BMW Presentation Final

8/3/2019 BMW Presentation Final

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2/14/2012 1

BIO MEDICALBIO MEDICAL

WASTEWASTEMANAGEMENTMANAGEMENT

PresentedPresented byby

Dr.Dr. JitendraJitendra saxenasaxena

Medical Officer HealthMedical Officer HealthBilaspurBilaspur


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Implementation of BMW rulesImplementation of BMW rules

19981998

High priority to Health & safety ofservices providers

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Environment (Protection) Act,Environment (Protection) Act,its Regulations & definitionsits Regulations & definitions

Ministry of Environment & Forests

Notification 20th

July 1998. Rulesunder section 6,8 & 25 ofEnvironment (Protection) Act, 1986called BMWM & handling rules 1998

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Rules apply to all those who

generate ,collect, Receive, storetransport, treat, dispose or handleBMW.

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DEFINITIONS CONTD (2)DEFINITIONS CONTD (2)

AUTHORISED PERSON

MEANS AN OCCUPIER OR OPERATORAUTHORISED BY THE PRESCRIBED

AUTHORITY TO GENERATE, COLLECT,RECEIVE, STORE, TRANSPORT, TREAT,DISPOSE AND/OR HANDLE BIO-MEDICALWASTE IN ACCORDANCE WITH THESERULES AND ANY GUIDELINES ISSUED BYTHE CENTRAL GOVERNMENT.


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DEFINITIONS CONTD(3)DEFINITIONS CONTD(3)

OCCUPIER

IN RELATION TO ANY INSTITUTIONGENERATING BIO-MEDICAL WASTE

WHICH INCLUDES A HOSPITAL,NURSING HOME, CLINIC, DISPENSARY,VETERINARY INSTITUTION, ANIMALHOUSE, PATHOLOGICAL LABORATORY,

BLOOD BANK BY WHAT EVER NAMECALLED, MEANS A PERSON WHO HASCONTROL OVER THAT INSTITUTIONAND / OR ITS PERMISES.


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DEFINITIONS CONTINUED (4)DEFINITIONS CONTINUED (4)

4. DUTY OF OCCUPIER

IT SHALL BE THE DUTY OF EVERY

OCCUPIER OF AN INSTITUTIONGENERATING BIO-MEDICAL WASTETO TAKE ALL STEPS TO ENSURE THATSUCH WASTE IS HANDLED WITHOUT

ANY ADVERSE EFFECT TO HUMANHEALTH (CLIENTS & COMMUNITY)AND THE ENVIRONMENT.


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Definition of BMWDefinition of BMW

Waste generated out of diagnosis,treatment or immunization procedure

carried out to an individual in anyhealth care or related institution

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Operator of BMW Facility

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BMW should not be mixed with other

waste Segregation - at the point of

generation

Segregation - responsibility of thegenerator

Transportation- with schedule IV

Specialized vehicle under MotorVehicle Act 1998

Not to be stored for more than 48

hours 11


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Prescribed Authority (PCB)Prescribed Authority (PCB)

Functions under the supervision &control of State Govt.

Applicant applies in Form I to PCB. Authorization granted for three

years, then renewal is needed.

Refusal with reasons. Decision with in 90 days.

May cancel or suspend the

authorization. 12


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AuthorizationAuthorization

Exempted-- less than 1000pts/month

Application in form-I

Required fee

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Advisory committeeAdvisory committee

Experts form Medical, Veterinary,

Environment Depts., Municipal adm,NGO ,PCB

Appellate authority with in 30 days


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Annual ReportAnnual Report

Form II by 31st January to St.PCB. St. PCB to Cent. PCB by 31st March


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Maintenance of recordMaintenance of record

and its

Availability for inspection


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Accident ReportingAccident Reporting

All major accidents in form III to PCB


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PunishmentPunishment

Cases in High courts only Imprisonment 6 months to 1 year

Fine up to 1 lac Rs.


