REQUIREMENTS OF HEALTH CARE INSTITUTIONS IN BIOMEDICAL

WASTE RULES

Presented by Smt. Rameena V VAssistant 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 Waste300 gm/bed/day

Biomedical Waste Management W h a t i s b i o m e d i c a l w a s t e ?

I s b i o - m e d i c a l w a s t e i n f e c t i o u s ?

N e e d f o r m a n a g e m e n t o f b i o - m e d i c a l w a s t e s

W h y s e g re g a t e ?

W h a t d o e s t h e c o l o r c o d e s i g n i f y ?

W h y u s e s e p a r a t e c o n t a i n e r s ?

W h a t i s t h e s a f e m e t h o d f o r S h a r p s d i s p o s a l ?

W h a t i s t h e m a x i m u m s t o r a g e t i m e f o r B M W ?

W h a t i s Tre a t m e n t & D i s p o s a l f a c i l i t y ?

W h a t a re t h e a d v a n t a g e s o f C o m m o n f a c i l i t y ?

H o w a n d w h e re t o l o c a t e C o m m o n f a c i l i t y ?

H o w t o t r a n s p o r t B M W t o c o m m o n f a c i l i t y ?

H o w t o re d u c e B M W ?

The Bio-medical Waste (Management and Handling)

Rules, 1998

Amended 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 rules6 schedules5 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 during Diagnosis, Treatment & Immunization

of human beings & animals and in

Research Activities

Production 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 WasteCategory

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

1. To prevent the spreading of infection

2. 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 31st January

every year by the HCIs to SPCB

in specified format before the 31st

March by the SPCB to the CPCB

Records

-- related togeneration, 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 CHEMICALS

2. 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 & AddressPhone 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 31st 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 200C

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 Counts100 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 H2 SO4 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. AnaerobicAnaerobic 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.

Characteristics Unit Tolerancelimit

1 pH - 6.5 – 9

2 Suspended Solids mg/l 100

3 BOD (3 days at 27 0 C)

mg/l 30

4 Oil & Grease mg/l 10

5 Bio assay test 90% 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