::: Hospital Services : Bio Medical Waste Management


BACKGROUND: “Cleanliness is next to Godliness”. The essence of this was aptly captured by Dravidians, who in 5000 BC gave due emphasis to immaculate town planning and safe and effective sewerage systems who got rid of all solid and liquid wastes generated by the pollution. They were indeed the pioneers as far as scientific waste management is concerned ; which is borne out from excavation of the Indus Valley Mohanje-daro and Harapa.The need for a strong biomedical waste management stems from Legal Obligation in accordance with the provisions of the Bio-Medical Waste (Management and Handling) Rules 1998, health hazards associated with improper hospital waste management: viz.
· Injuries from sharps to hospital personnel and waste handlers.
· Noso-comial infections
· Risks of infections for waste handlers, scavengers, and general public.
· Risks associated with hazardous chemicals, drugs & radiation
· Improper hospital waste management also results in air, water and soil pollution.

VISION & MISSION
Our Vision is to provide for a system of management of all potentially infectious and hazardous wastes  in accordance with  the Bio-Medical  Waste  (Management  and Handling) Rules 1998 to ensure safe living
Our Mission is to the vision of ensuring safe living with safe hospital practices through
· Change an age old “mind set” and attitude through knowledge and training.
· Definition of various categories of waste generated in the hospital.
· Segregation and collection of various categories of waste in specific containers, to enable each category to be treated in a suitable manner to render it harmless.
· Identification of proper “treatment technology” depending upon the category of waste generated.
· Creation of a system where all categories of personnel are responsible, and accountable for safe waste management.
· Change of usage patterns from single usage to multiple usage whenever possible and applicable to minimize disposals.
 
ADMINISTRATION
Hospital Waste Management Initiative in our hospital is handled by an efficient team of the SACS - sub commitee on  Biomedical Waste Management. It is a broad based committee with representative from hospital administration, clinical departments, microbiology & pathology departments and has powers to take decisions on all matters related to Bio-Medical Waste Management in the hospital. This smaller core group is responsible for implementation of the HWMI rules. The responsibilities of the various categories of the staff involved in the generation, collection, transportation, collection, treatment and disposal of wastes is formulated and implemented by this committee.
Lead : Dr. N.Palaniappan
Members
Dr.Lawrence Wesley
Dr. V.Ramasubramanian
Dr. K.Shantaraman
Dr. S.Natarajan
Dr. M.Sekar
Dr. R.Vairamuthuraju
Dr. M.S.Varadarajan
Dr. A.Balakrishnan
Dr. S.Meena
Dr. S.A.Manimala
CATEGORIZATION
CAT1 :Anatomical Wastes (human organs, body parts)
CAT2: Animal Wastes (animal organs, body parts carcasses, bleeding parts, fluid, blood)
CAT3:Microbiology & Biotechnology Wastes (laboratory cultures, stocks or specimens of microorganisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, waste from production of biologicals, toxins, dishes and devices used for transfer of cultures)
CAT4:Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps).
CAT5:Discarded Medicines (outdated contaminated and discarded medicines)
CAT6:Soiled Waste (materials contaminated with blood, and body fluids including cotton, dressings, solid linen, plaster casts, linen, beddings etc)
CAT7:Solid Waste (Wastes generated from disposable items other than the waste sharps such as tubings, catheters, intravenous sets etc.)
CAT8:Liquid Waste (waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities)
CAT9:Incineration Ash (ash from incineration of any bio-medical waste)
CAT10:Chemical Waste (chemicals used in production of biologicals, chemicals used in disinfection, as insecticides, etc.)
Do & Don’t List
 
Do
1.Segregate waste:
(a) Infection
(b) Non-Infectious/Garbage
(c) Sharps/Needles.
2.Use color coded containers/bags
3.Disinfect all sharps and plastic waste
4.Shred plastic waste
5.Use syringe and needle destroyer.
6.Incinerate blood soaked dressings.
7.Cover waste collection containers.
8.Transport through covered trolleys.
9.Use protective wear (mask, gloves, plastic aprons, gum boots to transporters and handlers).
10.Immunise all waste handlers.
 
Donts
1. Don’t mix the infectious with non-infectious waste.
2. Don’t throw sharps in the trash or into non-puncture proof containers.
3. Don’t recap the needle or bend or break needles by hand.
4. Don’t fill the waste container more than 3/4th of capacity.
5. Don’t allow un-authorized persons access to waste collection/storage areas.
6. Don’t use open buckets for infectious waste or sharps.
7. Don’t incinerate plastic waste.
 
