You are on page 1of 93

1

HOSPITAL WASTE
MANAGEMENT

According to Bio- Medical Waste ( Management


and Handling) Rules, 1998 of India,

Bio-medical waste means any


waste, which is generated during the
diagnosis , treatment or immunization of
human beings or animals or in research
or in the production or testing of
biological products.

Biomedical Waste Policy


3

BMW (Management and Handling ) rule


1998 was notified under the Environment
Protection Act 1986 on 20th July 1998 and
amendment followed in 2000.

Every Hospital to develop a


comprehensive system for handling
medical waste .

A licence obtained from State Pollution

DEFINITIONS
4

Hospital Waste: It refers to all waste ,


biological or non-biological , that is
discarded and is not intended for further
use.

Medical Waste: It refers to materials


generated as a result of patient diagnosis,
treatment , immunisation of human beings
or animals.

Infectious waste : These are the portions of


medical waste that could transmit an
infectious disease .

Pathological waste: Waste removed during


surgery / autopsy or other medical procedures
including human tissues , organs, body parts ,
body fluids and specimen along with their
containers.

HOSPITAL
WASTE
Biohazardo
us (20%)
Infectious (15%)

Non Infectious
(5%)
7

Non Hazardous
(80%)
Municipal
Dump

INFECTIOUS WASTE

Lab cultures
Waste from wards
Tissues (swabs)
Excreta
Human tissues or fluids
E.g. Body parts
Blood
Body fluids
Foetuses
Sharps-Needles
Infusion sets
Scalpels
Knives
Blades
Broken glass

NON-INFECTIOUS WASTE
Drugs expired
Genotoxic chemicals
Lab reagents
Expired Disinfectants
Batteries
Broken Thermometers
Gas cylinders
Radioactive waste

10

INFECTIOUS WASTE

MANAGEMENT

STEPS IN WASTE
MANAGEMENT
1. Protection
2. Segregation
3. Storage
4. Transportation
5. Treatment
11

GENERAL PRINCIPLES OF WASTE


MANAGEMENT
A clear policy for waste management
should be prepared .
Methods of waste segregation,
collection, storage, and disposal,
according to the resources available.
Roles of team members.

12

PROTECTION

13

WORKERS
PROTECTION

14

HELMET
EYE PROTECTORS
FACE MASK

PLASTIC APRON
HEAVY-DUTY
RUBBER GLOVES
NITRILE/
NEOPRENE GLOVES

GUM BOOTS

15

16

17

SEGREGATIO
N

18

Segregate waste at the point of


generation.
Required to separate harmful
and infected from harmless and
non contagious.

19

20

21

22

23

24

COLOUR CODING AND THE TYPE OF


CONTAINER FOR DISPOSAL OF BIO
MEDICAL WASTES
COLOUR
CODING

TYPE OF
WASTE
CONTAINER CATEGORY

YELLOW

Plastic Bag

Categories 1, 2, 3
& 6.

Disinfected
container/Plastic
bag

Categories 3, 6, 7

BLUE/ WHITE
TRANSLUCEN
T

Plastic Bag
/puncture proof
containers

Categories 4,
7

BLACK

Plastic Bag

Categories 5, 9, 10

RED

25

BACTERIOLOGY / MYCOLOGY/
VIROLOGY LABORATORY

26

SPECIMEN RECEIVED
27

LIQUID- Blood,
Urine,
Stool, Peritoneal
fluid,
Pleural fluid,
Synovial fluid,
CSF, pus,
sputum

SOLID- Anatomical
Tissues, Vaginal,
Throat, Wound swabs

PROCESSING

28

STAINING
CULTURE
BIOCHEMICAL TESTS
ANTIBIOTIC SENSITIVITY TESTING

DISCARDING OF WASTE
29

HUMAN
TISSUES

Liquid wasteUrine, stool,


peritoneal
fluid, pleural
fluid, synovial
fluid , CSF,
pus, sputum,
Plastic culture
plates , Swab
sticks

GLASS
SLIDES,
TEST TUBES

Treatment and Disposal of Liquid


waste
30

1. Autoclaving
Autoclave the liquid waste

Cooled , discarded down


the laboratory sink into
the sanitary sewer.

