` Dissertation Titled BIOMEDICAL WASTE MANAGEMENT & HANDLING

Submitted in fulfillment of the requirements of the degree of

Bachelor of Technology (Civil Engineering)

By Ranjit Bongane (081010107) Prashant Jawale (081010121) Jatann Khona (081010031) Kiran Rathod (081010151) Dhwani Thakkar (081011061) 2012

Prof. Sameer Sayyad Guide

Civil Enginnering Veermata Jijabai Technological Institute

Mumbai 400 019 2012

` STATEMENT OF THE CANDIDATE I declare that this written submission represents my ideas in my own words and where others ideas or words have been included, I have adequately cited and referenced the original sources.

I also declare that I have adhered to all principles of academic honesty and integrity and have not misrepresented or fabricated or falsified any ideas/ data/ facts/ source in my submission.

I understand that any violation of the above will be cause for disciplinary action by the Institute and can also evoke penal action from the sources which have thus not been properly cited or from whom proper permission has not been taken when needed.

Jatann Khona 081010031 Date:

` APPROVAL SHEET CERTIFICATE This is to certify that Jatann Khona, a student of Bachelor of Technology Civil Engineering, has completed the dissertation entitled, Biomedical Waste Management & Handling to our satisfaction.

Prof. Sameer Sayyad Guide

Prof. Vinay Topkar Head, Civil Engineering Department

Co-Guide

Director, VJTI

CERTIFICATE The dissertation, Biomedical Waste Management & Handling submitted by Jatann Khona, is found to be satisfactory and is approved for the Degree of Bachelor of Technology, Civil Engineering.

Contents
1. Introduction ............................................................................................................................ 1 2. Hazards Associated With Poor Health Care Waste Management .......................................... 5 3. Rules and Regulations Governing the Disposal of Biomedical Wastes ................................. 7 4. Common Processes Adopted for Handling & Management of BMW ................................. 10 4.1 Identification: .................................................................................................................. 10 4.2 Segregation: .................................................................................................................... 10 4.3 Containment: ................................................................................................................... 15 4.4 Labeling: ......................................................................................................................... 15 4.5 Storage: ........................................................................................................................... 16 4.6 Transportation: ................................................................................................................ 17 4.7 Treatment: ....................................................................................................................... 18 4.6.1 Biosafety: ................................................................................................................. 18 4.6.2 Concept of Disinfection and Sterilization: ............................................................... 18 4.6.3 Types of Treatments: ................................................................................................ 18 4.7 Advanced Methods of Biomedical Waste Treatment: .................................................... 23 4.7.1 Steam Sterilization: .................................................................................................. 23 4.7.2 Hydrogen Peroxide Gas Plasma: .............................................................................. 25 4.7.3 Plasma Pyrolysis: ..................................................................................................... 26 4.8 Disposal according to colour coding: ............................................................................. 26 4.8.1 Disposal of Yellow Bags: ......................................................................................... 26 4.8.2 Disposal of Red Bags: .............................................................................................. 27 4.8.3 Disposal of Blue Bags: ............................................................................................. 28 4.8.4 Disposal of Black Bags: ........................................................................................... 29 4.9 Safety Measures for the Medical and Para-medical staff: .............................................. 30 5. Scenario in Mumbai ............................................................................................................. 31 6. Case Study: Tata Memorial Hospital.................................................................................... 35 6.1 Segregation: .................................................................................................................... 36

` 6.2 Collection: ....................................................................................................................... 36 6.3 Storage: ........................................................................................................................... 37 6.4 Treatment: ....................................................................................................................... 37 6.4.1 Loading: ................................................................................................................... 38 6.4.2 Sterilization: ............................................................................................................. 39 6.4.3 De-pressurization & De-hydration: .......................................................................... 39 6.4.4 Unloading: ................................................................................................................ 40 6.4.5 Shredding: ................................................................................................................ 40 6.5 Disposal: ......................................................................................................................... 40 6.6 Waste Auditing: .............................................................................................................. 40 6.7 Testing: ........................................................................................................................... 42 6.8 Management at Tata Memorial Hospital: ....................................................................... 43 6.9 Safety Measures: ............................................................................................................. 43 6.10 Maintenance: ................................................................................................................. 44 7. Case Study: Kalyan Dombivali Municipal Corporation CBMWTF .................................... 45 7.1 Highlights of the Case Study: ......................................................................................... 46 7.2 The Process: .................................................................................................................... 46 7.3 Sources and quantity of bio-medical waste treated at plant: .......................................... 47 7.4 Storage Facility: .............................................................................................................. 47 7.5 Facilities available for workers: ...................................................................................... 47 7.6 Treatment Facilities Available at PRS Enterprises: ........................................................ 48 7.6.1 Incineration: ............................................................................................................. 48 7.6.2 Autoclave: ................................................................................................................ 50 7.6.3 Shredder: .................................................................................................................. 52 7.6.4 Accessories: .............................................................................................................. 53 7.7 Disposal: ......................................................................................................................... 54 8. Case Study of Biomedical Waste Treatment Plant at Taloja................................................ 54 8.1 Sources and quantity of bio-medical waste collected at plant: ....................................... 55 8.2 Procedure for Biomedical Waste Transportation and Storage: ...................................... 55 8.3 Storage facilities: ............................................................................................................ 56 8.4 Process: ........................................................................................................................... 56

` 8.5 Service Cost of the Facility: ............................................................................................ 57 8.6 Facilities available for workers: ...................................................................................... 57 8.7 Facilities available at this treatment plant: ..................................................................... 57 8.7.1 Incineration: ............................................................................................................. 57 8.7.2 Autoclave: ................................................................................................................ 59 8.7.3 Shredder: .................................................................................................................. 61 8.7.4 Accessories at plant: ................................................................................................. 62 8.8 Disposal: ......................................................................................................................... 62 8.8.2 Deep Burial: ............................................................................................................. 63 8.9 Highlights of the Case Study: ......................................................................................... 64

` LIST OF TABLE

` LIST OF FIGUREs

1. Introduction
Biomedical Waste (BMW) can be broadly defined as waste generated in the health care industry as a result of diagnosis, treatment and immunization of humans or animals. With the ever-growing population and the increasing need to cater to the large number of people, the number of health care facilities to provide medical aid is continuously growing. As a result the amount of biomedical waste generated is also continuously increasing. Proper handling and disposal of biomedical waste is of paramount importance because of its infectious and hazardous characteristics. Biomedical Waste is a subset of bio-hazardous waste. Bio-hazardous waste includes any waste item that is contaminated with a biological material that has an infectious disease transmission risk or an environmental release risk. Specifically, biomedical waste includes the following: Human blood, blood products, body fluids, tissues, organs and anatomical parts. Waste saturated with human blood, blood products, or body fluids. Discarded "sharps" used in patient, animal, or in medical or biomedical research laboratories. Cultures and stocks of infectious agents and devices used to transfer, inoculate, and mix cultures. Discarded clinical specimens and the associated containers. Discarded biologicals and waste from the production of biological. Recombinant DNA waste. Carcasses, body parts, bedding, or other waste generated by research facilities from animals containing organisms or agents not usual to the normal animal environment and which are pathogenic or hazardous to humans. Cytotoxic drugs not identified as hazardous waste. Material that has come in contact with and has no more than a trace of cytotoxic agents.

It should be noted that the term biomedical waste does not include the following:

[Type text]

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` Urine or feces. Wastewater treatment sludge and septage. Water samples used for and waste from routine screening. Animal carcasses, anatomical parts, bedding, or other waste generated in the routine handling of animals containing organisms or agents normally found in the animal environment. Band-Aids and other blood spotted items.

Locally, regionally, and internationally, there are many pressures being brought to bear on organizations in order to ensure that they are operating in an environmentally sound manner. They are being asked to do this while at the same time having to ensure that they provide their services/products in an economically efficient manner. Particularly in recent years, governmental and external agencies are requiring that all types of enterprises including health care institutions actively plan and ensure that they minimize the harm they cause to the environment.

Improper disposal of biomedical waste can result in the following: Organic portion ferments and attracts fly breeding. Injuries from sharps to all categories of health care personnel and waste handlers. Increase risk of infections to medical, nursing and other hospital staff. Injuries from sharps to health workers and waste handlers. Poor infection control can lead to serious infections in patients particularly HIV, Hepatitis B & C. Increase in risk associated with hazardous chemicals and drugs being handled by persons handling wastes. Poor waste management encourages unscrupulous persons to recycle disposables and disposed drugs for repacking and reselling. Development of resistant strains of microorganisms.

` The quantum of waste that is generated in India is estimated to be 1-2 kg per bed per day in a hospital and 600 gm per day per bed in a general practitioners clinic. E.g. a 100-bedded hospital will generate 100 200 kg of hospital waste/day. It is estimated that only 5 10% of this comprises of hazardous/infectious waste (5 10kgs/day).

Waste management is generally not given the importance it deserves, because the intrinsic value of the waste materials as an object of further utility has not been recognized. The net result is that one tries to cut the expenditure involved in waste disposal by small allotment of resources. A clean atmosphere and good housekeeping have a direct effect on the health, comfort and morale of patients, visitors and staff personnel alike. Cleanliness radiates a cheer and a well-kept organisation would give the public a feeling of confidence.

Thus the thesis aims to study in detail the methods of the collection, segregation, treatment and disposal of the biomedical waste generated in Mumbai and surrounding area in accordance with Biomedical Waste Management and Handling Rules, 2003 by the Ministry of Environment and Forests. With the case studies of the Tata Memorial hospital, common biomedical waste treatment facility at Kalyan and common biomedical waste treatment facility at Taloja; the students aim to closely examine and analyze the collection, storage, treatment and disposal of biomedical waste generated at/ brought to the site. Questionnaires, personal visits, interviews and secondary source of information will be the methodologies used. The scope of the thesis is to: Know the present scenario of handling and management of BMW in the city of Mumbai. Know the rules, regulations and general practices followed while handling and managing the BMW. Identify the items of waste generated in the health care facilities coming into the waste stream.