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Sources of BMWSources of BMW


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Why we need BMWMWhy we need BMWM

Harmful to humans ,animals &environment


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Type of HazardsType of Hazards

Infectious agents

Genotoxic material

Hazardous chemicals Radio-active Materials

May contain sharps


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Nature of HazardsNature of Hazards

Injuries by sharps

Nosocomial infections

Injuries to scavengers Change in microbial ecology

Antibiotic resistance

Due to chemicals


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Persons at RiskPersons at Risk

Staff

Patients

Visitors Support Staff

S. Karamcharis


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Hazards to AnimalsHazards to Animals

Vultures

Dogs & wild animals Grazing animals


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Hazards to PublicHazards to Public

Rag Pickers Garbage Workers

Animals Grazers


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Hazards to Environment-Ozone Layer


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Micro biology of Health Care WasteMicro biology of Health Care Waste

TYPE OFINFECTION

EXAMPLES OF CAUSATIVEORGANISMS

TRANSMISSIONVEHICLES

Gastroentericinfections

Enterobacteria e.g.Salmonella, Shigella sp;Vibrio cholerae; Helminths

Faeces and / or vomit

Respiratoryinfections

Mycobacterium tuberculosis;measles virus;streptococcus pneumoniae

Inhaled secretions;saliva

Ocular infectionGenital infections

Herpes virus Neisseriagonorrhoeae; herpes virus

Eye secretions Genitalsecretions

Skin infections Streptococcus sp Pus

Anthrax Bacillus anthracis Skin secretions

Meningitis Neisseria meningitis Cerebrospinal fluid

Acquiredimmunodeficiencysyndrome (AIDS)

Human immunodeficiencyvirus (HIV)

Blood, genitalsecretions


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TYPE OFINFECTION

EXAMPLES OFCAUSATIVEORGANISMS

TRANSMISSION VEHICLES

Haemorrhagicfevers

Junin, Lassa, Ebola andMarburg viruses

All bloody productsand Secretions

Septicaemia Staphylococcus spp Blood

Bacteraemia Coagulase-negativeStaphylo coccus sp.Staphylococcus aureus;Enterobacter,Enterococcus, Klebsiella,

and Streptococcus spCandidaemia Candida albicans Blood

Viral hepatitis A Hepatitis A virus Faeces

Viral Hepatitis B

and C

Hepatitis B and C viruses Blood and Body

fluids


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CATEGORIZATION OF BIOCATEGORIZATION OF BIO--MEDICAL WASTEMEDICAL WASTESCHEDULESCHEDULE I (SEE RULEI (SEE RULE -- 5)5)

OPTION WASTE CATEGORY TREATMENT &DISPOSAL

CATEGORYNO.1

HUMAN ANTATOMICAL WASTE (HUMANTISSUES ORGANS BODYPARTS)

INCINERATION/DEEP BURIAL, NODISINFECTION

CATEGORYNO. 2

ANIMAL WASTE (ANIMALTISSUES,ORGANS, BODYPARTS, CARCASSES,BLEEDING PARTS, FLUIDS, BLOODANDEXPERIMENTALANIMALUSED INRESEARCH WASTE GENERATED BYVETERINARY HOSPITALS/ COLLEGES,DISCHARGE FROM ANIMAL HOUSES)

INCINERATION/DEEPDUMPING, NODISINFECTION

CATEGORYNO. 3

MICROBIOLOGYAND BIOTECHNOLOGYWASTE (WASTES FROM LABORATORYCULTURES STOCKS OR SPECIMENS OFMICRO OPGANISMSLIVE ORATTENUATED

VACCINES, HUMAN ANDANIMAL CELLCULTURE USED IN RESEARCH ANDINFECTIOUSAGENTS FROM RESEARCHAND INDUSTRIALLABORATORIES,BIOLOGICALS,TOXINS,DISHESANDDEVICESUSED FORTRANSFER OFCULTURES)

INCINERATION ORDEEPDUMPING


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CATEGORYNO.4

WASTESHARPS (NEEDLES,SYRINGES,SCALPEL BLADES,

GLASSETC.THAT MAY CAUSEPUNCTUREAND CUTS.THISINCLUDES BOTH USEDANDUNUSEDSHARPS)

DISINFECTION (CHEMICALTREATMENT

AUTOCAVING/MICRO-WAVING AND MUTILATIONANDDEEPDUMPING /SHREDDING

CATEGORYNO. 5

DISCARDED MEDICINESANDCYTOTOXIC DRUGS(WASTESCOMPRISING OF OUTDATED,CONTAMINATEDANDDISCARDED MEDICINES)

INCINERATION OR /DESTRUCTION ANDDRUGSDISPOSAL IN SECUREDLANDFILLS

CATEGORYNO. 6

SOLID WASTE- ITEMSCONTAMINATED WITH BLOOD,BODY FLUIDS INCL. COTTON,DRESSINGS,SOILEDPLASTERCASTS,LINEN, BEDDINGS,OTHER MATERIAL

CONTAMINATED WITH BLOOD

INCINERATION,AUTOCLAVING/DEEPBURIAL NO CHEMICALTREATMENT

CATEGORYNO.7

SOLID WASTE- WASTEGENERATED FROMDISPOSABLE ITEMS OTHERTHAN WASTESHARPS(TUBINGS/CATHETERS/INTRAVENOUSSETSETC.)

