Medical Waste

Medical Waste

MEDICAL WASTE An Environmental Menace

CONTENTS What is medical waste Types of medical waste Categorization of medical waste Quantum of medical waste Regulatory frame work in India a) Bio-Medical Waste (Management and Handling) Rules 1998 b) Specific guidelines for handling sharps Management of medical waste Precautions while handling medical waste Treatment technologies for medical waste Conclusion References

WHAT IS MEDICAL WASTE Waste that is generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals, including but not limited to: Blood soaked bandages, Culture dishes and other glass wares, Discarded surgical gloves (after surgery), Discarded surgical instruments (scalpels), Needles( used to give shots or draw blood), Removed body organs (tonsils, appendices, limbs etc.),and Lancets.

TYPES OF MEDICAL WASTE Non infectious Infectious Hazardous Formaldehyde Blood and blood products Paper from offices Cytotoxic chemicals Corrugated cardboard Pathological waste Photographic chemicals Glass Sharps Radionuclides Metal Cultures and stocks of Solvents Plastic packaging infectious agents Food waste Contaminated equipment Toxic chemicals Waste anesthetic gases Isolation waste Glassware

CATEGORIZATION OF MEDICAL WASTE Medical waste is categorized in many ways in different parts of the world since it comprises a variable mixture of waste which are very different Some can be reused or recycled Some safely disposed off as household waste Some require special treatment and disposal techniques to guard against any risk to human health and environment. Waste categories are specified by national/local regulations.

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 and mutilation/shredding Category no.5 Discarded medicines and Cytotoxic drugs Incineration; destruction and drugs disposal in secured landfill Category no.6 Soiled Waste Incineration; autoclaving/micro-waving Category no.7 Solid waste Disinfection by chemical treatment; autoclaving/micro-waving and mutilation/shredding Category no.8 Liquid waste Disinfection by chemical treatment and discharge into drain Category no.9 Incineration Ash Disposal in municipal landfill Category no.10 Chemical Waste Chemical treatment; and discharge into drains for liquids and secured landfill for Solids.

QUANTUM OF MEDICAL WASTE Hospital waste generated in developing countries ( per patient) is much less as compared to the volume generated in the developed countries. Volume of waste generated from a medical facility in developing countries ranges from1-3Kg/day/bed as compared to 5-8Kg/day/bed in developed countries.

MANAGEMENT OF MEDICAL WASTE

The management of medical waste is still in its infancy all over the world. Unless carefully managed, medical waste can take diseases from hospital beds to our homes. In most of the developing countries, it is very poorly managed. In medical waste management the hazards and risks multiply not just to the generators and operators but also affect the general community.

Significant cooperation among the concerned parties and commitment in terms of time and resources. Ability and the willingness of the responsible parties to review their current practices and adopt prevention of waste generation as a priority. Limited access to financial resources as well as to scientific and technical assistance may also limit the success of a management programme. The best mantra which can be followed in the management of any type of waste is the three R’s that are Reduce, Reuse and Recycle.

Waste minimization 1. Segregation 2. Source reduction 3. Resource recovery and recycling 4. Education 5. Purchasing practices

REGULATORY FRAMEWORK IN INDIA In India, there was no legislation on medical waste till the MoEF proposed the first draft rules in 1995. The second draft rules were notified in1997. The final rules were notified on 20 July 1998 and were called Bio Medical Waste (Management and Handling) rules 1998 These rules were enacted under EPA 1986

The rules have specified a three bin system for the segregation of wastes: 1) Yellow bin 2) Blue bin 3) Puncture proof containers

Bio-Medical Waste (Management & Handling) Rules 1998 Salient features The rules apply to all persons who generate, collect, receive, transport, treat, dispose, store, or handle biomedical waste in any form. It is the duty of the occupier, where required to set up requisite bio-medical waste treatment facilities for treatment of waste, or ensure requisite treatment of waste at a common waste treatment facility.

Bio-medical waste is to be treated and disposed in accordance with Schedule I. Bio-medical waste has to be segregated at the point of generation before its storage, transportation, treatment and disposal. No untreated bio-medical waste can be kept beyond a period of 48 hours.

