BIO MEDICAL WASTE MANAGEMENT

1. BIO MEDICAL WASTE MANAGEMENT Dr. M. Balasubramanian Asst. Prof. of STD, Stanley Medical College IMA Former State Secretary

2. PHYSICIAN ADD YEARS TO LIFE & ADD LIFE TO YEARS OF THE PATIENTS

3. DOCTORS -- SAVIOURS OF MANKIND HOSPITALS – TEMPLES OF HEALING MEDICAL PROFESSION -- NOBLE

4. DOCTORS ARE GUIDED BY ETHICS BUT GOVERNED BY LAW

5. ACCOUNTABLE TO THE PATIENT ANSWERABLE TO THE COMMUNITY

6. NOSO COMIAL INFECTIONS HOSPITAL ACQUIRED INFECTIONS

7. PROPER DISPOSAL OF HOSPITAL WASTE – SOCIAL RESPONSIBILITY

8. POLLUTION CONTROL BOARD HOSPITAL as INDUSTRY TIIC LOAN

9. HOSPITALS CLASSIFIED UNDER OBNOXIOUS & HAZARDOUS INDUSTRY 

10. HOSPITALS, Mines, Cements, Fertilizers & Chemicals, Distilleries, Tanneries Hotels, Cinema Theatre, Lime Kilns, Stone Crushing unit NIL – No toxic substance, No effluent, No fugitive emissions, No use of fuel CATEGORY

11. HON’BLE SUPREME COURT OF INDIA • Writ Petition No 888 of 1996 • Public Interest Litigation • Mrs. Almitra H. Patel vs. Union of India • Pathetic Situation of Solid Waste Management Practices • Obligatory function of Urban Local Bodies • Resulting in problems of Health & Sanitation • No solution in sight. Hon’ble Supreme Court after several hearings, constituted a committee

12. INTERIM REPORT OF THE COMMITTEE • Domestic / Trade Waste • Construction Waste • Industrial Waste • Infectious & Hospital Waste. • Adverse impact on Human Health. • Grossly neglected. • Do not discharge their duties for safe disposale. • Infectious waste & sharps get mixed up with Domestic Waste. • Incinerators in certain Hospitals only – Often single chamber not affectively functioning. • Ministry of Environment, Govt. of India to issue mandatory instructions to rectify with a time frame.

13. Tamilnadu Pollution Control Board O/o District Environment Engineer, TN Pollution Control Board  Proc. No. DEE/TNPC Bd/TLR/BMW/INV/2001 Dated Sub : TNPC Board – Hazardous Substance Management – Failure to install Bio Medical Waste Treatment and disposal facility within the stipulated time schedule – Show Cause Notice – issued. Ref : The Bio Medical Waste (M & H) Rules 1998 as amended in 2000 notified under the Environment (Protection) Act 1986. 

14. Hence you are directed to show cause within fifteen days from the date of receipt of this notice so as to why penal for an offence punishable under Section 15 of Environment (Protection) Act, 1986 should not be initiated against you for not having complied with and contravening the said provisions of the Bio Medical Waste (Management & Handing) Rules 1998 as amended in 2000 and also to issue direction for closure of the unit and stoppage of power supplyetc., under Section (5) of the Environment (Protection) Act, 1986. DISTRICT ENVIRONMENTAL ENGINEER Tamilnadu Pollution Control Board.

15. SCHEDULE VI (see rule 5) SCHEDULE FOR WASTE TREATMENT FACILITIES LIKE INCINERATOR / AUTOCLAVE / MICROWAVE SYSTEM A.Hospitals and Nursing Homes in towns with population of 30 lakhs and above 30th June 2000 or earlier B. Hospitals and Nursing Homes in towns in towns with population of below 30 lakhs (a) with 500 beds and above by 30th June, 2000 or earlier (b) with 200 beds and above but less than 500 beds by 31st December, 2000 or earlier (c) with 50 beds and above but less than 200 beds by 31st December, 2001 or earlier (d) with less than 50 beds by 31st December, 2002 or earlier C. All other institutions generating bio-medical waste not included in A and B above by 31st December, 2002 or earlier

16. BIO MEDICAL WASTE MANAGEMENT • PROGRAMME PLANNING • Willingness • Self Motivation • Investments – Person, Place, Financial • Identifying Nodal Person – ICC – BMWM Committee. • Waste Survey • Evaluation of Existing Practice • Training • Implementing Segregation • Reporting and Feed Back • Review after one year.

