Biomedical waste management

Biomedical waste management has recently emerged as an issue of major concern not only to hospital, nursing home authorities but also to the environment. The biomedical wastes generated from health care unit depends upon a number of factors such as waste management methods, type of health care unit, occupancy of healthcare units, specialization of healthcare units ratio of reusable items in use, availability of infrastructure and resources etc.

Definition

· According to biomedical waste (management and handling) rules, 1998 of India “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

· The governmental of India (notification 1998) specifies that hospital waste management is a part of hospital hygiene and maintenance activities. this involves management of range of activities, which are mainly engineering functions, transportations, operation or treatment of processing systems and disposal of wastes.

· World health organization state that 85 % of hospital wastes are actually non-hazardous, whereas 10% are infectious and 5% re non-infectious but they are included in hazardous wastes. About 15%to 35% of hospital waste is regulated as infectious waste. this range is dependent on the total amount of waste generated (Glenn and Garhwal,1999).

1. TYPES OF HOSPITAL WASTES:

There are two types of hospital waste:

1. Risk waste

2. Non-risk waste

i. RISK WASTE:

This is further sub-divided in seven groups:

1. Infection waste

2. Pathological Waste

3. Sharps

4. Pharmaceutical waste

5. Genotoxic waste

6. Chemical waste

7. Radioactive waste

1. Infectious waste: This is the waste contaminated by any type of bacterium, virus, parasite or fungi which includes:

1. Cultures (the growing micro-organism in a nutrient medium such as gelatine, proteins from bone and skin) from laboratory work.

2. Waste from surgery and autopsies (postmortem)

3. Waste from infected patients

4. Waste from infected hemodialysis patients

5. Infected animals from laboratories

6. Any materials having been in contact with infected patients.

2. Pathological Waste : This waste include:

1.Tisues

2.organs

3.body parts

4.Fetuses (unborn vertebrates)

5. Blood and body fluids

3. Sharps: It includes following infected or not

1. Needles

2. Syringes

3. Scalpels

4. Infusion sets

5. Saws &knives

6. surgical blades

7. Broken glass

4. Pharmaceutical waste: These include:

1. Expired or unused pharmaceutical products

2. Spilled or contaminated pharmaceutical products

3. Surplus drugs or vaccines or sera

4. Discarded items used in handling pharmaceutical like bottle, gloves mask etc.

5. Genotoxic waste : These waste includes:

1. Cytotoxic drugs and outdated material

2. vomiting. feaces or urine from patients treated with cytotoxic drugs of chemicals

3.Contaminated materials from the preparation and administration of the drugs such as syringes, vials etc.

6. Chemical Waste: Theas includes:

1. Chemicals from diagnostic and experiments work

2.Cleaning processes

3.Hous keeping

4. Mercury waste such as broken clinical equipment spillage.

5. Cadmium waste, mainly from discarded batteries.

7.Radioactive Waste : These wastes includes liquid, or solid or gaseous waste contaminated with radio nuclides generated with radio nuclides generated from in vitro (outside) analysis of body tissues, involve(body organs imaging) and tumor localizations and investigation and therapeutic procedures.

ii. NON-RISK WASTE: It is that which a compatible to normal domestic garbage and presents no greater risk, therefore than waste from a normal home. This general waste is generated by almost everybody in the hospital. i.e. Administration, patient’s risk, cafeteria room, and nursing station.

Such waste includes:

1. Paper &cardboard

2. Packaging

3. Food waste i.e., left over food fruit and vegetable peelings

Source biomedical waste :

Hospital produce waste which is increasing over the year in its amount and type. The hospital waste ,in addition to the risk for patients and personnel who handle them also pose a threat to public health and environment.

Major sources:

· Govt. hospital/private hospital /nursing homes/dispensaries.

· Primary health centers.

· Medical colleges and research centers/paramedic services.

· Veterinary colleges and animal research centers.

· Blood bank/mortuaries/autopsy centers.

· Biotechnology institutions.

· Production units.

Minor source:

· Physicians/dentists clinics.

· Animal houses/slaughter houses

· Blood donation camps.

· Vaccination centers.

· Acupuncturists/psychiatric clinics/cosmetic piercing.

· Funeral services.

· Institutions for disabled persons.

2.HAZARDS ASSOCIATED WITH HOSPITAL WASTE :

Hospital waste an environmental hazard and its management:

· Hospital is a place of almighty, a place to serve the patient.

· Since beginning, the hospital are known for the treatment of sick person but we are unaware about the adverse effects of the garbage and filth generated by them on human body and environment.

· “Hospital waste” generated during the patient care. hospital waste is a potential health hazard to the health care workers, public and flora and fauna of the area.