2. Chemical Treatment
Add 1% hypochloride solution to a final dilution of
1:10
(1 part bleach to 9 parts contaminated
liquid)

solution sit for 30


minutes

flush down the laboratory sink with


copious amounts
of water

31

Do not autoclave liquids


containing chemical disinfectants

STAINED SLIDES
32

Slides immersed in discarding jar


containing measured volume of water
and a phenolic disinfectant e.g Hycolin
at a conc of 2% in water is generally
effective.
Left for overnight.
Jars emptied down the discard sink.

33

Disposal of used stained slides


Place the slides into a sharp disposal
container.
The slides are disposed either by an
autoclave or by a supervised
incineration.

CULTURE PLATES AND TUBES

Culture plates, drug sensitivity plates, culture


material with bacterial growth in liquid or
solid media in tubes, bottles and plates .
Directly loaded in to autoclave in autoclavable
plastic bags.

34

Melted media and liquids poured


down the drain with plenty of hot
water. The containers are washed
and reused.

Disposal of swab sticks- Incineration

Disposal of Human tissuesIncineration/ Deep Burial

35

TUBERCULOSIS LABORATORY

36

37

SPECIMEN RECEIVED- Sputum, Ascitic


fluid, Pleural Fluid, Pus, BAL
PROCESSING- Ziehl Neelsen Staining
Culture

DISCARDING OF WASTE
38

ANATOMICAL
TISSUE

SPUTUM
SAMPLE,
PUS,
ASCITIC
FLUID,
PLEURAL

ZN
SLIDES

Disposal of sputum container with


specimen
39

Non PVC plastic material


(polypropylene wherever available).

Put sputum cups, left over specimen, lids in


plastic bucket/bin with 5% phenolic
compound.
overnight for
at least 12
hours

40

Next day, drain off the phenol solution into


the drain

Put this container / bag into the autoclave


at 121C under 15 pounds pressure for 15
20 minutes.

Final disposal of containers by


mutilation/shredding.
If not available , deep burial pit.

41

Disposal of ZN slides
42

Place the slides into a puncture proof


container.
This bag then put in to an autoclave or
pressure cooker for autoclaving/boiling.
Dispose of the slides into a pit for
sharps
Under no circumstances should the
slides be broken or recycled.

Disposal of TB culture

Incineration/ Autoclaving

Disposal of Broom sticksIncineration

43

Disposal of used
Syringes/needles/broken vials
44

After administering injection, cauterize the


needle using a needle destroyer / cutter
Followed by cutting of the plastic hub of the
syringe without detaching the needle from
the syringe.

cauterized needles,
plastic
syringes
broken vials
ampoules

45

TRANSPORT TO COMMON WASTE TRANSPORT


FACILITY
- AUTOCLAVE

Dispose off the needles and broken vials into a


sharps pit;
Send the syringes for shredding/mutilation or
as a landfill in a deep burial pit.
46

SEROLOGY LABORATORY
47

Disposal of syringe and needle

SYRINGE

CAP

NEEDLE WITH HUB

48

Donot attempt to recap


49

PUT IN PUNCTURE-PROOF CONTAINERS


50

HOLE
WHERE N/S
IS
INSERTED
DETACHABLE
LID

AIRTIGHT
LID

Use the opening of


the box to separate
the needle along
with the hub, from
the
syringe. Thus, only
needle with the
hub
will be deposited
into the box.
51

Disposal of syringes
52

NOT DISCARDED IN PLASTIC BAGS

The syringes
which are
dismantledthick plastic
bag

53

Disinfection
54

Empty the content in large plastic bin


with sieve
Immerse this bin in another large bin
without sieve with 1%Na hypochlorite for
30 min
Blue bin for final disposal

55

56

The needles and syringes


disinfected in this manner
should be stored in a large
plastic bin for final disposal.