Ascertain generation of both infectious and general waste per bed per day for the health care unit visited / ascertain the amount of waste entering the treatment site. Study various methods of collection and separation of BMW from the hospital/at the site. Study in detail the various methods of treatment of BMW. To study the technicalities of the process and make conclusions or suggestions if required. Study the disposal of the waste after the treatment. Study advanced methods of treatment of biomedical waste.

2. Hazards Associated With Poor Health Care Waste Management

Proper handling and disposal of biomedical waste is of paramount importance because of its infectious and hazardous characteristics. Improper disposal can result in lot of ill effects / accidents / hazards to the humans or the environment associated with the waste. Some of them are mentioned below: Injuries from sharps to all categories of health care personnel and waste handlers. Poor infection control can lead to serious infections in patients particularly HIV, Hepatitis B & C. Poor waste management encourages unscrupulous persons to recycle disposables and disposed drugs for repacking and reselling. Development of resistant strains of microorganisms.

A hospital produces many types of waste material. In addition to the waste that is similar to the waste produced in resident buildings, hospitals generate pathological waste e.g.: blood soaked dressings, carcasses and similar waste. These waste materials must be suitably disposed of immediately lest they purify, emit foul smells, act as a source of infection and disease, and become a public health hazard.

Hospital waste is highly hazardous due to infectious and toxic characteristics. Inadequate waste management practices for infectious waste will cause environmental pollution, unpleasant smell, growth and multiplication of insects, rodents and worms and may lead to the transmission of communicable diseases such as gastro-enteric infections, HIV, Hepatitis B virus, AIDS and other agents associated with blood borne diseases to rag pickers and waste workers because unknowingly they rummage through all kinds of toxic substances while trying to salvage items which they can sell for reuse. Therefore, the disposal of healthcare wastes and their potential health impact are considered to be important public health issues.

` Persons at Risk of the Hazards of Medical Procedures Depending on the type of procedures, the persons at risk and mode of transmission in some common medical procedures are as given in Table 2.1. Table 2.1: Persons at risk of the Hazards from Biomedical Waste Procedure Person at risk Mode of Transmission

Collection of blood samples

Patient, health worker

Contaminated needle, gloves, skin puncture by needle or container, Contamination of hands by blood

Transfer of specimens (within Laboratory personnel laboratory)

Contamination of exterior of specimen container, Broken container, Splash of specimen

HIV serology and virology

Laboratory personnel

Skin

puncture,

splash

of

specimen, Broken specimen container, Perforated gloves Cleaning and Maintenance Laboratory Supporting staff Personnel Skin puncture or

contamination, Splashes, Contaminated work surface

Waste Disposal

Laboratory Personnel Support Contact Staff Transport worker waste

with

contaminated

Puncture wounds and cuts Shipment of specimens Transport Postal worker worker Broker or leaking specimen, containers and packages

3. Rules and Regulations Governing the Disposal of Biomedical Wastes

The Government of India has promulgated the Biomedical Waste (Management and Handling) Rules 2003. They are applicable to all persons who generate, collect, receive, store, transport, treat, dispose or handle biomedical wastes. This includes hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories and blood banks. After the notification of the Bio-medical Waste (Handling and Management) Rules, 1998, these establishments are slowly streamlining the process of waste segregation, collection, treatment and disposal.

These guidelines apply to, but are not limited to, the following facilities: Hospitals Nursing homes and extended care facilities Public health units Physicians offices/clinics Dentists offices/clinics Veterinarians offices/clinics Veterinary research, teaching and health care facilities Medical research and teaching establishments Health care teaching establishments Clinical testing or research laboratories Facilities involved in the production or testing of vaccines Mortuaries and funeral homes Coroners offices Nursing offices Blood banks and blood collection centers

It is mandatory for such institutions to: Set up biomedical waste treatment facilities like incinerators, autoclave and microwave systems for treatment of the wastes or make proper arrangements for the treatment of the wastes. Make an application to the concerned authorities for grant of authorization.

` Submit a report regarding information about the categories and quantities of biomedical wastes handled during the preceding year by 31 Jan every year. Maintain records about the generation, collection, reception, storage, transportation, treatment, disposal and/or any form of handling bio medical waste. Report immediately any accident to the prescribed authority.

Other Agencies Regulating different aspects of BMW are:

Occupational Safety & Health Administration (OSHA) regulates medical waste exposure to personnel in the workplace. Department of Transportation regulates medical waste transportation. Food and Drug Administration (FDA) regulates medical devices such as sharps containers which are designed to safely contain used needles, scalpels or other sharps. Nuclear Regulatory Commission regulates some types of radioactive medical waste. US Postal Service (USPS) regulates medical waste in the postal system. The federal Environmental Protection Agency (EPA) has regulations governing emissions from Hospital/Medical/Infectious Waste Incinerators as well as

requirements under the Federal. Insecticide, Fungicide and Rodenticide Act (FIFRA) for medical waste treatment technologies that use chemicals for treating the waste.

Responsibilities of departments dealing with BMW:

A. Principal Investigators (PI) and/or Supervisors: Individual laboratory principal investigators or department managers/supervisors are responsible for developing Standard Operating Procedures (SOPs) for identifying, segregating, and decontaminating infectious waste prior to disposal. These individuals are also responsible for ensuring that these SOPs are followed and that their staff is adequately trained to handle biohazardous materials/infectious waste.

B. Custodial Services: Custodial Services or Environmental Services, where appropriate, is responsible for transporting treated and properly packaged infectious and sharps waste to the appropriate disposal area.

` C. Property and Transport Services: Property and Transport Services is responsible for developing and maintaining disposal contracts for sharps waste, infectious waste and treated infectious waste, and are responsible for all communication with contracted vendor services. They also keep waste characterization profile forms current with Public Health.

D. Infectious/Biomedical Waste Contractors: Any contractor hauling tainted or untreated infectious/biomedical waste is responsible for being in full compliance with all local, state, and federal regulations regarding infectious/biomedical waste. The Contractor is also responsible for providing University infectious/biomedical waste generators with appropriate packaging materials, packing guidance, and copies of all required manifests in order to comply with appropriate Department of Transportation (DOT) regulations..

4. Common Processes Adopted for Handling & Management of BMW

4.1 Identification:
Individual principal investigators and/or departmental managers/supervisors are responsible for identifying the infectious/biomedical waste generated by their activity and segregating it into the appropriate waste stream.

4.2 Segregation:
The biomedical waste contains many things in it, and they should be classified according to their disposal methods, which will reduce time for further treatment and will be easy to transport to suitable site or place. They are classified and segregated as:

A. Sharps:
Sharps are deposited in red leak proof, rigid, puncture-resistant, durable plastic containers (sharps boxes). These containers are labeled with the biohazard symbol (red in color) and equipped with a tight-fitting lid for use during handling and transport. Re-usable sharps are safely segregated and contained in leak proof, rigid, puncture-resistant containers while waiting cleaning, decontamination, and sterilization before re-use.

B. Liquid Infectious/Biomedical Wastes:

Liquid infectious/biomedical waste is segregated and contained in leak proof, rigid containers. These containers are labeled with the biohazard symbol and the word "Biohazard." Approved chemical decontamination agent decontaminates liquid waste at the site. If transport is required before decontamination, transport through public hallways is kept to a minimum. The primary container must be placed within a secondary leak proof, rigid container (e.g., pail, box, or bin) during any transport. This secondary container must be labeled with the biohazard symbol and the words biohazardous waste or words that clearly denote the presence of infectious/biomedical

` waste. The outer container is either protected from contamination by a disposable liner, which is replaced when the biohazardous waste is removed.

The effluent generated from the hospital should conform to the limits defined in Table 4.1.

Table 4.1 Effluent standards from hospitals Parameteres PH Suspended solids Oil and grease BOD COD Bio-assay test Permissible Limits 6.3-9.0 100mg/l 10 mg/l 30 mg/l 250 mg/l 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 should be applicable.

C. Solid Infectious/Biomedical Waste:

Solid infectious/biomedical waste is segregated and contained in red or orange disposable, leak proof bags having enough strength to prevent ripping, tearing, breaking, or bursting under normal use. These red or orange bags are marked with the biohazard symbol and the word "Biohazard." Waste contained inside biohazard bags is stored and transported within leakproof outer secondary containers. This container must be labeled with the biohazard symbol and the words biohazardous waste.

D. Animal Waste and Carcasses:

Animal carcasses exposed to pathogens requiring bio-containment and Infectious Waste Management, all non-human primate carcasses are segregated from other waste and contained in red or orange biohazard bags. The biohazard bags are placed within labeled leak proof

` outer containers for handling and stored in designated freezers or refrigerators until packaged for shipment to an off-site incinerator.

E. Human Pathological Wastes:

Human pathological waste is segregated from other waste and contained in a biohazard bag. This material is returned directly to the Department of Biological Structure for cremation.

F. Human Pathological Wastes:

All specimens requiring gross or microscopic evaluation should be sent to HMC Pathology. Any solid tissue removed during a surgical procedure which is not sent to Pathology for examination, should be collected in a biohazard bag and taken to the HMC Operating Room (OR) pathological waste discard station. It should take place as close as possible to where the waste is generated.

