BIO-MEDICAL WASTE MANAGEMENTSELF LEARNING DOCUMENT FOR DOCTORS, SUPERINTENDENTS AND ADMINISTRATORS

Supported By World Health Organization (WHO), India Country Office, New Delhi

Prepared By

ENVIRONMENT PROTECTION TRAINING AND RESEARCH INSTITUTE Gachibowli, Hyderabad, Andhra Pradesh. www.eptri.com

Environment Protection Training & Research Institute, (EPTRI)

Acknowledgment
Bio- Medical Waste Management is an essential, fundamental and important activity of all hospital. This document on Bio-Medical Waste Management - Self Learning Document for Doctors, Medical Superintendents and Administrators, is an attempt to refresh and enhance the knowledge on bio-medical waste management.

Our sincere thanks to Mr. A.K. Sengupta, National Professional Officer, Sustainable Development and Environmental Health, World Health Organization (WHO), India Country Office, New Delhi for supporting this project and providing guidance at every level.

We are grateful to Mr. Indrajit Pal, IAS, Director General, for his encouragement in developing this document.

We wish to express our thanks and gratitude to everyone who contributed to this document.

Dr. Razia Sultana Project Coordinator, Director (Programs) i/c, EPTRI, Hyderabad, Andhra Pradesh

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Content

Page No.

1. Introduction………………………………………………………………………….. 2 1.1 Definition of Bio-Medical Waste……………………………………………... 3 1.2 Risk to Personnel Due to Bio –Medical Waste………………………………. 3 1.3 Dangers of Improper Management of Bio-Medical Waste…………………… 4 2. Regulations on Bio- Medical Waste Management………………………………… 6 2.1 National Legislations Governing Waste Management……………………. ….7 2.2 Excerpts from Bio-Medical Waste (Management and Handling) Rules,1998 and as Amended............................................................................................. …8 3. Role of Doctors, Medical Superintendent and Administrators of Hospitals In Bio-Medical Waste Management……………………………………………….. 13 3.1 3.1.1 3.1.2 3.1.3 3. 1.4 3.1.5 3.1.6 3.2 3.3 3.3.1 3.3.2 Planning and Designing of Bio- Medical Waste Management…….......... 14 Unit Wise Generation of Bio-Medical Waste……………………………..15 Waste Audit and Waste Minimization……………………………… …....16 Items and Equipments Required for Bio- Medical Waste Management…20 Placement of Required Items……………………………………………..24 Designing the Movement of Bio-Medical Waste…………………………24 Formation of Committee for Bio-Medical Waste Management…………..24 Reducing Risk of Disease Transmission and Response to Accidents…….26 Financial Management…………………………………………………...30 Cost of Bio-Medical Waste Management System Where common Bio-Medical Waste Treatment Facility is Not Available………….31 Cost of Bio-Medical Waste Management System Where Common Bio-Medical Waste Treatment Facility is Not Available………….31 4. Implementation of Bio- Medical Waste Management Plan……………………....33 4.1 Bio-Medical Waste Management in Hospitals Where Common BioMedical Waste Treatment Facility is Not Available………………………...34 4.2 Bio-Medical Waste Management in Hospitals Where Common BioMedical Waste Treatment Facility is Available……………………………..57 4.3 Bio-Medical Waste Management in PHCs and Small Units………………...69 5. Do’s and Don’ts ……………………………………………………………………...73 Annex 1 Bio-Medical waste (Management and Handling) Rules and Amendment…77

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Bio-Medical Waste Management- Self Learning Document For Doctors, Medical Superintendents and Administrators

About the Manual:
The concern for bio-medical waste management has been felt globally with the rise in infectious diseases and indiscriminate disposal of waste. This manual is useful for refreshing and or up gradation of knowledge of doctors, superintendents and administrators on bio-medical waste management. This will sensitize the reader about the impacts of improper waste management and acquaint them with laws and practices in India. The main bottleneck to sound bio-medical waste management is lack of training and appropriate skills, insufficient resource allocation and lack of adequate equipment. This document has been developed to create basic awareness about bio-medical waste management practices, equip the readers with enough skills for effectively managing bio-medical waste, safe guard themselves and the community against adverse health impact.

It is to be understood that management of bio medical waste is an integral part of health care. This manual on “Bio-Medical Waste Management - Self Learning Document for Doctors, Medical Superintendents and Administrators” contains five chapters describing introduction, legal provision, role of doctors and other cadres of staff in bio-medical waste management. Waste auditing, requirement of items and equipments, financial management, planning, designing and implementation of biomedical waste management with dos and don’ts has been provided. It covers safe, efficient and environmental friendly waste management options. It also contains safety procedures while handling waste. This will serve as a useful guide in planning, implementation and monitoring of bio-medical waste management program in hospitals.

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Bio-Medical Waste Management - Self Learning Document for Doctors, Medical Superintendents and Administrators 1. Introduction

About this Module This module focuses upon the importance and the purpose of Bio-medical waste management, definition of bio-medical waste, risks associated and dangers of improper management of bio-medical waste.

Learning Objectives:
• • • To define the bio-medical waste. To understand the importance and purpose of bio- medical waste management. To get familiarized with the risks involved and dangers of improper management of bio-medical waste.

Output:

The reader will be able to define bio-medical waste, understand the risks if not
managed properly and importance of bio-medical waste management.

Hospitals and other healthcare establishments have a “duty of care” for the environment, public health and have particular responsibilities in relation to the waste they produce (i.e., bio-medical waste). Negligence in terms of biomedical waste management significantly contributes to polluting the environment and affects the health of human beings. The waste generated by any hospital / health care facilities consists of general waste like packaging material, eatables, paper, wrapper etc., hazardous and infectious waste like out dated medicines, cytotoxic drugs, soiled dressing, swabs, cotton with blood and body fluid, dissected body organs and tissues, disposable syringes, intravenous fluid bottles, catheters, gloves, injection vials, needles, blades, scalpels etc. Quantity wise around 70 % - 80% is general waste and 20% - 30% is hazardous and infectious waste which poses risk to human health and
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environment. These two basic category of wastes (hazardous and infectious) should be segregated other wise the whole waste, the entire volume of waste will become infectious. 1.1 Definition of Bio-Medical Waste:

As per Bio-Medical Waste (Management and Handling) Rules, 1998 and amendments, 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 and including categories mentioned in schedule 1 of the Rule, is the bio-medical waste.

As per WHO norms the health-care waste includes all the waste generated by healthcare establishments, research facilities, and laboratories. In addition, it includes the waste originating from minor or scattered sources such as that produced in the course of health care undertaken in the home (dialysis, insulin injections, etc.). 1.2 Risks to Personnel Due to Bio-Medical Waste: Poor bio-medical waste management exposes hospital and other health care facility workers, waste handlers and community to infection, toxic effects and injuries. Doctors, nurses, paramedical staff, sanitary staff, hospital maintenance personnel, patients receiving treatment, visitors to the hospital, support service personnel ,workers in waste disposal facilities, scavengers, general public and more specifically the children playing with the items they can find in the waste outside the hospital when it is directly accessible to them are potentially at risk of being injured or infected when they are exposed to bio- medical waste. Risk to all those who generate, collect, segregate, handle, package, store, transport, treat and dispose waste ( an occupational hazard). Occupational exposure to blood can result from percutaneous injury (needle stick or other sharps injury), mucocutaneous injury (splash of blood or other body fluids into the eyes, nose or mouth) or blood contact with non-intact skin. Over 20 blood born diseases can be transmitted but particular concern is the threat of spread of infectious and communicable diseases like AIDS, Hepatitis B & C, Cholera, Tuberculosis, Diphtheria etc. Waste chemicals,
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radioactive waste and heavy metals also finds its way in waste stream which are also hazardous to health. 1.3 Dangers of improper Management of Bio-Medical Waste: There is public health hazard due to poor management of bio-medical waste which can cause a number of disease. Serious situations are very likely to happen when biomedical waste is dumped on uncontrolled sites where it can be easily accessed by public. Children and rag pickers are particularly at risk to come in contact with infectious waste. Inappropriate treatment and disposal contributes to environmental pollution (uncontrolled incineration causes air pollution, dumping in drains, tanks and along the river bed causes water pollution and unscientific land filling causes soil pollution).

In many parts of the country bio-medical waste is neither segregated nor disinfected. It is being indiscriminately dumped into municipal bins, along the roadsides, into water bodies or is being burnt in the open air. All this is leading to rapid proliferation and spreading of infectious, dangerous and fatal communicable diseases. The improper handling and mismanagement of bio- medical waste is posing serious problems, few of the problems due to improper disposal are as follows. • The infectious waste which is only 20% – 25% of the entire waste from hospitals is not segregated and is mixed with general waste by doing so the whole of waste may turn up to infectious waste. If the same is dumped into the municipal bin then there are fair chances of the waste in municipal bin to become infectious. • The disposal of sharps will lead to needle stick injuries, cuts, and infections among hospital staff, municipal workers, rag pickers and the general public. This will lead to transmission of diseases like Hepatitis B, C, E and HIV etc. • The needles and syringes which are not mutilated or destroyed are being circulated back through traders who employ the poor and the destitute to collect such waste for repackaging and selling in the market. • • One of the reasons for spreading of infection is reuse of disposable items like syringes, needles, catheters, IV and dialysis sets etc. The dumping of untreated bio-medical waste in municipal bins may increase
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the possibility of survival, proliferation and mutation of pathogenic microbial population in the municipal waste. This leads to epidemics and increased incidence and prevalence of communicable diseases in the community. • Chances of vectors are high, like cats, rats, mosquitoes, flies and stray dogs getting infected or becoming carriers which also spread diseases among the public.

WHO has estimated that, 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 infections). Epidemiological studies indicate that a person who experiences one needle-stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively to become infected with HBV, HCV and HIV. In 2002, the results of a WHO assessment conducted in 22 developing countries showed that the proportion of healthcare facilities that do not use proper waste disposal methods ranges from 18% to 64%.
(Source: AIDE-MEMOIRE by World Health Organization (WHO) Courtesy: Dept. of Protection of the Human Environment Water, Sanitation and Health)

It is estimated that approximately 3 million HCWs experience percutaneous exposure to blood borne viruses (BBVs) each year. This results in an estimated 16,000 hepatitis C, 66,000 hepatitis B and 200-5000 HIV infections annually. ( Source: Needle stick injuries in a tertiary care hospital by S T Jayanth et al , Indian Journal of Medical Microbiology, year 2009 , Vol. 27, Issue 1, page 44-47)

Questions 1. Define bio-medical waste? 2. Who are at risk if bio-medical waste is not managed properly? 3. What are the effects of improper management of bio-medical waste?

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2. Regulations on Bio-medical Waste Management
About this Module In this module the attention of reader is drawn on various legal provisions governed on waste management. The salient features of Bio-Medical Waste (Management and

Handling) Rules, 1998 and amendments has been provided.

