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Biomedical Waste Mgmt

MANDATORY INFORMATION FOR BMW 

 

Bio Medical Waste

 
 
Everything is made for a defined purpose “anything which is not intended for further use is termed as waste”. In the scientific and industrial era combined with increasing population and their demand, the turnover of products has gone very high resulting into increase in quantum of urban solid waste. With increasing need of Health Care in fast changing society the role of hospitals/nursing homes comes to the forefront. “Hospital is a residential establishment which provides short term and long term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for a person suffering or suspected to be suffering from disease or injury and for parturient. It may or may not also provide services for ambulatory patients on an outpatient basis”. In Delhi there are about 72 hospitals under Govt. Sector, 550 registered nursing homes and 936 dispensaries. In addition to this there are about 1560 unregistered establishments with different names like Nursing Homes, Medical Centres, Dental Hospitals, MTP Centres etc. About 40000 hospital beds are available in the public and private sector in Delhi. With increasing number of hospitals and nursing homes in Delhi, this number may go up even higher.
 
Historical Background:      
 
Hospital Waste or Health care waste should include any type of material generated in Health Care Establishments including aqueous and other liquid waste. Hospital waste means “Any solid, fluid or liquid waste material including its container and any other intermediate product which is generated during short term and long term care consisting observational, diagnostic, therapeutic and rehabilitative services for a person suffering or suspected to be suffering from disease or injury and for parturients or during research pertaining to production and testing of biological during immunization of human beings. Hospital waste includes garbage, refuse, rubbish and Bio Medical Waste”.
 
 
Waste management is one of the important public health measures. If we go into the historical background, before discovery of bacteria as cause of disease, the principle focus of preventive medicine and public health has been on sanitation. The provision of potable water, disposal of odour from sewage and refuse were considered the important factors in Prevention of epidemics.
 
Coming back to modern age, on the eve of 21st century with increased use of disposable material and the presence of dreaded disease like Hepatitis – B and AIDS, it is utmost important to take care of the infected and hazardous waste to save the mankind from disaster. The Health care institutions or hospitals which are responsible for care of morbid population are emitting voluminous quantity of rubbish, garbage and Bio Medical Waste matter each day from wards, operation theatre and outpatient areas. Proper management of hospital waste is essential to maintain hygienic, aesthetics, cleanliness and control of environmental pollution.
 
The hospital waste like body parts, organs, tissues, blood and body fluids along with soiled linen, cotton, bandage and plaster casts from infected and contaminated areas along with used needles, syringes and other sharps are very essential to be properly collected, segregated, stored, transported, treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection. Various communicable diseases, which spread through water, sweat, blood, body fluids and contaminated organs, are important to be prevented. The Bio Medical Waste scattered in and around the hospitals invites flies, insects, rodents, cats and dogs that are responsible for the spread of communication disease like plague and rabies. Rag pickers in the hospital, sorting out the garbage are at a risk of getting tetanus and HIV infections. The recycling of disposable syringes, needles, IV sets and other article like glass bottles without proper sterilization may be responsible for Hepatitis, HIV, and other viral diseases. It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner.
 
With the proliferation of blood born diseases, more attention being focus on the issue of infectious medical waste and its disposal, Health care institutions must be aware of the potential risk in handling infectious waste, and adhere to the highest standards of disposal and transport. Education of the staff, patients and community about the management of the infectious waste is crucial in today’s health care arena.
 
 
1.       Supreme Court judgment dated 1st March 1996 in connection with safe disposal of hospital waste ordered that
 
  i.  All hospitals with 50 beds and above should install either their own incinerator or an equally effective alternative method before 30th November 1996.
 
   ii. The incinerator or the alternative method should be installed with a necessary pollution control mechanism confirming to the standard laid down by Central Pollution Control Board (CPCB).
   
iii. Hazardous medical waste should be segregated as source of disinfected before final disposal.
   