17. HOSPITAL WASTES Non Infectious Infectious Biodegradable Non Biodegradable Non Sharps Sharps Solids Liquids Incinerable Non Incinerable (Autoclave, Microwave)

18. SCHEDULE – 1 (See Rule 5) CATEGORIES OF BIO MEDICAL WASTE

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

20. SEGREGATION OF WASTE RED BAG OR CONTANIER No Sharps In this bag PLASTIC WASTE IV Sets Tubings Blood & Urine bags Syringes

21. YELLOW BAG OR CONTAINER SEGREGATION OF WASTE No Plastics In this bag INFECTIOUS WASTE Soiled bandages Dressings Cotton Swabs Sanitary Pads

22. SEGREGATION OF WASTE Needles and Ampoules to be put in the separate puncture proof bin provided

23. SEGREGATION OF WASTE

24. DOCTORS • Do not dispose dressings in patients bin / Ask for disposal bags. • Ensure all the plastics and gloves are cut and put into bleach solution. • Ensure all used injections are cut using needle cutters. • Ensure compliance of this scheme during ward visits

25. NURSES • Put cut gloves and plastic in bleach solution. • Put all other infectious waste, such as pathological waste, bandages, dressings, cotton etc… in yellow bin. • Always cut needles with the needle cutter and disinfect with bleach solution. • All sharps to be put in needle cutter container. • Help patients understand the scheme.

26. LAB TECHNICIANS • Use gloves during all tests. • Reusable items to be soaked in bleach and heated at high a temperature. • Media plates to be put in separate bleach solution. • Cut gloves, syringes to be put in red coloured bin with bleach. • Needles to be cut with needle cutter and disinfected with bleach. • Sharps to be put in needle cutter container.

27. WARDS BOYS / AYYAS • Cut all tubes. • Cut all gloves. • Check if waste in bleach in only plastic or glass. If not, report to the supervisor. • Help patients understand the scheme

28. DO’S • Segregate waste as per category • Put waste in correct bin wiz. Plastic/rubber waste in Red, Anatomical soiled waste in Yellow, Non-infectious general waste in Black and Sharps in Blue Puncture Proof Container. Ensure colour bags of the same colour as bins. • Ensure that the plastic bag has bio-hazard symbol and label. • Remove plastic bags when ¾ full, tie the bags properly. Ensure bag is properly tied / sealed to avoid spilling. • Remove bags by Wheel Barrows only to the waste storage site. • Cut the needle (disposable) before throwing it. • Wear protective gear while handling waste. • Always snipe the IV bottle, cut the IV sets, and fingers of gloves before throwing it in the bin or sending it back to the store. • Always keep your record book on waste activity up to date.

29. DON’TS • Put the waste indiscriminately. • Put wrong bags in bin. (Adhere to colour code.) • Fill the bags till neck. (Waste would otherwise spill over.) • Handle waste without protective clothing. • Drag the bags after removal. (Bags can burst and the site could be repulsive.) • Never recap the needle. (Never re-use needle without disinfection) • Mix non infectious waste with infectious waste.

30. DON’T MIX INFECTIOUS WASTES WITH MUNICIPAL WASTE

31. SEGREGATE AS PER COLOUR CODING AT THE POINT OF GENERATION ITSELF

32. REALISE THE SIGNIFICANE OF RED & YELLOW

33. NEVER PUT YELLOW BAG IN RED BIN AND RED BAG IN YELLOW BIN

34. OUT HOUSE MANAGEMENT • Role of Common Facilitator • To collect Bio Medical Waste from Individual Hospital every day. • To transport in closed container Van safely to the Treatment plant. • To erect common offsite BMWM Treatment facility in accordance with the standard prescribe BMWM Rules and approval from Tamilnadu Pollution Control Board. • To dispose various categories of Bio Medical Waste by approved techniques. • To train the individual hospitals staffs regarding BMWM

35. MEMORANDUM OF UNDERSTANDING BETWEEN IMA & G.J. MULTI CLAVE INDIA (P) Ltd Tariff agreed – Rs. 3 per bed per day on the basis of declared bed strength of Health Care Establishment. Comparison of Tariff -- Per bed and Per kg of Waste (Average Bio Medical Waste Per Bed Per Day - 400 gms) For a Hospital of 30 Beds with average occupancy of 20 Beds Bio Medical Waste Generated 20 x 400 gms = 8Kg Amount to be given 8 x Rs. 9 = Rs. 72/-. Amount to be given per bed 30 x Rs. 3 = Rs. 90/- (Bio Medical Waste from OP, Casualty & OT included)

36. Let us prove that we are ECO FRIENDLY To make others shed their hostility and become MEDICO FRIENDLY

37. Thankyou