Learning Objectives: • • To know various rules governing waste management. To know Bio-Medical Waste (Management and Handling) Rules, 1998 and Amendments. Output:

The reader will be able to understand various regulations which governs the waste management and the salient features of Bio-Medical Waste

(Management and Handling) Rules, 1998 and amendments. Establishment of a sustainable bio-medical waste management system gets benefit from a national legal framework that regulates and organizes the different elements of a waste management system. Legislation usually places obligations and controls on what is permitted and prescribes sanctions on those that deviate from accepted practice. In reality, a law will remain ineffective if sources (finance, material and knowledge) are not available in the hospitals or health care sectors to implement it and or if enforcement is weak. The five guiding principles governing in waste-related laws are the “polluter pays” principle, this requires any waste producer to be made legally and financially responsible for the safe and environmentally sound disposal of their waste. The responsibility to ensure that the disposal of waste causes no environmental damage is placed upon each waste generator, the “precautionary” principle, the rationale of the principle is that if the outcome of a potential risk is suspected to be serious, but may not be accurately known, it should be assumed that this risk is high. This has the effect of obliging health care waste generators to operate a good standard of
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waste collection and disposal, as well as provide health and safety training, protective equipment and clothing for their staff , the “duty of care” principle, this recognizes that any person managing or handling health care waste, or waste-related equipment, is morally responsible to take good care of the waste while it is under their responsibility, the “proximity” principle, the philosophy behind this principle is that treatment and disposal of hazardous waste (including health care waste) should take place at the nearest convenient location to its place of generation, in order to minimize the risks to the general population. This does not necessarily mean treatment or disposal has to take place at each health care establishment; instead it could be done at a facility shared locally or at a regional or national location. An extension to this principle is the expectation that every country should make arrangements to dispose of all wastes in an acceptable manner inside its own national borders and prior informed consent principle / also known as ‘cradle to grave’ control, this principle introduces the concept that all parties involved in the generation, storage, transport, treatment and disposal of hazardous wastes (including health care waste) should be licensed or registered to receive and handle named categories of waste. In addition, only licensed organizations and sites are allowed to receive and handle these wastes. No hazardous wastes (including health care waste) should leave a place of waste generation until the subsequent parties (e.g. transport, treatment and disposal operators and regulators) are informed that a waste consignment is ready to be moved. 2.1 National Legislations Governing Waste Management: National legislation is the basis for bio-medical waste management practices in the country. It establishes control and permits for the disposal. The regulatory frame work which governs the management of waste is as follows. • • • • • The Water (Prevention and Control of Pollution) Act, 1974 (for liquid waste) The Air (Prevention and Control of Pollution) Act, 1981( for air quality) The Environment (Protection) Act, 1986 Hazardous Wastes (Management, Handling and Transboundary Movement) Rules, 2008 (for hazardous waste). The Bio- Medical Wastes (Management and Handling) Rules 1998 (for hospital waste)
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• •

The Municipal Solid Wastes (Management and Handling) Rules, 2000 (for domestic municipal waste) Battery (Management and Handling) Rules, 2001 (for used batteries waste). 2.2 Excerpts from Bio- Medical Waste (Management and Handling) Rules 1998 and as Amended:

The Bio-Medical Waste Management and Handling Rules regulate bio-medical waste management at local, regional and national level. The rules provides a general foundation for improving bio- medical waste management systems by indicating in broad terms what is regarded as good and acceptable practice in the hospitals or health care institutions. The main benefit of a national law covering hospital waste is that it can give a uniform basis for a country to develop good practices by providing the definition of waste, its categories , defined legal obligations of waste producers, requirements for record-keeping and reporting to regulatory agencies, authority for an inspection system, establishment of procedures to permit or prohibit some waste handling, treatment and disposal practices and the courts with powers to settle disputes and impose penalties on offenders. This rule has 14 sections, 6 schedules and 5 forms and is applied to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste in any form. As per the rule "Occupier" means in relation to any institution generating bio-medical waste, which includes a hospital, nursing home, clinic dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called, means a person who has control over that institution and / or its premises. The duty of every occupier of an institution generating bio-medical waste is to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment.

No untreated bio-medical waste shall be kept stored beyond a period of 48 hours, provided that if for any reason it becomes necessary to store the waste beyond such period, the authorized person must take permission from the prescribed authority and take measures to ensure that the waste does not adversely affect human health and the environment. "Authorized Person" means an occupier or operator authorized by the

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prescribed authority to generate, collect, receive, store, transport, treat, dispose and or handle bio-medical waste in accordance with these rules and any guidelines issued by the Central Government. The “Prescribed Authority” for the enforcement of provisions of these rules shall be the State Pollution Control Boards in respect of states and the Pollution Control Committees in respect of the Union territories. The “Prescribed Authority” for the health care establishments of Armed Forces under the Ministry of Defence shall be the Director General, Armed Forces Medical Services. Every occupier of an institution generating, collecting, receiving, storing, transporting, treating, disposing and / or handling bio-medical waste in any other manner, shall make an application in form 1 to the prescribed authority for grant of authorization. Occupier of clinics, dispensaries, pathological labs, blood banks providing treatment / services to less than 1000 patients per month are exempted for taking authorization. Every authorized person shall maintain records related to the generation, collection, reception, storage, transportation, treatment, disposal and or any form of handling of bio-medical waste in accordance with these rules and any guidelines issued. All these records can be subjected to inspection and verification by the prescribed authority at any time. When any accident occurs at any institution or facility or any other site where bio-medical waste is handled or during transportation of such waste, the authorized person shall report the accident to the prescribed authority. The Segregation, Packaging, Transportation and Storage is as follows. • •

Bio-medical waste shall not be mixed with other wastes. Bio-medical waste shall be segregated into containers / bags at the point of generation in accordance with Schedule II prior to its storage, transportation, treatment and disposal.

• •

The containers shall be duly labeled as per schedule III. If a container is transported from the premises where bio-medical waste is generated to any waste treatment facility outside the premises, the container shall, apart from the label prescribed in Schedule III, also carry information prescribed in Schedule IV. The schedule IV describes the type of waste where it is generated and to where it is being transferred.

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The Treatment and Disposal of bio-medical waste shall be in accordance with Schedule I and in compliance with Schedule V. The schedule 1 describes category wise treatment and disposal methodology and schedule V presents the standards for incinerators, autoclave, liquid waste, microwave and deep burial. The schedule I, II and III are as follows. Schedule 1: Categories of Bio-Medical Waste Waste Category Category No. 1 Human Anatomical Waste (body parts, organs, human tissues etc.). 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, colleges, discharge from hospitals, animal houses). Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or micro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures). Category No. 4 Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps). Waste Category Type Treatment and

Disposal Option+ Incineration deep burial* Incineration deep burial* @ @ / /

Local autoclaving / micro waving / incineration @

Category No. 5 Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines).

Category No. 6 Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood). by Category No. 7 Solid Waste (Waste generated from disposal items Disinfection other than the sharps such a tubings, catheters, chemical treatment @ @ autoclaving / intravenous sets etc.). micro waving and mutilation/ shredding ## by Category No. 8 Liquid Waste (Waste generated from laboratory Disinfection and washing, cleaning, housekeeping and chemical treatment disinfecting activities). @ @ and discharge into drains
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Disinfection (chemical treatment @ @ / autoclaving / micro waving and mutilation / shredding ## Incineration @ / destruction and drugs disposal in secured landfills Local autoclaving / micro waving / incineration @

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Category No. 9 Incineration Ash (Ash from incineration of any bio-medical waste). CategoryNo.10 Chemical Waste (Chemicals used in production of biologicals, chemicals used in disinfection, as insecticides, etc.).

Disposal in municipal landfill Disinfection by chemical treatment @ @ and discharge into drains for liquids and secured land fill for solids

Note @ There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. *Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas. @@ Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection. ## Mutilation / shredding must be such so as to prevent un authorized reuse. + Options given above are based on available technologies. Occupier / operator wishing to use other state of the art technologies shall approach the Central Pollution Control Board to get the standards laid down to enable the prescribed authority to consider grant of authorization. Schedule II: Color Coding and Type of Container for sposal of Bio-Medical Waste Color Type of Waste Category Treatment options as per Coding Container Schedule I Yellow Plastic bag. Cat. 1, Cat. 2, and Incineration/deep burial Cat. 3, Cat. 6 Cat. 3, Cat.6, Autoclaving / Micro waving / Red Disinfected Chemical Treatment container / plastic Cat.7. bag Cat. 4, Cat. 7. Autoclaving / Micro waving / Blue / White Plastic bag / Chemical Treatment and Translucent puncture proof Destruction / shredding Container Black Plastic bag Cat. 5 and Cat. 9 Disposal in secured landfill and Cat. 10. (Solid) Notes: 1.Colour coding of waste categories with multiple treatment options as defined in Schedule I, shall be selected depending on treatment option chosen, which shall be as specified in Schedule I. 2.Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics. 3.Categories 8 and 10 (liquid) do not require containers / bags. 4.Category 3 if disinfected locally need not be put in containers / bags.

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Schedule III Label for Bio-Medical Waste Containers/ Bags
BIOHAZARD CYTOTOXIC

C
CYTOTOXIC CYTOTOXIQUE

HANDLE WITH CARE

Note: Label shall be non-washable and prominently visible. Questions 1. Name Acts and Rules which governs waste management. 2. Categorize the bio-medical waste as per Bio-Medical Waste (Management and Handling) Rules, 1998 and amendments. 3. How many colors of waste bags or bins have been mentioned in the Rule and for what purpose?

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3. Role of Doctors, Medical Superintendent and Administrators In Bio- Medical Waste Management
About this Module This module deals with the role of Doctors, Medical Superintendents and

Administrators of hospitals in panning and designing of Bio- Medical Waste Management. Unit wise generation of waste, its audit and minimization techniques, items and equipments required to manage the waste and their placement has been mentioned. Financial management as per methodology adopted for disposal is explained. Learning Objectives: • • • To enhance knowledge and skills on waste audit, waste minimization, financial management. To understand unit wise generation of waste. To know items required to manage waste and their placement in each unit.

Output: • The reader will be able to understand unit wise generation of waste, perform waste audit and waste minimization techniques and will be able to do financial management in bio-medical waste disposal. Dealing bio-medical waste in safe manner is the responsibility of all medical staff. Every person including Doctors and Medical Superintendents producing waste

items are responsible for ensuring its safe segregation at the point of generation itself. Bio-medical waste is poorly managed in many hospitals not only in India, worldwide. Identifying the causes and then supporting improvements in the system are key skills that doctors, medical superintendents and administrators of hospitals need to develop. Assess the waste handling and treatment system of bio-medical waste and its mandatory compliance
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with regulatory notifications. Estimate the amount of non-infectious and infectious waste, preferably category wise, generated in different wards or sections. Analyze the bio-medical waste management system, including policy, practice, storage, collection, transportation, treatment, disposal and compliance with the standards prescribed under the regulatory framework. In order to develop a model bio-medical waste management system in the hospital, create awareness among all the stakeholders about the importance of bio-medical waste management, related regulations and how to dispose off the waste. The doctors, Medical Superintendents and the Administrators should have ‘will’ to improve waste management from a poor standard of performance to a better one. To improve the performance, develop policy, plan, look for waste minimization options, provide the required materials for waste management and implement sustainable waste management system. Arrange for regular training for all the staff and organize refresher courses, monitor and over see bio-medical waste management system regularly. While monitoring care should be taken that it is necessary to ensure that each type of segregated waste are kept intact in separate specific containers and disposed off in separate specific ways, other wise medical staff will loose confidence in the benefit of waste segregation if all wastes are remixed in subsequent handling and disposal. Doctors, Superintendents and Administrators are responsible, have to play a vital role in planning, designing and implementing biomedical waste management system, reducing risk of disease transmission by taking appropriate measures, response to accidental spillage and financial management.

3.1 Planning and Designing of Bio- Medical Waste Management: All the medical staff should realize that it is part of their duty to tackle bio-medical waste management problems. To plan and design bio-medical waste management one should know how much and what type of waste is generated and from which unit. Is waste minimization possible if so in which unit and for what type of waste. What all items and equipments and their quantities are required for managing the waste. What type of disposal methodology is to be adopted to suit to their facility. Ascertain whether common bio-medical waste facility is available in the area or not. Forming a waste management committee will enhance the waste management practice. For planning and designing of bio-medical waste management, unit wise generation of waste, its audit and minimization, items and equipments required for managing the
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waste and its appropriate placement , defining route of movement of waste and finance management needs to be taken into consideration.

