REQUIREMENTS OF HEALTH CARE INSTITUTIONS IN BIOMEDICAL
Presentations text content in REQUIREMENTS OF HEALTH CARE INSTITUTIONS IN BIOMEDICAL
REQUIREMENTS OF HEALTH CARE INSTITUTIONS IN BIOMEDICAL WASTE RULES
Kerala State Pollution Control BoardSlide2
Health care unit Waste Management Health care of public Prevention of health hazards caused due to the activities at a health care unitSlide3
Waste streams from a Health care unit
Biomedical waste ( BMW)
Non Biomedical waste
Emission from Generators
Quantity of Waste Generation
Liquid waste - 450 l/bed/day
Biomedical Waste Management
is biomedical waste?
Is bio-medical waste infectious?
of bio-medical wastes
What does the color code signify?
Why use separate containers?
What is the safe method for Sharps disposal?
What is the maximum storage time for BMW?
What is Treatment & Disposal facility?
What are the advantages of Common facility?
How and where to locate Common facility ?
How to transport BMW to common facility?
How to reduce BMW?Slide7
The Bio-medical Waste (Management and Handling) Rules, 1998Amended in 2000
Notified by Ministry of Environment & Forests, Govt of
in exercise of powers u/s 6, 8 & 25 of the Environment (Protection) Act 1986
Set up proper BMW treatment & disposal facilities
Ensure proper segregation, packaging, transportation & storage of BMW
Applying for authorization
Furnishing annual report
Maintenance of records
Colour coding & type of container
Labelling of containers/bags
Labelling for transportation
Standards for treatment &
Time schedule to set up
Application for authorisation
Waste generated duringDiagnosis, Treatment & Immunization of human beings & animals and inResearch ActivitiesProduction or testing of biologicals categories mentioned in Schedule 1
are infectious and hazardous - need to be managed carefullySlide14
BIOMEDICAL WASTE MANAGEMENT
Categories of Biomedical Waste
Human anatomical waste
Microbiology and Biotechnology waste
Discarded medicines and
Rules apply to
who generate, collect, receive, store, transport, treat, dispose or handle
biomedical waste in any formSlide18
for enforcement of the provisions of the rules
State Pollution Control Board
Responsibilities of Occupier
Take all steps to handle wastes properly without causing any adverse effect to human health and the environment
Submit annual returns
Occupier of a health care institution - Person who has control over that institution and/or its premisesSlide20
Why Biomedical Waste goes untreated?
Pollutants are invisible
Authorities are overburdened with their prime duties
Lack of awareness
Lack of training
Lack of dedicated manpower for waste managementSlide21
The purpose of legislation is to
To prevent the spreading of infection
To prevent the reuse of disposable items discarded from the hospitalsSlide22
Salient features of the Bio-Medical Waste(Management and Handling) Rules, 1998
shall not be mixed with other
No treated biomedical waste shall be stored for beyond 48
Biomedical waste shall segregated into containers/bags labelled according to schedule 3 at the point of generation in accordance with schedule 2 prior to its storage, treatment, transportation and disposal.Slide23
If a container is transported from its originated premises to any waste treatment facility outside the premises, it shall also carry information prescribed in schedule 4 apart from a label prescribed in schedule 3
Biomedical waste shall be treated and disposed in accordance with schedule 1 and in compliance with the standards in schedule 5.Slide24
occupier has to obtain authorization of state pollution control board under biomedical waste rules.
Every occupier/operator shall submit an annual report to the prescribed authority in for 2 by 31 Jan every year including details on categories and quantities of biomedical waste handled during the preceding year.Slide25
Every authorized person shall maintain records related to generation, collection, reception, transportation, treatment, disposal of biomedical waste in accordance with these rules and guidelines
When an accident occurs at any institution for biomedical waste treatment or during its transportation, the authorized person shall report the accident in Form 3 to the prescribed authority
to be obtained by
All hospitals having inpatients
All clinics, pathological laboratories, blood banks etc. serving more than 1000 persons per month
All operators providing facilities for biomedical waste transport, treatment and disposalSlide27
Information about categories & quantities of
Form II before the 31
January every year by the HCIs to
specified format before the 31
March by the SPCB to the CPCBSlide28
-- related to
generation, collection, reception, storage, transportation, treatment and disposal
to be maintained by HCIsSlide29
during handling or transportation of BMW
to Board’s offices by telephone/fax/
telegram and in Form IIISlide30
Any person aggrieved by an order made by the Board can prefer appeal within 30 days before the Appellate AuthoritySlide31
Penal provisions (Sn.15 of Environment Act)
Noncompliance with the provisions of the Rule is a criminal offence and shall be punishable
with imprisonment for a term that may extend up to 5 years or with fine, which may extend to one lakh rupees or with both
If the failure or contravention continues, with an additional fine which may
extend to Rs. 5000 for every day
in which the failure continue after the first conviction.
