my study on Bio-medical waste management in general hospital Sirsa(Haryana)

1. Bio-medical waste management in General Hospital, Sirsa Presented by- Dr.Jaideep Master in Public Health (Student) Panjab University, Chandigarh

3. Objective :- To evaluate Bio-medical waste management in General Hospital ,Sirsa Methodology :- Study Area :- General Hospital, Sirsa, Haryana. Study Period:- January 2009 Study design:- Crossectional & observational study Study Tools:- 1.Self assessment on Bio-medical waste (management &handling) Rules 1998 2.Interview of Health workers & Synergy waste management (P) ltd. Workers 3.Observation of Bio-medical waste segregation &handling in the Hospital. 4.Information of agreement and other bio-medical waste management measures of General hospital Sirsa were collected through R.T.I. Act 2005.

6. Schedule-I CATEGORIES OF BIO-MEDICAL WASTE Option Waste Category Treatment & Disposal Category No. 1 Human Anatomical Waste (human tissues, organs, body parts) incineration @/deep burial* Category No. 2 Animal Waste (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses) incineration@/deep burial* Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory cultures, stocks or micro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer of cultures) local autoclaving/micro-waving/incineration@ Category No. 4 Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that may cause punture and cuts. This includes both used and unused sharps) disinfection (chemical treatment @@@/auto claving/microwaving and mutilation/shredding## Category No. 5 Discarded Medicines and Cytotoxic drugs (Waste comprising of outdated, contaminated and discarded medicines) incineration@/destruction and drugs disposal in secured landfills

7. Schedule-I CATEGORIES OF BIO-MEDICAL WASTE (continue) Category No. 6 Soiled Waste (items contaminated with blood, and body fluids including cotton, dressings, soiled plaster casts, lines, bedding, other material contaminated with blood) incineration@autoclaving/microwaving Category No. 7 Solid Waste (Waste generated from disposal items other than the sharps such a tubings, catheters, intravenous sets etc.) disinfection by chemical treatment@@ autoclaving/microwaving and mutilation/shredding## Category No. 8 Liquid Waste (Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities) disinfection by chemical treatment@@ and discharge into drains Category No. 9 Incineration Ash Ash from incineration of any bio-medical waste) disposal in municipal landfill Category No. 10 Chemical Waste (Chemicals used in production of biologicals, chemicals used in production of biologicals, chemicals used in disinfection, as insectricides, etc.) chemical treatment@@ and discharge into drains for liquids and secured landfill for solids

8. Schedule-I CATEGORIES OF BIO-MEDICAL WASTE (continue) Note : @ There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. * Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas. @@ Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It musts be ensured that chemical treatment ensures disinfection. ## Multilation/shredding must be such so as to prevent unauthorised reuse.

9. 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. 4. Category 3, if disinfected locally need not be put in containers/bags. Colour Coding Type of Container Waste Category Treatment options Yellow Plastic Bag Categories 1, 2, 3 & 6. Incineration/ deep burial Red Disinfected container/Plastic bag Categories 3, 6, 7 Autoclaving/Micro-waving/Chemical Treatment Blue/White Translucent Plastic Bag /punctproof containers Cat. 4, Cat. 7 Autoclaving/Micro-waving/ Chemical Treatment & Destruction / shredding Black Plastic Bag Categories 5, 9, 10 Disposal in secured landfill.

11. Schedule-III LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS BIOHAZARD SYMBOL CYTOTOXIC HAZARD SYMBOL BIOHAZARD CYTOTOXIC HANDLE WITH CARE Note : Lable shall be non-washable and prominently visible.

12. HARYANA GOVERNMENT (ENVIRONMENT DEPARTMENT) In exercise of the powers conferred by rule 9 of the Bio-Medical Waste (Management and Handling) Rules, 1998, the Governor of Haryana hereby constitutes an Advisory Committee for the purpose of the said rule 9 consisting of the following members, namely :- 1. Commissioner and Secretary to Government, Haryana Environment Department Chairman 2. Chairman, Haryana State Pollution Control Board, Chandigarh Member 3. Engineer-in-Chief, PW (Public Health) Department, Haryana, Chandigarh Member 4. Director General, Health Services, Haryana Chandigarh ,Member 5. Director, Animal Husbandry Haryana, Chandigarh, Member 6. Dean, College of Veterinary Sciences, Chaudhry Charan Singh, Haryana Agriculture University, Hisar Member 7. Dean, Medical College, Rohtak, Member 8. President, Indian, Medical Association Haryana Branch, Member 9. Director Environment, Haryana Member-Secretary The 23rd July, 1999

13. NODAL AGENCY FOR AUTHORISATION Haryana State Pollution Control Board PENALTY:- Defaulters to be penalised as per provisions of Environment (Protection) Act 1986 and other Pollution Control Acts. Punishment – imprisonment for a term which may extend for 5 years with fine which may extend to Rs. one lakh, or with both. If failure or contravention of the provisions of the Act continues, additional fine which may extend to Rs.5000/- per day is levied upto the date the contravention is removed. If the failure or contravention continues beyond a period of one year after the date of conviction, the offender shall be punished with imprisonment for a term which may extend upto 7 years.

18. Medical waste segregation awareness boards presents in different wards of hospital

19. Availability and position of dustbins in wards Card box was used as dustbin

20. Medical Ward Card box was used as dustbin

21. Surgical Ward

22. Ortho Ward

23. Gyn.Ward

24. EMERGENCY WARD

25. Guidelines for use of Red dustbin Red dustbins in General Hospital

26. Red dustbins in General Hospital

27. Yellow dustbins in General hospital Guidelines for use of yellow dustbin

28. Yellow dustbins in General Hospital

29. Yellow dustbins in General hospital

30. Guidelines for use of blue dustbin Blue dustbins in General Hospital

31. Disposable Syringe Prepared for re use

32. Disposable Syringe Prepared for re use Disposable Syringe in Wash basin

33. Bio-medical waste mixed with Municipal waste in G.H.Sirsa campus Human Placenta

34. Medical waste

36. Rag pickers with BMW

37. Transportation of BMW from G.H.Sirsa

38. Incinerator of hospital Started in 1998, Cost 9 lakh 19 thousand. (Not used by hospital authority)

45. Conclusions The absence of waste management, lack of awareness about the health hazards, insufficient financial and human resources and poor control of waste disposal are the most common problems connected with health-care wastes. An essential issue is the clear attribution of responsibility of appropriate handling and disposal of waste. According to the 'polluter pays' principle, this responsibility lies with the waste producer, usually being the health-care provider, or the establishment involved in related activities. We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules, as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society. The challenge before us, therefore, is to scientifically manage growing quantities of biomedical waste that go beyond past practices. If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community.

47. 8.Issuance of all protective clothes such as, gloves, aprons, masks etc. without fail. 9.Maintenance of Record registers for this purpose. 10.Regular medical check-up (half-early) of staff associated with BMWM. 11.Tracking of Bio Medical Waste upto point of Disposal. 12.Segregated collection and transportation - The use of colour coding and labelling of hazardous waste including local language. 13.Safety of handling. 14.Selection of safe and environmentally-friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste. 15.Proper treatment and final disposal. Government commitment and support is needed to reach an overall and long-term improvement of the situation, although immediate action can be taken locally.

49. Thanks !! HPH ( Health Promoting Hospital) indicator