Chemical Treatment
1. Do apply to sharp or infected plastic waste.
2. Do use 1% hypochlorite or equivalent disinfectant. Proper concentration is essential.
3. Do ensure all surfaces come in contact with chemical (including lumen).
4. Do let the contact time be at least 30 minutes.
5. Do change chemical solutions frequently (with every shift).
6. Do handle with gloves and mask. Wear apron and boots if splashing is expected.
7. Don’t chemically treat waste that needs incineration.
OPERATIONS MANAGEMENT
1. Quantum of Wastes: Approximate Estimates of 2 Kg. of wastes are generated per bed per day - This is a tremendous volume
2. Generation of Wastes
Type Site Disposal
Non-Hazardous Office, Kitchen, Rest rooms, Hostels, Residential areas,
Pantries, Stores.
Tirunelveli City Corporation
Hazardous Casualty, Triage Wd, IMCU, ICCU, PICU, ISCU, NICU, IOCU, ITCU, Major & Minor OT in all blocks, Male, Female and Pediatric Post OP, Labour, Male Female and Pediatric Wards in all Blocks, Central Lab, Blood Bank,  Pharmacy&  Medical Stores, Male, Female and Pediatric OPDs’,  Injection Rooms, Procedure Rooms, Dialysis and Endoscopy rooms, CT Scan, Ultrasound, X-ray, Doppler, MRI rooms, mammogram, Radiotherapy and Follow up clinics Based on the Biomedical Waste Management Protocols of HWMI of TVMC. Presently handled by
3. Segregation of Wastes: Segregation or the separation of different categories of waste by sorting at the point of generation, has been considered as the “key” as it allows special attention to be given to the relatively small quantities of infections and hazardous waste, thus reducing the risks and cost of waste management. Conversely small errors at this stage can create lot of subsequent problems. It is now universally accepted that segregation is the responsibility of the generator of wastes i.e. the doctor, nurse or paramedical personnel. However, in reality, this job is always relegated to the sanitary worker or hospital servant; and it becomes a truly difficult task to segregate or sort out various categories, once they have been mixed up. Factors affecting segregation at source:
- Hospital policy and procedures
- Motivation and training of doctors, nurses and paramedics.
- Facilities for segregation
- System for segregation:

WHAT GOES WHERE GUIDE


  CAT1 : Anatomical Wastes (human organs, body parts)
CAT2: Animal Wastes (animal organs, body parts carcasses, bleeding parts, fluid, blood)

  USE TWIN BIN TO DISINFECT
CAT4: Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps).

 
DISINFECTED CAT4
Waste Sharps
METALS
DISINFECTED CAT4
Waste Sharps
GLASS

  USE TWIN BIN TO DISINFECT - CAT3, 6,7 WASTE
Plastic 25litres Bin
Non-Plastic 15litres Bin
 

  CAT5: Discarded Medicines (outdated contaminated and discarded medicines)
CAT9: Incineration Ash (ash from incineration of any bio-medical waste)
CAT10: Chemical Waste (solid chemicals used in production of biologicals, solid chemicals used in disinfection, as insecticides, etc.)

  Non-Hazardous : Office, Kitchen, Rest rooms, Hostels, Residential areas, Pantries, Stores.
 
4. Transportation of Waste: Transportation is divided into intramural (internal) and extra mural (external) transportation. - Intramural (internal) transport: The sanitation staff will be responsible for transporting the different coloured polythene bags in garbage bins from the wash rooms, nursing station and treatment rooms of each ward on push carts and garbage trolleys, from all floors and wings. The waste is taken through service ramp in covered trolleys to the ground floor; and from there to the BMW Collection Area in the hospital campus. The general waste is deposited at the municipal dumps, opposite the mortuary. Any spillage or leakage is reported to Sanitary Inspector and it is his/her responsibility to get the respective trolleys/carts disinfected. - Extramural(external) transport: The segregated bags are weighed recorded and handed over to the BMW Management Agency  outsourced by the hospital. The vehicle comes once in a day without fail.

