REQUIREMENTS OF HEALTH CARE INSTITUTIONS IN BIOMEDICAL

REQUIREMENTS OF HEALTH CARE INSTITUTIONS IN BIOMEDICAL WASTE RULES

Presented by

Smt.

Rameena

V

V

Assistant Engineer

Kerala State Pollution Control Board

Health care unit Waste Management Health care of public Prevention of health hazards caused due to the activities at a health care unit

Waste streams from a Health care unit

Biomedical waste ( BMW)

Non Biomedical waste

Sullage

Sewage

Garbage

Emission from Generators

Noise

Quantity of Waste Generation

Solid Waste

-1.5

to 2

kg/bed/day

Liquid waste - 450 l/bed/day

CLASSIFICATION

SOLID WASTE

Biomedical Waste

300 gm/bed/day

Biomedical Waste Management

What

is biomedical waste?

Is bio-medical waste infectious?

Need for

management

of bio-medical wastes

Why segregate?

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?

The Bio-medical Waste (Management and Handling) Rules, 1998Amended in 2000

Notified by Ministry of Environment & Forests, Govt of

India

in exercise of powers u/s 6, 8 & 25 of the Environment (Protection) Act 1986

BMW Rules

14 rules

6 schedules

5 forms

Important Rules

Set up proper BMW treatment & disposal facilities

(Rule 5

)

Ensure proper segregation, packaging, transportation & storage of BMW

(Rule 6

)

Applying for authorization

(Rule 8)

Furnishing annual report

(Rule 10

)

Maintenance of records

(Rule 11)

Accident reporting

(Rule 12)

Schedules

Waste

categorisation

(

Sch

I

)

Colour coding & type of container

(

SchII

)

Labelling of containers/bags

(

Sch

III

)

Labelling for transportation

(

Sch

IV

)

Standards for treatment &

disposal

(

Sch

V

)

Time schedule to set up

(

Sch

VI)

Forms

Application for authorisation

(Form I)

Annual report

(Form II)

Accident reporting

(Form III)

Authorisation

(Form IV)

Appeal

(Form V)

Waste generated duringDiagnosis, Treatment & Immunization of human beings & animals and inResearch ActivitiesProduction or testing of biologicals categories mentioned in Schedule 1

What is

biomedical Waste

?

Bio-medical

wastes

are infectious and hazardous - need to be managed carefully

BIOMEDICAL WASTE MANAGEMENT

COLLECTION

TREATMENT

DISPOSAL

Categories of Biomedical Waste

Category No.

Type

Nature

1

Human anatomical waste

Infectious

2

Animal waste

Infectious

3

Microbiology and Biotechnology waste

Infectious

4

Waste sharps

Infectious

5

Discarded medicines and

cytotoxic

drugs

Potentially toxic

6

Soiled waste

Infectious

7

Solid waste

Infectious

8

Liquid waste

Infectious

9

Incineration ash

Toxic waste

10

Chemical waste

Toxic waste

Rules apply to

all persons

who generate, collect, receive, store, transport, treat, dispose or handle

biomedical waste in any form

Prescribed

Authority

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

Obtain

authorization

Submit annual returns

Maintain records

Report accidents

Occupier of a health care institution - Person who has control over that institution and/or its premises

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 management

The purpose of legislation is to

To prevent the spreading of infection

To prevent the reuse of disposable items discarded from the hospitals

Salient features of the Bio-Medical Waste(Management and Handling) Rules, 1998

BMW

shall not be mixed with other

wastes

No treated biomedical waste shall be stored for beyond 48

hours

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.

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.

Every

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.

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

.

Authorisation

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 disposal

Annual report

Information about categories & quantities of

BMW

in

Form II before the 31

st

January every year by the HCIs to

SPCB

in

specified format before the 31

st

March by the SPCB to the CPCB

Records

-- related to

generation, collection, reception, storage, transportation, treatment and disposal

to be maintained by HCIs

Reporting Accidents

--

during handling or transportation of BMW

to Board’s offices by telephone/fax/

telegram and in Form III

Appeal

Any person aggrieved by an order made by the Board can prefer appeal within 30 days before the Appellate Authority

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 years

SCHEDULE II- COLOUR CODING

Human Anatomical waste

Microbiology

& Biotechnology waste

Soiled waste

Cat 1,2,3 &6

Microbiology

& Biotechnology waste

Soiled waste

Solid Waste

Cat 3,6 &7

Waste sharps

Solid Waste

Cat 4&7

Discarded Medicines & Cytotoxic drugs

Incineration ash

Chemical waste

Cat 5,9 & 10

Yellow Bags and Bins

Red Bags and Bins

Sharp Containers

Black Bags and Bins

ARRANGEMENTS FOR SEGREGATION AT NURSING STATION

Yellow

1. Post Operative Organs 2.Placenta- 3. Plaster Of Paris (POP)- 4. Microbiological Waste-

Yellow

5. Soiled Cotton 6. Dressing Materials 7. Beddings, Blood contaminated clothes 8. Teeth

Red

1. Syringes 2. I.V. Sets- 3. Catheters- 4. Gloves

Red

5. Urine Bags- 6. Blood Bags- 7. Dialysis Kit-

Sharp container

1. Broken Glass 2. Ampules- 3. Slides 4. VIELS

Sharp container

1. Needles- 2. Blades- 3. Scalpels- 4. Nails-

Black

1.SOLID CHEMICALS2. Cytotoxic Drugs

SPECIAL ATTENTION WHILE HANDLING GLASS & METALS

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Classification of Waste Category

Option

Waste Category

Treatment and Disposal

Category no.1

Human Anatomical waste

Incineration; deep burial

Category no. 2

Animal Waste

Incineration; deep burial

Category no. 3

Microbiology and biotechnology waste

Local autoclaving micro-waving/incineration

Category no. 4

Waste Sharps

Disinfection (chemical treatment autoclaving/micro-waving) and mutilation/shredding

Category no. 5

Discarded medicines and cytotoxic drugs.