3.1.1 Unit Wise Generation of Bio- Medical Waste: Depending on the services offered by hospitals or health care establishments, there exist the type of facilities or units in the hospitals. Activities in each unit and number of units should be identified along with the generation of type of bio-medical waste expected. A preliminary study should be taken up before attempting to waste audit and its minimization. In general various types of units available in any hospitals are out patient, injection room, general ward, labour room, operation theater, intensive care unit, casualty or emergency , laboratory and pharmacy etc. Observe waste generation in each unit, segregate the waste as per rule at its generation place, weigh it daily for one week, aggregate it and then predict for monthly waste generation. If the segregation is not good then take the total weight of waste unit wise and 10 % to 25% will be the infectious waste. Depending on the activities performed in each unit, different types of waste is generated. The expected type of waste generated unit wise is as follows. Unit Out Patient Waste Generation Soiled Waste,(gauze, bandages etc.), Solid waste (Plastic) and Sharps Injection Room General Ward Labour Room Soiled Waste, Sharps and Solid waste Sharps waste, Solid waste and Soiled waste Body part (placenta etc.) ,Sharps waste, Solid waste and Soiled waste Operation Theater Intensive Care Unit Casualty/ Emergency Laboratory Body parts, Sharps waste, Solid waste and Soiled waste Sharps waste, Solid waste, Soiled waste Sharps waste, Solid waste and Soiled waste Sharps waste, Solid waste, Soiled waste, Biologicals (culture / media) Pharmacy Discarded medicines

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General Units in Hospitals

3.1.2 Waste Audit and Waste Minimization: After knowing the waste generation in all units in a hospital, perform waste audit and then minimize the generation of waste. This is one of the main step in planning and designing of bio-medical waste management. The audit will give the clear picture of what type of waste, how much and from where it is generated. This information will be helpful to opt for waste minimization, items and equipments required for segregation and treatment of waste and their placement in different units. To know how much and what type of waste is generated in each medical area, segregate the waste at the point of generation category wise in specific color codes as per BioMedical Waste (Management and Handling) Rules. The following steps will help in finding the waste generated quantity wise/ category wise and unit wise. • Ascertain how many medical areas produce bio-medical waste. List all the departments and study on its activities, production of waste and quantity. • Find the composition of the waste in each place. Segregate waste category wise, weigh

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it daily at least for one week and then average to monthly. The waste generated is not same in all the areas producing waste. • • Keenly look for waste minimization options in all the departments. Along with the solid waste generation assessment, liquid waste assessment is also necessary. Waste minimization benefits the waste producers. The costs for the purchase of goods, waste treatment and disposal are reduced and the liabilities associated with the disposal of waste are lessened. By implementing policies and practices such as purchasing restrictions to ensure the selection of methods or supplies that are less wasteful or generate less hazardous waste can lead to source reduction. Use such materials which can be recycled either on-site or off-site. Careful segregation (separation) of waste into the ten categories (solid and liquid) as per rule helps to minimize the quantities of hazardous / harmful waste. Careful management of stores will prevent the accumulation of large quantities of outdated chemicals or pharmaceuticals and limit the waste to the packaging (boxes, bottles, etc.) plus residues of the products remaining in the containers. These small amounts of chemical or pharmaceutical waste can be disposed of easily and relatively cheaply, whereas disposing of larger amounts requires costly and specialized treatment, which underlines the importance of waste minimization. Suppliers of chemicals and pharmaceuticals can also become responsible partners in waste minimization. The health service can encourage this by ordering only from suppliers who provide rapid delivery of small orders, who accept the return of unopened stock, and who offer offsite waste management facilities for hazardous wastes. Medical and other equipment used in a hospital may be reused provided that it is designed for the purpose and will withstand the sterilization process. Reusable items may include certain sharps, such as scalpels and hypodermic needles, syringes, glass bottles and containers, etc. After use, these should be collected separately from non reusable items, carefully washed (particularly in the case of hypodermic needles, in which infectious droplets could be trapped), and may then be sterilized. Although reuse of hypodermic needles is not recommended, it may be necessary in establishments that cannot afford disposable syringes and needles. Plastic syringes and catheters should not be thermally or chemically sterilized, they should be
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discarded for recycling industries. Long-term radionuclides conditioned as pins, needles, or seeds and used for radiotherapy may be reused after sterilization. Special measures must be applied in the case of potential or proven contamination with the causative agents of transmissible diseases. Care should be taken while opting for recycle or reuse of materials, medical and other equipments. Ensure that effective sterilization is attained. Sterilization can be achieved by thermal sterilization and chemical sterilization. Dry sterilization is an exposure to 160 °C for 120 minutes or 170 °C for 60 minutes in an oven. Wet sterilization is an exposure to saturated steam at 121°C for 30 minutes in an autoclave. Sterilization by ethylene oxide is done by exposing to an atmosphere saturated with it for 3–8 hours, at 50°– 60°C, in a reactor tank “gas-sterilizer”, the tank should be dry before injection of the ethylene oxide. Ethylene oxide is a very hazardous chemical, this process should therefore be undertaken only by highly trained and adequately protected technical personnel. Exposure to a glutaraldehyde solution for 30 minutes will sterilize the material and this process is safer for the operators than the use of ethylene oxide but is microbiologically less efficient. The effectiveness of thermal

sterilization may be checked by the Bacillus stearothermophilus test and for chemical sterilization by the Bacillus subtilis test.

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Units in Hospitals - Assessment of Waste Generation and Waste Audit

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3.1.3

Items and Equipments Required for Bio- Medical Waste

Management: The items and facilities required for managing the bio-medical waste are as follows. • • Protective aids like gloves, boots, over garment/ apron etc (for self protection against infection / injury). Colored bins and bags (yellow, red / blue & white puncture proof translucent, black and green). The Bio Hazard Label should be on all bins and bags except on black and green. The Cytotoxic Label should be on black bin and bag. The green color bin should be used for general waste which is like domestic waste ( for segregation of waste). • • • • • • Big blue or red container (for storing mutilated and disinfected plastic waste). Temporary central storage room (to keep all categories of waste after segregation before disposal). Trolley (to carry the waste to temporary central storage place). Needle cutter or Needle burner (for destroying injection needle). Scissors or knife (for destroying plastic waste). Incinerator where Common Bio-Medical waste Treatment Facility is not available (for incinerating waste, but having individual incinerator is discouraged). • Deep burial pit where population is less than 5,00,000 and in rural areas where Common Bio- Medical Waste Treatment Facility is not available (for burial of waste category 1 and 2 ). • • • • • • Sharp pit where Common Bio-Medical waste Treatment Facility is not available (for encapsulating disinfected mutilated sharps). Autoclave / Microwave (for disinfection). Sodium hypo Chlorite solution (for disinfection). Soap (to wash hands). Secured landfill Waste water treatment plant [ for chemical (liquid) and liquid (lab and washing etc.) waste]

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Items And Equipments Required For Bio-Medical Waste Management
.

Mask

Cap

Gloves

Boots or closed-toe Shoes

Over garment / Apron

Waste Segregation Bags and Bins

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Needle Cutter

Dedicated Trolley

Scissors and Disinfection Solution

Temporary Central Storage Room

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Deep Burial

Incinerator

Sharp Pit

Autoclave

Shredder

Waste Water Treatment Plant

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3.1.4 Placement of Required Items:

Waste will be generated depending on the activity of each individual unit. After ensuring the category and quantity of waste generation, required items to manage the bio-medical waste should be placed appropriately. In general the requirement of biomedical waste management items and its placement in each unit is as follows.

Unit Out Patient Injection Room General Ward Labor Room Operation Theater Intensive Care Unit Casualty/ Emergency Laboratory Pharmacy

Requirement and Placement in Units Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical. Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical. Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical. Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical. Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical. Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical. Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical. Yellow / red , blue and white puncture proof translucent bag & bin / container, needle cutter, scissor and disinfection chemical. Black bin or bag.

3.1.5 Designing the Movement of Bio- Medical Waste: The movement of waste should be such that after segregating the waste in specific color coded bags from individual units, it should be placed in dedicated trolleys to transport the waste to temporary storage place for onward transmission to final disposal place. The route should be pre defined, that is it should neither be through inter units nor from crowded places. Care should be taken that there should not be any spillages from bins / bags/ trolleys while movement or transporting the bio-medical waste.
Dedicated Trolley

3.1.6 Formation of Committee for Bio- Medical Waste Management: A committee to be constituted with representative members drawn from all the departments of hospital ( doctor/ specialist doctor, nurse, paramedical staff etc.)
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representative from each cadre and one from Common Bio-Medical Waste Treatment Facility if available. The committee should meet once in a week to discuss on continual improvement of bio-medical waste management and its minimization. The coordinator will be on turn wise basis for a period of one month from each

department who will be in charge for bio-medical waste management and allocates resources to support the system and ensures arrangements are in place to deal with emergencies and investigates any waste-related accidents. Heads of medical departments ensure that all their staff are aware of the waste segregation and local storage procedures, encourage good practices and enforce compliance. Matron or head nurse will be responsible for a continual training and also to new nurses and new recruits on good bio-medical waste handling practices. They should over see the handling of bio-medical waste by class IV employees, like there should not be any spillage along the way, should carry the waste through predefined routes etc., and ensures that supplies of consumable items are available (e.g. waste bags, etc.).

The committee should ensure technically feasible, environmentally sound, economically viable and socially acceptable system for management of bio-medical
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waste. The committee members should guide the staff in assessing the

waste

generation in hospital with frequent intervals of time, details of assessment should include minimum weight of bio-medical waste in each unit of hospital and composition of which to be determined by segregating the waste at the point of generation itself. A person to be designated to assess the level of scavenging if any or recycling taking place inside the hospital, along transportation routes and at final disposal sites , also determine social issues in relation to scavenging taking place. The committee to meet once in fortnight and review and analyze existing bio-medical waste generation, storage, collection and its frequency and disposal system with due regards to level of segregation. Review existing awareness on bio-medical waste management among all cadres of staff and prepare training need analysis (TNA) and organize programs. Committee should also over see the whether consent of operation has been obtained or not and other regulatory parameters.

3.2 Reducing Risk of Disease Transmission and Response to Accidents: Diseases can be transmitted from Doctors and Nurses to patient (due to unwashed hands, contaminated sharps, or improperly cleaned reusable equipment). Patient to Health Worker (due to being accidentally needle stick or sharps that have been used on patients. Also due to blood or body fluids accidentally splashing onto or coming in contact with broken skin). Health Worker to Family and Community (health workers with unclean hands or contaminated clothing or shoes can carry infection home to family members). Health Facility to Community (improper disposal of biomedical waste can lead to transmission of disease to community members due to needle stick injury or needle reuse, droplet infection, respiratory route, skin contacts etc). The risk can be reduced by following the guidelines mentioned below. • • Handle all sharps with care to minimize needle stick injury. Instruct the staff that while handling waste they should wear appropriate protective clothing, including a water resistant apron, thick gloves, boots or closed-toe shoes, and eye protection. • • • Do not allow to sort waste or open waste containers to sort waste. Educate the staff to wash hands after working with waste or infected material. Before and after examining patient or in between two patients wash hands.

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• • • • •

Be aware of procedures for treatment of injuries, cleaning of contaminated areas and reporting sharps injuries or accidents. Report sharps injuries to the appropriate personnel. Injuries should be followed up by post-exposure prevention treatment. Head nurse should maintain a log of all accidents. A full course of hepatitis B and tetanus vaccination will protect from the hepatitis -B virus and tetanus.

Health workers are at risk of accidental needle stick or other injuries from sharps. World health Organization (WHO) recommends the following steps after a needle stick injury. • • • • • • • • Wounds and skin sites exposed to blood or body fluids should be washed with soap and water; and mucous membranes flushed with water. If blood or body fluids have gotten into eyes, splash eyes with clean water. Immediately report the incident to a designated person or head nurse. Retain, if possible, the item involved in the incident, get details of its source for identification of possible infection. Seek additional medical attention in an emergency health department as soon as infection identified (based on body substance and severity of exposure). Get blood tests or other tests and counseling, if indicated. Record the incident. Investigate the incident and identify and implement remedial action to prevent similar incidents in the future. Health workers need to protect themselves by establishing a barrier between themselves and the infective agent. The type of protection needed depends on the worker’s activities. Protective clothing must be worn at all times when handling biomedical waste. It must be properly maintained and kept clean. The clothing should not be taken home, must remain at the health facility to avoid possible contamination of the community. Protective clothing includes: • Gloves-always wear gloves when contaminated items are handled. PunctureResistant gloves should be used when handling sharps containers or bags with unknown contents.