Prescribed Authority Authorization Advisory committee Annual report Maintenance of records Accident reporting Appeal

Specific guidelines for handling sharps Definition of sharps: The rules categorize sharps in Category No 4.Sharps are defined as comprising of needles, syringes, scalpels, blades, glass, i.e. anything that may cause puncture and cuts. These include both used and unused sharps. Segregation and storage: The types of containers prescribed for waste sharps have to be puncture-proof and can be blue, white or translucent in color.

Treatment: Chemical treatment /autoclaving/ rotoclaves/ microwaving. Mutilation prior to disposal is mandatory to prevent any unauthorized re-use. Final disposal: After disinfection and mutilation of sharps they should be disposed in secured landfills as per the rules. As secured landfills are not available everywhere alternate systems recommended include:

a) Sharps pit: Pit can be dug and lined with brick, masonry or concrete rings. The pit should be covered with a heavy concrete slab.

a)Encapsulation: Sharps are collected in puncture-proof and leak proof Containers. When a container is threequarter full, a material such as cement mortar, bituminous sand, plastic foam, or clay is poured in until the container is completely filled. After the medium has dried, the containers are sealed and disposed of in landfill sites.

PRECAUTIONS FOR HANDLING MEDICAL WASTE Never transfer sharps directly from person to person Never overload bins used for storing Bio Medical Waste Do not inhale chemicals directly. Use always mask. Never transfer sharp directly Never recap the needles Keep away sharps medicines from children

TREATMENT TECHNOLOGIES FOR MEDICAL WASTE 1)Incineration Most common method. Temperature:1600 F - 2500 F or 871 C - 1371 C Over 90% of infectious waste is often burned in incinerators. Incinerators are either located onsite or offsite.

Advantages: 1) Reduce landfill cost. 2) Reduces overall energy cost. Disadvantages: 1)Emit toxic air pollutants. 2) Incineration ash is potentially hazardous. 3)Health impacts of incineration

2)Steam sanitation Carried out in device called Autoclave Process takes 30-90 minutes Temperature: 30-190 C Volume reduced by 75% Residue can be landfilled Used for low radioactive, chemical, pathological waste

3) Dry heat disinfection Fragmentation of waste and preheating in a rotating auger Temperature varies from 110-140 C Process takes 20 min. Volume reduced by 80% Recommended for the treatment of infectious waste and sharps

4)Chemical disinfection This technology is used for : a) Infected body fluids b) Microbiological waste c) Reusable objects d) Hospital sewer systems Chemicals used are: a) Aldehydes b) Chlorine compounds c) Ammonium salts d) Phenol compounds

5) Microwave sanitation Microorganisms destroyed by waves of frequency 2450MHz. Waste are shredded before the process. Volume reduced by 80%.

6) Hydroclave Based on hydrolysis of organic material. Dry, sterilized waste are shredded and their volume reduced by 80%. Total process takes one hour. Used for infectious and anatomical waste.

7) Rotoclave Process is fully automated. Modernized version of autoclave. Sterilizing agent is water vapour in a rotating pressure chamber. Used for laboratory waste, bedding material & animal waste.

7) Vermiculture-deep burrowing earthworms The only alternative that holds promise for waste disposal seems to be ingoing back to mother earth. Earthworms have succeeded in reducing even the toughest of pathogens to compost dust. This bioreactor work silently without making its presence felt-there is no smell, it does not attract flies and the result is rich manure.

CONCLUSION With newer diseases attacking human kind, it is incumbent on the part of the medical fraternity to ensure that hospitals don’t become breeding grounds for infections. Awareness and sensitization at all levels through education, training and internal communication are must.

REFERENCES Books Environmental treatment technologies for Hazardous and Medical waste by Subijoy Dutta Environmental chemistry by A.K.Dae Environmental law by P.S Jaswal Internet www.noharm.org www.medical-advisor.org www.toxicslink.org www.medicalwaste.com www.cpcb.nic.in www.medind.nic.in