical waste (Cont…)
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- 13. Cytotoxic drugs Lab reagents Genotoxicwaste Chemical waste 13
- 14. Waste with highcontent of heavy metals Worn out batteries Blood pressure guages 14
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- 17. The exposure tohazardous health care waste can result in 1. Infection 2. Genotoxicity and Cytotoxicity 3. Chemical toxicity 4. Radioactivity hazards. 5. Physical injuries 6. Public sensitivity.
- 18. Infection The infectious agentsenter in he body through Puncture, Abrasion, Cut in the skin; Through mucous membranes; By inhalation and ingestion.
- 19. Most Common Infections 1.Gastro enteric through faeces and/or vomit e.g. Salmonella, Vibrio Cholera, Helminthes Hepatitis A 2. Respiratory through inhaled secretions e.g. Mycobacterium tuberculosis; measles virus; streptococcus pneumonae 3.Ocular infections through eye secretions e.g. Herpes virus, 4. Skin infection through pus e.g. Streptococcus spp , 5. Meningitis through Cerebrospinal fluid e.g. neisseria meningitides,
- 20. Most Common InfectionCont. 6. Blood borne diseases • AIDS • Septicaemia and bacteraemia • Viral Hepatitis B & C 7. Hemorrhagic fevers through body fluids • Junin, Lassa, Ebola and Marburg viruses
- 21. Genotoxicity and Cytotoxicity ChemicalToxicity • Irritant to skin and eyes E.g. alkylating agent, intercalating agent • Carcinogenic and Mutagenic e.g. Secondary neoplasia due to chemotherapy • Many drugs are hazardous • May cause intoxication , burns, poisoning on exposure
- 22. Radioactivity Hazards Physical Injuries Radioactivewaste exposure may cause headache, dizziness, vomiting, genotoxicity and tissue damage May result from sharps, chemicals and explosive agents Public sensitivity Visual impact of the anatomical waste, recognizable body parts
- 23. Cat- 1 HumanAnatomical Wastes Cat- 2 Animal Anatomical Wastes Cat- 3 Microbiology and Biotechnology wastes Cat- 4 Waste Sharps Cat- 5 Discarded medicines and Cytotoxic drugs Classification of Waste Category as per WHO standard
- 24. Cat- 6 SailedWastes Cat- 7 Solid Wastes Cat- 8 Liquid wastes Cat- 9 Incineration Ash Cat- 10 Chemical wastes Classification of Waste Category as per WHO standard cont…
- 25. Pharmaceutical Waste Blood bagsfound in the municipal waste stream in violation of rules for such waste. 25
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- 27. 27 WASTE CATEGORY TYPE OF WASTE TREATMENTAND DISPOSAL OPTION Category No. 1 Human Anatomical Waste (Human tissues, organs, body parts) Incineration@ / deep burial* Category No. 2 Animal Waste (Animal tissues, organs, body parts, carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals and colleges, discharge from hospitals, animal houses) Incineration@ / deep burial* Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or specimen of live micro organisms or attenuated vaccines, human and animal cell cultures used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins and devices used for transfer of cultures) Local autoclaving/ microwaving / incineration@ Categories of Biomedical Waste Schedule as per WHO Standard
- 28. 28 Category No. 4 WasteSharps (Needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps) Disinfecting (chemical treatment@@ / autoclaving / microwaving and mutilation / shredding Category No. 5 Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated, contaminated and discarded medicines) Incineration@ / destruction and drugs disposal in secured landfills Category No. 6 Soiled Waste (Items contaminated with body fluids including cotton, dressings, soiled plaster casts, lines, bedding and other materials contaminated with blood.) Incineration@ / autoclaving / microwaving Category No. 7 Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets, etc.) Disinfecting by chemical treatment@@ / autoclaving / microwaving and mutilation / shredding# # Categories of Biomedical Waste Schedule as per WHO standards Cont….
- 29. 29 Category No. 8 LiquidWaste (Waste generated from the laboratory and washing, cleaning, house keeping and disinfecting activities) Disinfecting by chemical treatment@@ and discharge into drains Category No. 9 Incineration Ash (Ash from incineration of any biomedical waste) Disposal in municipal landfill Category No.10 Chemical Waste (Chemicals used in production of biologicals, chemicals used in disinfecting, as insecticides, etc.) Chemical treatment @@ and discharge into drains for liquids and secured landfill for solids. Categories of Biomedical Waste Schedule as per WHO standards cont….
- 30. Color Coding ForSegregation of BMW COLOR WASTE TREATMENT Yellow Human & Animal anatomical waste / Micro-biology waste and soiled cotton/dressings/linen/beddings etc. Incineration / Deep burial Red Tubings, Catheters, IV sets. Autoclaving / Microwaving / Chemical treatment Blue / White Waste sharps ( Needles, Syringes, Scalpels, blades etc. ) Autoclaving / Microwaving / Chemical treatment & Destruction / Shredding Black Discarded medicines/cytotoxic drugs, Incineration ash, Chemical waste. Disposal in secured landfill
- 31. 1. Survey ofwaste 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.