2. Ministry of Environment & Forest, Govt. of India issued a notification for Biomedical Waste (Management & Handling) Rules 1998 in exercise of powers conferred by Section 6, 8 & 25 of the Environment (Protection) Act, 1986 that was published in The Gazette of India Extraordinary, Part-II, Section 3-Sub-Section (ii) New Delhi, July 27, 1998. These rules are further amended in 2000 & 2003. Under these rules:
   
a) The Delhi Pollution Control Committee has been designated as Prescribed Authority to implement these rules in the National Capital Territory of Delhi.
   
b) In exercise of the Powers conferred by Rule 9 of the Bio-Medical Waste (Management & Handling) Rules, 1998 the Lt. Governor of Delhi has constituted an Advisory Committee Vide No. F. 23 (322)/95/ EN/99 to act such authority under the said Rules. The composition of the Advisory Committee has 10 members with Pr. Secretary (Health), Govt. of Delhi as Chairman and Director Health Services as Member Secretary / Convener. Under Chairmanship of Principal Secretary (Health & Family Welfare) this Committee meets from time to time to discuss and decide about various issues connected with these rules.
   
It is primary responsibility of the government to implement the recommendations and directions of the Supreme Court and Biomedical Waste (Management & Handling) Rules 1998 in public interest, so that biomedical waste does not cause any harm to men, animal and environment.
 
There is a big network of Health Care Institutions in Delhi. Although, these are not under one banner but these can be utilized by better coordination among different organizations. The organization-wise Institutions are as follows: -
 
 
Sl. No. Organization Hospitals No. Of Beds

Dispen
saries

Allop
athic

Homeo Ayur Unani SHS MHS MCWC Total
1 Delhi Govt 31 7704 385 187 51 12 0 63 72 0 385
2 MCD 15 3625 274 37 14 99 15 0 0 109 274
3 NDMC 2 200 45 11 12 10       12 45
4 ESIC 4 1000 34 34             34
5 Central Govt. 10 3840 99 84 11 3 1       99
6 Autonomous 6 2994 0               0
7 Defence 3 1850 1 1             1
8 DVB 0   24 24             24
9 DJB 0   15 14   1         15
10 DTC 0   27 27             27
11 SBI 0   9 9             9
12 RBI 0   8 8             8
13 Railways 2 466 12 12             12
14 BHEL 0   3 3             3
15 Indian Airlines 0   3 3             3
16 Regd. NH 606 14950 0               0
17 Un Regd. NH 1550 ~ 5000 0               0
  Total 2229 41629 939 454 88 125 16 63 72 121 939
 
 
These Health Care Institutions are inclusive of Allopathic, ISM and Homeopathic. The hospitals and dispensaries mainly under Delhi Government, Municipal Corporation of Delhi, New Delhi Municipal Council, Employees State Insurance Corporation and Central Government Health Scheme require special attention. Equally important is the private sector comprising of major hospitals, nursing homes, clinics, blood banks, diagnostic laboratories, and Unani, homeopathy and Sidda Dava-khanas. At present there are 606 registered nursing homes under this directorate in Delhi. 
 
 
 
 
Under Biomedical Waste (Management & Handling) Rules 1998, all health care institutions are required to handle biomedical waste in a specified manner. Delhi is generating approximately 7000 metric tons of waste out of which 70 tons are Biomedical Waste. The Government hospitals and major private hospitals have their own arrangement for treatment of biomedical waste. Total no of beds in Delhi government hospitals are 6278. The smaller Nursing Homes and Clinics, which cannot make their own arrangements due to high cost involved in treatment facilities, require some alternative modalities. Keeping in view the difficulties faced by smaller Nursing Homes/Clinics/Blood Banks/Diagnostic Laboratories etc., Government is taking initiatives to establish centralized waste treatment facilities. The Government of NCT of Delhi (GNCTD) has been allotted land by Delhi Development Authority (DDA) for establishment of Centralized Biomedical Waste treatment facilities 1000 sq. meter each at Okhla and Gazipur in Delhi. The tenders for centralized facility at Okhla have already been finalized and awarded to M/s Synergy Waste Management Pvt. Ltd.  and as the possession of land at Gazipur has been taken over by Government and the tenders for the same will be invited soon. The facility at Okhla will be operational by November 2005. The Government of NCT of Delhi has planned to utilize the above two sites for establishing Centralized Bio-Medical Waste Treatment facilities as a joint venture with the private sector/NGO etc. to be identified and selected through a transparent process.  For this venture, Government of NCT of Delhi shall only provide infrastructural support to the selected party/agency in terms of transfer of the above sites on such terms and conditions as shall be approved by the Delhi Development Authority. Neither any additional capital expenditure for the establishment of the facility nor any recurring revenue expenditure for operation and maintenance of the facility will be forthcoming from the GNCTD.  Given the above conditions, the party for the joint venture shall be selected who is able to offer the services to the Hospitals/ Nursing Homes/ Clinics etc. at the most reasonable rates conforming to all the required statutory conditions.
 