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Boots or closed-toe shoes- rubber boots or leather shoes provide extra protection to the feet from injury by sharps or heavy items that may accidentally fall. They must be kept clean. When possible, avoid wearing sandals or shoes made of soft materials.

• • •

Aprons- rubber or plastic aprons provide a protective, waterproof barrier to the body. Goggles- plastic goggles can protect the eyes from accidental splashes. Hand washing- Wash with soap and antiseptic detergent.
Protective Aids

The measures that could / should be taken in case of accidental spillages in hospitals is as follows. 1. Evacuate the contaminated area. 2. Decontaminate the eyes and skin of exposed personnel immediately. 3. Inform the designated person who should coordinate the necessary actions. 4. Determine the nature of the spill. 5. Evacuate all the people not involved in cleaning up.

Spillage

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6. Provide first aid and medical care to injured individuals. 7. Secure the area to prevent exposure of additional individuals. 8. Provide adequate protective clothing to personnel involved in cleaning-up. 9. Limit the spread of the spill. 10. Neutralize or disinfect the spilled or contaminated material if indicated. 11. Collect all spilled and contaminated material. Sharps should never be picked up by hand, brushes and pans or other suitable tools should be used. Spilled material and disposable contaminated items used for cleaning should be placed in the appropriate waste bags or containers. 12. Decontaminate or disinfect the area, wiping up with absorbent cloth. The decontamination should be carried out by working from the least to the most contaminated part, with a change of cloth at each stage. Dry cloths should be used in the case of liquid spillage, for spillages of solids, cloth impregnated with water (acidic, basic, or neutral as appropriate) should be used. 13. Rinse the area, and wipe dry with absorbent cloths. 14. Decontaminate or disinfect any tools that were used. 15. Remove protective clothing and decontaminate or disinfect it if necessary. 16. Seek medical attention if exposure to hazardous material has occurred during the operation. If the spillage of mercury occurs then collection of mercury spill and storage aspect is as follows. 1. Remove everyone from the area that has been contaminated with mercury. Keep the heat below 20°C and ventilate the area if possible. 2. Put on face mask in order to prevent breathing of mercury vapor. 3. Remove all jewelry from hands and wrists so that the mercury cannot combine (amalgamate) with the precious metals. 4. Appropriate personal protective equipment (rubber gloves, goggles / face shields and clothing) should be used while handling mercury. 5. Locate all mercury beads carefully. Cardboard sheets should be used to push the spilled beads of mercury together. Mercury should be placed carefully in a container with some water. 6. Never use a broom or a vacuum cleaner.

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7. It should not be swept down the drain and wherever possible, it should be disposed off at a hazardous waste facility or given to a mercury-based equipment manufacture. Collection of Mercury Beads

3.3

Financial Management:

According to the “polluter pays principle”, all organizations are financially liable for the safe management of any waste it generates. The costs of separate collection, appropriate packaging, and on-site handling are internal to the establishment and paid as labor and supplies costs. The costs of off-site transport, treatment, and final disposal are external and paid to the contractors who provide the service (common bio-medical waste treatment facilitator). Where common bio- medical waste treatment facility is not available, the costs of construction, operation, and maintenance of systems for managing the waste can represent a significant part of the overall budget of a hospital. They should be covered by a specific allotment from the hospital budget. Certain basic principles should always be respected in order to minimize these costs. Waste minimization, segregation, and recycling are recommended which can greatly reduce disposal costs. The benefits of producing less waste are evident, and segregation prevents the unnecessary treatment of general waste by the costly methods necessary for waste management. For government-owned hospitals, the government may use general revenues to pay the cost of the waste management system. For private organizations, they need to implement waste management system from their own resources. Since few years
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privatization of waste management system ( common bio-medical waste treatment facility) is gaining importance and it should be encouraged to reduce environmental pollution in the vicinity of hospitals. For cost estimation all hospitals need to establish accounting procedures to document the costs they incur in managing waste. Accurate record keeping and cost analysis must be undertaken which helps to reduce management cost. All the activities of bio-medical waste management should be observed with out compromise in its cost involved. The requirement of items and equipments and placement of these has been discussed in 3.4 and 3.5, hence depending on the waste management plan budget should be allocated. 3.3.1 Costs of Waste Management System Where Common bio- Medical Waste Treatment Facility is Not Available: An Initial capital investment is necessary for management of bio medical waste. Cost on the following items has to be taken into account. Plant and equipment ( sterilizer, shredder, incinerator / deep burial where population is less than 5000 population in rural areas), utility requirements (fuel, electricity, water, etc.), operation and

maintenance, consumables, incinerator building, waste storage room, offices, waste collection trucks, bins/containers / bags for transporting waste from hospitals to incinerator site, trolleys for collecting waste bags from wards, bag holders to be located at all sources of waste in hospitals, weighing machines for weighing waste bags, protective clothing, disinfecting solution, soap to wash hands and mutilating agents. The indirect operating costs involves training, replacement of parts, consumables, vehicle maintenance, uniforms and safety equipment, ash disposal, compliance monitoring of flue-gas emissions, project management and administrative costs for the organization responsible for the execution and long-term operation of the project. 3.3.2 Costs of Waste Management System Where Common bio- Medical Waste Treatment Facility is Available: When the common bio-medical waste treatment facility is available, the cost of colored bags / bins / containers, trolley for transporting the waste to temporary storage place, mutilating agents, protective clothing, disinfecting solution, soap to wash hands needs to be considered. The treatment like autoclave , shredding etc. will be taken

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care by common bio-medical waste treatment facility along with final disposal of waste.

Questions 1. How to perform waste audit? What is waste minimization? 2. Name protective aids. 3. What measures should be taken in case of accidental spillages in a hospital? 4. How mercury is to be picked up when there is spillage of mercury?

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4. Implementation of Bio- Medical Waste Management Plan

About this Module – This module explains the implementation of bio-medical waste management plan in hospitals where common bio-medical waste treatment facility is not available and or available, in primary health centers and in small hospitals situated in rural areas. Learning Objectives:
• • To understand the various steps involved in management of bio-medical waste in the absence of common bio-medical waste treatment facility. To understand the various steps involved in management of bio-medical waste in the presence of common bio-medical waste treatment facility.

• To get familiarized with management of bio-medical waste in primary health
centers and in small hospitals in the rural areas.

Output:

The readers will be able to implement bio-medical waste management plan
properly in their hospitals.

The bio-medical waste management is a crucial one which starts from point of generation and ends at point of disposal. Policy on bio-medical waste management needs to be evolved on the feasibility option and optimal sustainable treatment technologies. There are various options available for managing bio-medical waste and the selection of treatment and disposal depends on the availability and non availability of common bio-medical waste treatment facility, nature of hospital ( large scale or small scale) place where it is situated etc. The implementation plan for bio-medical waste management with various options is as follows.

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4.1 Bio- Medical Waste Management in Hospitals Where Common Bio- Medical Waste Treatment Facility is Not Available: The bio-medical waste management starts from the point of generation. Waste minimization options should be considered and adopted. After the waste is generated the immediate step is segregation followed by collection, storage, transportation, treatment and disposal. The path between the two points (cradle to grave) can be segmented schematically as • • • • Identification of areas of waste generation Categorization, quantification of waste and minimization Segregation, handling and storage Treatment, destruction and disposal

The detailed implementation of bio-medical waste management plan where common bio-medical waste treatment facility is not available is as follows. Identification of Areas of Waste Generation: To identify areas of waste generation, list out units available in the hospital and a survey of all the units will help to identify waste generation. In almost all the units (out patient, wards, operation theater, labour room, laboratories, intensive care units etc.), waste is generated, only difference will be in quantity and category.

Categorization, Quantification of Waste and Minimization: Categorize the waste according to Bio-Medical Waste (Management and Handling) Rules. The quantification will help in placing the bins / bags of appropriate size, quantity and at appropriate places as close to the source of waste generation. Waste minimization helps in reducing the burden of waste management in special way. Waste minimization practice should be adopted at source of generation ( reuse, recycle and reduction). Reuse of chemicals, medical equipments etc. translates into cost saving. Recycling of specific materials like disinfected and shredded plastic helps a secondary industry. Reduction in waste generation decreases waste disposal costs. All the categories of bio-medical waste have been mentioned in chapter two, quantification and waste minimization has been explained in chapter three. The ten categories of bio-medical waste mentioned above are as follows.
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• •

Category 1: Human Anatomical Waste (body parts, organs, human tissues etc.). Category 2: 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).

Category 3: Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or 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 biologicals, toxins, dishes and devices used for transfer of cultures).


Category 4: Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps).

• •

Category 5: Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines). Category 6: Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, beddings, other material contaminated with blood).

• • • •

Category 7: Solid Waste (Waste generated from disposable items other than the waste sharps such as tubings, catheters, intravenous sets etc.). Category 8: Liquid Waste (Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities). Category 9: Incineration Ash (Ash from incineration of any bio-medical waste). Category 10: Chemical Waste (Chemicals used in production of biologicals, chemicals used in disinfection, as insecticides, etc.).

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Categories of Bio-medical Waste

Category 1 : Human Anatomical Waste

Category 2: Animal Waste

Category 3: Micro & Biotech Waste

Category 4: Waste Sharp

Category 5: Discarded Medicine & Cytotoxic Drugs

Category 6: Soiled Waste

Category 7: Solid Waste

Category 8: Liquid Waste

Category 9: Incineration Ash

Category 10: Chemical Waste Solid and Liquid 36

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Segregation, Handling and Storage: Segregation is a very important factor in waste management system. Depending upon the treatment and disposal option for various categories of wastes, specific colored containers are required to segregate and store it at temporary central storage place till it is disposed off. The disposal should be with in 48 hours. The waste which goes for incinerator or deep burial, should be collected in yellow plastic bag or bin. The waste which is planed for autoclaving or

microwaving or chemical treatment and finally to find its way in secured landfill or for recycling, should be collected in red or blue bin or bag. The waste sharps such as needles, blades etc. which is for disinfection, destruction or shredding should be collected in white puncture proof translucent container, which will be encapsulated or can go for recycling as final disposal. The chemical waste (solid), out dated medicines and cytotoxic drugs which goes for disposal in secured land fill should be collected in black bin or bag with Cytotoxic label. All the bins and bags should have biohazard label except on black colored bin or bag on which cytotoxic label to be inserted. The details of segregation of waste into specific color coded bags or bins, as per treatment and disposal option planned is presented below. Maximizing segregation is very effective in reducing waste management costs, environmental impacts and also complexity of management.

Handling of waste needs attention. As soon as the waste is generated it should be segregated into specific color coded containers or bags. When these are 3/4th filled then it should be picked up from the neck and placed so that bags can be picked up by the neck again for further handling. While handling care should be taken to reduce the risk of needle prick injury and infection. No other forms of waste should be mixed with bio-medical waste. The waste should not be over loaded while transporting. The movement of waste in the wheeled trolleys, containers or carts should be through pre defined route within the hospital till it reaches central temporary storage place. These trolleys should not be used for any other purpose and need to be cleaned daily.