FINAL DISPOSAL
For needles-SHARP PITS or
ENCAPSULATION
For syringes-SHREDDING OR BURIAL
ON SITE

57

Labelling
58

Day:______ Month _________


Year ______________
Waste Category No. _________

Date of generation__________

Waste Class
Waste Description

Sender's Name & Address

Phone No.:_________________

Receiver's Name & Address

Phone No.:_______________

Telex No. _________________

Telex No.:_______________

Fax No. ___________________

Fax No.:________________

Contact Person _____________

Contact Person:____________

In case of emergency please Contact:


Name & Address:

Phone No.

Covered
containers to be
used for waste
segregation.
Bags/ Containers
to be filled 2/3rd
ofcapacity

STORAGE
59

BIG ENOUGH TO
STORE BAGS
PROPERLY
VENTILATED
NOT STORED FOR
MORE THAN 24
HRS

TRANSPORTATION
60

Closed vehiclestruck, tractor, trolley

61

WASTE TREATMENT
62

Incineration
Autoclaving
Microwaving
Hydroclaving
Chemical treatment
Inertization
Land disposal/ fill

63

64

PRINCIPLE :
High temperature dry oxidation process that
reduces organic & combustible waste to
inorganic & incombustible waste
Reduction of waste volume & weight.
Wastes that cannot be recycled, reused or
disposed off in a land fill site.

TYPES OF INCINERATORS
65

DOUBLE CHAMBERED
SINGLE CHAMBERED
ROTATORY KILNS

Double- chamber pyrolytic incinerators


66

2 Chambers

Pyrolytic chamber/primary chamber---800


C
Post combustion/secondary chamber--1000 C
Chimney

67

USES
68

ADEQUATE

Infectious waste
Pathological waste
Pharmaceuticals
INADEQUATE
Genotoxic waste
Radioactive waste

69

Single-chamber
incinerator

Used only when pyrolytic incinerators


not affordable.

Rotatory kilns

Operate at high temp


Cause decomposition of genotoxic
substances and high- resistent
chemicals.

NOT TO BE INCINERATED
70

Pressurised gas containers


Silver salts
Polyvinyl chloride(PVC)
broken thermometers, used batteries
Sealed ampoules or ampoules containing
heavy metals

AUTOCLAVING
71

Circulation of steam through infectious


waste
Prevaccum autoclave/ gravity autoclave
121C TEMP & 15 pounds for 60 mins

For microbiological waste, blood &


blood products, body fluids, used
sharps.

72

MICROWAVING
73

LOADING DEVICE -transfers the waste into shredder


SHREDDER - Break into small pieces
Shredded waste mixed with water subjected to
microwaves
Frequency 2450 MHz , Wave Length 12.24 nm.
Water in waste heated by microwave.
Heat waste to temp. of 97-100 C . Cycle time- 40 to
45 mins
Infectious components destroyed by heat
conduction.
Finally passed to landfill.

No Microwaving to be done

Cytotoxic,
ardous or
Hazardous
or
radioactive waste,
Radioactive
contaminated waste.
animal parts and
Contaminated
body
large metal parts
parts, tissues and
large metal parts.

74

HYDROCLAVING
75

Wet thermal sterilization.


Double walled ,horizontally mounted
cylinder.
Steam is injected into outer jacket to
heat the inner chamber containing
waste.
Moisture in waste evaporates as steam.

The Hydroclave Process Stage one


Medical Waste is deposited in the Hydroclave vessel.
76

The Hydroclave can


process:
Bagged waste, in ordinary
bags
Sharps containers
Liquid containers
Cardboard containers
Metal objects

The Hydroclave Process Stage two


The waste fragmentation and sterilization
77

A.

Powerful rotators mix


the waste and breaks
it into small pieces.
B. Steam fills the double
wall (jacket) of the
vessel and heats the
vessel interior.
C. The liquids in the
waste turn to steam.
D. After 20 minutes the
waste and liquids are
sterile.

