1 / 30

Bio-Medical Waste Management Satish Sinha

Bio-Medical Waste Management Satish Sinha . History of medical waste. Medical Waste Tracking Act in US I Draft Rules in India–1995 Final Rules in 1998, 2 amendments and 5 guidelines Evolution of Rules and Practices through National Experiences

snana
Télécharger la présentation

Bio-Medical Waste Management Satish Sinha

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Bio-Medical Waste ManagementSatish Sinha

  2. History of medical waste • Medical Waste Tracking Act in US • I Draft Rules in India–1995 • Final Rules in 1998, 2 amendments and 5 guidelines • Evolution of Rules and Practices through National Experiences • National Guidelines on BMW, Guidelines on Incineration, CTFs, Immunization Waste and Mercury

  3. Various networks NGOs • Health Care Without Harm (HCWH) Injection safety: • SIGN (Safe Injection Global Network) Anti-incineration: • GAIA (Global Anti Incinerator Alliance) Mercury • Zero Mercury World Health Assembly • Patient safety

  4. Stockholm Convention on Persistent Organic Pollutants • an international environmentaltreaty • aims to eliminate or restrict the production and use of persistent organic pollutants (POPs). • entered into force on 17 May 2004 with ratification by 128 and 168 signatories.

  5. Basel Convention • Control of Tran boundary Movement of Hazardous Wastes and Their Disposal • Minimize hazardous waste generation and dispose it nearest to the point of generation

  6. Environmental Regulations • Environment Protection Act, 1986 • BMW Rules 1998 • Municipal Waste (Management and Handling) Rules, 2000 • Atomic Energy Act • Hazardous Wastes (Management & Handling) Rules, 1989 • E-Waste Rules • Batteries (M&H) Rules 2001 • Manufacture, Storage and Import of Hazardous Chemicals rules, 1989

  7. Patient safety and Bio-medical waste management • In 2002 World Health assembly, passed a resolution calling member states to work for safety of Patients. • In Oct. 2004, World alliance for Patient safety was formed, who have identified certain challenges in relation to safety of patients. First Challenge is “Clean care is Safer Care” (2005) • A formal pledge committing to address health care-associated infection in the country was signed by Government of India.

  8. Priority areas for Patient safety • Safe clinical practices and hand hygiene • Safe Surgical practices • Blood Safety • Safe Injections Practices • Health Care Waste Management Rules and guidelines are available but implementation is very poor. Lack of training or poor training is also a factor. It has not been given the due priority by most of the states and dedicated budget is required. All states should focus on this.

  9. Health care associated infections • Complicate between 5-10% of admissions in acute care hospitals in industrialized countries • It is estimated that this risk is up to 20 times higher in developing world • At any given time, 1.4 million people worldwide suffer from HAI, and at least 50% of HCAI are preventable.

  10. Unsafe injections • India contributes to 25%-30% of the global injections (WHO, 1999) • Annual injection usage ~ 3 – 6 billion, of this nearly two-thirds (62.9%injections) unsafe India CLEN Study 2002-04

  11. Why Follow Universal Precautions • The prevalence rate of blood born disease- Hepatitis B 38/1000, HIV 7/1000 (NACO 1993) • Difficult to test each patient • NSI and other sharp injuries are the key Canadian health issue, affecting 70000 people per year and costing around dollar 140 million. • A safety programme at Toronto Hospital achieved 80% reduction in injuries within an year.

  12. What is this concern for? • Infectious waste (solid and liquid) • Sharps waste • Cytotoxic waste • Pharmaceutical waste • Radioactive waste • Chemicals and disinfectants • Pressurised containers

  13. BMW Rules and Key Actors • Notified in 1998 • Concept of PPP model • Identified technologies and standards • CPCB • SPCB • Department of Health Headline of presentation to come here (on slide master)

  14. Know your waste

  15. Waste Treatment & Disposal System

  16. Schedule II

  17. Bio-medical waste and technology • Technology is only a fraction of the solution. • Major components of waste management are: • Segregation of waste • Waste minimisation • Reducing use of hazardous substances or processes • Waste Audit

  18. Approved treatment methods • Autoclave • Chemical disinfection • Hydroclave • Microwave • Incineration • Any other technology after CPCB approval

  19. In house management of waste • 1.Survey2.Meeting with the heads of all the departments3.Forming a waste management committee4.Rounds of wards to see the functioning 5.Creating a model ward6.Suggest equipment procurement7.Formal training for all the nursing staff8.Implementing the system throughout the hospital

  20. Right Technology Medical waste management is 80% segregation and 20% technology • Incineration: Pathological Waste and Body Parts , no chlorinated plastics • Autoclaving: All except body parts and pathological waste • Microwaving: All except pathological waste and metals • Chemical: Mainly plastics

  21. Of site management of waste-Centralized Facilities • Draft Guidelines on Common facilities- • Treatment facilities- 90% non-burn, 10% waste- burn • Limits incineration to Categories 1&2 • Atleast 1 Km from residential areas. Acceptable in industrial area • One operator allowed to cater upto 10,000 beds, situated within 150 km radius • Segregation is the role of generator; operator can report mixing of waste to the prescribed authority

  22. Hurdles in Implementation • Issues of Capacity • Low priority • Resource Allocation • Fixed Mindset • Injection safety, chemical safety and waste management issues yet to find space in development planning

  23. At the SPCB level • Capacity and resource • Monitoring and control • Transparency of processes • Hierarchy of control • Independent audits • Awareness of community • Increasing outreach of centralized facility to rural areas

  24. At the Hospital level • Mindset issues • Involvement of senior management • Resource availability and prioritising • Government Hospitals biggest defaulters • Capacity Building • Implementation bottlenecks • Responsibility fixing • Monitoring and Accreditation • Periodic Waste audits wrt economics

  25. At the CTF level • Untrained Staff • Poor maintenance of equipment • Effluent Treatment Plants • Maintenance of records • No power back ups • Closed door, non transparent • Differential charges • Flawed systems • Profit driver • Need for accreditation

  26. Way Forward • Resource allocation for waste management • Maintaining a pool of trainers at block/ district levels • Stakeholders involvement • Incorporation into curricula of medical, nursing and paramedical colleges • Up gradation to latest developments in BMW management • Waste minimizations policy • Appropriate technology selection • Pro-environment procurement policy

  27. Emerging Issues Mercury • First mercury documentation in healthcare in 2004: 3 kg/ hospital/year • Public notices by DPCC • Mercury phase-out committee formed by DHS • Delhi hospitals to phase out mercury • No new mercury equipment procurement in Delhi government hospitals • HCEs aiming for ISO/ NABH to phase out mercury

  28. Emerging Issues Injection Safety • Increased attention by hospitals • Fines on unattended needles • No to recapping • Reporting of needle stick injury and follow up Chemical Safety • Monitored use of Glutaraldehyde, formaldehyde, benzene, cytotoxic drugs etc.

  29. Thank You Toxics LinkH-2, Jungpura Ext.New Delhi 110014011-24328006, 24320711info@toxicslink.org www.toxicslink.org

More Related