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Segregation of Waste in Specific Colored Bins Depending on Treatment and Disposal Technology

Yellow Plastic Bag – Non Chlorinated
Cat -1 Human Anatomical Waste , Cat -2 Animal Waste, Cat -3 Microbiology & Biotechnology Waste, Cat-6 Soiled Waste Treatment & Disposal- Incineration or Deep Burial

Blue Plastic Bag
Cat -7 Solid Waste Treatment & Disposal- Autoclaving or Microwave or Chemical Treatment and Destruction or Shredding- Recycling

White Translucent Puncture Proof Container
Cat – 4 Sharps Waste Treatment & Disposal- Autoclaving or Microwave or Chemical Treatment and Destruction or Shredding- Encapsulation on Secured Landfill

Red Disinfected container / plastic bag
Cat-3 Microbiology & Biotechnology Waste, Cat – 6 Soiled Waste, Cat-7 Solid Waste Treatment & Disposal- Autoclaving or Microwave or Chemical Treatment – Secured Landfill and Cat. 7 Recycle Black Plastic bag Cat-5 Discarded Medicine & Cytotoxic Drugs, Cat – 9 Incineration Ash Cat – 10 Chemical Waste (solid) Treatment & Disposal- Disposal in Secured Landfill Storage location for hospitals / health-care waste should be designated inside its premises. The waste in the bags or containers should be stored in central storage place in an area or room of a size appropriate to the quantities of waste produced and the frequency of collection. Recommendation for storage facilities with in the hospitals is as follows. • • The storage area should have an impermeable, hard-standing floor with good drainage; it should be easy to clean and disinfect. There should be a water supply for cleaning purposes.
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• • • • • • • •

The storage area should afford easy access for staff in charge of handling the waste. It should be possible to lock the store to prevent access by unauthorized persons. Easy access for waste-collection vehicles is essential. There should be protection from the sun. The storage area should be inaccessible for animals, insects, and birds. There should be good lighting and at least passive ventilation. The storage area should not be situated in the proximity of fresh food stores or food preparation areas. A supply of cleaning equipment, protective clothing, and waste bags or containers should be located conveniently close to the storage area.

Cytotoxic waste should be stored separately from other health-care waste in a designated secure location. Central Storage Place

Treatment, Destruction and Disposal: The various treatment, destruction and disposal methods for each category of waste as per bio-medical waste management and handling rules are mentioned below. Category 1 Human Anatomical Waste (human tissues, organs, body parts): As soon as it is segregated in yellow colored bin or bag, before 48 hours it should be incinerated or deep burial. The deep burial option is for towns where population is less than five lakh and in rural areas.

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Category 2 Animal Waste (animal tissues, organs, body parts, bleeding parts etc.): As soon as it is segregated in yellow colored bin or bag, before 48 hours it should be incinerated or deep burial. The deep burial option is for towns where population is less than five lakh and in rural areas. Category 3 Microbiology and Biotechnology Waste (waste from Lab, cultures, stocks or specimens human and animal cells etc.): As soon as it is segregated before 48 hours it should be incinerated or deep burial. The deep burial option is for towns where population is less than five lakh and in rural areas. Other option is disinfect and put it in secured landfill. Category 4 Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps): After the injection is administered the needles should be cut from the hub by a needle cutter, both the needle and the syringe become useless and can’t be reused. The cut needle gets segregated in the pot which is fixed to the needle cutter. The cut syringe goes in the plastic bucket with sieve, which has 1% sodium hypochlorite solution or any other equivalent chemical agent. Metal needle from the pot can be stored in the puncture proof translucent container having 1% sodium hypochlorite solution or any other equivalent chemical agent. It must be ensured that chemical treatment ensures disinfection. The disinfected needle can be encapsulated for disposal into municipal secured landfill or can be given to authorized metal recycler. If auto disabled syringes are provided it prevents the reuse of non sterile syringes as it self locks after single use. The waste syringes will follow the same route of management of sharps waste. Category 5 Discarded medicines and Cytotoxic drugs (waste comprising of outdated, contaminated and discarded medicines.): Either directly incinerate or after destruction put it in secured landfill.

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Category 6 Soiled waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, beddings, other material contaminated with blood.): Either incinerate or disinfect by autoclaving / microwaving and put it in secured landfill. Category 7 Solid waste (waste generated from disposable items other than waste sharps such as tubings, catheters, intravenous sets etc.): Destroy the plastic waste to ensure prevention of reuse and disinfect by keeping in 1% sodium hypochlorite solution or any other equivalent chemical agent. It must be ensured that chemical treatment ensures disinfection. If recycling of plastic waste is planned, care should be taken to give to authorized recycler only after disinfection and shredding. Category 8 Liquid waste (waste generated from laboratory and washing, cleaning, house-keeping and disinfection activities): The liquid waste generated from labs and washing, cleaning and house keeping need to be treated to the standards prescribed and flush in the drains. The standard for liquid waste is as follows. Standards for liquid waste: The effluent generated from the hospital should conform to the following limits: PH 63-9.0, Suspended solids - 100 mg/l, Oil and grease - 10 mg/l, BOD - 30 mg/l, COD 250 mg/l, Bio-assay test - 90% survival of fish after 96 hours in 100% effluent.

These limits are applicable to those, hospitals which are either connected with sewers without terminal sewage treatment plant or not connected to public sewers. For discharge into public sewers with terminal facilities, the general standards as notified under the Environment (Protection) Act, 1986 shall be applicable. Category 10 Chemical waste (chemical used in production of biological, chemicals used in disinfection, as insecticides, etc.): Chemical waste that is chemical used in production of biological, chemicals used in
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disinfection, as insecticides, etc. should be treated by using 1% sodium hypochlorite solution or any other equivalent chemical agent. It must be ensured that chemical treatment ensures disinfection. After treatment discharge into drains for liquids and secured landfill for solid. As per the guidelines issued by Central Pollution Control Board disposal of biomedical waste by individual hospitals is discouraged and common bio-medical waste treatment facilities are encouraged. Pictorial representation of detail implementation plan of action with various technological options category wise is presented below. Provision of Common Bio-Medical Waste Treatment Facility (CBMWTF) if in

course of time comes up has also been considered and provided in the implementation plan.

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 1: HUMAN ANATOMICAL WASTE

BODY PART

YELLOW BIN

CENTRAL STORAGE PLACE

INCINERATIOR

DEEP BURIAL

CBMWTF
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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 2: ANIMAL WASTE

EXPERIMENTAL ANIMAL

YELLOW BIN

INCINERATIOR

DEEP BURIAL

CBMWTF

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 3: SOILED WASTE

MICROBIOLOGY AND BIOTECHNOLOGY WASTE

RED BIN

CENTRAL STORAGE PLACE

AUTOCLAVE

CBMWTF

MUNICIPAL SECURED LANDFILL

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 4: WASTE SHARP

WASTE SHARPS

MUTILATION

DISINFECTION

CENTRAL STORAGE

METAL RECYCLER CBMWTF SHARP PIT

GLASS WASTE

BLUE BIN

GLASS RECYCLER

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 5: DISCARDED DRUGS AND MEDICINES

DISCARDED DRUGS AND MEDICINES BLACK BIN

SEPARATE STORAGE PLACE

MUNICIPAL SECURED LANDFILL

CBMWTF

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 6: SOILED WASTE

SOLIED WASTE YELLOW BIN

CENTRAL STORAGE

INCINERATOR

DEEP BURIAL

CBMWTF

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 6: SOILED WASTE

SOILED WASTE RED BIN

CENTRAL STORAGE

AUTOCLAVE

CBMWTF

MUNICIPAL SECURED LANDFILL
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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 7: SOLID WASTE ( PLASTIC)

PLASTIC WASTE

MUTILATE

CENTRAL STORAGE PLACE

CBMWTF

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 7: SOLID WASTE

PLASTIC WASTE

MUTILATE

RED BIN

CENTRAL STORAGE AUTOCLAVE

PLASTIC RECYCLER

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 8: LIQUID WASTE )

LIQUID WASTE

EFFLUENT TREATMENT PLANT

DISCHARGE INTO DRAIN

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 9: INCINERATOR ASH

INCINERATOR ASH

BLACK BIN

MUNICIPAL SECURED LANDFILL

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 10: CHEMICAL WASTE

BLACK BIN CHEMICAL SOLID WASTE

MUNICIPAL SECURED LANDFILL

CBMWTF

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 10: CHEMICAL WASTE

CHEMICAL LIQUID WASTE

EFFLUENT TREATMENT PLANT

DISCARGE INTO DRAIN
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The details of category wise treatment and disposal methods are presented in the following table. Category Wise Treatment and Disposal Category 1.Human anatomical waste 2.Animal Waste 3.Microbiology and Biotechnology Waste 4.Waste Sharps Treatment and Disposal No treatment required, incineration@/ deep burial* No treatment required, incineration @/ deep burial* No treatment required, incineration @ Autoclaving / microwaving, municipal secured landfill Mutilating / shredding / disinfection and encapsulation municipal secured landfill Mutilating / shredding / disinfection and nonencapsulation, possibility of recycling shall be explored No treatment required, incineration @ Destruction, municipal secured landfill No treatment required, incineration @ Autoclaving / microwaving, municipal secured land fill Disinfection @@ / autoclaving / microwaving / mutilating / shredding##, recycling or municipal secured land fill Disinfection by chemical treatment @@ ,discharge into drain No treatment required, disposal in municipal land fill / Secured Landfill Chemical treatment @@ ,discharge into drains for liquids and secured landfill for solids.

5.Discarded medicines and Cytotoxic 6.Soiled waste (Cotton dressings etc.) 7.Solid waste ( Tubing , Catheters etc) 8.Liquid waste 9.Incineration ash 10. Chemical waste (Chemicals used in production of biological, Chemicals used in disinfection etc.)

@@ Chemical treatment using at least 1 % hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection. # # Mutilation/shredding must be such so as to prevent unauthorized re-use @ There will be no chemical pre-treatment before incineration. Chlorinated plastic shall not be incinerated. * Deep burial shall not be an opinion available only in towns with population less than five lakhs and rural areas. Occupier / Operator wishing to use other state of the art technologies shall approach the Central Pollution Control Board to get the standards laid down to enable the prescribed authority to consider grant of authorization.
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4.2 Bio- Medical Waste Management in Hospitals Where Common BioMedical Waste Treatment Facility is Available: As mentioned above at 4.1 that bio-medical waste management covers • • • • Identification of areas of waste generation Categorization, quantification of waste and minimization Segregation, handling and storage Treatment, destruction and disposal

The bio-medical waste management in hospitals where common bio-medical waste treatment facility is available, the above first three steps should be followed exactly as mentioned at 4.1 (identification of areas of waste generation, categorization, quantification of waste and minimization and segregation, handling and storage). After having kept in temporary central storage place , the waste should be collected with in 48 hours by common bio-medical waste treatment facility for final treatment, destruction and disposal. The detailed prerequisites for giving to common biomedical waste treatment facility for final treatment, destruction and disposal, category wise is as follows. Category 1 Human Anatomical Waste (human tissues, organs, body parts): After segregation the waste in yellow colored bin or bag it should be kept in temporary central storage place from where it is to be collected by common biomedical waste treatment facility with in 48 hours. The waste does not need any treatment before handing over to common bio-medical waste treatment facility. Category 2 Animal Waste (animal tissues, organs, body parts, bleeding parts etc.): After segregation the waste in yellow colored bin or bag it should be kept in temporary central storage place from where it is to be collected by common biomedical waste treatment facility with in 48 hours. The waste does not need any treatment before handing over to common bio-medical waste treatment facility.

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Category 3 Microbiology and Biotechnology Waste (waste from Lab, cultures, stocks or specimens human and animal cells etc.): After segregation the waste in yellow or red colored bin or bag it should be kept in temporary central storage place from where it is to be collected by common biomedical waste treatment facility with in 48 hours. The waste does not need any treatment before handing over to common bio-medical waste treatment facility.

Category 4 Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps): After mutilation keep the sharps in white translucent puncture proof bin having 1% sodium hypochlorite solution for disinfection . When it occupies 3/4th of the bin, hand over to the common bio medical waste treatment facility.

Category 5 Discarded medicines and Cytotoxic drugs (waste comprising of outdated, contaminated and discarded medicines.): Keep the waste in black bag or bin having cytotoxic label on it and hand over to the common bio medical waste treatment facility. The waste does not need any treatment before handing over to common bio-medical waste treatment facility.