Table 4.2 Categories of Biomedical Waste Category Treatment & Disposal Waste Category

Cat. No. 1

Incineration /deep burial

Human Anatomical Waste (human tissues, organs, body parts)

Cat. No. 2

Incineration /deep burial

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)

` Cat. No. 3

Local autoclaving/ micro waving/ incineration

Microbiology & Biotechnology waste (wastes from laboratory cultures, stocks or specimens of micro-organisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biological, toxins, dishes and devices used for transfer of cultures)

Cat. No. 4

Disinfections (chemical treatment /autoclaving/micro waving and mutilation shredding Incineration / destruction & drugs disposal in

Waste Sharps (needles, syringes, scalpels blades, glass etc. that may cause puncture and cuts. This includes both used & unused sharps)

Discarded Medicines and Cytotoxic drugs (wastes comprising of outdated, contaminated and discarded medicines)

Cat. No. 5

secured landfills

Cat. No. 6

Incineration, autoclaving/micro waving

Solid Waste (Items contaminated with blood and body fluids including cotton, dressings, soiled plaster casts, line beddings, other material contaminated with blood)

` Cat. No. 7

Disinfections by chemical treatment autoclaving/micro waving & mutilation Shredding.

Solid Waste (waste generated from disposable items other than the waste sharps such as tubing, Catheters, intravenous sets etc.)

Cat. No. 8

Disinfections by chemical treatment and discharge into drain

Liquid Waste (waste generated from laboratory & washing, cleaning , house-keeping and disinfecting activities) Incineration Ash (ash from incineration of any bio-medical waste)

Cat. No. 9

Disposal in municipal Landfill

Cat. No. 10

Chemical treatment & discharge into drain for liquid & secured landfill for solids

Chemical Waste (chemicals used in production of biological, chemicals, used in disinfect ion, as insecticides, etc)

Table 4.3 Colour coding for the waste Colour Coding Yellow Red Plastic bag Disinfected Container/ bag Plastic Type of Containers Waste Category 1,2,3,6 3,6,7 Treatment Options as per Schedule Incineration/deep burial Autoclaving/Micro waving/ Chemical Treatment

` Blue/ White translucent

Plastic bag/ puncture 4,7 proof container

Autoclaving/Micro waving/ chemical treatment and destruction/shredding

Black

Plastic bag

5,9,10 (Solid)

Disposal in secured landfill

4.3 Containment:

Red bags for containment of biomedical waste will comply with the required physical properties. Sharps will be placed into sharps containers at the point of origin. Filled red bags and filled sharps containers will be sealed at the point of origin. Red bags and sharp containers, when sealed, will not be reopened. Ruptured or leaking packages will be placed into a larger container without disturbing the seal.

4.4 Labeling:
All sealed biomedical waste red bags and sharps containers will be labeled with the facilities name and address prior to transporting. Red bags will be sealed and transported 30 days after initial biomedical waste is placed in the bag. Sharp containers (with sharps only) will be sealed and transported after they are full. Shipping containers must be labeled with transporters name, address, registration number, and 24-hour phone number. Reusable waste containers must be made of metal or rigid plastic and able to withstand exposure to common cleaning agents. They must be colour-coded according to the type of waste for which they are intended and labelled with the biohazard symbol.

Reusable waste containers should be inspected for holes or leaks each time they are emptied and their colour coding and labelling renewed if necessary. Holes or leaks must be repaired or the waste container replaced.

` Reusable waste containers must be cleaned regularly to prevent odours and as soon as possible if waste materials leak or spill within the containers.

BIOHAZARD SYMBOL

CYTOTOXIC HAZARD SYMBOL

Fig 4.1 Symbols

4.5 Storage:
Red bags and sharp containers will be stored in the clinics. For all generators, biomedical wastes should be: Stored in a manner and location that is protected from weather and animals and does not provide a breeding place or food source for insects. Exposure to the public should be minimized. Placed in a container separate from other wastes. Stored in containers so as to prevent leakage, punctures, and ripping during storage, handling and transportation. Containers shall be red or orange in color OR clearly marked with the universal biohazard symbol OR clearly marked with the word BIOHAZARD. Sealed red bags, sharps containers, and outer containers should be stored in areas that are restricted through the use of locks, signs, or location.

` Waste generating facilities cannot store biomedical waste for more than 30 days. The 30-day period commences when the first non-sharps item of biomedical waste is placed into a red bag or sharp container, or when a sharps container containing only sharps is sealed. Biomedical waste remains at the generating facility until removed by the transporter.

4.6 Transportation:
The collection and transportation of bio-medical waste shall be carried out in a manner so as to avoid any possible hazard to human health and environment. Collection and transportation are the two operations where the chances of segregated biomedical waste coming in contact with the public, rag pickers, animals/birds, etc are high. Therefore, all care shall be taken to ensure that the segregated bio-medical waste, handed over by the healthcare units, reach CBWTF without any damage, spillage or unauthorized access by public, animals etc. Vehicles used to transport biomedical waste must not be used to transport mixed cargoes of wastes and other goods, including food or other goods for human consumption. The storage compartment should be locked at all times that the biomedical waste transportation vehicle is being operated or contains any waste. The size of the van would depend on the waste to be carried per trip. In case, the waste quantity per trip is small, covered container of 1-2 m3, mounted on 3-wheeled chassis and fitted with a tipping arrangement can be used.

The storage compartment must be refrigerated if the period of time between generation and disposal of the biomedical waste exceeds four days, This applies when biomedical waste must be transported over long distances.

The storage compartment must be cleaned regularly with an approved disinfectant to prevent odours and as soon as possible if waste materials leak or spill within the compartment.

4.7 Treatment:
4.6.1 Biosafety:
Biosafety is essentially a preventive concept and consists of wide variety of safety precautions that are to be undertaken, either singly or in combination, depending on the type of hazard by all medical, nursing and paramedical workers as well as by patients, attendants, ancillary staff and administrators in a hospital or treatment site.

4.6.2 Concept of Disinfection and Sterilization:

Disinfection and sterilization are important procedures in biosafety. Disinfection refers to procedures, which reduce the number of microorganisms on an object or surface but not the complete destruction of all microorganisms. Sterilization on the other hand, refers to procedures, which would remove all microorganisms from an object. Sterilization is undertaken either by dry heat (for 2 hours at 1700C in an electric oven method of choice for glass ware and sharps) or by various forms of moist heat (i.e. boiling in water for an effective contact time of 20 min or steam sterilization in an autoclave at 1210C for 20 min) decontamination of Infectious/Biomedical Waste.

4.6.3 Types of Treatments:

All biomedical waste, including sharps and syringes must be treated by incineration, steam sterilization, or chemical disinfection before disposal in the municipal waste stream. The following methods of treatment are used to decontaminate the infectious/biomedical waste:

4.6.3.1 Off-Site Treatment: Biohazardous waste or sharps containers should be placed in a cardboard box labeled with the biohazard symbol for shipment through an appropriate biomedical waste disposal vendor for off-site treatment or incineration. Boxes containing biomedical waste that should be incinerated rather than other treatment methods should be labeled with incinerate only on both sides of the container. Such labels are available from the vendor or the EHSO. Packaging, labeling, and manifesting this waste must follow the procedures as given in guidelines, Regulated Medical Waste Shipping Procedures.

4.6.3.2 Incineration:
Following standards should be followed for incineration: Combustion efficiency (CE) shall be at least 99.00%. The Combustion efficiency is computed as follows: C.E. = [(%CO2) / (%CO2 + % CO 3)] X 100 The temperature of the primary chamber shall be 800 50C. The secondary chamber gas residence time shall be at least I (one) second at 1050 50C, with minimum 3% oxygen in the stack gas.

It should also be noted that: 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. Only low sulphur fuel shall be used as fuel in the incinerator.

4.6.3.3 Steam Sterilization:

Biomedical waste that is to be steam sterilized should be collected in biohazard bags and transported to the sterilization site in a durable, leak proof container, which is closed for transport from the laboratory. After sterilization, but before disposal in the municipal waste stream, all treated biomedical wastes should be enclosed in an unmarked outer bag or box that is not red or labeled with the biohazard symbol. Any biomedical waste that has been treated as described above and packaged such that it is clearly evident that the waste had been effectively treated is not subject to regulation as biomedical waste and may be collected, transported, and disposed of as municipal waste.

4.6.3.4 Autoclave Treatment:

This is a process of steam sterilisation under pressure. It is a low heat process in which steam is brought into direct contact with the waste material for duration sufficient to disinfect the material. These are also of three types: Gravity type, Pre-vacuum type and Retort type.

` In the first type (Gravity type), air is evacuated with the help of gravity alone. The system operates with temperature of 121 deg. C. and steam pressure of 15 psi. for 60-90 minutes. Vacuum pumps are used to evacuate air from the Prevacuum autoclave system so that the time cycle is reduced to 30-60 minutes. It operates at about 132 deg. C. Retort type autoclaves are designed to handle much larger volumes and operate at much higher steam temperature and pressure. Autoclave treatment has been recommended for microbiology and biotechnology waste, waste sharps, soiled wastes and solid wastes. This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognisable so that the treated residue can be land filled. Sanjay Gandhi Memorial Hospital in Delhi has installed a Prevacuum Autoclave.

4.6.3.5 Hydroclave Treatment:

Hydroclave is an innovative equipment for steam sterilisation process (like autoclave). It is a double walled container, in which the steam is injected into the outer jacket to heat the inner chamber containing the waste. Moisture contained in the waste evaporates as steam and builds up the requisite steam pressure (35-36 psi). Sturdy paddles slowly rotated by a strong shaft inside the chamber tumble the waste continuously against the hot wall thus mixing as well as fragmenting the same. In the absence of enough moisture, additional steam is injected. The system operates at 132 deg.C. and 36 psi steam pressure for sterilisation time of 20 minutes. The total time for a cycle is about 50 minutes, which includes start-up, heat-up, sterilisation, venting and depressurisation and dehydration. The treated material can further be shredded before disposal. The expected volume and weight reductions are upto 85% and 70% respectively. The hydroclave can treat the same waste as the autoclave plus the waste sharps. The sharps are also fragmented. This technology has certain benefits, such as, absence of harmful air emissions, absence of liquid discharges, nonrequirement of chemicals, reduced volume and weight of waste etc. Tata Memorial Hospital in Mumbai has installed the first hydroclave in India in September 1999.