DISINFECTION BYCHEMICALTREATMENT/AUTOCLAVING


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CATEGORY

NO.8

LIQUID WASTE GENERATED FROM

LABORATORYAND WASHING,CLEANING, HOUSEKEEPING AND

DISINFECTING ACTIVITIES. All

antiseptics.

DISINFECTION BY CHEMICAL

TREATMENTANDDISCHARGE

INTO DRAINS

CATEGORYNO. 9

INCINERATION ASH (ASH FROMINCINERATION OF ANY BIO-

MEDICAL WASTE ).

DISPOSAL IN MUNICIPAL

LANDFILL

CATEGORYNO.10

CHEMICAL WASTE (CHEMICALUSEDIN PRODUCTION OF BIOLOGICALS,CHEMICALSUSED IN DISINFECTION,INSECTICIDES,DEVELOPER/FIXER

FROM X-RAY,un-used reagents.DDT)

CHEMICALTREATMENTANDDISCHARGE INTO DRAINS FORLIQUIDSANDSECUREDLANDFILL FORSOLIDS.FIXERTO BESOLD.DEVELOPER INTO

THEDRAINS


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CLASSIFICATION OF BMWCLASSIFICATION OF BMWAND COLOUR CODINGAND COLOUR CODING

CLASSIFICATION OF BMW AND COLOURCODING

Schedule II (See Rule 6) Category wise storage of BMW in the colour

coded bins after segregation: Yellow Cat.1,2,3,&6

Incineration/deep burial All type of tissue ( body parts, pus, blood, body

fluids, sputum, lab culture ,vaccines )

Red Cat.7Autoclaving/chem. treatment Tubings, catheter, I.V. sets, plastic syringes and

other plastic material.


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Blue Cat.4

(puncture proof containers) Shredding/autoclaving/chem. treatment

Blades, needles, slides, ampoules, glassvials, foils of the tablets and capsules.

Black Cat. 5, 9 &10.

Disposal in secured landfill

General (household) waste, fixer from

radiology dept., incineration ash.


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A few examples of waste:

Infectious waste:

Contaminated dressings, bodyparts, placenta, disposablespecimens/containers/wood/paper/plastic/glassetc, sharp object-- blades/needles, broken glass,pieces of bones, nails, disposable syringes ,usedcatheters/I.V. sets/rubber tubing's,

microbiological waste, culture plates, specimencontainers. It also includes the BMW beinggenerated from minor or scattered sources suchas that produced in the course of healthcareundertaken in home (dialysis, insulin injections).

General waste:Kitchen garbage, laundry waste,

general washing, disposable wrappers & packingmaterial like paper, plastic and wood.


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Hazardous waste:

Radioactive materials &

radiations, cytotoxic drugs, pressurizedcontainers, mercury.

Chemical waste:

Reagents, developer, savlon,Lysol, gluteraldehyde, expired drugs.

Genotoxic waste:

It is highly hazardous and mayhave mutagenic, teratogenic or carcinogenic

effects. It has the ability to kill or stop the growthof certain living cells and is used in chemotherapyof cancer


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How to minimize BMWHow to minimize BMW

AV. Qty. 1.5 to 2.2 kg/day/bed

Remember 3 Rs reduce, reuse,recycle


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ReduceReduce

Less prescription of injections

Proper segregation

15-20% BMW-1%sharp,4%chemical, 10 -15%infectious &pathological

80-85% general waste All colour coded bins at the point of

generation

Sieved containers


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ReuseReuse

Linen ,glass syringes, sheets, gowns

instruments, glass slides. Use of tooth brushes

Slides in RNTCP programme are not

re-used.