Category 6 Soiled waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, beddings, other material contaminated with blood.): After segregation the waste in yellow or red colored bin or bag it should be kept in temporary central storage place to be collected by common bio-medical waste treatment facility with in 48 hours. The waste does not need any treatment before handing over to common bio-medical waste treatment facility. Category 7 Solid waste (waste generated from disposable items other than waste sharps such as tubings, catheters, intravenous sets etc.): As soon as the solid plastic waste is generated, mutilate, disinfect, keep in red or blue colored bin or bag and hand over to common bio-medical waste treatment facility.
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Category 8 Liquid waste (waste generated from laboratory and washing, cleaning, house-keeping and disinfection activities): The liquid waste generated from labs and washing, cleaning and house keeping need to be treated to the standards prescribed and flush in the drains. The standard for liquid waste is as follows. Standards for liquid waste: The effluent generated from the hospital should conform to the following limits: PH 63-9.0, Suspended solids - 100 mg/l, Oil and grease - 10 mg/l, BOD - 30 mg/l, COD 250 mg/l, Bio-assay test - 90% survival of fish after 96 hours in 100% effluent.

These limits are applicable to those, hospitals which are either connected with sewers without terminal sewage treatment plant or not connected to public sewers. For discharge into public sewers with terminal facilities, the general standards as notified under the Environment (Protection) Act, 1986 shall be applicable. Category 10 Chemical waste (chemical used in production of biological, chemicals used in disinfection, as insecticides, etc.): Chemical waste that is chemical used in production of biological, chemicals used in disinfection, as insecticides, etc. should be treated by using 1% sodium hypochlorite solution or any other equivalent chemical agent. It must be ensured that chemical treatment ensures disinfection. After treatment discharge into drains for liquids and for solid chemical waste, hand over to common bio medical waste treatment facility.

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 1: HUMAN ANATOMICAL WASTE

BODY PART

YELLOW BIN

COMMON BIO-MEDICAL WASTE TREATMENT FACILITY

CENTRAL STORAGE PLACE

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 2: ANIMAL WASTE

EXPERIMENTAL ANIMAL

YELLOW BIN

COMMON BIO-MEDICAL WASTE TREATMENT FACILITY

CENTRAL STORAGE PLACE

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 3: MICROBIOLOGY & BIOTECHNOLOGY

MICROBIOLOGY & BIOTECHNOLOGY WASTE

YELLOW BIN

RED BIN

CENTRAL STORAGE PLACE

COMMON BIO-MEDICAL WASTE TREATMENT FACILITY

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 4: WASTE SHARPS

WASTE SHARPS

MUTILATION & DISINFECTION

COMMON BIO-MEDICAL WASTE TREATMENT FACILITY

CENTRAL STORAGE PLACE

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 5: DISCARDED DRUGS AND MEDICINES

DISCARDED MEDICINES &CYTOTOXIC DRUGS BLACK BIN

SEPARATE STORAGE PLACE

COMMON BIO-MEDICAL WASTE TREATMENT FACILITY

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 6: SOILED WASTE

SOILED WASTE

CENTRAL STORAGE PLACE

COMMON BIO-MEDICAL WASTE TREATMENT FACILITY

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 7: SOLID WASTE

SOLID WASTE (PLASTIC)

MUTILATION

COMMON BIO-MEDICAL WASTE TREATMENT FACILITY

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BIO-MEDICAL WASTE MANAGEMNET CATEGORY 8: LIQUID WASTE AND CATEGORY 10: CHEMICAL LIQUID WASTE

LIQUID WASTE

EFFLUENT TREATMENT PLANT

DISCARGE INTO DRAIN

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BIO-MEDICAL WASTE MANAGEMENT CATEGORY 10: CHEMICAL WASTE

CHEMICAL WASTE (SOLID)

BLACK BIN

COMMON BIO-MEDICAL WASTE TREATMENT FACILITY

CENTRAL STORAGE PLACE

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4.3 Bio- Medical Waste Management in Primary Health Centers and Small Scale Units in Rural Areas In Primary Health Centers (PHCs) and in small scale hospitals the quantity of waste generated is too small because the activities taken up in these hospitals are restricted to certain extent. All categories of waste is not generated as the activity of medical treatment is minimum. In general the categories of waste generated are category 1: human anatomical waste, category 4: sharps waste, category 5: discarded medicines, category 6: soiled waste, category 7: solid waste (plastic ), category 8: liquid waste, category 10: chemical waste and general domestic waste. As the PHCs are scattered small units and placed in far away from the common bio-medical waste treatment facility, it is not feasible for the facilitator to collect waste from these places with in 48 hours. Same case with small scale hospitals in the rural areas. In absence of such facility / arrangement, a cost effective management plan for bio-medical waste disposal is designed. Segregation, treatment and disposal are the main steps in managing bio-medical waste. Category wise segregation, treatment and disposal for the above mentioned categories is as follows. Category 1 (Human anatomical waste) and Category 6 (soiled waste), should be segregated immediately as soon as the waste is generated in yellow color bin or bag. No treatment is required for these two types of wastes. With in 48 hours it should be buried in deep burial pit Category 4 (waste sharps ), as soon as the injection is administered the needle should be mutilated and store in white puncture proof translucent container having 1 % sodium hypo chlorite solution or any other equivalent chemical. When it is 3/4th filled the mutilated needles to be poured in sharp pit and lock the lid of the pit.

Category 7 (solid plastic waste), mutilate the plastic waste and disinfect with 1 % sodium hypo chlorite solution or any other equivalent chemical. After ensuring disinfection store in a big blue bin for sale to authorized recyclers. Category 5 (discarded drugs ), put it in secured landfill or hand over to the District Medical Health Officer (DM&HO) for onward transmission to secured landfill.

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Category 8( liquid waste), liquid waste generated from laboratory ,washing, cleaning and house keeping need to be treated to the standards prescribed and flush in the drains. The standard for liquid waste is as follows. Standards for liquid waste: The effluent generated from the hospital should conform to the following limits: PH 63-9.0, Suspended solids - 100 mg/l, Oil and grease - 10 mg/l, BOD - 30 mg/l, COD 250 mg/l, Bio-assay test - 90% survival of fish after 96 hours in 100% effluent.

These limits are applicable to those, hospitals which are either connected with sewers without terminal sewage treatment plant or not connected to public sewers. For discharge into public sewers with terminal facilities, the general standards as notified under the Environment (Protection) Act, 1986 shall be applicable. Category 10 (chemical waste), chemical used in production of biological, chemicals used in disinfection, as insecticides, etc. should be treated by using 1% sodium hypochlorite solution or any other equivalent chemical agent. It must be ensured that chemical treatment ensures disinfection. After treatment discharge into drains for liquids and for solid chemical waste put it in secured landfill or hand over to DM & HO for onward transmission to secured landfill. The implementation plan for bio-medical waste management for Primary Health Centers (PHCs) and small scale hospitals in rural areas is presented in the following table.

Implementation Plan for Bio- Medical Waste Management in Primary Health Centers and Small Scale Hospitals in Rural Areas
Cate gory 1 Waste Human anatomical waste Requirement 1.Deep burial pit 2.Yellow bin / bag Treatment and Disposal Post disposal Treatment is not required. If deep Handover the yellow bin or bag to burial then transporter of CBMWTF or Deep cover it with burial. soil and lime. If deep burial then cover it with soil and lime.

6

Soiled Waste

1.Deep burial pit Treatment is not required. 2.Yellow or Red bin / Handover the yellow bin or bag to bag transporter of CBMWTF or Deep burial.

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4

Waste Sharps 1.Needle cutter/ burner 2.Sharp pit 3.White puncture proof translucent container 4. 1% Sodium Hypo Chlorite solution Solid Waste 1.Scissors / knife for (Plastic) mutilation 2. 1% Sodium Hypo Chlorite solution 3.Blue bin / bag

Mutilate the needle & disinfection. Handover the container to transporter of CBMWTF Or Dispose mutilated needles in sharp pit

If it is put in sharp pit then close the sharp pit and lock it.

7

5

Discarded Medicines

Secured Landfill

Mutilate the plastics & disinfection. Handover the bin or bag to transporter of CBMWTF Or Store in bigger container and dispose by sale to authorized recycling industry. Treatment is not required. Secured landfill or hand over to DM&HO Treat the waste and disinfect. For liquid waste allow it to reach the drain and for solid waste put it in black bin and then in to secured landfill or hand over to DM&HO No treatment required, put in secured land fill.

8 & Liquid Waste Disinfection Chemical 10 & Chemical Waste

6

General Green bin Waste like paper, eatables etc.

The detail of deep burial pit and sharp pit are as follows Deep Burial Pit: • A pit or trench should be dug out about 2 meters deep. It should be half filled with waste, then covered with lime within 50 cm of the surface, before filling the rest of pit with soil. • • • • • • It must be ensure that animals do not have any access to burial site. Covers of galvanized iron / wire meshes may be used. On each occasion, when wastes are added to pit, layer of 10 cms of soil shall be added to cover the wastes. Burial must be performed under close and dedicated supervision. Pits should be distant from habitation so as to ensure that no contamination of ground water occurs. The area should not be prone to flooding or erosion. The institution shall maintain record of all the pits for deep burial Fencing of the deep burial pit has to be maintained
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• •

The deep burial site should be relatively impermeable and no shallow well should be close to the site. The location of the deep burial site will be authorized by the prescribed authorities.

Sharp Pit: A pit is to be dug according to the requirement of the hospital. All the sides of the pit should be plastered with cement. A cylindrical metal pipe of 4 inches diameter or more is fixed at the ceiling of the pit. The opening of the metal pipe should have locking facility. The sharps are deposited in this pit through the pipe from the puncture proof translucent container after mutilating. Questions 1. Name the categories of bio-medical waste and mention color coded bins or bags for their segregation? 2. Which categories of waste should be mutilated? 3. Does the waste needs any treatment before incineration?

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5. Do’s & Don’ts
About this Module This module contains specific information on Dos and Don’t s while managing biomedical waste. This will highlight on the activities or action to be performed or not during bio-medical waste management.

Learning Objectives:
• To understand do and not to do actions during bio-medical waste management.

Output:

The reader will be able to understand performance of various actions during biomedical waste management, reason out adoption of various technologies for segregation, store, transport, treat and dispose the bio-medical waste category wise.

Do’s 1. Generate waste when it is essential. 2. Segregate waste as soon as it is generated into specified categories of waste. 3. Collect the waste in specific color coded covered bins having bio hazard logo. 4. Put the body parts and animal waste in yellow container. 5. Soiled waste to go into yellow or red container. 6. As soon as the solid waste (plastic waste) is generated mutilate it so that it can not be reused again and put in blue or red container. 7. Destroy needle by using needle cutter or needle burner. 8. Keep the needles in puncture proof, translucent container having 1% sodium hypochlorite solution and put the plastic syringe in blue or red container. 9. The cytotoxic drugs or discarded medicine to be placed in black container having cytotoxic logo on it. 10. Clean the bins regularly with soap and water and disinfect the bins regularly. 11. Collect the domestic waste/eatables, wrappers, fruit peels, papers etc. in green bin.
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12. Adopt waste minimization practice. 13. Carry / transport the waste in closed containers. 14. Use dedicated waste collection bins / trolleys / wheel barrows for transporting waste. 15. Transport waste through a pre- defined route within the Hospital. 16. Mutilate the needle soon after injection. 17. Mutilate plastic waste (solid waste) as soon as it is generated. 18. Disinfect needle and solid waste (plastic) after mutilation. 19. Dispose body parts in yellow bin and handover to Common Bio Medical Waste Treatment Facility for incineration. 20. Before handing over to CBMWTF for disposal, wastes sharps should be kept in white translucent bin filled with disinfectant solution. 21. All liquid chemical waste should be drained out in to drains only after chemical treatment. Don’ts 1. Do not generate waste unnecessary for e.g. avoid injection by prescribing oral medicines. 2. Never mix infectious and non- infectious waste 3. Never mix chlorinated wastes with such wastes those which have designated for incineration. 4. Never overfill the bins. 5. Never store waste beyond 48 hrs. 6. There should not be any spillage on the way of transport. 7. Avoid transport of waste through crowded areas. Do not throw infectious waste into general waste without any pre- treatment and mutilation. 8. Don’t dispose the body part into deep burial where population is above 5lakh. 9. Don’t dispose the solid waste (plastic) and sharp waste without mutilation and disinfection.