4.6.3.6 Microwave Treatment:

` This again is a wet thermal disinfection technology but unlike other thermal treatment systems, which heat the waste externally, microwave heats the targeted material from inside out, providing a high level of disinfection. The input material is first put through a shredder. The shredded material is pushed to a treatment chamber where it is moistened with high temperature steam. The material is then carried by a screw conveyor beneath a series (normally 4-6 nos.) of conventional microwave generators, which heat the material to 95-100 deg. C. and uniformly disinfect the material during a minimum residence time of 30 minutes and total cycle is of 50 minutes. A second shredder fragments the material further into unrecognisable particles before it is automatically discharged into a conventional / general waste container. This treated material can be landfilled provided adequate care is taken to complete the microwave treatment. Microwave technology has certain benefits, such as, absence of harmful air emissions (when adequate provision of containment and filters is made), absence of liquid discharges, non requirement of chemicals, reduced volume of waste (due to shredding and moisture loss) and operator safety (due to automatic hoisting arrangement for the waste bins into the hopper so that manual contact with the waste bags is not necessary). However, the investment cost is high at present. According to the rules, category nos, 3 (microbiology and biotechnology waste), 4 (waste sharps), 6 (soiled waste) and 7 (solid waste) are permitted to be microwaved. It should be noted that microwave treatment should not be used for cytotoxic, hazardous or radioactive wastes, contaminated animal carcasses, body parts and large metal items. 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.

4.6.3.7 Chemical Treatment:

Chemical or liquid disinfectants may be used for treatment of biomedical waste where contact time, concentration, and quantity of the chemical disinfectant are sufficient to achieve microbial inactivation of the waste. Chemical disinfection may not be used for: porous material material embedded with infectious agents, such as agar plates mixed waste such as material that is both biomedical and radioactive waste hazardous drug waste

` pharmaceutical waste contaminated sharps collected in a sharps container.

If chemical disinfectants are used, they must have been shown to be effective against the organisms present. Important considerations include: temperature time of contact pH concentration penetrability reactivity of organic material at the site of application

(For example, for blood or media containing significant organic material, autoclaving should be considered instead). Manufacturers specifications and procedures should be considered when using chemical disinfectants. Biomedical waste that has been effectively treated can be disposed of into the regular solid waste receptacle unless the material qualifies as sharp, in which case the material should be placed in a puncture-proof container prior to disposal. Certain chemical disinfectants, such as bleach and alcohol, can be poured down the sink after being used for treatment. Other disinfectants, such as phenol and gluteraldehyde, require management as a hazardous waste. The management after use should be considered when selecting chemical or liquid disinfectant.

4.6.3.8 Deep Burial:

The standards for deep burial are as follows: A pit or trench should be dug about 2 metres 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. It must be ensured that animals do not have any access to burial sites. Covers of galvanised iron/wire meshes may be used. On each occasion, when wastes are added to the pit, a layer of 10 cm of soil shall be added to cover the wastes. Burial must be performed under close and dedicated supervision. The deep burial site should be relatively impermeable and no shallow well should be close

` to the site. The pits should be distant from habitation, and sited 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. The location of the deep burial site will be authorised by the prescribed authority. The institution shall maintain a record of all pits for deep burial.

4.7 Advanced Methods of Biomedical Waste Treatment:

4.7.1 Steam Sterilization:
Sterilization involves the use of a physical or chemical procedure to destroy all microbial life, including highly resistant bacterial pores. The major sterilizing agents commonly used in healthcare facilities today are a) saturated steam, b) ethylene oxide gas, c) hydrogen peroxide gas plasma, and d) liquid chemicals. Dry heat is also used, although less commonly. And a new sterilizing agent, ozone, has recently become available for use in the US. Steam Saturated steam under pressure is the oldest and most widely used, economical, effective and reliable method of sterilization available to health care facilities. The steam sterilizer consists of a pressurized chamber, increasing the pressure in the chamber elevates and holds the temperature. The sterilizer chamber and all contents must be free of any air entrapment to ensure direct contact of the steam to all surfaces to be sterilized. Steam sterilizers are designed to eliminate all air from the chamber during the conditioning phase in the sterilization cycle. Steam is vaporized water and serves as the conduit to rapidly permeate packaging delivering high temperature moist heat to all contents and destroying microorganisms. Steam kills microorganisms by coagulating and denaturing the cell protein. Due to the very high temperatures and moisture associated with steam sterilization it may only be used with heat and moisture stable medical devices, instruments and compatible materials. The different types of steam sterilization processes include: Dynamic air removal process,also known as pre-vacuum, high-vacuum, or mechanical air removal. Dynamic air removal steam sterilizers utilize a mechanical vacuum pump to suck air from the sterilizer chamber during the condition phase of the sterilization cycle. Since the removal of air is mechanical the total cycle time is less than that of a gravity cycle. Gravity, downward air displacement process, relies on gravity to remove air from the sterilizer chamber. Since steam is lighter than air, as it enters the sterilizer chamber it rises to

` the top. As the chamber fills with steam, the steam forces the air down and out of the chamber drain. An abbreviated steam sterilization cycle, known as flash, can be accomplished in either a prevacuum or gravity displacement sterilizer. Flash sterilization is intended for emergency use when instrumentation is urgently needed and time does not allow for routine processing. Flash sterilized items are intended for immediate use. An abbreviated steam sterilization cycle, known as flash, can be accomplished in either a prevacuum or gravity displacement sterilizer. Flash sterilization is intended for emergency use when instrumentation is urgently needed and time does not allow for routine processing. Flash sterilized items are intended for immediate use. Steam Parameters The essential conditions for steam sterilization are temperature, saturated steam, time and pressure. Recommended minimum sterilization times for wrapped instruments: Prevacuum: 270 F 4 min exposure; 30 min drying time Gravity displacement: 250 F 30 min exposure; 45 min drying time Recommended minimum flash sterilization times for unwrapped metal or non-porous item: Prevacuum: 270 F 3 min exposure; no drying time High-speed gravity 270 F 3 min exposure; no drying time Recommended minimum flash sterilization times for unwrapped metal items with lumens and porous items (e.g., rubber, plastic) sterilized together Prevacuum: 270 F 4 min exposure; no drying time
o o o o o

Ethylene Oxide Ethylene Oxide (EO) is a low temperature sterilization method that has been used for many years. The low temperature process makes it suitable for the sterilization of heat and moisture sensitive medical devices that cannot tolerate the high temperatures and moisture associated with steam sterilization. EO is a colorless gas, which destroys microorganisms by a process called alkylation. The EO penetrates the cells membrane and reacts with the nuclear material rendering it unable to metabolize and reproduce. Ethylene Oxide Parameters

` There are four primary conditions/requirements to effectively sterilize with EO (1) gas concentration (2) humidity, (3) temperature and (4) time. A change in any one of these conditions will require an adjustment of other conditions. For example if the temperature is decreased the exposure time must be extended. Because of the vast differences in the configuration, density, design and permeability of products routinely sterilized in the hospital setting standard cycle parameters have been established to accommodate the most challenging of circumstances. EO sterilizers are designed and programmed to operate at the required concentration and humidity levels for the established routine hospital cycles parameters. Relative humidity 50 75% (items should be completely dried prior to packaging and being placed in sterilizer) Temperatures range from 85-145 F depending on cycle chosen, chamber size, and gas blends (manufacturers instructions to be followed) Exposure Time is usually 2 hours or longer depending on load capacity, density and porosity Aeration times and temperatures; 8 hours at 140F and 12 hours at 122 F.
o o o

4.7.2 Hydrogen Peroxide Gas Plasma:

Gas Plasma is a low temperature sterilization alternative that has been available for several years and is suitable for many heat sensitive and moisture sensitive or moisture stable medical devices. Unlike EO sterilization, gas plasma sterilization is devoid of the occupational, environmental and patient safety concerns. Gas plasma is also less expensive and total cycle times are significantly less than EO. Medical devices are ready for use following sterilization without the need for aeration. This method disperses a hydrogen peroxide solution in a vacuum chamber, creating a plasma cloud, reactive species are generated from the hydrogen peroxide that are reactive with microorganisms. Gas Plasma sterilizes by oxidizing key cellular components of the microorganisms, which inactivates and destroys them. There are some restrictions on lumen devices validated for sterilization by this method based on gauge and length of the device. Users should obtain documentation from the manufacturer for appropriate use and restrictions. Gas plasma is not compatible with highly porous absorbers, such as cellulose, and paper products and cannot be utilized to process liquids.

Hydrogen Peroxide Gas Plasma Parameters: Temperature range varies but is maintained between 104-131F

` Total cycle time will range between 28 - 75 minutes depending on the sterilizer model and size.

4.7.3 Plasma Pyrolysis:

Plasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste. It is an environment-friendly technology, which converts organic waste into commercially useful by products. The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste, biomedical waste and hazardous waste in a safe and reliable manner. Medical waste is pyrolysed into CO, H2, and hydrocarbons when it comes in contact with the plasma-arc. These gases are burned and produce a high temperature (around 1200C.)

