Bio-Medical Waste

Management
Satish Sinha

History of medical waste

Medical Waste Tracking Act in
US
I Draft Rules in India1995
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

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
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 510% 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

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
disease- Hepatitis 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?

Infectious waste (solid and liquid)

Sharps waste
Cytotoxic waste
Pharmaceutical waste
Radioactive waste
Chemicals and disinfectants
Pressurised containers

BMW Rules and Key

Actors
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

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 waste

Inc/alternate

Category 4

Waste sharps

Disinfection &
autoclaving/microwavin
g/shredding & mutilation

Category 5

Discarded medicines,
cytotoxic drugs

Inc/landfill

Category 6 & Solid waste

7

Autoclaving,
microwaving &
mutilation for category 7

Category 8

Liquid waste

Disinfection

Category 9

Incineration ash

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,
container/ plastic solid & soiled
bag
waste

Autoclaving/Micr
owaving/Chemica
l Treatment

Blue/White
translucent

Plastic
bag/puncture
proof
container/Sharps
Blaster

Waste sharps &

solid waste

Autoclaving/Micr
owaving/Chemica
l Treatment &
destruction/shred
ding

Black

Plastic bag

Discarded
medicine,

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

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
waste-Centralized 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

Bio-medical waste treated /day

319453 kgs
143952 kgs

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

413500#
295270

414956#

291983

14898

Hurdles in
Implementation

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

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

Mindset issues
Involvement
of
senior
management
Resource
availability
and
prioritising
Government
Hospitals
biggest
defaulters
Capacity Building
Implementation bottlenecks
Responsibility fixing

At the CTF level

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
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

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

Emerging Issues
Injection Safety

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

Thank You
Toxics Link
H-2, Jungpura Ext.
New Delhi 110014
011-24328006, 24320711

info@toxicslink.org
www.toxicslink.org