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Dr. Selwyn A Colaco Chief Operating Officer Narayana Hrudayalaya Hospitals, Bangalore

Dr. Selwyn A Colaco Chief Operating Officer Narayana Hrudayalaya Hospitals, Bangalore. Bio-medical Waste Management Issues and Challenges. I. Environmental Legislation. The Air (Prevention and Control of Pollution) Act, 1981 The Environment (Protection) Act, 1986

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Dr. Selwyn A Colaco Chief Operating Officer Narayana Hrudayalaya Hospitals, Bangalore

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  1. Dr. Selwyn A Colaco Chief Operating Officer Narayana Hrudayalaya Hospitals, Bangalore Bio-medical Waste Management Issues and Challenges

  2. I. Environmental Legislation • The Air (Prevention and Control of Pollution) Act, 1981 • The Environment (Protection) Act, 1986 • The Hazardous Waste (Management & Handling) Rules, 1989 • The National Environmental Tribunal Act, 1995 • The Biomedical Waste (Management & Handling) Rules, 1998 • The Municipal Solid Waste (Management & Handling) Rules, 2000

  3. Implementation of BIO-MEDICAL WASTE RULES 1998 BMW Rules have been adopted and notified with the objective to stop the indiscriminate disposal of hospital waste/ bio-medical waste and ensure that such waste is handled without any adverse effect on the human health and environment.

  4. Implementation of BIO-MEDICAL WASTE RULES 1998 • Health care waste includes • Waste generated by the health care facilities • Research facilities • Laboratories • Biomedical waste in hospitals • 85% are non-infectious • 10% are infectious • 5% are hazardous 4

  5. Basic Principles • Segregation and safe containment of waste at the health facility level • Processing and storage for terminal disposal

  6. Basic Principles • Bio-medical waste shall not be mixed with other wastes. • Segregation at source – both at ward and unit level • Color coding to support segregation at source • Bio-medical waste shall be segregated into containers/ bags at the point of generation in accordance with Schedule II (BMW Rules 1998) prior to its storage, transportation, treatment and disposal. 6

  7. Basic Principles • The containers shall be labeled according to Schedule III (BMW Rules 1998) • Transport waste safely to pick up site • Identify destination for each type of waste and ensure safe disposal • Keep track of usage 7

  8. Transportation & Storage of BMW • Untreated biomedical waste shall be transported only in vehicles authorized for the purpose by the competent authority as specified by the government. • Untreated bio-medical waste shall not be kept/stored beyond a period of 48 hours. • If for any reason it becomes necessary to store the waste beyond such period, measures must be taken to ensure that the waste does not adversely affect human health and the environment.

  9. Biomedical Waste Management - Issues Unsafe collection Use/Reuse of equipment Unsafe disposal

  10. Biomedical Waste Management - Issues • Not considered important • Lack of interest from senior management • No ownership of the process • Awareness of problems • Appreciate the need for constant monitoring

  11. Biomedical Waste Management - Issues • Segregation of waste not taken seriously at user level • Non compliance with color coding • Monitoring segregation at source – low budgets allocated – costs are not always known • Cost of color coding, staff, transport and disposal • Quantification of waste generated is not accurately done 11

  12. Biomedical Waste Management - Issues • Protection of healthcare workers not given adequate thought • Clinical waste dumped with non infectious waste - Risk for healthcare workers and public • Waste disposal not effective, often dumped in open landfills 12

  13. Biomedical Waste Management - responsibilities • Responsibility for waste disposal – head of facility, but devolved to members of the waste management team • Each healthcare worker – segregation and appropriate disposal • Private companies – from collection point in hospital to disposal • Medical waste segregation awareness and Information should be available in all areas of hospital 13

  14. Challenges: Need for protocol and policies… To provide protection for Healthcare workers Patients Community at large - from the risk of infections Compliance with statutory requirements Government of India -1998 biomedical waste management and handling rules under EPA (compels hospitals, clinics, labs to ensure safe and environmentally sound management of waste generated at their establishments)

  15. Challenges • Establishing robust waste management policies within the organization • Organization wide awareness about the health hazards • Sufficient financial and human resources • Monitoring and control of waste disposal • Clear responsibility for appropriate handling and disposal of waste. 15

  16. ADRESSING THE ISSUES • Need to build-up of a comprehensive system, address responsibilities, resource allocation, handling and disposal • This is a long-term process, sustained by gradual improvements. • Specific personnel need to be assigned to monitor the bio-medical waste management in the hospital. • Man power needs and other resources for the BMWM of hospital to be addressed. • Quality assessment of bio-medical waste management should be done from time to time.

  17. ADRESSING THE ISSUES • Segregated collection and transportation - The use of color coding and labeling of hazardous waste. • Clear directives in the form of a posters and notice to be displayed in all concerned areas in English and local languages. • Safety of handlers. • Raising Awareness about risks related to health-care waste; training staff and HCW on safe practices. • Selection of safe and environmentally friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste. 17

  18. ADRESSING THE ISSUES • Issue of all protective clothes such as, gloves, aprons, masks etc. to all HCW. • Regular medical check-up (half-yearly) of staff associated with BMWM. • Maintenance of Record registers for this purpose. • Containers should be robust and leak proof • Tracking of Bio Medical Waste upto point of Disposal. • Proper treatment and final disposal.

  19. Thank you Any Questions? 19

  20. Schedule-I CATEGORIES OF BIO-MEDICAL WASTE

  21. Schedule-I CATEGORIES OF BIO-MEDICAL WASTE (continued)

  22. Schedule-I CATEGORIES OF BIO-MEDICAL WASTE (continue)

  23. Schedule-II COLOUR CODING AND THE TYPE OF CONTAINER FOR DISPOSAL OF BIO MEDICAL WASTES Notes:1. Colour coding of waste categories with multiple treatment options as defined in schedule 1, shall be selected depending on treatment option chosen, which shall be as specified in Schedule I.2. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics.3. Categories 8 and 10 (liquid) do not require containers/bags.

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