If the failure or contravention continues beyond a period of one year after the date of conviction, the imprisonment term
may extend to 7 yearsSlide32
SCHEDULE II- COLOUR CODING
Human Anatomical waste
& Biotechnology waste
Cat 1,2,3 &6
& Biotechnology waste
Cat 3,6 &7
Discarded Medicines & Cytotoxic drugs
Cat 5,9 & 10Slide33
Yellow Bags and BinsSlide34
Red Bags and BinsSlide35
Black Bags and BinsSlide37
ARRANGEMENTS FOR SEGREGATION AT NURSING STATIONSlide38
1. Post Operative Organs 2.Placenta- 3. Plaster Of Paris (POP)- 4. Microbiological Waste-Slide39
5. Soiled Cotton 6. Dressing Materials 7. Beddings, Blood contaminated clothes 8. TeethSlide40
1. Syringes 2. I.V. Sets- 3. Catheters- 4. GlovesSlide41
5. Urine Bags- 6. Blood Bags- 7. Dialysis Kit-Slide42
1. Broken Glass 2. Ampules- 3. Slides 4. VIELSSlide43
1. Needles- 2. Blades- 3. Scalpels- 4. Nails-Slide44
1.SOLID CHEMICALS2. Cytotoxic DrugsSlide45
SPECIAL ATTENTION WHILE HANDLING GLASS & METALS
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Classification of Waste Category
Treatment and Disposal
Human Anatomical waste
Incineration; deep burial
Category no. 2
Incineration; deep burial
Category no. 3
Microbiology and biotechnology waste
Local autoclaving micro-waving/incineration
Category no. 4
Disinfection (chemical treatment autoclaving/micro-waving) and mutilation/shreddingSlide47
Category no. 5
Discarded medicines and cytotoxic drugs.
Incineration; destruction and drugs disposal in secured landfill.
Category no. 6
Disinfection by chemical treatment autoclaving/micro-waving and mutilation / shredding.
Category no. 7
/microwaving/ (disposables) shredding
Category no. 8
Disinfection by chemical treatment and
treated in ETP.
Category no. 9
Disposal in Municipal landfill.
Category no. 10
Chemical treatment; and discharge into drains for liquid and secured land fill for solids.Slide48Slide49
Storage of waste (from generation till treatment) shall not exceed 48 hours. Refrigerated storage is preferable
Indoor storage areas shall have restricted access and shall be located away from pedestrian traffic
Storage area shall be constructed with smooth and easily cleanable materials that are impervious to liquids
Liquid generated from floor washing in the storage area should be diverted to the waste water treatment plant
Biohazard symbol should be clearly displayed
The symbol shall be non-washable and prominently
In cases where the storage area is used for both general and biomedical waste storage, care shall be given to prevent contamination of general waste from biomedical waste.
Packages containing biomedical waste should remain sealed until it reaches the treatment site; no compaction or squeezing is allowed.Slide52
Label for packaging & storage
BIOHAZARD CYTOTOXIC HAZARD
HANDLE WITH CARESlide53
Vehicle shall be authorized by the KSPCB for the purpose
Vehicle shall be labeled with biohazard
No compaction of waste is allowed
Residual or accidental spills of packages should be washed and diverted to the liquid waste stream for treatment and disinfection
Transporter should not accept the waste if it is not properly segregated, packed and labeled
Transporter shall give a receipt of pick up of waste to the waste generator
Before returning the vehicle, it shall be decontaminated
In case of any accident, the transporter shall report in Form III to
Driver of the vehicle shall be trained on how to deal with accidents, break down etc
Compliance with the provisions under Motor Vehicle RulesSlide55
LABEL FOR TRANSPORT
Day ............ Month ..............
Date of generation ...................
Waste category No.
Sender's Name & Address Receiver's Name & Address
Phone No ........ Phone No ...............
Telex No .... Telex No ...............
Fax No ............... Fax No .................
Contact Person ........ Contact Person .........
In case of emergency, please contact
Name & Address :
Procedure for setting up common facility
Land to be identified & provided by Local
Detailed work plan to be submitted by local
SPCB after evaluation of proposal shall issue
‘Consent to Establish’ with required
On establishing the facility, it shall be inspected
be issued by the
Common Facility in Kerala - IMAGE, Palakkad
Defaults of health care unitsGeneral Observations of Board
1. Only Septic tank-soak pit facilities are provided for the treatment of sewage and
2. No segregation/ treatment of bio-medical liquid effluent which is having highly hazardous potentials before sending to ETP
3. No access to ETP
4. Poor maintenance of ETPSlide59
5. No trained operator for ETP and incinerator
6. Variation in actual bed strength and agreement document
7. No display board with respect to segregated collection
8. Inadequate colour coded containers
9. Deep burial pit without meeting specifications
10. Inadequate number in needle cutters/burners
11. No record keeping
12. Annual report submission – non compliance and incorrect informationSlide60
Integrated Clearance System
The Board introduced an integrated clearance procedure and State Govt accepted the proposal and amended the Water Rules and the Air Rules dated 9/6/2006.