· Hospital acquired infection, transfusion transmitted diseases, rising incidence of hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of catching many diseases

· Air pollution due to emission of hazardous gases by incinerator such as furan, dioxin , Hydrochloric acid etc. have compelled the authorities to think seriously about hospital waste and diseases transmitted through improper disposal of hospital waste.

· This problem has now become a serious threat for the public health and, ultimately the central government had to intervene for enforcing proper handling and disposal of hospital waste and an act was passed in July 1996 and a biomedical waste(handling and management)rule was introduced in 1998

· A modern hospital is a complex, multi disciplinary system which consumes thousand of items for delivery medical care and is a part of physical environment.

· All these product consumed in the hospital leave some unusable leftovers i.e. hospital waste

· The last century witnessed the rapid mushrooming of hospital in the public and private sector, dictated by the needs of expanding population.

· The advent and acceptance of “disposable” has made the generation of hospital wast asignificant factor in current scenario.

Amount and composition of hospital waste generated:

(a) Amount :

Country	Quantity(kg/bed/day)
U.k	2.5
U.S.A	4.5
France	2.5
Spain	3.0
India	1.5

(b) Hazardous/non-Hazardous:

Hazardous	15%
a)hazardous but – infective	5%
b)Hazardous and infective	10%
Non-hazardous	85%

By weight
	Plastic	14%
Combustible
	Dry cellublostic solid	45%
	Wet cellublostic solid	18%
Non-combustible		20%

Biomedical Waste :

Any solid, fluid and liquid or liquid waste, including its container and any intermediate product, which is generated during the diagnosis, treatment or immunization of human being or animals, in research pertaining thereto, or in the production or testing of biological and the animal waste from slaughter house houses or any other similar establishment. all biomedical waste are hazardous.in hospital it comprises of 15% of total hospital waste.

Rationale of Hospital Waste management :

Hospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15%of hospital waste i.e ., Biomedical waste” is hazardous, not the complete. The question then arises that what is the need or rationale for spending so much resources in terms of money, man power ,material and machine for management of hospital waste the reasons are :

· Injuries from sharps leading to infection to all categories of hospital personnel and waste handler.

· Nosocomial infections in patients from poor infection control practice and poor waste management.

· Risk of infection out side hospital for waste handlers and scavenger and at time general public living in the vicinity of hospitals.

· Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels.

· “Disposable” being repacked and sold by unscrupulous laments without even being washed.

· Drugs which have been disposed of being repacked and sold off to unsuspecting buyers.

· Risk of air ,water and soil pollution directly due to waste, or due to defective incineration emissions &ash.

3.DECONTAMINATION OF HOSPITAL WASTE :

Decontamination of hospital waste must be carried out at the site of collection to prevent the spread of infection and to control the hazards associated with infection.

1. Anatomical waste (yellow): It is directly sent to disposal site without any treatment in the hospital.

2. Infectious waste(red bags ): They are also sent to storage site or disposal site without any intervention of deep burial or incineration. The plastic and rubber disposables are mulilatd (cut into pieces to prevent reuse ) and disinfected in the ward by putting into 1% bleaching solution for ½ hr or sodium hypochlorite solution and then packed in blue bags for disposal.

3. Sharps : The infectious needles are destroyed and disinfected by collecting them in 1% sodium hypochlorite solution before being finally disposed of. They should always be stored in puncture-proof transparent container.

4. Cytotoxic waste : it should be collected in strong, leak –proof containers clearly labelled as “cyto-toxic waste”.

4.SEGREGATION AND TRANSPORTATION :

Segregation :

The waste should be segregated at the point of generation from non-risk wate.it is useful for safe disposal of risk waste. The process of segregation at source has two advantages.

1. The risk waste is separated from non-risk waste which accounts for 205 of the total medical waste.

2. At source segregation minimizes the chance of infection and injury to the persons who handle the waste.

· The person responsible for waste handling must do source segregation to reduce the chance of infection and lesser amount of waste to be incinerated.

· Segregation must be practiced from the source of generation to handling, transportation till the final disposal.

· All categories of risk waste other than sharps are collected in “white colour” container lined with plastic bag.

· The sharps are stored in “red” colour hard plastic container lined with a plastic bag

· The medical staff cuts the needles of syringes making it unfit for reuse.. if the sharp container is to be incinerated. It shall be placed in the yellow waste bag with the other risk waste

Large quantities of pharmaceutical waste shall be returned to suppliers.

· Small quantities may be placed in a yellow waste bag, preferably after being crushed.

· Radio Active waste may be placed in large yellow container or drum and may be marked with “radio active” waste non infectious radioactive waste may be placed in white bags

· The non risk waste is stored separate from all other waste and is collected in a “Blue” container with a plastic bag lining.

