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Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD

Bio-Medical Waste (Management and Handling) Rules, 1998: Issues, Challenges and Possible Solutions. Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD. Dept. of Hospital Administration, PGIMER, Chandigarh. Contents. 2. 1. 4. 3. Environment (Protection) Act, 1986.

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Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD

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  1. Bio-Medical Waste (Management and Handling) Rules, 1998: Issues, Challenges and Possible Solutions Prof. Anil Kumar Gupta Medical Superintendent-cum-HOD Dept. of Hospital Administration, PGIMER, Chandigarh

  2. Contents 2 1 4 3

  3. Environment (Protection) Act, 1986 BMW (Management and Handling) Rules, 1998 Non-compliance: punishable Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  4. Section 15 of Environment (Protection) Act, 1986 Punishment for non-compliance • Non-compliance to BMW (M & H) Rules, 1998 • Imprisonment up to 5 years and fine up to 1 Lac or both For first offence • Additional fine to the tune of Rs. 5000 per day If contravention continues If contravention continues beyond a period of 1 year • Imprisonment up to 7 years CME Sep 26-27, 2013

  5. Section 17 of Environment (Protection) Act, 1986 and/or Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  6. Implication of section 17 for a health care administrator • Health care administrator should maintain documentary evidence of all steps taken by him to impress upon HCWs to follow all provisions of Rules • If violation occurs, the health care worker who did not manage BMW properly will be held liable • Health care administrator would be saved of vicarious liability. Agenda in Hospital Management Board for impressing upon doctors to Manage BMW properly at source Some of the notices issued for compliance of BMW (M & H) Rules, 1998

  7. Section 5 of Environment (Protection) Act, 1986 Closure of Health Care Facility may be ordered for non-compliance to the rules. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  8. Bio-Medical Waste (Management and Handling) Rules, 1998 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  9. Some Pictures Showing Poor BMW Management in Different Parts of Country

  10. Hindustan Times, New Delhi, 22-May-2013 • 33 hospitals in Delhi found flouting BMW norms. • 4 weeks time was given to dispose BMW as per norms otherwise authorities will face prosecution. • According to Times of India 24th August, 2013 news item "These hospitals have not remedied all shortcomings and have not fully complied with disposal of biomedical waste rules.

  11. The Tribune 11-Jan-2013 The Tribune 16-Jan-2013 • 87% Army, 61% Air Force facilities lack proper authorization • Records not maintained for collection of waste, its movement to incinerator, disposal of incineration ash etc. Many Hospitals and Nursing Homes are dumping their BMW on roadsides and vacant plots in Patiala

  12. The Tribune 23-July-2011 The Tribune 10-May-2011 Legal proceedings initiated by PPCB against 10 Government and 15 Private hospitals in Panjab for violating norms of BMW (M & H) Rules, 1998 The HPCB served notices on 4 defaulting hospitals in Ambala. The hospitals were disposing untreated BMW

  13. The Tribune 4-July-2011 The Tribune 11-July-2011 22 teams of Punjab Pollution Control Board inspected 108 hospitals on 02-July-2011 54 hospitals in Punjab issued notice by PPCB The Tribune 17-July-2011 • 3 hospitals shut down • Prosecution proceedings initiated against 8 hospitals under Environment (Protection) Act, 1986 • Bank guarantee varying from Rs 25,000 to Rs 2.5 Lac obtained from 34 hospitals

  14. BMW (M & H) Rules, 1998.htm These rules apply to all persons who handle Bio-Medical Waste in any form…Rule 2 Doctors Administrators Nurses BMW It is duty of every occupier to ensure that BMW is handled in such a manner that it has no adverse effect on human health and environment… Rule 4 Sanitation workers Engineering section Team Work Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  15. Authorization for Handling BMW…Rule 8 Authorization for BMW management to be taken by every HCF serving 1000 or more patients per month a b Authorization initially for one year, then for 3 years, to be renewed every 3 years. Pre-requisites for authorization c Submission of to prescribed authority i.e. pollution control board/committee i FORM I ii Submission of prescribed fee Fee prescribed by PPCB Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  16. Salient Features of Rules…contd. Segregation at source Maintenance of Records … Rule 11 Bio-medical waste shall be segregated at source in colour-coded containers…Rule 6 (2) Records related to BMW to be maintained Records subject to inspection and verification by the prescribed authority at any time. Storage of BMW No untreated bio-medical waste shall be kept stored beyond a period of …Rule 6 (5) 24 hrs.