Question:

1. Which photographs (1 to 27) presented below reflects right action and which is wrong action? Give reasons?

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1

2

3

4

5

6

7

8

9

10

11

12

13

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15 14

16

17

18

19

20

21

22

23 24 25

26

27
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Annexure - 1
Bio- Medical Waste (Management and Handling) Rules, 1998 and Amendments S.O. 630 (E).-Whereas a notification in exercise of the powers conferred by Sections 6, 8 and 25 of the Environment (Protection) Act, 1986 (29 of 1986) was published in the Gazette vide S.O. 746 (E) dated 16 October, 1997 inviting objections from the public within 60 days from the date of the publication of the said notification on the Bio-Medical Waste (Management and Handling) Rules, 1998 and whereas all objections received were duly considered.. Now, therefore, in exercise of the powers conferred by section 6, 8 and 25 of the Environment (Protection) Act, 1986 the Central Government hereby notifies the rules for the management and handling of bio-medical waste. 1. SHORT TITLE AND COMMENCEMENT: (1) These rules may be called the Bio-Medical Waste (Management and Handling)(Second Amendment ) Rules, 2003. (2) They shall come into force on the date of their publication in the official Gazette. 2. APPLICATION: These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio medical waste in any form. 3. DEFINITIONS: In these rules unless the context otherwise requires (1) (2) (3 "Act" means the Environment (Protection) Act, 1986 (29 of 1986); "Animal House" means a place where animals are reared/kept for experiments or testing purposes; "Authorisation" means permission granted by the prescribed authority for the generation, collection, reception, storage, transportation, treatment, disposal and/or any other form of handling of bio-medical waste in accordance with these rules and any guidelines issued by the Central Government. "Authorised person" means an occupier or operator authorised by the prescribed authority to generate, collect, receive, store, transport, treat, dispose and/or handle bio-medical waste in accordance with these rules and any guidelines issued by the Central Government; "Bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activitiescategories mentioned in Schedule I; "Biologicals" means any preparation made from organisms or microorganisms or product of metabolism and biochemical reactions intended for use in the diagnosis, immunisation or the treatment of human beings or animals or in research activities pertaining thereto;
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(4)

(5)

(6)

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(7)

(8)

(9)

(10)

"Bio-medical waste treatment facility" means any facility wherein treatment. disposal of bio-medical waste or processes incidental to Such treatment or disposal is carried out and includes common treatment facilities. 7 (a) “Form” means Form appended to these Rules "Occupier" in relation to any institution generating bio-medical waste, which includes a hospital, nursing home, clinic dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called, means a person who has control over that institution and/or its premises; "Operator of a bio-medical waste facility" means a person who owns or controls or operates a facility for the collection, reception, storage, transport, treatment, disposal or any other form of handling of biomedical waste; "Schedule" means schedule appended to these rules;

4. DUTY OF OCCUPIER: It shall be the duty of every occupier of an institution generating bio-medical waste which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment. 5. TREATMENT AND DISPOSAL (1) Bio-medical waste shall be treated and disposed of in accordance with Schedule I, and in compliance with the standards prescribed in Schedule V. Every occupier, where required, shall set up in accordance with the time- schedule in Schedule VI, requisite bio-medical waste treatment facilities like incinerator, autoclave, microwave system for the treatment of waste, or, ensure requisite treatment of waste at a common waste treatment facility or any other waste treatment facility.

(2)

6. SEGREGATION, PACKAGING, TRANSPORTATION AND STORAGE (1) (2) Bio-medical waste shall not be mixed with other wastes. Bio-medical waste shall be segregated into containers/bags at the point of generation in accordance with Schedule II prior to its storage, transportation, treatment and disposal. The containers shall be labeled according to Schedule III. If a container is transported from the premises where bio-medical waste is generated to any waste treatment facility outside the premises, the container shall, apart from the label prescribed in Schedule III, also carry information prescribed in Schedule IV. Notwithstanding anything contained in the Motor Vehicles Act, 1988, or rules there under, untreated biomedical waste shall be transported only in such vehicle as may be authorised for the purpose by the competent authority as specified by the government.
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(3)

(4)

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(5)

(6)

No untreated bio-medical waste shall be kept stored beyond a period of 48 hours Provided that if for any reason it becomes necessary to store the waste beyond such period, the authorised person must take permission of the prescribed authority and take measures to ensure that the waste does not adversely affect human health and the environment. The Municipal body of the area shall continue to pick up and transport segregated non bio-medical solid waste generated in hospitals and nursing homes, as well as duly treated bio-medical wastes for disposal at municipal dump site.

7. PRESCRIBED AUTHORITY (1) The prescribed authority for enforcement of the provisions of these rules shall be the State Pollution Control Boards in respect of States and the Pollution Control Committees in respect of the Union territories and all pending cases with a prescribed authority appointed earlier shall stand transferred to the concerned State Pollution Control Board, or as the case may be, the Pollution Control Committees. (1A). The prescribed authority for enforcement of the provisions of these rules in respect of all health care establishments including hospitals, nursing homes, clinics, dispensaries, veterinary institutions, Animal houses, pathological laboratories and blood banks of the Armed Forces under the Ministry of Defence shall be the Director General, Armed Forces Medical Services. (2) (3) (4) The prescribed authority for the State or Union Territory shall be appointed within one month of the coming into force of these rules. The prescribed authority shall function under the supervision and control of the respective Government of the State or Union Territory. The prescribed authority shall on receipt of Form 1 make such enquiry as it deems fit and if it is satisfied that the applicant possesses the necessary capacity to handle bio-medical waste in accordance with these rules, grant or renew an authorisation as the case may be. An authorisation shall be granted for a period of three years, including an initial trial period of one year from the date of issue. Thereafter, an application shall be made by the occupier/operator for renewal. All such subsequent authorisation shall be for a period of three years. A provisional authorisation will be granted for the trial period, to enable the occupier/operator to demonstrate the capacity of the facility. The prescribed authority may after giving reasonable opportunity of being heard to the applicant and for reasons thereof to be recorded in writing refuse to grant or renew authorisation. Every application for authorisation shall be disposed of by the prescribed authority within ninety days from the date of receipt of the application. The prescribed authority may cancel or suspend an authorisation, if for reasons, to be recorded in writing, the occupier/operator has failed to comply with any provision of the Act or these rules : Provided that no authorisation shall be cancelled or suspended without living a reasonable opportunity to the occupier/operator of being heard.
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(5)

(6)

(7)

(8)

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8. AUTHORISATION (1) Every occupier of an institution generating, collecting, receiving, storing, transporting, treating, disposing and/or handling bio-medical waste in any other manner, except such occupier of clinics, dispensaries, pathological laboratories, blood banks providing treatment/service to less than 1000 (one thousand) patients per month, shall make an application in Form 1 to the prescribed authority for grant of authorisation. Every operator of a bio-medical waste facility shall make an application in Form 1 to the prescribed authority for grant of authorisation. Every application in Form 1 for grant of authorisation shall be accompanied by a fee as may be prescribed by the Government of the State or Union Territory. The authorization to operate a facility shall be issued in Form IV, subject to conditions laid therein and such other condition, as the prescribed authority, may consider it necessary.

(2)

(3)

(4)

9. ADVISORY COMMITTEE (1) The Government of every State/Union Territory shall constitute an advisory committee. The committee will include experts in the field of medical and health, animal husbandry and veterinary sciences, environmental management, municipal administration, and any other related department or organisation including non-governmental organisations. As and when required, the committee shall advise the Government of the State/Union Territory and the prescribed authority bout matters related to the implementation of these rules. (2) Not with standing anything contained in sub-rule ( 1) , the Ministry of Defence shall constitute in that Ministry, an Advisory Committee consisting of the following in respect of all health care establishments including hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories and blood banks of the Armed Forces under the Ministry of Defence , to advise the Director General, Armed Forces Medical Services and the Ministry of Defence in matters relating to implementation of these rules, namely:(1) Additional Director General of Armed Forces Medical Services

…….. Chairman

(2)

A representative of the Ministry of Defence not below the rank of Deputy Secretary, to be nominated by that Ministry

…….. Member

(3)

A representative of the Ministry of Environment and Forests not below the rank of Deputy Secretary To be nominated by that Ministry ...…….. Member
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(4)

A representative of the Indian Society of Hospitals Waste Management, Pune

….….... Member”

9A. Monitoring of implementation of the rules in Armed Forces Health Care Establishments (1) The Central Pollution Control Board shall monitor the implementation of these rules in respect of all the Armed Forces health care establishments under the Ministry of Defence. (2) After giving prior notice to the Director General Armed Forces Medical Services, the Central Pollution Control Board along with one or more representatives of the Advisory committee constituted under sub-rule (2) of rule 9 may, if it considers it necessary, inspect any Armed Forces health are establishments. 10. ANNUAL REPORT Every occupier/operator shall submit an annual report to the prescribed authority in Form 11 by 31 January every year, to include information about the categories and quantities of bio-medical wastes handled during the preceding year. The prescribed authority shall send this information in a compiled form to the Central Pollution Control Board by 31 March every year. 11. MAINTENANCE OF RECORDS (1) Every authorised person shall maintain records related to the generation, collect ' ion, reception, storage, transportation, treatment, disposal and/or any form of handling of bio-medical waste in accordance with these rules and any guidelines issued. All records shall be subject to inspection and verification by the prescribedauthority at any time.

(2)

12. ACCIDENT REPORTING When any accident occurs at any institution or facility or any other site where biomedical waste is handled or during transportation of such waste, the authorised person shall report the accident in Form Ill to the prescribed authority forthwith. 13. APPEAL (1) Any person aggrieved by an order made by the prescribed authority under these rules may, within thirty days from the date on which the order is communicated to him, prefer an appeal in form V to such authority as the Government of State/Union Territory may think fit to constitute: Provided that the authority may entertain the appeal after the expiry of the said period of thirty days if it is satisfied that the appellant was prevented by sufficient cause from filing the appeal in time.
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(2) Any person aggrieved by an order of the Director General, Armed Forces Medical Services under these rules may, within thirty days from the date on which the order is communicated to him prefer an appeal to the Central Government in the Ministry of Environment and Forests.”. 14. COMMON DISPOSAL/INCINERATION SITES. Without prejudice to rule 5 of these rules, the Municipal Corporations, Municipal Boards or Urban Local Bodies, as the case may be, shall be responsible for providing suitable common disposal/incineration sites for the biomedical wastes generated in the area under their jurisdiction and in areas outside the jurisdiction of any municipal body, it shall be the responsibility of the occupier generating bio-medical waste/operator of a bio-medical waste treatment facility to arrange for suitable sites individually or in association, so as to comply with the provisions of these rules SCHEDULE I (See Rule 5) Waste Category Category No. 1 Human Anatomical Waste (body parts, organs, human tissues etc.). 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, colleges, discharge from hospitals, animal houses). Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or micro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures). Category No. 4 Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps). Waste Category Type Treatment and

Disposal Option+ Incineration deep burial* Incineration deep burial* @ @ / /

Local autoclaving / micro waving / incineration @

Category No. 5 Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines). Category No. 6 Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material

Disinfection (chemical treatment @ @ / autoclaving / micro waving and mutilation / shredding ## Incineration @ / destruction and drugs disposal in secured landfills Local autoclaving / micro waving / incineration @
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contaminated with blood). by Category No. 7 Solid Waste (Waste generated from disposal items Disinfection other than the sharps such a tubings, catheters, chemical treatment @ @ autoclaving / intravenous sets etc.). micro waving and mutilation/ shredding ## by Category No. 8 Liquid Waste (Waste generated from laboratory Disinfection and washing, cleaning, housekeeping and chemical treatment disinfecting activities). @ @ and discharge into drains in Category No. 9 Incineration Ash (Ash from incineration of any Disposal bio-medical waste). municipal landfill by CategoryNo.10 Chemical Waste (Chemicals used in production of Disinfection biologicals, chemicals used in disinfection, as chemical treatment @ @ and discharge insecticides, etc.). into drains for liquids and secured land fill for solids Note @ There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. *Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas. @@ Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection ## Mutilation / shredding must be such so as to prevent un authorized reuse. + Options given above are based on available technologies. Occupier / operator wishing to use other state of the art technologies shall approach the Central Pollution Control Board to get the standards laid down to enable the prescribed authority to consider grant of authorization.

