Planning & Management of Bio Medical Waste

1. H O P E S Planning & Management of Bio Medical Waste MS. JAGRUTI BHATIA

2. TheHistory • Awareness campaign by Dr Paul Connett’s visit. • NGO and public pressure on the govt. & Policy makers. • Involvement of the medical fraternity. • Pilot project to understand the implications. • Change in law.

3. The Waste Plan • Setting up a team • Create Awareness/Sensitization • Conducting a waste audit - Identify quantum of waste category wise • Decision on end treatment options • Drawing up a facility wise detail plan • Allocating resources • Training of Trainers • Extend the program to all staff from CEO to sanitary attendants • Monitor - Implementation of plan • Record / Report • Monitoring, Review & Refresher training

4. The Team • A responsible person designated as ‘Waste Manager’ . • Housekeeping manager / Attendant In Charge (Mukadam). • Nursing Director/Superintendent. • Infection Control Nurse, Key members from the Infection Control Team. • A representative from the management. • A representative from the Doctors / Consultants. • Sister In Charges.

5. Awareness Bio Medical Waste Management The Whys??? and Why Nots’???

6. Awareness Hospital Waste Disposal Health Hazard Environmental Hazard Aesthetic Issue

7. Awareness Environmental Hazard : • Hospital waste contains a higher amount of chlorinated plastics. • Dumped in dumping grounds where rag pickers burn it leading to high levels of pollution • Burning chlorinated plastics under incomplete combustion releases many harmful pollutants key among them being Dioxins & Furans

8. Awareness • Dioxin : A Unique Killer • Two aspects of Dioxin toxicity from the public health perspective: • - wide variety of harmful health effects • - low levels of exposure - EPA’s acceptable daily exposure 0.01 picograms/kg/day. • Gets transferred through the food chain causing various health effects • Humans routinely consume 300 to 600 times this amounts

9. Classification Of Hospital Waste The Waste Plan

10. Color Coding Type of Container Waste Category Yellow Plastic Bag Human Anatomical Waste, Discarded medicines, cytotoxic drugs (Cat. 1,2 &5) Red Disinfected Container / Plastic bag Microbiology & Biotechnology, toxins, Soiled waste(contaminated with bld & body fluids, plaster, cotton, dress), Solid Wastes (disposables) (Cat.3, 6,7) Blue / White Puncture Proof cont Waste Sharps Black Plastic Bag Bio degrad Incinerator ash (sec landfill), chemical waste (neutralise), Household / kitchen waste, Non-infectious bio degradable Color Coding System - Segregation

11. Color Coding Treatment Options Yellow Incineration / Deep Burial Red Autoclaving / Micro-waving / Chemical treatment Blue / White Autoclaving / Micro-waving / Chemical treatment and destruction & shredding Black Disposal In secured landfill - Bio degradable – vermi-composting / composting Color Coding System - Treatment

12. Color Coding System - Segregation

13. Conducting a waste audit • Based on the facility plan, areas for sample audit are selected for hospitals > 100 beds, for smaller hospitals all areas are covered • Is conducted in 2 phases • Before starting the training program • After waste management planning & training • The waste management team is trained to instruct, segregate & quantify waste as is the current hospital practice • Time frame one to two weeks based on the hospital size

14. Conducting a waste audit

15. End treatment facility • After waste audit decision on the end facility to be developed • Should be based on type of waste generated, quantity & statutory requirement • Will also depend on available options from central facility. • Population etc.

16. Central Treatment Facility - Mumbai

17. Waste Collection Hopper -Central Treatment Facility - Mumbai

18. Implementing Waste Plan • Allocating color coded bags and bins in accordance with facility plan ensuring segregation as per the rules • TOT – explaining the plan, to also include worker safety measures • Scheduling the collection timings within the hospital • Transportation system within hospital • Developing Storage facilities in-house

19. Sharps Management Plan • Institute a sharps management plan • Available option: • Needle burners (are a better option) • Needle cutters after which you disinfect & discard • Disinfect in puncture proof jerry cans with disinfecting solution (like 1% Na Hypochorite) if tranporter takes authorisation from PCB for responsibility of pilferage, the better option is still to mutilate and disinfect before discard.

20. Color Coding System - Segregation

21. Sharps Management Plan

22. Transportation: Points to be remembered: • The containers to be puncture proof and bags to be sturdy, leak proof for high risk waste • The bags to be tied by the neck while transportation • Transportation trolleys and specific lifts or timings to be designated • Staff handling this to wear protective clothing, gloves, mask, aprons etc. • If bags tear or get contaminated they be placed in a new clean bags ( double bagging ) • Never allow any person to put hands inside the bag • Stringent Infection Control Policies to be formed & implemented

23. Monitor & Review Training Evaluation Training Tools: • Conducting pre and post training tests • Monitoring of model sessions by Trainers • Post training exams conducted for trained staff by trainers

25. Records & Reports: • Waste Audit & record keeping • Ward reporting format checklist • Nurse Station • Sanitation Supervisor • Program In Charge As per the MOEF Rules, • Annual Report format (Form II, Rule 10) • Accident Reporting (Form III, Rule 12)

28. Recycling & Waste Minimization:

29. Recycling & Waste Minimization:

30. Worker Safety: • Teach employees’ responsibility • Issuance of protective equipment like gloves, mask • Establishment of an occupational health program that includes immunization, post-exposure prophylaxis, and medical surveillance

31. THANK YOU THINK TODAY TO ENSURE A BETTER TOMMOROW

32. Contact: HOPES – HELP ORGANISATION FOR PEOPLE ENVIRONMENT & SOCIETY 119, UDYOG BHAVAN SONAWALA ROAD GOREGAON (EAST) 400 063. TEL: 28777214 FAX: 28777431 EMAIL: info@hopesindia.com WEB: www.hopesindia.com