Incineration; destruction and drugs disposal in secured landfill.

Category no. 6

Soiled Waste

Disinfection by chemical treatment autoclaving/micro-waving and mutilation / shredding.

Category no. 7

Solid Waste

Chemical Disinfection/autoclaving

/microwaving/ (disposables) shredding

Category no. 8

Liquid waste

Disinfection by chemical treatment and

treated in ETP.

Category no. 9

Incineration Ash

Disposal in Municipal landfill.

Category no. 10

Chemical waste

Chemical treatment; and discharge into drains for liquid and secured land fill for solids.

NEEDLE DESTRUCTION

Storage

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

visible

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.

Label for packaging & storage

BIOHAZARD CYTOTOXIC HAZARD

HANDLE WITH CARE

Transportation

Vehicle shall be authorized by the KSPCB for the purpose

.

Vehicle shall be labeled with biohazard

symbol

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

KSPCB

Driver of the vehicle shall be trained on how to deal with accidents, break down etc

.

Compliance with the provisions under Motor Vehicle Rules

LABEL FOR TRANSPORT

Day ............ Month ..............

Year ...........

Date of generation ...................

Waste category No.

Waste class…

Waste description…

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 :

Phone No.

Procedure for setting up common facility

Land to be identified & provided by Local

body

Detailed work plan to be submitted by local

body

/ entrepreneur

to

SPCB

SPCB after evaluation of proposal shall issue

‘Consent to Establish’ with required

conditions

On establishing the facility, it shall be inspected

by SPCB

for

checking

adequacy and

authorization shall

be issued by the

SPCB

with necessary

conditions

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

sullage

.

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 ETP

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 information

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.

Check list for the integrated clearance of the Board

BMW

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

st

January

Waste water

Facility for effluent treatment has to be provided

Ensure that all streams, sewage,

sullage

( 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 specified

CHARACTERISTICS OF WASTEWATER FROM HOSPITALS

Characteristics

Parameters

Physical

Odour, Colour,

Turbidity, suspended solids, Total dissolved solids.

Chemical

pH, BOD, COD, Chloride, Sulphate, Phosphate, Total Nitrogen, Oil and grease.

Biological

Pathogenic Organics indicated by presence of Coli form organisms

RANGE OF CHARACTERISTICS OF WASTEWATER

Sl.No

Parameter

Unit

Range

Tolerance limits stipulated by KSPCB

1.

pH

-

6.76-7.85

5.5-9.0

2

Odour

-

Foul Smell

-

3

Suspended Solids

mg/l

275-1636

100

4

Total dissolved solids (inorganic)

mg/l

248-715

2100

5

COD

mg/l

295-935

250

6

BOD 5 days at 20

0

C

mg/l

160-481

30

7

Chloride (as

Cl

)

mg/l

44-169

1000

8

Sulphate (as SO4)

mg/l

14-36

1000

9

Phosphates

(as P)

mg/l

6-19

5

10

Total Nitrogen (as N)

mg/l

66-168

100

11

Oil and Grease

mg/l

4-18

10

12

Total

Coliforms

MPN/ 100 ml

>1800

0

13

Faecal E.Coli

Counts

100 ml

22->1800

0

IMPACT OF THE POLLUTANTS ON ENVIRONMENT

Parameter

Impact on

Environment

1.Odour

Poor

apetite

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.

2.Colour

Inhibits penetration of light to water limiting photosynthesis by microorganisms

and thereby adversely affecting natural oxygenation of water.

3.Turbidity

Inhibits penetration of light to water limiting photosynthesis by microorganisms

and thereby adversely affecting natural oxygenation of water.

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.

6. pH

Alter the concentration of hydrogen ion in the receiving water body.

7. BOD

Deplets dissolved oxygen from water causing danger to aquatic life.

8. COD

Depletes dissolved oxygen from water causing danger to aquatic life.

9. Chloride

Bitter taste, Free chlorine toxic to fish and other aquatic life.

10. Sulphate

Products H

2

SO

4

which is corrosive.

11. Phosphate

Overgrowth of objectionable plant forms (eutrophication), may bring about oxygen depletion in water.

12. Nitrogen

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.

METHODS AND EQUIPMENTS FOR WASTE WATER TREATMENT

Method

Purpose

Equipments

1. Preliminary treatment

To remove larger floating and suspended solid matter

Grit removal

Removal of oil and grease

Screens

Grit tanks

Skimming tanks

2. Primary treatment

To remove suspended solids

Settling tanks or clarifiers with or without flocculation or chemical coagulation

3. Secondary treatment

a. Aerobic

To remove organic matter biologically

Trickling filters, activated sludge process , fluidized bed bio-reactors, rotating biological contactor, aerated lagoon

b. Anaerobic

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.

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% effluent

EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNIT

EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNIT

EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNIT

AIR POLLUTION

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.

Thank You