4.8 Disposal according to colour coding:

4.8.1 Disposal of Yellow Bags:
YELLOW BAGS (INFECTIOUS WASTE)

INCINERATION

INCINERATION ASH

REMOVE GLASS/ METALS

ASH FOR SECURE LANDFILLING

4.8.2 Disposal of Red Bags:

RED BAGS

WASTE

PLASTIC MATERIAL

INCINERAB LE WASTE

NON INCENERA BLE WASTE

AUTOCLAV ING OF TUBES

AUTOCLAV ING OF SYRINGES

INCINERATI ON

PACKED IN BLACK BAGS

MATERIAL FOR RECYCLIN G

SHREDDIN G

ASH FOR SECURE LANDFIILI NG

MUNCIPAL WASTE BINS

MATERIAL FOR RECYCLIN G

4.8.3 Disposal of Blue Bags:

BLUE BAGS (GLASS WASTE)

SEGREGATI ON

WASTE

CONTAMIN A-TED GLASS BOTTLES

INCINERAB LE WASTE

NON INCINERAB LE WASTE

PLASTIC MATERIAL

CHEMICAL DISINFECTI ON

INCINERATI -ON

PACKED IN BLACK BAGS

AUTOCLAVI NG OF TUBES

AUTOCLAVI NG OF SYRINGES

MATERIAL FOR RECYCLING

ASH FOR SECURE LANDFILL

MUNCIPAL WASTE BINS

MATERIAL FOR RECYCLING

SHREDDING

MATERIAL FOR RECYCLING

4.8.4 Disposal of Black Bags:

CARBOY NEEDLES SHARPS DIPPED IN DILUTED SODIUM HYPOCHLORITE

CUT AND DRAIN IN MUNCIPAL DRAIN

AUTOCLAVING OF SYRINGES

NEEDLES

SHREEDING

SAFE STORAGE

MATERIAL FOR RECYLING

SECURE LANDFILLING

4.9 Safety Measures for the Medical and Para-medical staff:

The following instructions need to be notified and strictly adhered to: Clear directives in the form of a notice to be displayed in all concerned areas. Issuances of all protective clothes such as, gloves, aprons, masks etc. without fail Sterilization of all equipment and issue of only properly sterilized equipment and tool, such as, surgical tools to the medical personnel. Maintenance of this purpose. Provision of disinfectant, soap etc of the right quality and clean towels / tissue paper. Regular medical check up (half-yearly).

Safety Measures for cleaning and Transportation Staff: Display of illustrated notices with clear instructions for dos and donts in Hindi and the local language. Issuance of all protective gears such as, gloves, aprons, masks, gum boot etc. without fail. Provision of disinfectant, soap etc of the right quality and clean towels. Provision of a wash area, where they can take bath, if needed/desired. Washing and disinfecting facility for the cleaning equipment and tools. Regular medical check-up (at least half-yearly.)

5. Scenario in Mumbai
The quantum of waste that is generated in India is estimated to be 1-2 kg per bed per day in a hospital and 600 gm per day per bed in a general practitioners clinic. It is estimated that only 5 10% of this comprises of hazardous/infectious waste. A study in February 2010 evaluating the Central Pollution Control Board (CPCB) has found that almost 50 per cent of biomedical waste is being disposed off with municipal garbage. The Biomedical Waste Management Act, 1998, mandates hospitals to handle their wastes in an environmentally and scientifically sound manner. Only half of the total biomedical waste generated in the country is treated according to rules while the rest is dumped with municipal solid waste, posing a risk to environment and human health, according to a study. The incineration of infectious medical wastes is compulsory for hospitals in the country, but many hospitals either do not have this facility or the machines are lying idle.

Biomedical Waste (Management and Handling) Rules (BMW Rules) were promulgated under the Environment (Protection) Act, 1986. In Maharashtra, Maharashtra Pollution Control Board (MPCB) is the apex agency to enforce these Rules. Health Care Establishments (HCEs) are the major generators of the BMW. HCEs need to take authorization from MPCB for handling of BMW. The HCEs are classified into two categories: 1. Bedded HCEs- (Hospitals/ Nursing Homes with Bed Facility) 2. Non-bedded HCEsa) Treating/ Providing Service to 1000 and above Patients per Month b) Treating/ Providing Service to less than 1000 Patients per Month c) Education, Research Institute, Veterinary Hospitals, etc. (herein referred to as Others

` The figure 5.1 below shows the number of HCEs in Maharashtra. It can be clearly seen that Mumbai has the highest number of HCEs. The source is MPCB and the values are till June 2011. Fig. 5.1 Classification of HCEs bedded

Thus Mumbai is the largest producer of biomedical waste in Maharashtra. The figure 5.2 illustrates the total amount of biomedical waste in different cities of Maharashtra. Fig. 5.2 Amount of Biomedical waste in different states of Maharashtra

` The biomedical waste in Mumbai is either treated by the health care facilities by in house mechanism or sent to the common biomedical waste treatment facilities at various locations across the city. The list of the common treatment facilities in and around Mumbai is as given in Table 5.1

Table 5.1 Common treatment facilities in and around Mumbai

Indias largest biomedical waste treatment facility exists at the Deonar dumping ground, Mumbai. The 2.1 million dollar plant treats waste from approximately 1000 facilities. The centre spread over 4000 square meters of land is run by SMSL Watergrace Products. 8-10 metric tons of biomedical waste is treated per day by this centre which was initiated by the government body, Maharashtra Pollution Control Board towards their campaign of clamping down on companies not adhering to proper disposal of waste. SMSL Envoclean operates 35 trucks to transport the waste to the fully automated centre on a daily basis. The process of waste disposal includes shredding, autoclave and incineration and exhaust is treated prior to being released to reduce pollution levels. (http://greenu.org/biomedical-waste-centre-mumbai/) Stressing that new technologies have to be promoted for destruction of toxic bio-medical wastes, the government has developed a new technology, to check proper collection and disposal of biomedical waste to prevent environmental damage and health hazard. In Thane and Navi Mumbai approximately, 525 to 625 kilograms of biomedical waste is generated from private hospitals, nursing homes and medical practitioners daily respectively. Apart from this, 200 kg bio-medical waste is generated by government hospitals. Equal

` quantity of biomedical waste is also generated from the neighboring cities like Panvel, Dombivli and Kalyan informed NMMC (Navi Mumbai Municipal Corporation). MPCB has fitted the GPS devices on more than 140 of its trucks to trace their movement online from a control centre in Pune and Aurangabad in Maharashtra. MPCB now wants to implement the system in Raigad, Thane, Ratnagiri, Sindhudurg and other parts of the Konkan region. The system enables monitoring of the vehicles movement in real-time and helps calculate the number of trips of a particular vehicle from the pick-up source to dumping sites. The common bio-medical waste treatment at Kalyan-Dombivli also caters to neigbouring regions of Ambernath, Badlapur, Ulhasnagar and Bhiwandi. There are three other plants at Taloja, Kalva and Deonar as well. Thus, a major part of Maharashtras biomedical waste is being treated at Mumbai. This indicates that the government needs to exponentially increase the number of Common Biomedical Waste Treatment Facilities in the country. "As per the Bombay High Court order, biomedical waste generated from hospitals, clinics, pathological laboratories should not be recklessly dumped as there is risk of infections. Under Environment Protection Act (EPA) biomedical waste is to be treated and disposed off in scientific manner," Thus more attention needs to be paid at proper disposal of BMW.

6. Case Study: Tata Memorial Hospital

The case study was carried out at Tata Memorial Hospital, Dr. E. Borges Marg, Parel East, Mumbai 400012, India. The main aim of the study was to examine the handling and the management of biomedical waste. The emphasis of the study was based on the in-house treatment process (Hydroclave) employed at the hospital. The case study also includes relevant literature supporting the investigation. The case study included 3 visits to the hospital in the months of January and February, 2012. Fig 6.1 Location of Tata Memorial Hospital

Source: Google Maps The steps which are carried out in the Biomedical Waste Management & Treatment are as follows: 1. Segregation at Source 2. Collection at Source 3. Storage 4. Transportation

` 5. Treatment 6. Disposal We have successfully completed a case study on the Tata Memorial Institute Biomedical Waste Management System. The case study is summarised as follows.

6.1 Segregation:
Segregation as mentioned above is started at the source itself. The Biomedical Waste is stored and transported in yellow bags and yellow bins. The general waste is stored and transported in green bags and black bins. Thus there are two types of bags being employed at the Tata Memorial Hospital, namely Black bags and Yellow bags. The yellow bags & black bags are kept in bins at different units throughout the Hospital. The hospital staffs are told to put the infectious wastes and general wastes in the different bags as mentioned above. Thus the segregation starts at the source itself.

6.2 Collection:
The labour staffs start at 7.30am every morning and collects the biomedical wastes from the various units. The Yellow bag is generally filled with Biomedical Waste up to 75% of its capacity. The labour staffs pack the bags and puts them in yellow bins. Sharp containers are collected from various units and they along with the yellow bins are brought to the Biomedical Treatment Facility which is in the same complex as that of the Tata Memorial Hospital. The sharp containers are available in the following sizes: 1 litre, 2 litres and 5 litres. During the collection of the wastes the representative of each department puts his signature in the log book with the date and time of collection so as to maintain records. The collection of the waste from different units in the hospital is done twice a day: 1) At 7.30am 2) At 7.30pm

Units which generate the maximum amount of waste: 1. Operation Theatre 2. Minor Operation Theatre 3. Labs 4. General Ward & ICU.

6.3 Storage:
The bins are weighed at the Biomedical Waste Treatment Facility. The empty weight of the bins is known. Then the following formula is used to calculate the weight of the waste: Weight of waste (in kg) = Weight of filled up bin (in kg) Weight of empty bin (in kg) All the readings are noted down in the log book. The bins can be stored with biomedical waste for a period of not more than 48 hours from the time of collection. Thus all the waste then goes into the treatment process.