- 32. 5: Managing MedicalWaste Slide 32 Steps to Manage Hazardous Wastes before Disposal 1. Know what hazards you have 2. Purchase smallest quantity needed, and don’t purchase hazardous materials if safe alternative exists **Use mercury-free thermometers
- 33. 5: Managing MedicalWaste Slide 33 Steps to Manage Hazardous Wastes (cont..) 3. Limit use and access to trained persons with personal protective gear
- 34. 5: Managing MedicalWaste Slide 34 4. Use Engineering Controls such as Ventilation, Hoods for Select Hazards
- 35. 5: Managing MedicalWaste Slide 35 5. Get Rid of Unnecessary Stuff • Don’t accumulate unneeded products • Don’t let peroxides and oxidising agents turn into bombs Photo of bomb robot called into hospital to dispose of picric acid.
- 36. 5: Managing MedicalWaste Slide 36 6. Label with Agent, Concentration and Hazard Warnings • Examples of hazard labels:
- 37. 5: Managing MedicalWaste Slide 37 7. Communicate about Workplace Hazards • Job description • Posters on doors • Labels on hazards • Give feedback on use of PPE and disposal in evaluation • Role model safe use and disposal • Contact point who is responsible
- 38. 5: Managing MedicalWaste Slide 38 8. Recycle Products When Possible
- 39. Source Reduction • SourceReduction - ways to lessen the amount of material – Segregation - keeping noninfectious waste out of the infectious waste stream – Minimization - reduce or eliminate waste at the source – Engineering controls - methods to reduce quantity of waste(smaller containers)
- 40. Conclusion • Thus refusedisposal cannot be solved without public education. • Individual participation is required. • Municipality and government should pay importance to disposal of waste economically. • Thus educating and motivating oneself first is important and then preach others about it. •
- 41. Lets Make ThisWorld A Better Place to Live in. THANK YOU
Editor's Notes
- #3 Oral cancer ranks number one among men and number three among women in India. Oral cancer constitutes 12% of all cancers in men and 8% of all cancers among women.
- #5 Adequate medical supplies are already a problem for many developing countries like India, but disposal of biomedical waste is another, more serious matter
- #8 Bio-medical waste, if not handled and disposed indiscriminately, may cause adverse effects on human health & environment. According to the available information from the State Pollution Control Boards (2007-08) 52,001 (53.25 %), Health Care Establishments (HCEs) are in operation without obtaining authorization from their respective SPCB/PCC. Approximately 288.20 tons per day (56.87%) out of 506.74 tons per day wastes generated is being treated either through Common Bio-medical Waste Treatment Facilities (159 in number), or captive treatment facilities. There are 602 Bio-medical Waste Incinerators (which include both common and captive incinerators), 2218 autoclaves, 192 microwaves, 151 hydroclaves and 8,038 shredders in the country. About 424 (70.4%) out of 602 incinerators are provided with air pollution control devices and 178 (29.6 %) incinerators are in operation without air pollution control devices.The Ministry of Environment and Forests (MoEF), Government of India, has notified The Bio-Medical Waste Management and Handling Rules, 1998 and The Bio-Medical Waste (Management and Handling) (Amendment) Rules,2003 to provide for statutory and obligatory guidelines for health care waste management.Central Pollution Control Board has also issued guidelines on Central Bio-medical Waste Treatment Facilities (CBWTF) and Design and Construction of Incinerator. However, the implementation of these Rules and guidelines as well as the condition of medical waste management in general, remains grossly unsatisfactory.
- #18 Inadequate waste management thus will cause environmental pollution, unpleasant smell, growth and multiplication of vectors like insects, rodents and worms and may lead to the transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from syringes and needles contaminated with human. Although there are no exhaustive documented studies on health hazards associated with poor hospital waste management, some indicators like progressive increase in hospital infection rate, increasing resistance to wide variety of antibiotics are the pointers to the way in which poor hospital waste management can contribute to the ill health plaguing the health care institutions. In addition to health risks associated with the poor management of bio-medical waste, due consideration must be given to the impact on environment, especially to the risks of pollution of water, air and soil. Hence, collection and disposal of waste in the proper manner is of great importance as it can decrease directly and indirectly health risk to people, and damage to flora, fauna and the environment
- #19 Commonest infections, which can result from mishandling of hospital/health care waste, are gastro enteric through faeces and/or vomit (Salmonella, Shigella spp., Vibrio Cholera, Helminthes; Hepatitis A), Respiratory through inhaled secretions; saliva (Mycobacterium tuberculosis; measles virus; streptococcus pneumonae), Ocular infections through eye secretions (Herpes virus), Genital infections (Neisseria gonnorrhoeae; herpes virus), Skin infection through pus (Streptococcus spp.), meningitis through Cerebrospinal fluid (neisseria meningitides), AIDS through blood and sexual secretions (HIV), Haemorrhagic fevers through body fluids (Junin, Lassa, Ebola and Marburg viruses), Septicaemia and bacteraemia through blood (staphylococcus aureus, Enterococcus, enterobacter, klebsiella and streptococcus) and Viral Hepatitis B & C through blood and body fluids (hepatitis B and C viruses).