  17. Salient Features of Rules…contd. Rule 5 and Schedule I Chemical treatment of waste sharps and disposable items shall be done at source to ensure disinfection Mutilation of waste sharps such as hypodermic needles and disposable items shall be done at source to prevent their unauthorized re-circulation Items to be incinerated shall not be chemically pre-treated Chlorinated plastics shall not be incinerated

  18. Common Biomedical waste Treatment facility (CWTF) Clause 5 (2) of BMW (M & H) Rules, 1998 allow the occupier to avail facility of CWTF for disposal of waste generated in his premises. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  19. Over all containers having BMW Over all containers having cyto-toxic drugs Over all containers having radioactive waste Symbols Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  20. Salient Features of Rules…contd. Annual report for BMW…Rule 10 Every occupier/operator shall submit an annual report to the prescribed authority in by 31st January every year, to include information about the categories and quantities of bio-medical wastes handled during the preceding year. FORM II Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  21. Annual Report sent by PGI to CPCC Quantity of waste generated for each category of BMW is mentioned Treatment modalities used for BMW are mentioned Name and address of agency to which recyclable waste sold is mentioned Page 1 Page 2 Page 3

  22. Salient Features of Rules…contd. • ACCIDENT REPORTING…Rule 12 When any accident occurs at any institution or facility or any other site where bio-medical waste is handled or during transportation of such waste, the authorized person shall report the accident in to the prescribed authority forthwith. FORM III Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  23. 6 Schedules of BMW (M & H) Rules, 1998 Schedule I Prescribes 10 categories of BMW Prescribes colour coding and type of container for disposal of BMW Schedule II Schedule III Prescribes Label for BMW containers/bags Schedule IV Prescribes Label for transport of BMW containers/bags Prescribes standards for treatment and disposal of BMW Schedule V Schedule VI Prescribes time limit for installation of BMW treatment facilities

  24. 3 Forms of BMW (M & H) Rules, 1998 Form I Application for Authorization/renewal Form II Annual Report Form III Accident Reporting Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  25. Summary of Salient Features of BMW (M & H) Rules, 1998 1 5 2 4 3

  26. Bio-Medical Waste (Management and Handling) Draft Rules, 2011 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  27. Bio-Medical Waste (Management and Handling) Draft Rules, 2011 Notified on 24th August, 2011 Published by Ministry to invite objections and suggestions Will become applicable after their publication in Official Gazette Will replace Bio-Medical Waste (management and handling) Rules, 1998 Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  28. Salient Features of Draft Rules, 2011 Every occupier shall take authorization irrespective of no. of patients visiting health care facility Categories of BMW reduced from 10 to 8 (liquid waste and incineration ash now not separate category) Colour coding of waste collecting bags and treatment options re-specified to avoid overlapping and confusion Non-Chlorinated plastic bags for all categories of BMW Occupier shall also observe applicable guidelines issued by CPCB from time to time Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  29. Salient features of Draft Rules, 2011…contd. Following additional duties of Occupier • To provide training to all HCWs To immunize all HCWs • To ensure occupational safety of all HCWs by personal protective equipments • Recyclable waste (plastics and glass) may be disposed through authorized recyclers after autoclaving or microwaving followed by shredding

  30. Salient features of Draft Rules, 2011…contd. Following additional duties of Occupier To conduct annual health check-up for all HCWs • To establish a BMW management cell • if there are more than 30 beds in health facility • such cell will meet once every 6 months • records of the minutes to be sent to prescribed authority with annual report

  31. Draft Rules…contd. New Forms and Schedule • Form IV • for grant of authorization, • Form V • for filing appeal and • form VI • for report of CWTF specified. • Schedule VI • for specifying duties of various authorities Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  32. Draft Rules Monitoring Committee Every State and Union Territory shall constitute a monitoring committee • to monitor compliance to rules • it shall submit its report to state advisory committee, CPCB and State Pollution Control Board/Committee every 6 months. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  33. Draft Rules Every healthcare facility to have equipments like autoclave or microwave, shredder etc. or Should join CWTF Health Care Facility with more than 500 beds may install incinerator subject to environmental clearance Municipal corporation to provide land for CWTF or installation of incinerator Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  34. Draft Rules Rules are thus intended to be made more comprehensive, more specific, increasing accountability at all levels.