6.4 Treatment:
The biomedical treatment process used at Tata Memorial Hospital is the Hydroclave process. The Hydroclave is essentially a double-walled (jacketed) cylindrical, pressurized vessel, horizontally mounted, with one or more side or top loading doors, and a smaller unloading door at the bottom. The very small Hydroclave units have a single side door for both loading and unloading. The Hydroclave performs the following functions: Sterilizes the waste utilizing steam, similar to an autoclave, but with much faster and much more even heat penetration. Hydrolyzes the organic components of the waste such as pathological material. Removes the water content (dehydrates) the waste. Breaks up the waste into small pieces of fragmented material. Reduces the waste substantially in weight and volume. Accomplishes the above within the totally sealed vessel, which is not opened until all waste it totally sterile. The model of the Hydroclave used at the Tata Memorial Hospital is Hydroclave S-25. It started its operations on 10th September, 1999. The loading capacity of the machine is 110kgs. The Hydroclave consists of the following components: 1. Boiler 2. Hydroclave tank 2. Rotating arm

` 3. Sprinkler Mechanism 4. Exhaust Mechanism 5. Steam Jacket 6. Water Tank (200 litres capacity) 7. Safety devices (Pressure release valves, etc.) 8. Motor 9. Shredder 10. Data recording Instruments

6.4.1 Loading:
The waste can be loaded into the Hydroclave treatment vessel by various means, depending on your requirements: In smaller units dropping the waste bags manually into a side or end door. In medium-sized units by tipping waste containers into top or angled loading doors. Electric or hydraulic tipping devices are an available option with the Hydroclave. In medium to large sized units, for large scale commercial operation, a combination of conveyors, hoppers and tippers are available to load the waste into large top loading doors.

At Tata Memorial Hospital, the biomedical waste (sharps container, yellow bags excluding glass material) is put into the Hydroclave tank manually. The loading is done depending on the weight (90kg to 100kg) or the volume of the waste. When the waste container many high density items (like sharps) the loading is done according to weight. If the waste contains many low density items (like gloves and cotton) then the loading is done according to volume. No special operator skill is required, since over-loading or loading too tightly is not an issue with this type of process. The loading time and weight is noted down in the log book. The door of the tank is shut and thus the tank is now air-tight. The water from the tank is taken into the boiler where it is converted in to steam. This jacket steam now enters into the steam jacket which surrounds the Hydroclave tank. The steam is kept in continuous motion till sterilization is complete. The jacket steam condenses into clean, hot condensate, which is returned back to

` the steam boiler. This unique feature makes the Hydroclave so efficient in operation no steam or hot condensate is lost. The steam heats up the wall common between the vessel and the steam jacket. During heat-up, the shaft and mixing arms rotate, causing the waste to be fragmented and continuously tumbled against the hot vessel walls. At this point, the waste is broken up into small fragments, and all material heats up rapidly, being evenly and thoroughly exposed to the hot inner surfaces. The moisture content of the waste will turn to steam, and the vessel will start to pressurize. As more and more steam is circulated the pressure and the temperature gradually rise. This rise in the temperature is noted down by the temperature and pressure gauges. The minimum air pressure inside the vessel is kept at 21 psi and the maximum air pressure does not exceed 32 psi. Initially, no steam will be injected into the waste. If there is not enough moisture in the waste to pressurize the vessel, a small amount of boiler steam is added until the desired pressure is reached. At the end of this period, the correct sterilization temperature and pressure are reached, and the sterilization period is initiated automatically.

6.4.2 Sterilization:
By PLC control (Computer controlled units are also available), the temperature and pressure are maintained for the desired time to achieve sterilization. If for any reason the sterilization parameters drop below desired levels, the sterilization cycle is stopped, and re-initiated. This ensures sterilization prior to commencement of the next stage. The mixing/fragmenting arms continue to rotate during the entire sterilization period, to ensure thorough heat penetration into each waste particle. The intense subjugation of the waste to such temperature and pressure moisture in a dynamic environment causes the waste to hydrolyze, which is a rapid decomposition of organic waste material. Sterilization cycle lasts 30 minutes where the temperature is maintained at 123C.

6.4.3 De-pressurization & De-hydration:

After sterilization the sprinkler system in the steam jacket is activated. This leads to the condensation of the steam and the pressure and temperature of the system reduces gradually. This causes initial waste dehydration due to depressurization. The steam to the jacket will remain on, agitation continues, and the waste loses its remaining water content through a combination of heat input from the jacket and continued agitation. All waste, no matter how

` wet initially, even liquid waste, will be dehydrated by this process. This is carried out for a period of 5 minutes.

6.4.4 Unloading:
At the end of the depressurization/dehydration period, jacket steam is shut off, the discharge door is opened, and the powerful mixing arms are reversed to a clockwise rotation. Due to the unique construction of the mixing arms, the opposite rotation causes the fragmented waste to be pushed out of the vessel discharge door, into a shredder. The waste may also be discharged into a waste container or onto a conveyor, if no shredding is required.

6.4.5 Shredding:
The waste can be fine-shredded prior to final disposal, by a separate shredding system. The shredder cuts all the waste into unrecognizable forms. This shredded waste is put into the BMC waste bins. Shredding takes approximately 30 minutes to complete. The treated waste is non-infectious and can be directly be dumped in landfills.

6.5 Disposal:
The disposal of the shredded waste has been outsourced to another company named FORCE. The shredded waste is carried by the dump trucks to their processing site. This waste is then segregated into plastics, PVC, rubber, steel, etc. Maximum amount of the waste is recycled. Very less percentage of waste goes to the landfill. The whole process takes approximately two and a half hours to finish.

6.6 Waste Auditing:

The technician at Tata Memorial Hospital has to keep the records of the data. Parameters like weight of waste collected, number of bags collected, number of sharp containers, weight of sharp container, weight of glass vials, load size, total number of loads, loading start and end times. A sample table of the daily log book is as shown in table 6.1.

Table 6.1 Sample of a daily log book

Loading

No. yellow bags

Of Weight of Sharp yellow bags (kg) container number

Sharp container weight (kg)

Weight

Total

of glass load vials (kg) size (kg) 90 91

1 2

58 53

83 81

13 22

7 10

15 4

Time Start time Sterilization start time Sterilization finish time Process finish time

Load 1 8:15am 9:45am 10:30am 11:00am

Load 2 11:15am 11:45am 12:30am 1:10am

These daily values are maintained and at the end of the year these values are compiled into an annual summary report. An excerpt from the report is shown in the Table 6.2.

Table 6.2 Summary of annual report

2008 (kg.) Max. medical waste collected in a day 447

2009 (kg.) 505

Average no. of loads required/day

Average medical waste treated in kgs/day

298

304

Average medical waste collected in a month

7,623

7,674

Percentage down time of the system

0.33

Maximum infectious waste treated in a day: 499kg Maximum loads in a day: 5 Average infectious wastes treated in a day: 331kg Average loads per day: 4 Total infectious waste treated 2000-2009= 800 tons. Cost of treatment = Rs. 14 / kg. Average waste generated = 1 to 1.5 kg/day/bed

6.7 Testing:
In all, 2 tests are carried out at the biomedical treatment facility at Tata Memorial Hospital. They are as follows: 1. Water Test: The water test is performed on the effluent water from the vessel. There are chances that this water contains toxic and foreign chemicals which may be hazardous to life. This water is tested by the BMC authorities.

2. Spore Test: In this test the bacterial spores are kept in a vial and are made to undergo the Hydroclave treatment. After the process is over the bacteria is sent for testing and if the vial is completely sterilized then the Hydroclave is functioning properly else the Hydroclave is not working efficiently. This test if performed every month. The spore used for the test is Bacillus stearothermophilus spores with at least 10000 spores per millilitre.

6.8 Management at Tata Memorial Hospital:

The Biomedical Waste Treatment Facility comes under the Microbiology department. This department is headed by Dr. Kelkar. The employees of the Treatment facility work in 2 shifts: 1. from 8pm to 4pm. 2. from 4pm to 8pm. There is a one of recess time in a day. The Hydroclave runs 6 times a week (except Sunday). Sunday is a holiday for the workers and other staff. The treatment facility has 2 head technicians. There are a total of 6 workers working in the shifts.

6.9 Safety Measures:

All the workers and the head technicians are well trained in biomedical waste treatment rules and procedures. They are educated about the various emergency and mandatory procedures to be followed. The workers are provided with the following equipment during working hours: 1. Shoes 2. Masks 3. Gloves 4. Uniforms 5. Goggles Every injury during the handling and treatment of the waste is reported and the victims blood is checked for any abnormalities and infections.

6.10 Maintenance:
The maintenance of the Hydroclave is on a contract basis. There is an Annual Maintenance Contract (AMC). Maintenance is carried out two times in a month. Basic maintenances are carried out like grease checks, oil checks, alignment of moving parts and various other checks.

7. Case Study: Kalyan Dombivali Municipal Corporation CBMWTF

This plant was established in year 2000, and has been working for last 11 years. It is a small capacity treatment plant as small quantity of bio-medical waste is treated as compared to other large capacity bio-medical waste treatment plant. This plant is run by PRS enterprises on BOOT (built, own, operate & transfer) basis. Fig 7.1 Kalyan Dombivali Municipal Corporation CBMWTF

Rules followed for bio-medical waste 1998 at this plant: This rules are apply to all persons who generate, collect, receive, store, transport, treat, disposal, or handle bio-medical waste in any form.