 There are 31 Hospitals under Government of Delhi. Four Hospitals are having Incinerators and 9 hospitals are having Autoclaves and Shredders for Scientific Management of Bio-Medical Waste. Bio-Medical Waste from these Hospitals, where such facilities are not available are segregated and transported in special van to Hospitals where such facilities exist.  
 
 
The Bed Strength in Delhi Govt. Hospitals:
 
         
 
 
During the 10th five-year plan special vehicles will be purchased to monitor biomedical waste in Delhi Government hospitals. All hospitals under GNCT Delhi have already been requested to have separate budget head in their hospitals for Biomedical Waste Management.  * Indoor facilities are being operationalised
 
 
A team comprising of Additional Secretary (Health), Project Director (COEH) and Programme Officer (BMW) DHS (HQ) carry out regular inspection of these Hospitals under NCT of Delhi. The regular monitoring will be done to ensure implementation of these rules in hospitals and dispensaries under government of NCT of Delhi. The biomedical waste management cell will also display the information on website: Delhigovt.nic.in
 
A team comprising of Additional Secretary (Health), Project Director (COEH) and Programme Officer (BMW) DHS (HQ) carry out regular inspection of these Hospitals under NCT of Delhi. The regular monitoring will be done to ensure implementation of these rules in hospitals and dispensaries under government of NCT of Delhi. The biomedical waste management cell will also display the information on website: Delhigovt.nic.in
 
A team comprising of Additional Secretary (Health), Project Director (COEH) and Programme Officer (BMW) DHS (HQ) carry out regular inspection of these Hospitals under NCT of Delhi. The regular monitoring will be done to ensure implementation of these rules in hospitals and dispensaries under government of NCT of Delhi. The biomedical waste management cell will also display the information on website: Delhigovt.nic.in
 
 
 
 
All Hospitals and 184 Dispensaries under this Directorate have obtained authorization from DPCC under Bio-medical Waste (Management & Handling) Rules 1998. Authorization for new hospital and new dispensaries will obtain during current year. Delhi Govt. has carried out various activities like engagement of transporters for Bio-Medical Wastes, printing of leaflets, newspaper advertisement, applied for authorization from DPCC for remaining 19 dispensaries. We have also purchased 2 plots of land, 1000 sq. meters each at Gazipur and Okhla. The possession at Okhla has already been taken over the entrepreneur.
 
 
Establishment of Occupational Safety & Health Cell in the DHS (HQ) & BMW Mgmt. will be part of it.
   
The authorization for the remaining/new Dispensaries will be taken from DPCC.
   
Transportation of BMW from Hospital and dispensaries where treatment facilities are not available will be done by Centralized treatment facility Operator.
   
Behaviour change communication/IEC activities will be carried out through Newspaper advertisement and awareness generation among the community using posters, pamphlets booklets, hoardings, Guidelines, TV, Doordarshan, Calendars, Radio, Metro Trains & Unipoles etc.
   
  Procurement of Segregation Bags, containers and other materials used in management of Biomedical Waste.
   
Establishment of Centralized Bio-Medical Waste Treatment Facilities with the help of Private Entrepreneurs at Gazipur.
   
Inspection of Hospitals and dispensaries under Delhi Govt. for BMW.
   
Organization of workshop / seminars on Bio-Medical Waste Management 
   
   
Hospital waste / health care waste includes all the waste generated by health care establishments, research facilities, and laboratories including minor or scattered source-such as care taken at home (Insulin Injection).
   
About 75% to 90% of the waste produced by health care providers is non-hazardous “general waste” comparable to domestic waste. 
   