  35. Case Studies Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  36. 6 Case Studies on BMW Management Segregation of waste 1 and 2 Installation of Autoclave/Hydroclave/ETP 3 6 CASE STUDIES To upgrade incinerator or to join CWTF 4 5 Authorization to handle BMW 6 Non-installation of syringe destroyers CME Sep 26-27, 2013 Deptt. of Hosp. Admn. PGI, Chd.

  37. Case Study 1 On Segregation of BMW Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  38. Case study 1 In October 2005, the waste transportation vehicle of PGI was found allegedly dumping hazardous waste in municipal committeedumping ground that is meant for dumping general waste only. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  39. Issue MC Chandigarh noticed on 5th October 2005 that some plastic bags containing hazardous BMW were dumped by PGI vehicle at MC dumping site

  40. Notice issued by MC to PGI on 5th Oct 2005 PGI asked to give undertaking that BMW will not be dumped at the MC dumping ground in future Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  41. Notice by CPCC to PGI on 07th Oct 2005 Show-cause within 15 days as to why prosecution should not be initiated against you

  42. Provisions of BMW (M & H) Rules, 1998 violated This was a violation of Rule 6 (1) which states that Bio-medical waste shall not be mixed with other wastes. This was also a violation of Rule 4 of BMW (M and H) Rules, 1998 which states that it shall be the duty of every occupier of waste generating institute to take all steps to ensure that BMW is handled in such a manner that there is no adverse effect to human health and environment. Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  43. Damage caused due to above violation • Impounding of waste containing vehicle of PGI by MC 1 2 • Notices by MC and CPCC to PGI A risk of punishment under section 15 of Environment (Protection) Act, 1986 3 Adverse publicity by media affecting reputation of PGI 4

  44. Immediate actions taken by PGI For release of vehicle Undertaking given to MC that every care will be taken to prevent dumping of hazardous BMW of hospital at the MC dumping ground in future MC authorities were contacted with a request to release the van of PGI as impounding of van was adversely affecting further waste management in PGI The van was released in the evening of 05th Oct in the interest of public service Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  45. Immediate actions taken… contd. An Enquiry was ordered by PGI authorities to ascertain cause of wrong segregation and to suggest remedial actions so that such violation does not happen in future Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  46. Findings of inquiry Lapse has occurred wherein BMW meant for incineration reached dumping ground of MC showing wrong segregation 1 There is inadequate/improper supervision of waste collection, its segregation and disposal particularly from Research Block A and B areas 2 The acute shortage of disposal bags is adding to the problem of waste collection 3 To prevent such problems occurring in future concerning BMW, more educational activities need to be undertaken for all HCWs especially Research Block and Laboratory Staff 4

  47. 3 Main Causes of Wrong Segregation Inadequate supervision, 1 Shortage of waste bags 2 Remedial measures required to address these issues Lack of awareness /training of some of HCWs 3

  48. Remedial measures taken Written Instructions to Sanitation deptt • Ensure BMW not dumped at MC ground • Concerned S.I. to certify that material being dumped has been inspected and verified by him and does not contain any BMW • Stickers containing name of ward/lab on bags to identify erring ward/lab • SI will maintain a register that will be checked by S.O. weekly • Any deficiency noted shall be brought to notice of higher authorities 1 Addressing inadequate supervision

  49. Remedial measures taken Written Instructions to Nursing Staff: To pay utmost attention for proper segregation of BMW at source 1 Addressing inadequate supervision Deptt. of Hosp. Admn. PGI, Chd. CME Sep 26-27, 2013

  50. Remedial measures taken Duties/roles well defined for supervisors: • DNS/Sister Gr-I/sanitation Officers/Officer Incharge: Supervision, education and motivation of HCWs b)Sanitary Inspector (incharge of refuse collection point): • To ensure that only general waste (black bags) are loaded on dumpers for MC ground • Information about those wards/labs, if any, from where un-segregated waste is sent to refuse collection point should be immediately brought to the notice of authorities 1 Addressing inadequate supervision

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