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SCHEDULE-II (See Rule 6) COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTES

Color Coding Yellow Red

Type of Container Plastic bag.

Waste Category Cat. 1, Cat. 2, and Cat. 3, Cat. 6 Cat. 3, Cat.6, Cat.7.

Treatment options as per Schedule I Incineration/deep burial Autoclaving / Micro waving / Chemical Treatment Autoclaving / Micro waving / Chemical Treatment and Destruction / shredding Disposal in secured landfill

Disinfected container / plastic bag Blue / White Plastic bag / Translucent puncture proof Container Black Plastic bag

Cat. 4, Cat. 7.

Cat. 5 and Cat. 9 and Cat. 10. (Solid)

Note: 1. Colour coding of waste categories with multiple treatment options as defined in Schedule I, shall be selected depending on treatment option chosen, which shall be as specified in Schedule I 2. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics 3. Categories 8 and 10 (liquid) do not require containers / bags. 4. Category 3 if disinfected locally need not be put in containers / bags.

SCHEDULE-III (See Rule 6) Label for Bio Medical Waste Containers/ Bags BIOHAZARDS

C
CYTOTOXIC CYTOTOXIQUE

HANDLE WITH CARE Note : Lable shall be non-washable and prominently visible.

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SCHEDULE IV (see Rule 6) LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS/BAGS Day ............ Month .............. Year ........... Date of generation ................... Waste category No ........ Waste class 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 V (see Rule 5 and Schedule 1) STANDARDS FOR TREATMENT AND DISPOSAL OF BIO-MEDICAL WASTES STANDARDS FOR INCINERATORS: All incinerators shall meet the following operating and emission standards A. Operating Standards 1. Combustion efficiency (CE) shall be at least 99.00%. 2. The Combustion efficiency is computed as follows: %C02 C.E. = ------------ X 100 %C02 + % CO 3. The temperature of the primary chamber shall be 800 ± 50 deg. C°. 4. The secondary chamber gas residence time shall be at least I (one) second at 1050 ± 50 C°, with minimum 3% Oxygen in the stack gas. B. Emission Standards Parameters Concentration mg/Nm3 at (12% CO2 correction)

(1) Particulate matter 150 (2) Nitrogen Oxides 450 (3) HCI 50 (4) Minimum stack height shall be 30 metres above ground (5) Volatile organic compounds in ash shall not be more than 0.01%

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Note : • Suitably designed pollution control devices should be installed/retrofitted with the incinerator to achieve the above emission limits, if necessary. • Wastes to be incinerated shall not be chemically treated with any chlorinated disinfectants. Chlorinated plastics shall not be incinerated. • Toxic metals in incineration ash shall be limited within the regulatory quantities as defined under the Hazardous Waste (Management and Handling Rules,) 1989. • Only low sulphur fuel like L.D.0dLS.H.S.1Diesel shall be used as fuel in the incinerator. STANDARDS FOR WASTE AUTOCLAVING: The autoclave should be dedicated for the purposes of disinfecting and treating biomedical waste, (I) When operating a gravity flow autoclave, medical waste shall be subjected to: (i) a temperature of not less than 121 C' and pressure of 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes; or (ii) a temperature of not less than 135 C° and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes; or (iii) a temperature of not less than 149 C° and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes. (II) When operating a vacuum autoclave, medical waste shall be subjected to a minimum of one pre-vacuum pulse to purge the autoclave of all air. The waste shall be subjected to the following: (i) a temperature of not less than 121 C° and pressure of 15 psi per an autoclave residence time of not less than 45 minutes; or (ii) a temperature of not less than 135 C° and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes; (III) Medical waste shall not be considered properly treated unless the time, temperature and pressure indicators indicate that the required time, temperature and pressure were reached during the autoclave process. If for any reasons, time temperature or pressure indicator indicates that the required temperature, pressure or residence time was not reached, the entire load of medical waste must be autoclaved again until the proper temperature, pressure and residence time were achieved. (IV) Recording of operational parameters Each autoclave shall have graphic or computer recording devices which will automatically and continuously monitor and record dates, time of day, load identification number and operating parameters throughout the entire length of the autoclave cycle. (V) Validation test Spore testing : The autoclave should completely and consistently kill the approved biological
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indicator at the maximum design capacity of each autoclave unit. Biological indicator for autoclave shall be Bacillus stearothermophilus spores using vials or spore Strips; with at least 1X104 spores per milliliter. Under no circumstances will an autoclave have minimum operating parameters less than a residence time of 30 minutes, regardless of temperature and pressure, a temperature less than 121 C° or a pressure less than 15 psi. VI) Routine Test A chemical indicator strip/tape the changes colour when a certain temperature is reached can be used to verify that a specific temperature has been achieved. It may be necessary to use more than one strip over the waste package at different location to ensure that the inner content of the package has been adequately autoclaved STANDARD FOR LIQUID WASTE: The effluent generated from the hospital should conform to the following limits PARAMETERS PH Susponded solids Oil and grease BOD COD Bioassay test effluent. PERMISSIBLE LIMITS 63-9.0 100 mg/l 10 mg/l 30 mg/l 250 mg/l 90% survival of fish after 96 hours in 100%

These limits are applicable to those, hospitals, which are either connected with sewers without terminal sewage treatment plant or not connected to public sewers. For discharge into public sewers with terminal facilities, the general standards as notified under the Environment (Protection) Act, 1986 shall be applicable. STANDAR DS OF MICROWAVING 1 Microwave treatment shall not be used for cytotoxic, hazardous or radioactive wastes, contaminated animal car cases, body parts and large metal items. 2. The microwave system shall comply with the efficacy test/routine tests and a Performance guarantee may be provided by the supplier before operation of the limit. 3. The microwave should completely and consistently kill the bacteria and other pathogenic organisms that is ensured by approved biological indicator at the maximum design capacity of each microwave unit. Biological indicators for microwave shall be Bacillus Subtilis spores using vials or spore strips with at least 1 x 101 spores per milliliter. STANDARDS FOR DEEP BURIAL 1. A pit or trench should he dug about 2 meters deep. It should be half filled with waste, then covered with lime within 50 cm of the surface, before filling the rest of the pit with soil.

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2. It must be ensured that animals do not have any access to burial sites. Covers of galvanised iron/wire meshes may be used. 3. On each occasion, when wastes are added to the pit, a layer of 10 em of soil shall be added to cover the wastes. 4. Burial must be performed under close and dedicated supervision. 5. The deep burial site should be relatively impermeable and no shallow well should be close to the site. 6. The pits should be distant from habitation, so as to ensure that no contamination occurs of any surface water or ground water. The area should not be prone to flooding or erosion. 7. The location of the deep burial site will be authorised by the prescribed authority. 8. The institution shall maintain a record of all pits for deep burial. SCHEDULE VI (see Rule 5) SCHEDULE FOR WASTE TREATMENT FACILITIES LIKE INCINERATOR/ AUTOCLAVE / MICROWAVE SYSTEM A. Hospitals and nursing homes in towns with by 30th June,2000 or earlier population of 30 lakhs and above Hospitals and nursing homes in towns with population of below 30 lakhs (a) With 500 beds and above by 30th June, 2000 or earlier (b) With 200 beds and above but less than 500 beds by 31st December, 2000 or earlier (c) With 50 beds and above but less than by 31st December, 2001 or earlier 200 beds (d) With less than 50 beds by 31st December, 2002 or earlier All other institutions generating bio- medical waste not included in by 31st December, 2002 or earlier A and B above

B.

C.

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FORM I (see rule 8) [APPLICATION FOR AUTHORISATION /RENEARL OF AUTHORISATION] (To be submitted in duplicate.) To The Prescribed Authority (Name of the State Govt / UT Administration) Address. 1. Particulars of Applicant (i) Name of the Applicant (In block letters & in full) (ii) Name of the Institution: Address: Tele No., Fax No. Telex No. 2. Activity for which authorisation is sought: (i) Generation (ii) Collection (iii) Reception (iv) Storage (v) Transportation (vi) Treatment (vii) Disposal (viii) Any other form of handling 3. 4. Please state whether applying for fresh authorisation or for renewal: (In case of renewal previous authorisation-number and date) (i) Address of the institution handling bio-medical wastes: (ii) Address of the place of the treatment facility: (iii) Address of the place of disposal of the waste: (i) Mode of transportation (in any) of bio-medical waste: (ii) Mode(s) of treatment: Brief description of method of treatment and disposal (attach details): (i) Category (see Schedule 1) of waste to be handled (ii) Quantity of waste (category-wise) to be handled per month

5.

6. 7.

8. Declaration I do hereby declare that the statements made and information given above are true to the best of my knowledge and belief and that I have not concealed any information. I do also hereby undertake to provide any further information sought by the prescribed authority in relation to these rules and to fulfill any conditions stipulated by the prescribed authority. Date : Place : Signature of the Applicant Designation of the Applicant
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Environment Protection Training and Research Institute (EPTRI)

FORM II (see rule 10) ANNUALREPORT (To be submitted to the prescribed authority by 31 January every year). 1 . Particulars of the applicant: (i) Name of the authorised person (occupier/operator): (ii) Name of the institution: Address Tel. No Telex No. Fax No. 2. Categories of waste generated and quantity on a monthly average basis: 3. Brief details of the treatment facility: In case of off-site facility: (i) Name of the operator (ii) Name and address of the facility: Tel. No., Telex No., Fax No. 4. Category-wise quantity of waste treated: 5. Mode of treatment with details: 6. Any other information: 7.Certified that the above report is for the period from..……………………………….....… Date ............................... Place.............................. Signature ................................. Designation.............................

FORM III (see Rule 12) ACCIDENT REPORTING 1. Date and time of accident: 2. Sequence of events leading to accident 3. The waste involved in accident: 4. Assessment of the effects of the accidents on human health and the environment,. 5. Emergency measures taken 6. Steps taken to alleviate the effects of accidents 7. Steps taken to prevent the recurrence of such an accident ………………………… Date ............................... Place.............................. Signature ........................................... Designation..........................................

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References:

1. Bio Medical Waste (Management and Handling) Rules, 1998 and amendments 2. Guidelines for Common Bio-medical Waste Treatment Facility by Central Pollution Control Board 3. Health Care Waste Management (HCWM) by WHO / Annette Pruess, E. Giroult, P. Rushbrook 4. http://www.scribd.com/doc/14034406/BioMedical-WasteManagement? autodown=doc 5. Training Manual- Training for workers in the management of sharp waste, version 1, October 2005 by USAID and PATH- www.nursingworld.org/occupational 6. Bio Medical Waste Management: An infra structural survey of hospitals By Lt. Col. S.K.m.Rao et al 7. Shaner, H. et al. (1993) An Ounce of Prevention: Waste Reduction Strategies for Health Care Facilities. American Society for Healthcare Environmental Services. Chicago, IL. A Resource Kit for Pollution Prevention in Health Care. 8. www.nursingworld.org/occupational environmental American nurses association, safe needle safe life 2008 study of nurses views on work place safety and needle stick injury. 9. Safe Management of Waste From Health Care Activities 10. http://www.all creatures.org/wlalw/rat-01-jpg 11. British Journal of Industrial Medicine 1987- Occupational Hazards in Hospitals: Accident, Radiation, Exposure to Noxious Chemicals, Drugs Addiction and Psychic Problems and Assualt by J J Guestal 12. Preparation of National Health Care Waste Management Plans in Sub-Saharan Countries- UNEP- SBC and WHO 13. National Health Care Waste Management Plan – Kingdom of Lesotho 14. Infection Prevention and Waste Management for Merrygold Health NetworkParticipants Manual 2008- Supported by USAID,SIFPSA and Implemented by HLFPPT

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