· The blue container should be located in the corridors open spaces and other visiting places etc.

Container Specification :

All container in hospital wards and departments should be capable of handling waste without spillage a puncture. The container should be hard polythene material.

1.Segregation of waste :

Segregation is the essence of waste management and should be done at the source of generation of Bio-medical waste e.g. all patient care activity areas, operation theatres, labour rooms, treatment rooms etc. the responsibility of segregation should be with the generator of biomedical waste i.e., doctors, nurses technicians etc., (Medical and paramedical personnel).the bio-medical waste should be segregated as per categories mentioned in the rules.

2.Collection of bio-medical waste :

Collection of bio-medical waste should be done as per bio-medical waste(Management and handling )Rules. At ordinary room temperature the collected waste should not be stored for more than 24 hours.

Type of container and colour code for collection of Bio-Medical Waste

Category	Waste class	Type of container	Colour
1	Human anatomical waste	Plastic	Yellow
2	Animal waste	-do-	-do-
3	Microbiology and biotechnology waste	-do-	Yellow/Red
4	Waste sharp	Plastic bag puncture proof containers	Blue/white Translucent
5	Discarded medicines	Plastic bags and cytotoxic waste	Black
6	Solid(biomedical waste)	-do-	Yellow
7	Solid(plastic)	Plastic bag puncture proof containers	Blue/white translucent
8	Incineration waste	Plastic bag	Black
9	Chemical waste(solid)	-do-	-do-

3.Transportation :

· Within hospital, waste routes must be designated to avoid the passage of waste through patient care areas.

· Separate time should be earmarked for transportation of bio-medical waste to reduce chance of it’s mixing with general waste.

· Desiccated wheeled containers, trolleys or cart should be used to transport the waste /plastic bags to the site of storage/treatment,

· Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage.

· The wheeled containers should be so designed that the waste can be easily loaded, remains secure during transportation, does not have any sharp edges and is easy to clean and disinfect.

· Hazardous biomedical waste needing transport to a long distance should be kept in containers and should have proper labels.

· The transport is done through desiccated vehicles specially constructed for the purpose having fully enclosed body, lined internally with stainless steel or aluminium to provide smooth and impervious surface which can be cleaned.

· The drivers compartment should be separated from the load compartment with a bulkhead. The load compartment should be provided with roof vents for ventilation.

Disposal :

Biomedical waste treatment &disposal :

Health care waste is a heterogeneous mixture, which is very difficult to mange as such. But the problem can be simplified and its dimension reduced considerably if a proper management system is planned.

Incineration Technology : This is high temperature thermal process employing combustion of the waste under controlled condition for converting them into inter material and gases. Incinerators can be oil fired or electrically powered or a combination thereof. Broadly ,three types of incinerators are used for hospital waste: multiple hearth type, rotary kiln and controlled air types.

All the types can have primary and secondary combustion chambers to ensure optimal combustion. These are refractory lined.

Non-incineration Technology : Non-incineration treatment includes four basic processes: Thermal, chemical, irradiative, and biological. The majority of non-incineration technologies employ the thermal and chemical processes.

The main purpose of the treatment technology is to decontaminate waste by destroying pathogens.

Autoclaving

· The autoclave operates on the principle of the standard pressure cooker.

· The process involves using steam at high temperatures.

· The steam generated at high temperature penetrates waste material &kills all the microorganism.

Microwave Irradiation :

· The microwave is based on the principal of generation of high frequency waves.

· These waves cause the particles within the waste material to vibrate, generating heat.

· This heat generated from within kills all pathogens.

Chemical Methods:

· 1% Hypochlorite solution can be used for chemical disinfection

Plasma Pyrolysis :

Plasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste. It I an environment-friendly technology, which convert organic waste into commercially useful by products. The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste, biomedical waste and hazardous waste in a safe and reliable manner.

Biomedical waste management Rules :

Safe disposal of biomedical waste is now a legal requirement in india. The biomedical waste management and handling ) rules,1998 came into force on 1998. In accordance with these rules, it is the duty of every “occupier” i.e., a person who has the control over the institution or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment.

It consist of six schedules.