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RecycleRecycle

Proper shredding of plastic material


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Universal PrecautionsUniversal Precautions All waste hazardous

Handling of mercury Segregation -early & proper Color coded bins Training of staff PPE Proper Handling of BMW Proper transportation

Accident reporting Immunization of staff B.P. not in pits Careful handling of sharps Puncture Proof container - sharps Sieved containers Disinfection of reusable items

No direct touch Bags/ bins dont drag Proper hand washing Don't. correct errors of segregation Chemical & pharma waste if small then collect with infections waste Proper disposal of large quantity of expired drugs Disposal of chemical waste


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Response toResponse toaccidents/exposuresaccidents/exposures

Care of wound

Antibiotics if needed HIV testing & PEPT

Inform Infection control officer


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Material and suppliesMaterial and supplies PPES--- cap, gown, goggles ,gum boots, gloves,

aprons, masks

Color coded bins

Weighing machine

Syringe cutters

B.Powder

Wheeled trolley

Scissors

Savlon Polythene bags-- color coded

Sieved containers


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Polythene bagsPolythene bags

Leak resistant

Impervious to moisture

Strong. Thickness- 55 microns Sealing facility

Color coded


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Bins-swing covers/footoperated


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Carts/trolleyCarts/trolley

Properly designed

Stable

Do not produce noise No sharp edges

Easy to disinfect, drain & handle


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SegregationSegregation

Why we need it

Reduce the quantity of BMW

Ensure proper disposal At the point of generation

Color coded bins

Empty it-- when 2/3 full


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ShreddingShredding

Syringe cutters

At workable height Away from kids

Scissors for BMWM

Proper shredding


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DisinfectionDisinfection

1% B.P. solution-1% availablechlorine.

35 gms./ litre 1/2kg or less pack

Stability-- 3 hours

Contact time-- 1/2hr. Air-tight container


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If deep dumping

Tissue should not be disinfected


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Treatment of spills


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Disinfection of sputum cups 5%phenol for 18 hours. And thenshredding.


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Decontamination of blankets ,mattresses, OT table & labour Table


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AutoclavingAutoclaving

Temp 1210 c, Pressure 15 lbs/sq. inch for 60 mint1350 c 31 451490 c 35 30


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MICROWAVING


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Validation Test -Sterilables


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StorageStorage

Bins are emptied after every 3 Hours


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Storage RoomStorage Room

Near the parking point

Floor elevated, Impermeable

Hand washing facility

Room washing facility

One Exhaust Fan

Locking of Doors

No entry for rats & reptiles


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Handling ofHandling ofMercuryMercury

Dont Touch

Use Syringe

Store in water Sale it out


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TransportationTransportation

2/3 Filled bag, Tied up, Removed andreplaced

Bag once closed should not be opened

Dont drag

Dont Store for more then 48 hours

Vehicle-closed ban with logo

Scheduled IV


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DisposalDisposal

Deep burial

No. Bleaching Powder inside

BMW then 10 cm Soil

2 X 2 X 2 meter

2/3 Filled then lime & Soil


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IncinerationIncineration

Reduces organic , Combustible wasteto inorganic, non-combustible waste

Reduces Volume and weight

Two chambers

Temp 800 +- 500c

1050+- 500

c


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Incineration contd.Incineration contd.

Steam , CO2 and some other gases are produced

Nitrogen oxides Metals , halogenic acids ash

- Incomplete incineration

- Carb.mono-oxide, di-oxins, furans, co-planar- Affect immune system- Development of Nervous, endocrine and

reproductive system- Skin lesion

- Chimney 30 mtrs. height- Ash--- deep dumping

N t t b i i t dN t t b i i t d


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Not to be incineratedNot to be incinerated

Pressurized containers Reactive chemical waste

Silver Salts

Radiographic waste

Sealed ampouls /vials

Halogenated Plastic

Thermometers

Used batteries Lead lined panels


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Construction of PitsConstruction of Pits

One pucca pit with concrete roof One Kuchcha pit with steel structure


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Sub centre level 2 X 2 feet aresufficient

C t t ith th tC t t ith th t


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Contract with the operatorContract with the operator

Written agreement between M.O. I/Cand operator

Operator empanelled by PCB

Rates by negotiation

May be tenders in future


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Procedure for authorization

Application From No. I Fee Structure

>> 500 beds---10,000/yr

200-500 beds -5000/Yr

50-199 beds -3000/Yr

Less then 50 beds-1000/Yr

No beds -500/Yr

(OPD more than 1000/months)

Permission with in 90 daysAppeal with 30 days


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Record Keeping

Daily Log Book

Report Form II by 31st Jan

Accident reporting

Transportation Schedule IV


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Management at Institutional Level

Incineration is the choice Deep dumping-- second best

Level I & II --deep burial

Level III /CHC/CH/RH-- either

Level IV and above-- Incineration


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Responsibility and supervision