The Hydroclave Process Stage three


Vessel venting and dehydration
78

A.

The vent is opened,


and the vessel depressurizes.
B. Steam heat and mixing
continue until all the
liquids are evaporated
and the waste is dry.

The Hydroclave Process Stage four


Unloading the Waste
79

A.

The unloading door is


opened.
B. The mixer now rotates in
the opposite direction, so
angled blades on the
mixer can push the waste
out the unloading door.
C. The dry, sterile waste can
be fine-shredded further
or dropped in a waste
disposal bin.
The waste is now ready for safe disposal!

Pathological waste,
Sharps containers
Liquid containers
Cardboard
containers
Metal objects

80

Hydroclave

No pre-shredding of

infectious waste
High level of sterility
Low operating cost

(by steam)

81

Microwave
(non-pressure type)

Must pre-shred
No sterility, only
disinfection
High operating
cost
(expensive
electricity)

Chemical Treatment
82

FORMALDEHYDE
ETHYLENE OXIDE
GLUTRALDEHYDE
SODIUM HYPOCHLORITE
CHLORINE DIOXIDE
PHENOLS
Suitable for Liquid waste treatment
blood, urine, stool, hospital sewage.

LAND DISPOSAL
83

Municipality/medical authority lacks


means to treat medical waste before
disposal.
2 types
Open dumps
Sanitary land disposal

Sanitary Land fill


84

Requires digging a pit 5 meters deep and 2 meters wide, having


tightly fitted heavy lid on top . Once a week, cover the waste material
with a layer of dried leaves (10cm thick) or a layer of quick lime.
Some essential elements for design and operation of a sanitary
landfill are:1. A specifically designated place . Proper permission to use the place
for final disposal must be obtained from the relevant authority.
2. Site should be away from residential areas.
3. Location should be such that vehicles carrying waste can reach the
site easily in all weathers.
4. Should not be in vicinity of a drinking water source as pollution may
result.
5. A final cover constructed to prevent the rain water infiltration when
each phase of landfill is completed.
6. Waste should be buried as rapidly as possible so as to minimize the
exposure to human/ animals.

INERTIZATION
85

Waste mixed with cement before disposal


Prevents waste from migrating into ground
water
Pharmaceutical waste

DISPOSAL
86

For needles-SHARP PITS or


ENCAPSULATION
For syringes-SHREDDING OR BURIAL ON
SITE

SHARP PITS
87

Pretreatment with disinfectent not reqd


1mt x1mt x 1mt concrete lined pit with a
cemented lid
Needle container discarded entirely,
Or contents emptied directly in pit

ENCAPSULATION
88

Needle containers are placed in metal


drums or plastic containers upto
Add CEMENT or CLAY
Allow to hard
Seal the container
Dispose off in landfill sites
Cheap & safe

89

Disposal of plastic
syringes

SHREDDINGhand mill or
electric shredder.
Later can be
buried
MUTILATION-tip
cut with hub
cutter or scissor
& then buried

90

HOSPITAL WASTE MANAGEMENT COMMITTEE AND ITS FUNCTION


91

It functions under the Chairmanship of the Medical


Superintendent.
It is a broad based committee with representative from
various clinical departments, including Medical store,
sanitation, Nursing and engineering Depts.
Function of the Committee :
Implementation of the Bio-Medical Waste (Management
and Handlings) Rules published in gazette of India of 27th
July, 1988; under the provisions of Environment Act 1986
in the hospital.
Monitor and ensure effective, hospital waste management
in the Hospital.
Organize proper and timely; training program for all
categories of workers.

Referances
92

Parks Textbook of Preventive and Social


Medicine.
Guidelines on safe disposal of Used
Needles and
Syringes in the Context of Targeted
Intervention for
Injecting Drug Users.
Technical and Operational Guidelines for
Tuberculosis Control.

93