As a part of integrated clearance, air act, water act, hazardous waste rules and plastic rules has been integrated.Slide61Slide62
Check list for the integrated clearance of the Board
Segregation as per Schedule II
Affiliation to IMAGE/ NOT
Mutilation of injection syringes, catheters, IV bottles
Maintenance of Registers for the category wise generation of waste and disposal
If not affiliated to IMAGE individual facilities as per Schedule I
Operation and Maintenance of each facility
Disinfection of biomedical liquid effluent
Disposal as per Schedule I
Maintenance of registers as above
Annual report submission by 31
Facility for effluent treatment has to be provided
Ensure that all streams, sewage,
( floor wash, hand wash, bathroom wash and canteen effluent & laundry and disinfected biomedical liquid effluent) are connected to ETP
80 % of the water consumption is considered as Effluent generation. Ensure adequate capacity for ETP
Water meters should be installed to record water consumption
Monthly water consumption reports has to be submitted
Operation and maintenance of ETP
Effluent monitoring reports as per the periodicity specified Proper disposal of treated effluent as specifiedSlide64
CHARACTERISTICS OF WASTEWATER FROM HOSPITALS
Turbidity, suspended solids, Total dissolved solids.
pH, BOD, COD, Chloride, Sulphate, Phosphate, Total Nitrogen, Oil and grease.
Pathogenic Organics indicated by presence of Coli form organismsSlide65
RANGE OF CHARACTERISTICS OF WASTEWATER
Tolerance limits stipulated by KSPCB
Total dissolved solids (inorganic)
BOD 5 days at 20
Sulphate (as SO4)
Total Nitrogen (as N)
Oil and Grease
MPN/ 100 ml
IMPACT OF THE POLLUTANTS ON ENVIRONMENT
for food, lowered water consumption, impaired respiration, nausea and vomiting, mental perturbation ,deterioration of personnel and community pride, interfere with human relations, discourage capital investment, lower socio-economic status and deter growth.
Inhibits penetration of light to water limiting photosynthesis by microorganisms
and thereby adversely affecting natural oxygenation of water.
Inhibits penetration of light to water limiting photosynthesis by microorganisms
and thereby adversely affecting natural oxygenation of water.Slide68
4. Total dissolved solids (inorganic)
Inhibits penetration of light to water limiting photosynthesis by microorganisms and thereby adversely affecting natural oxygenation of water.
5. Suspended solids
Aesthetically displeasing and provided adsorption sites for chemical and biological agents. Organic solids may be degraded, biologically, resulting in objectionable by-products. Biologically active (live) suspended solids may include disease-causing organisms as well as organisms such as toxin- producing strains of algae.
Alter the concentration of hydrogen ion in the receiving water body.Slide69
Deplets dissolved oxygen from water causing danger to aquatic life.
Depletes dissolved oxygen from water causing danger to aquatic life.
Bitter taste, Free chlorine toxic to fish and other aquatic life.
which is corrosive.
Overgrowth of objectionable plant forms (eutrophication), may bring about oxygen depletion in water.Slide70
Nitrate poisoning can cause death,’blue body’ syndrome (methamog lobinemia)
13. Oil and grease
Interfere with the biological life in the surface waters and create unsightly floating matter and film, cut off sunlight from water limiting photosynthesis by microorganisms and thereby affecting the natural oxygenation of water.
14. Pathogenic Organisms
Cause disease of gastro-intenstinal tract such as typhoid and paratyphoid fever, dysentery, diarrhoea and cholera.Slide71
METHODS AND EQUIPMENTS FOR WASTE WATER TREATMENT
1. Preliminary treatment
To remove larger floating and suspended solid matter
Removal of oil and grease
2. Primary treatment
To remove suspended solids
Settling tanks or clarifiers with or without flocculation or chemical coagulation
3. Secondary treatment
To remove organic matter biologically
Trickling filters, activated sludge process , fluidized bed bio-reactors, rotating biological contactor, aerated lagoonSlide72
Anaerobic lagoon, anaerobic contactor and filter, anaerobic fluidized bed bioreactor
4. Tertiary treatment
Final treatment for further improvement of wastewater
Micro strainer, sand filters, lagoons, land treatment, activated carbon adsorption, disinfection, ion exchange.Slide73
Treated Effluent Standards
Sl.No.CharacteristicsUnitTolerancelimit 1pH-6.5 – 92Suspended Solidsmg/l1003BOD (3 days at 27 0 C)mg/l304Oil & Greasemg/l105Bio assay test90% survival of fish after 96 hours in 100% effluentSlide74
EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNITSlide75
EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNITSlide76
EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNITSlide77
D.G. sets shall be acoustically enclosed
Exhaust pipe of D.G. sets shall meet the height restrictions.
Incinerator shall be of the desired specification and shall be equipped with the air pollution control facilities and its chimney shall meet height specifications.
Periodical emission monitoring reports shall be submitted.Slide78