ON SITE RESPONSIBILITY
I. Generation & Segregation:
The Staff Nurse / Nursing Sister / Male Nursing Assistant should  ensure  that
· all coloured bins are available with Bio Hazard symbol
· all bins should have same coloured polythene bags with Bio Hazard symbol
· Ensure all users of the ward use the correct bins
· The bins should be kept in or near the place of washing or easy disposals
· The bins should NOT be kept open or near the patient beds
· Change the bags when they are 3/4th full.
· Tie the mouth of the filled bag & label it
· Ensure the sanitation staff remove the bags daily or when ever they accumulate to be transported immediately to the CSA.
· Ensure proper record entries of the bags and waste weight.
II. Transport and Storage:
The Sanitary Staff should  ensure  that
· all coloured bins have Bio Hazard symbol
· all bins have same coloured polythene bags with Bio Hazard symbol
· Ensure that the users of the ward have used the correct bins
· Ensure to tie the mouth of the filled bag & whether it is properly labeled
· Ensure to remove the bags daily or when ever they accumulate and  transport them immediately to the CSA after weighing and recording.
· Wear Personal Protection Equipments like mask, gloves, shoes, apron while on duty.
· Use only the trolley allocated for this work
· Ensure the trolley is clean
· Ensure the bags are transported covered and without spillage.
Use only the designated route to the CSA from the wards.
III. Supervision of Transport and Storage
The Sanitary inspector should  ensure  that
· all coloured bins have Bio Hazard symbol
· all bins have same coloured polythene bags with Bio Hazard symbol
· Ensure that the users of the ward have used the correct bins
· Ensure that the sanitary staff ensure
      - the mouth of the filled bag
      - the bags are properly labeled
      - the bags are properly weighed and recorded
- removal of bags daily or when ever they accumulate
- transport them immediately to the CSA.
- sanitary staff wear Personal Protection Equipments like mask, gloves, shoes, apron while on duty.
- Use only the trolley allocated for this work
- Ensure the trolley is clean
- Ensure the bags are transported covered and without spillage.
- Use only the designated route to the CSA from the wards.
- To deposit the bags in the correct place in the storage area.
Role of Sanitation Inspector
· The Sanitation Inspector will be responsible for the implementation, monitoring and evaluation of hospital waste management
· The SI shall supervise the process till final disposal.
· The SI will attend the BMWM Committee meetings
· The SI will ensure the training of all Sanitation staff posted under him.
· Regular in-service training and evaluation of the sanitation attendants will be carried out by him.
· He will also provides feed back information to Officer Incharge Waste Management in case of accidents and spills.
Role of Nursing Superintendents
· The Nursing Superintendent Matron Grade I will designate one of the Deputy NS (Matron Grade II) for Hospital Waste Management
· The DNS will be responsible for close monitoring of the activity.
· The DNS will conduct surprise rounds and will review and evaluate the various aspects of hospital waste management at all levels from generation and segregation to final disposal.
· The DNS will attend the meetings of Hospital Waste Management Committee on behalf of the NS & co-ordinate the training of nurses on Hospital Waste Management with administration.
Role of Resident Medical Officer
· The RMO shall be the Officer In charge of HWMI implementation
· The RMO shall liaise with the Heads of Departments, Leads of Infection Control Committee and Biomedical Waste Management Committee and Matron.
· The RMO will be member of the  Hospital Biomedical Waste Management Committee.
· The RMO will be responsible for monitoring the program on a daily basis at all levels ie:  generation, segregation, collection, storage, transportation, treatment and further disposal.
· The RMO shall be responsible for circulation of all policy decisions on hospital waste management
· The RMO shall be responsible for accident reporting to prescribed authority.
Role of Heads - Departments/ Labs / Units.
· They shall be responsible for formulation waste management procedures
· They shall be responsible for action of waste management procedures for their departments in conformity with the general guidelines issued by administration.
· They will be responsible for encouraging all staff, doctors, nurses, paramedics and other staff, to train in HWMI
· They will liaise with the RMO for administrative support.
· They will be responsible for implementation of the necessary guidelines.
· They will be responsible to teach and train students in their departments on the importance of BMWM principles and procedures.
· They shall ensure supervision of their wards, offices and labs are compliant to the guidlelines
Functions of Hospital Waste Management Committee
1. Circulation of Bio-Medical Waste Rules and guidelines
2. Fixing responsibilities of individual professionals in these guidelines.
3. Conduct of awareness programs
4. Training of Faculty & Residents of “Biomedical Waste Management & Handling Rules’ 1998.”
5. To conduct training programmes for Medical, Nursing and Sanitation
Professionals
6. To formulate detailed plan of action in regard to HWMI
7. To procure items required and make them available in all patient care areas.
Role of Medical Superintendent
· The MS is overall responsible for the formulation and implementation of guidelines for HWMI
· The MS has to ensure that waste is handled without any advance effect to human health and environment.
· The MS shall take the advice and help of the BMWM Committee and the RMO.
· As the “occupier”, the MS is responsible for applying for grant of authorization to the prescribed authority i.e. TN Pollution Control Board.
· The MS is also responsible for submitting an annual report to the prescribed authority regarding information about categories and quantities of Bio-Medical Wastes handled during the previous year.
· The MS shall answer queries of the higher authorities.
TRAINING ON HOSPITAL WASTE MANAGEMENT
To comprehend and implement the Bio-Medical Waste (Management and Handling) Rules’ 1998, it is mandatory to provide training to all categories of staff i.e. resident, doctors,  nurses,  paramedical  staff, hospital and sanitation attendants, patient  and thei r attendants, canteen staff, operation of Bio-Medical Waste treatment facilities. Our Training Program  is run round the year and includes the following :
(i) Awareness of different categories of waste and potential hazard
(ii) Waste minimization, reduction in use of disposables
(iii) Segregation policy
(iv) Proper and safe handling of sharps
(v) Use of protective gear
(vi) Colour coding of containers
(vii) Appropriate treatment of waste
(viii) Management of spills and accidents
(ix) Occupational health.
Biohazard Symbol
 

 

 

 

 

 

 

 

 

 

 

 
 



 
 



 

 

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