Segregation Generator

Supervision by Deptt. In charges

Q.C. Sanitation, MO I/C


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Handling of BMW in field campusdeep burial or Transportation &

disposal by incineration


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Health & Safety ProtectionsHealth & Safety Protections

PPEs

Proper handling of BMW

Immunization Dont touch directly

Behavioral change

Management practices


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Training programme of StaffTraining programme of Staff

All categories of staff Behavioral Change

Training & supervision


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Object of TrainingObject of Training

Awareness regarding health safety &

environment Awareness regarding safety at work

place

Awareness regarding role of eachstaff member


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Training of the communityTraining of the community

Prevent exposure to BMW Risk of BMW


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Monitoring and EvaluationMonitoring and Evaluation

Supervision of the record Decrease in the number of accidents

Campus looks clean


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FORM I

(See Rule 8) APPLICATION FORAUTHORIZATION (To be submitted in duplicate) To The Prescribed Authority (Name of the State Govt/UT Administration) Address: 1. Particulars of Application i) Name of the Applicant (Block letter & in full) ii) Name of the Institution: Address: Tel No. Fax No. Telex No.


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2. Activity for which authorization is sought:

i) Generationii) Collectioniii) Receptioniv) Storagev) Transportationvi) Treatmentvii) Disposalviii) Any other form of handling

3. Please state whether applying for fresh authorization or for renewal:(In case renewal previous authorization number and date)

4. i) Address of the institution handling bio-medical waste:ii) Address of the place of the treatment facility.iii) Address of the place of disposal of the waste.

5. i) Mode of transpiration (in any) of bio-medical waste:ii) Mode(s) of treatment.


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6. Brief description of method of treatment and disposal(attach details):

7. i) Category (See Schedule I) of waste to be handled.

ii) Quantity of waste (category wise) to be handled permonth. 8. Declaration I do hereby declare that the statements made

and information given above are true to the best of myknowledge and belief and that I have not concealed any

information. I do also, hereby, undertake to provide anyfurther information sought by the prescribed authority inrelation to these rules and to fulfil any conditions stipulatedby the prescribed authority.

Date: Signature of applicant: Place: Designation of applicant

FORM II


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FORM II

(See Rule 10)ANNUAL REPORT

(To be submitted to the prescribed authority by 31 Januaryevery year)

1. Particulars of the application:i). Name of the authorized person (occupier / operator):

ii). Name of the institution:AddressTel No Fax No.

2. Categories of waste generated and quantity on amonthly average basis:

3. Brief details of the treatment facility:

In case of off site facility.i). Name of the operator.ii). Name and address of the facility:


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Tel No. Telex No. Fax No.

4. Category-wise quantity of waste treated.

5. Mode of treatment with details:

6. Any other information:

7. Certified that the above report is for theperiod from

Date:Signature

Place:Designation

NAME OF THE HEALTH CARE FACILITY:

FORM III


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(See Rule 12)

ACCIDENT REPORTING 1. Date and time of accident. 2. Sequence of events leading to accident. 3. The waste involved in accident. 4. Assessment of the effects of the accidents on human

health and the environment: 5. Emergency measures taken. 6. Steps taken to alleviate the effects of accidents: 7. Steps taken to prevent the recurrence of such an

accident: Date:

Signature: Place:

Designation:

SCHEDULE V


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(See Rule 5)

SCHEDULE FOR WASTETREATMENT FACILITIESLIKE INCINERATOR / AUTO

CLAVE/MICROWAVESYSTEM

A. Hospital and nursing homes in towns withpopulation of 30 lakhs and above

By 31st December,1999 orearlier

B. Hospitals and nursing homes in towns withpopulation of below 30 lakhs.

I with 500 beds and above

II with 200 beds and above but less than 500beds.

III With 50 beds and above but less than 200beds

IV With less than 50 beds.

By 31st Dec.,1999 or earlier.

By 31st Dec., 2000 or earlier.



C. All other institutions generating bio-medicalwaste not included in A and B above. By 31st Dec., 2002 or earlier.

SCHEDULE III


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SCHEDULE III(SEE RULE 6)

LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

SCHEDULE IV


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SC U

(SEE

RULE

6)Level for transport of Bio-Medical WasteContainers /BagsDay.. Month.Year.Date of GenerationWaste category No. .Waste class:Waste description:Senders Name &Address: Receivers Name &Address;Phone No.. Phone No..Telex No. . Telex No. .Fax No. Fax No.

Contact Person Contact Person In case of emergency please contact:Name &Address:Phone No:Note:L b l h ll b h bl d i tl i ibl

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