` Bio-medical waste is any waste generated during diagnosis, treatment or immunization of human being or animals, and including all the categories mentioned in schedule I. Bio-medical waste treatment facility means any facility wherein treatment, disposal of bio-medical waste is carried out. Operator of 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 bio-medical waste.

7.1 Highlights of the Case Study:

The Plant design capacity is 3 tons BMW/day At this plant Capacity of Incinerator is 90 kg/hr. Also, Capacity of Autoclave is 100 kg/hr And Capacity of Shredder is 75 kg/hr Area covered by this plant is as follows: KDMC area, additional capacity can be made available to cater future need as well as additional BMW from nearby areas like Ulhasnagar Municipal Corporation, Bhiwandi Municipal Corporation etc. can be treated here. Specially designed vehicles are used for the Collection and transport of bio-medical waste. The plant is run by: M/s PRS Enterprises on BOOT (Built, Own, Operate, & Transfer).

7.2 The Process:

At this treatment plant bio-medical waste is collected in day time and actual treatment is carried out in night as there is problem of load shading in day time. Duration of working time is from 11 pm in night to 7 am in morning. First the waste from different bio-medical waste generating agencies is collected at site with help of special vehicles, and then this waste is segregated in different colour codes as per their treatment. These bags are then carried for treatment in respective instruments like incinerator, autoclave and shredder.

7.3 Sources and quantity of bio-medical waste treated at plant:

The sources of bio-medical waste are hospitals, pathological laboratories and clinics. This plant collects waste from areas of Ulhasnagar, Ambarnath, and Badlapur etc. This plant covers more than 971 beds. Summary of number of beds is as shown in table 7.1. Table 7.1 Sources of Biomedical Waste arriving at KDMC plant. NO. AREA BEDS HOSPITALS PATH LAB 1 2 3 4 5 6 KDMC AREA BADLAPUR AMBARNATH ULHASNAGAR BHIWANDI SHAHAPUR TOTAL 3262 272 446 1380 920 185 6465 237 25 29 70 87 8 456 130 2 5 15 13 0 165 327 4 5 6 4 4 350 694 31 39 91 104 12 971 CLINICS TOTAL

At this plant more than 20390 kg of waste is treated per month.

7.4 Storage Facility:

At this plant area for segregation, storage and treatment is different. The segregated waste in day time is immediately treated in night and this cycle continues for whole year. In case of overload of bio-medical waste it is stored in storage compartment for small duration.

7.5 Facilities available for workers:

At this plant workers are provided with hand gloves, mask shoes and other things to protect their direct contact with bio-medical. Every week there was medical checkup held for workers.

7.6 Treatment Facilities Available at PRS Enterprises:

7.6.1 Incineration:
The segregated waste filled in yellow colour plastic bags are treated in incinerator. In these yellow bags all waste in category no. 1, 2, 3 and 6 is included such as human anatomical parts, body fluids animal waste, animal tissues etc. Combustion efficiency (CE) shall be at least 99.00 % and at this plant efficiency is 99%.

Fig. 7.2 Incinerator at KDMC

` A. Primary Chamber: The waste is charged in this chamber through a feeding door. The incineration of waste is carried out in starved air, known as Pyrolytic condition. Subsequently, the waste is decomposed into gas containing combustibles and carbonaceous material. The low velocity of gas also helps in minimizing carry over the particulate matter. The temperature is controlled between 800-900C with the help of burner to ensure efficient combustion of carbon. Sterile ash is removed from de-ashing door.

B. Secondary chamber: The flue gas from the primary chamber containing volatiles and unburnts passed to the secondary chambers. Here it is burnt under turbulent conditions and with an additional supply of combustion air. Complete oxidation is ensured by maintaining temperature above 1000C with the help of burner and providing adequate residence time (min 1 sec). Rate of treatment by this instrument is 90 kg/hour. The ash from incinerator is then carried to deep burial site for its final dispose.

Fig 7.3 Venturi Scrubber at KDMC Plant

The flue gas from the secondary chamber then passes through the downstream air pollution control system. This system is designed to remove particulate matter and acidic pollutants present in the flue gas generated during incineration. The system comprises of Ventury scrubber droplet separator followed by an induced draft fan, all made of corrosion resistant material. The flue gas from the secondary chamber is cooled to 850C and then sent to Ventury scrubber, a high energy device where sub micronic particulate matter as well as acidic pollutants is scrubbed. Here, the acidic components are removed by absorption with caustic and the particulates by the internal impaction energy. A high pressure drop across the ventury scrubber imparts sufficient energy which helps in atomizing the scrubbing liquid and thus trapping even the minute particulates. The flue gas then enters tangentially into the droplet separator, which is of cyclonic type. By the action of centrifugal force, the larger droplets present in the flue gas are removed. This helps in protecting the impeller of the ID fan maintains the negative draft and draws out the clean gas into the atmosphere through a stack.

7.6.2 Autoclave:

` Fig. 7.4 Autoclave at KDMC Plant

Fig. 7.5 Autoclave schematic diagram

7.6.2.1 Construction: The chamber is constructed of heavy duty stainless steel 316 to with stand pressure of 1.3kg/cm / 2.2kg/cm2 corresponding to temperature of 121/134C as in standard case

` it is always less than 200C. Two rails are provided in the chamber bottom for easy loading and unloading of the material on carriage. The standard sterilizer is supplied with single door or double doors made of 304/316 S. S. the doors are either manually operated hinged type or having automatic sliding arrangement, at this plant hinge type of doors were provided. A special provision prevents the operators from opening the door in following events: I) When the chamber is under pressure and II) When one door is open the other cannot be opened (for sterilizer with 2 doors). Vacuum breaker is heavy duty safety valve provided in this equipment. Plug screen in the chamber: It is useful to prevent the choking of the discharge line with solids & it is easily removable for regular cleaning. A thermostatic steam trap/air vent is fitted in chamber discharge line for automatic removal of air and chamber condensate intermittently. S. S. baffle

plate is fitted in the chamber in front of the steam inlet for roper distribution of steam in the chamber and to avoid the entering steam from directly hitting onto the load. They are provided with Temperature and pressure/vacuum indicator (gauges), the piping of stainless steel 304/316 S. S. complete with necessary values etc. The sterilizer is operated by steam supplied by in built electric steam generator. Autoclave can be supplied with 301/316 S. S. steam generator operable on elec. / steam coil. It has safety features such as low water cut off, pressure control etc. The chamber is constructed of heavy duty stainless steel 316 to with stand pressure of 1.3 kg/cm2/ 2.2 kg/cm2 and also to withstand vacuum of 26" /28" of Hg in chamber.

7.6.2.2 Process: Bio-medical waste is segregated at plant and filled in red or blue bags which contain waste of category no. 3, 4, 6, & 7. In this instrument waste is charged manually placed in the compartments provided in autoclave directly and allowed it to get treated with the contact of hot and pressured steam. Waste is allowed to react with steam for 60 to 90 minutes. Vacuum system is used for effective air removal from autoclave chamber. It consists of efficient of water-ring type vacuum pump, condenser etc. Rate of treatment by this instrument is 100 kg/hour. The residue from autoclave after treatment is then sending for land filling for its final disposal.

7.6.3 Shredder:

Fig 7.6 Shredder at KDMC Plant

7.6.3.1 The Process: The material to be shredded is fed into the hopper. Due to the unique design of cutting unit, material is pulled into the cutting chamber. The shafts made of high strength steel alloys are fitted with cutters hating angular teeth, cutters are heat treated to avoid damage and for longer life. Cleaning fingers can be easily replaced if damaged. The unit is supplied with control unit, which has an automatic reversing function. This function will protect the shredder from over load damages. It also has auto shut down in case of frequent auto reversal, idle run etc. The control system can be changed as per specific customer requirement of ram assistance, reversal etc.

7.6.4 Accessories:
Special hoppers are designed for specific material to be shredded. Ram assistance is provided to push the material in cutting chamber.

` Trolleys are present for handling waste. Conveyor belts. External panelling covers etc.

Rate of treatment for this equipment is 75kg/hour. This accessory helps to smoothen the working of equipment. In this treatment volume and weight of waste is reduce to about 85 to 90 %. The residue from this shredder is sending for recycle. Shredding of various

materials such as medical waste, wood waste, plastic, and cartons, glass bottles etc. is done in hospital, pharmaceuticals and other industries.

7.7 Disposal:
At this site no disposal method is carried out, hence waste generated after treatment from incineration and autoclave it is directly send to Taloja treatment plant for its final disposal i.e. deep burial or secure land filling. The liquid waste after treatment is then transferred to sewers pipes. Liquid waste is first treated by effluent treatment plant to reduce harmful components from it.

8. Case Study of Biomedical Waste Treatment Plant at Taloja

Fig. 8.1 Location of Taloja Treatment Plant

Taloja plant is run by Ramky group. In 2000 Ramky group opened up new branch named as Ramky and Enviro Engineering Ltd. This branch started management and treatment of different waste. In 2003 they started treating bio-medical waste and handle 14 bio-medical waste treatment plants at present. The person we contacted was Pravin Jadhav (Manager Laboratory.). We visited plant on 9th January, 2012 from 11 am to 4 pm. The plant was associated with treatment and disposal of bio-medical waste by different methods. A Common Bio-medical Waste Treatment Facility (CBWTF) is a set up where bio-medical waste, generated from a number of healthcare units, is imparted necessary treatment to reduce adverse effects that this waste may pose. The treated waste may finally be sent for disposal in a landfill or for recycling purposes. Installation of individual treatment facilities by small healthcare units requires comparatively high capital investment. In addition, it requires separate manpower and infrastructure development for proper operation and maintenance of treatment systems. The concept of CBWTF not only addresses such problems but also prevents proliferation of treatment equipment in a city. In turn it reduces the monitoring pressure on regulatory agencies. By running the treatment equipment at CBWTF to its full capacity, the cost of treatment of per kilogram gets significantly reduced. Its considerable advantages have made CBWTF popular and proven concept in many developed countries.