Schedule -1

Schedule-2

Schedule-3

Schedule-4

Schedule-5

Schedule-6

Schedule -1: Categories of Bio-medical Waste

Option	Treatment & Disposal	Waste category
Category 1	Incineration /deepburil	Human anatomical waste (human issues, organs, body parts)
Category-2	Incineration/Deepburial	Animal waste animal tissues, organs ,body parts car cases, bleeding parts fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospital and house
Category-3	Local autoclave/microwaving/incineration	Microbiology and biotechnology waste (Wastes from laboratory cultures, stocks or specimens of micro-organism live or attenuated vaccines, human and animal cell culture uses in research and industrial laboratories waste from production of biological, toxins, dishes and devices used for transfer of cultures).
Category-4	Disinfection (chemical treatment /autoclaving microwaving and mutilation /shredding	Waste sharps (needles, syringes, scalpels bands, glass etc. that may cause puncture and cuts. this includes both use and unused sharps).
Category-5	Incineration/destruction and drugs disposal in secured landfills	Discarded medicine and cytoxic drugs(wastes comprising of outdated contaminated and discard medicines).
Category-6	Incineration, autoclaving/microwaving	Solid waste (item contaminated with blood and body fluids including cotton, dressing, solid plaster casts, line bleedings, other material contaminated with blood)
Category-7	Disinfection by chemical treatment and discharge into drain	Solid waste (waste generated from disposable items other than the waste sharps such as tubing, catheters intravenous sets etc.
Category-8	Disinfection by chemical treatment and discharge into drain	Liquid waste(waste generated from laboratory and washing, cleaning housekeeping and disinfecting activities).
Category-9	Disposa in municipal landfill	Incineration ash(ash from incineration of any bio-medical waste)
Category-10	Chemical treatment and discharge into drain from liquid and secured landfill solids	Chemical waste (Chemical used in production of biological, chemicals used in disinfection as insecticides, etc.)

Schedule 2: Colour coding and Type of container for Disposal of Bio-medical Wastes

Colour coding	Type of containers	Waste Category	Treatment option as per schedule -1
Yellow	Plastic bag disinfection	1,2,3,6	Incineration /deep burial
Red	Disinfected container/plastic bag	3,6,7	Autoclaving/micro waving/chemical treatment and destruction/shredding
Blue/white Translucent	Plastic bag/puncture proof container	4,7	Autoclaving/micro waving chemical treatment and destruction /Shredding
Black		5,9,10(solid)	Disposals in second landfill

Schedule 5: Label for Transport of Bio-medical waste container/Bags

Day ………………………..Month…………………………………………year…………………………………..

Date of generation……………………………………………………………………………………………………

Waste category No………………………………………………………………………………………………………

Waste Description………………………………………………………………………………………………………

Sender’s Name & Address Receiver’s Name &Address

Phone No……………………………Phone No………………………………………

Telex No……………………………..Telex No…………………………………………..

Fax No………………………………Fax No……………………………………………

Contact person…………………………… contact person……………………………………………………..

In case of emergency please contact Name &Address :…………………………………………………………………….

…………………………………………………………………………………………………………………………………………………………

Phone No…………………………………………………………………………………..

Note: Label shall be non-washable and prominently visible.

Schedule-5

Standards for treatment & disposal of Bio-Medical wastes standards for Incinerators.

Schedule-6

Schedule for waste Treatment Facilities like Incineration/Autoclave/microwave system.10 (Source –the Bio medical waste (Management and Handling Rules 1998).

Benefits of Biomedical Waste Management :

· Cleaner and healthier surroundings.

· Reduction in the incidence of hospital acquired and general infections.

· Reduction in the cost of infection control within the hospital.

· Reduction in the possibility of disease and dearth due to reuse and repack-again of infectious disposables.

· Low incidence of community and occupational health hazards.

· Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste.

· Improved image of the healthcare establishment and increases the quality of life.

Recommendation :

1. For the use of incinerator training should be given to some number of persons from staff.

2. Specific fund should be allocated for the use of incinerator.

3. Every hospital should have special boxes to use as dustbin for bio-medical waste.

4. Bio-medical waste should not b mixed with other waste of municipal corporation.

5. Private hospitals should also be allowed to use incinerator ,which is installed ,in govt. hospital. For this purpose a specific fee can be charged from private hospitals.

6. Special vehicle i.e. Bio-medical waste vehicle should be started to collect waste from private hospital and private medical clinics and carry it up to the main incinerator.

7. As provided by Bio-medical waste rules, the hole of the waste should be fragmented into colours due to their hazardous nature.

8. Bio-medical waste management board can be established in each district.

9. Either judicial powers should be given to the management board or special court should be established in the matters of environment pollution for imposing fines and awarding damages etc.

10. Housekeeping staff wear protective device such as gloves, face masks gowns, while handling the waste.

11. There is biomedical waste label on waste carry bag and waste carry trolley and also poster has put on the all adjacent to the bins(waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule. Carry bags also have the biohazard symbol on them.

Hospital waste refers to all waste generated, discarded and not intended for further in the hospital.