   
WHO has classified hazardous waste into following categories: -
   
1.  Infectious  waste: (suspected to
contain pathogens):
e.g. laboratory culture, waste from isolation wards, tissue-swabs, material in contact with infected patient, excreta.
       
2.  Pathological waste: (containing human
tissue or fluids):
e.g. body parts blood and other body fluids, foetuses.
       
3.  Sharps: (Sharp material): e.g. needles; infusion sets; scalpels; knives; blades; broken glass.
       
4.  Pharmaceutical waste: (containing pharmaceuticals) e.g. expired drugs; contaminated bottles; boxes
       
5.  Genotoxic waste: e.g. waste containing cytostatic drugs; genotoxic chemicals.
       
6.  Chemical waste: e.g. laboratory reagents; film developer expired disinfectants, solvents.
       
7.  Waste with heavy metals: e.g. batteries; broken thermometer
       
8.  Pressurized containers:   e.g. gas cylinders; gas cartridges; aerosol cans.
     
9.  Radioactive material: e.g. unused liquid from radiotherapy; contaminated glass ware; urine excreta from patient treated with unsealed radio nucleotides.
     
 
The exposure to hazardous health care waste can result into:
 
1. Infection.
 
2. Genotoxicity and Cytotoxicity
   
3.  Chemical toxicity
   
4. Radioactivity hazards.
   
5. Physical injuries
   
6. Public sensitivity.
   
1.  Infection: -The infectious agents can enter in the body through a puncture, abrasion, or cut in the skin; through mucous membranes; by inhalation and ingestion. Commonest infections, which can result from mishandling of hospital/health care waste, are gastro enteric through faeces and/or vomit (Salmonella, Shigella spp., Vibrio Cholera, Helminthes; Hepatitis A), Respiratory through inhaled secretions; saliva (Mycobacterium tuberculosis; measles virus; streptococcus pneumonae), Ocular infections through eye secretions (Herpes virus), Genital infections (Neisseria gonnorrhoeae; herpes virus), Skin infection through pus (Streptococcus spp.), meningitis through Cerebrospinal fluid (neisseria meningitides), AIDS through blood and sexual secretions (HIV), Haemorrhagic fevers through body fluids (Junin, Lassa, Ebola and Marburg viruses), Septicaemia and  bacteraemia through blood (staphylococcus aureus, Enterococcus, enterobacter, klebsiella and streptococcus) and Viral Hepatitis B & C through blood and body fluids (hepatitis B and C viruses).
     
2. Genotoxicity and Cytotoxicity: -many cytotoxic drugs are extremely irritant and have harmful local effects after direct contact with skin and eyes (alkylating agents; Intercalating agents; vinca alkaloids and derivatives and epipodophyllotoxins). Many neoplastic drugs are carcinogenic and mutagenic; secondary neoplasia is known to be associated with chemotherapy.
     
3. Chemical toxicity: - many of chemicals and pharmaceutical drugs used in health care establishments are hazardous (e.g. toxic, genotoxic, corrosive, flammable, reactive, explosive and shock-sensitive). They may cause intoxication by acute or chronic exposure, injuries including burns, poisoning.
     
4. Radioactivity hazards: The radioactive waste exposure may cause headache, dizziness, vomiting, genotoxicity and tissue damage.
     
5. Physical injuries: - May result from sharps, chemicals and explosive agents
     
6. Public sensitivity: -The general public is very sensitive about visual impact of the anatomical waste, recognizable body parts including foetuses if handled improperly.
     
For further information write/contact to: Dr. K. S. Baghotia State Programme Officer (BMW-Mgmt.), spobmw@yahoo.com Directorate of Health Services, GNCT of Delhi, F-17, Karkardooma, Delhi – 110032, E-mail: baghotia@yahoo.com
   
   
Dr. K. S. Baghotia
   
State Programme Officer (BMW-Mgmt.),
 
spobmw@yahoo.com
 
Directorate of Health Services, GNCT of Delhi,
 
F-17, Karkardooma, Delhi – 110032, E-mail: baghotia@yahoo.com
 
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Last Updated : 22 Mar,2014