8.1 Sources and quantity of bio-medical waste collected at plant:

All waste generated in BMC (Brihanmumbai Municipal Corporation) & NMMC (Navy Mumbai Municipal Corporation) is treated at this plant. Overall 63% of waste is from BMC and 37% of waste from NMMC is treated at this plant. From 340 hospitals and 1340 clinics bio-medical waste is collected at this plant which covers 6800 beds. At this plant large quantity of waste is treated by different methods.

8.2 Procedure for Biomedical Waste Transportation and Storage:

Bio-Medical waste shall not be mixed with other wastes. 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 motor vehicles Act, 1988, or rules there under, untreated bio-medical waste shall be transported only in such vehicle as may be authorised for the purpose by the competent authority as specified by the government. No untreated bio-medical waste shall be kept stored beyond a period of 48 hrs.

` 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. This Ramky group collects bio-medical waste from different components like hospitals clinics etc. for this they use specially designed vehicles as show in image: Figure 8.2 The transport vehicle

8.3 Storage facilities:

Here, storage sheds are provided and used when plant is gets overloaded. Special space was provided for storage of waste.

8.4 Process:
Waste is segregated at its source i.e. in hospitals and clinics and then from this bio-medical waste generating agencies waste is transported to treatment plant with help of special design vehicle with suitable facilities in it. Depending upon treatment and season, waste is stored in storage compartments for specific period. After treatment solid waste generated like ash from incinerator and autoclave are send for its final disposal of land filling and waste from shredder is recycled or send for land filling.

8.5 Service Cost of the Facility:

Before joining the facility, the Private operator of the said facility makes an agreement with the individual healthcare units to negotiate the terms and conditions. At this plant Rs. 6/kg charge is collected from each bio-medical waste generating agency.

8.6 Facilities available for workers:

At this plant workers are provided with hand gloves, mask shoes and other things to protect their direct contact with bio-medical. Every week there was medical checkup held for workers.

8.7 Facilities available at this treatment plant:

8.7.1 Incineration:
Fig 8.3 The Incinerator at Taloja Treatment Plant

` The dimension of incinerator is 2900mm in length, 1800mm height and width of 2000mm, having fuel storage capacity of 500 litres. Two ash removal doors were provided to it. High alumina, fire brick, refractory and insulation bricks were used as lining material. It is designed for temperature up to 1300C and operating temperature is 1050C. Incinerator is provided with chimney having conical base which is self supported having circular cross section with 400mm diameter at top and 1200mm diameter at bottom with 30 metre height. Incinerator is connected to chimney via ventury and wet scrubber. Heat is generated in it by oil fire technique. Waste charging is done through belt conveyor. All the equipments are auto controlled.

The plant is operated at night from 11 p.m. and works for 8 hours. The waste is collected in day time. The rate of waste treated in incinerator is 250 kg/hr. It needs fuel of 200litre/day for running it. Capital investment for incinerator was 55 lacks. Human waste and liquid waste are directly fed into incinerator. At this plant 78865 kg of waste is treated by incinerator per month. Fig. 8.4 Typical Incinerator Operations in BMW Facility The process of incineration is carried out as follows: A. Primary Chamber:

` The waste is charged in this chamber through a feeding door. The incineration of waste is carried out in starved air, known as Pyrolytic condition. Subsequently, the waste is decomposed into gas containing combustibles and carbonaceous material. The low velocity of gas also helps in minimizing carry over the particulate matter. The temperature is controlled between 800-900C with the help of burner to ensure efficient combustion of carbon. Sterile ash is removed from de-ashing door.

B. Secondary chamber: The flue gas from the primary chamber containing volatiles and unburnts passed to the secondary chambers. Here it is burnt under turbulent conditions and with an additional supply of combustion air. Complete oxidation is ensured by maintaining temp. Above 1000 Celsius with the help of burner and providing adequate residence time (min 1 sec). Incineration thermally decomposes matter through oxidation, thereby reducing and minimizing the wastes, and destroying their toxicity, since it is primarily organic substances that can undergo and sustain thermal degradation. The waste generated after treatment of bio-medical waste like sterile ash is send for its final disposal i.e. land filling

8.7.2 Autoclave:
Two autoclaves of different capacity were there as shown in figure 8.5. Fig 8.5 Autoclaves at Taloja Treatment Plant

Gravity type of autoclave is installed at this plant which operates at 121C temperature and 15 psi pressure. Detention time of 30 min. is provided after each cycle. The chamber is constructed of heavy duty stainless steel 316.Two rails are provided in the chamber bottom for easy loading and unloading of the material on carriage. The sterilizer is supplied with single door or double doors made of 304/316 S. S. the doors are either manually operated hinged type or having automatic sliding arrangement. A special provision which prevents the operators from opening the door in events when the chamber is under pressure and when one door is open the other cannot be opened (for sterilizer with 2 doors). S. S. Baffle plate fitted in the chamber in front of the steam inlet for proper distribution of steam in the chamber and to avoid the entering steam from directly hitting onto the load. Temperature and pressure/ vacuum indicator (gauges) are provided on instrument from which direct reading can be taken. The sterilizer is operated by steam supplied by in built electric steam generator. Here, Autoclave can be supplied with 301/316 S. S. steam generator operable on electric/ steam coil. It has safety features such as low water cut off, pressure control etc. The chamber is constructed of heavy duty stainless steel 316 to with stand pressure of 1.3 kg/cm2 to 2.2 kg/cm2 and also to withstand vacuum of 26" /28" of Hg in chamber. All other features remain same as per high pressure units.

8.7.2.1 Accessories:

` Vacuum system This system is used for effective air removal from autoclave chamber. It consists of efficient of water-ring type vacuum pump, condenser etc.

8.7.2.2 Process:
Autoclaving is a low-heat thermal process where steam is brought into direct contact with waste in a controlled manner and for sufficient duration to disinfect the wastes. For ease and safety in operation, the system is horizontal type and exclusively designed for the treatment of bio-medical waste. For optimum results, prevacuum based system is preferred against the gravity type system. It is provided with tamper-proof control panel with efficient display and recording devices for critical parameters such as time, temperature, pressure, date and batch number etc.

8.7.3 Shredder:
Shredding is a process by which waste are deshaped or cut into smaller pieces so as to make the wastes unrecognizable. The material to be shredded is fed into the hopper. Due to the unique design of cutting unit, material is pulled into the cutting chamber. It helps in prevention of reuse of bio-medical waste and also acts as identifier that the wastes have been disinfected and are safe to dispose off.

8.7.3.1 The cutting unit:

The shafts made of high strength steel alloys are fitted with cutters hating angular teeth, cutters are heat treated to avoid damage and for longer life. Cleaning fingers can be easily replaced if damaged.

8.7.3.2 Control system:

The unit is supplied with control unit, which has an automatic reversing function. This function will protect the shredder from over load damages. It also has auto shut down in case of frequent auto reversal, idle run etc. The control system can be changed as per specific customer requirement of ram assistance, reversal etc. Fig 8.6 The Shredder at Taloja Treatment Plant

8.7.4 Accessories at plant:

Special hoppers are designed for specific material to be shredded. Ram assistance is provided to push the material in cutting chamber. Trolleys are used for handling. Conveyor belts are also provided. External panelling covers etc.

8.8 Disposal:
At this plant both bio-medical waste and municipal waste are treated and disposed hence they provide zero discharge system. For treating liquid effluent from different equipments this plant has cooling, pressure sand filter, activated carbon filter, neutralization, re-circulation into scrubber.

They carry out effluent disposal in following ways: from incinerator effluent comes i.e. incineration ash is send for Secured landfill.

` Plastic waste after disinfection and shredding are send for recycling or municipal Land filling. Sharps, after disinfection (if encapsulated) are transported for Municipal landfill. Treated wastewater is passed directly to Sewer/drain or for recycling. Oil & grease are passed for incineration.

8.8.2 Deep Burial:

At the deep burial site, a pit or trench is dug about 2 m deep. It is half filled with waste, and then covered with lime within 50 cm of the surface, before filling the rest of the pit with soil. Animals do not have access to burial sites. Covers of galvanized iron/wire meshes may be used but at this plant, greenery was planted on it. On each occasion, when wastes are added to the pit, a layer of 10cm of soil is added to cover the wastes. Burial is performed under close and dedicated supervision. The deep burial site should be relatively impermeable and no shallow well should be close to the site according to the standards of deep burial hence at this plant water proofing sheets is used. The pits should be distant from habitation, and sited so as to ensure that no contamination occurs of any surface water or ground water. The location of the deep burial site is authorized by the prescribed authority. The institution maintains a record of all pits for deep burial time to time. In rainy seasons this activity is stopped and the waste from hospitals and clinics is stored at provided storage facilities. This storage houses are provided with controlled temperature and other factors. After rainy season waste is treated and deep burial is carried out again. Fig 8.7 Cement containers for Sharp Disposal

Treatment and disposal of waste is in accordance with MoEF & PCB regulations.

8.9 Highlights of the Case Study:

Name of common Biomedical Waste treatment facility: CBMWT&DF (Common Biomedical management of Waste Treatment & Disposal Facility) Total No HCE's covered: 598 Total No. of Beds: 4680 beds Equipments available at plant: Incinerator, Shredder, Autoclave. Number & capacity of Double Chamber Capacity Treatment Facilities installed at Incinerator: 250kg/hr Auto-Clave Capacity: 150kg/hr Shredder Capacity: 50kg/hr Disposal methods: Recycle, Land filling