Bio Medi Waste

7/27/2019 Bio Medi Waste

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INTRODUCTION:-

Waste produced in the course of health care activities carries a higher

potential for infection and injury than another type of waste. There for it is

essential to have safe and reliable method for its handling. Inadequate

inappropriate handling of health care waste may have serious public health

consequences and significant impact on the environment. Appropriate

management of health care waste in thus a crucial component of environmental

health protection and it should become an integral feature of health care

protection

DEFINITION:-

According to bio medical waste rules 1998 of India ,bio-medical waste

means any waste which is generated during the diagnosis ,treatment or

immunization of human being or animals or in research activities pertaining there

to or in the production or testing of biological

CLASSIFICATION OF HEALTH CARE WASTE [W .H. O]

INFECTIOUS WSATE:- waste suspected to contain pathogens

E.g. laboratory cultures, waste from isolation wards, tissues, materials or

equipment that have been in contact with infected patients PATHOLOGICAL WASTE:- human tissues or fluids

e.g. Body parts, blood and other body fluids, feature

SHARPS:-Instruments having sharp end or pointed end

E.g. needle, infusion sets, scalpels, knives, blades, broken glass

PHARMACEUTICAL WASTE:- Waste containing pharmaceuticals

E.g. pharmaceutical that are expired or no longer needed items contaminated

by or containing pharmaceuticals [, bottle, boxes]

GENOTOXIC WASTE:- Waste contain substances with genotoxic

properties e.g. waste containing cystostatic drugs[often used in cancer

therapy] ,genotoxic chemicals


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CHEMICAL WASTE: - Waste containing chemicals. E.g. laboratory

reagents, film developer, disinfectant ant that are expired or no longer

needed, solvents

WASTE WITH CONTENT OF HEAVY METALS:- batteries ,broken

thermometers, blood pressure gauzes

PRESURIZED CONTAINERS:- Gas cylinder, gas cartridges ,aerosol cans

RADIOACTIVE WASTE:- Waste contain radio active substances e.g.

unused substance from radio therapy or laboratory research

SOURSES OF HEALTH CRAE WASTE:-

Government hospital

Private hospitals

Nursing homes

Physician clinic or office

Dentist office or clinic

Dispensaries

Primary health care centre

Medical research and training establishments

Mortuaries

Blood bank and collection centers

Animal houses

Slaughter houses

Laboratories[clinic, pathology, hematology, microbiology]

Research organizations

Vaccinating centers

Bio-technology institutions

HEALTH CARE WASTE GENERATION:-

In middle and low income countries health care waste generated is lower

than high income countries. Developing countries that have performed their own

surveys of health carte waste find the following essentials for an average


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distribution of health care wastes useful for preliminary planning of waste

management

80% general health care waste which may be dealt with by normal

domestic and urban waste management system

15% pathological and infectious waste

1% sharps waste

3% chemical and pharmaceutical waste

Less than 1% special waste such as radioactive or cytotonic waste

,pressurized containers or broken thermometers and used batteries

HEALTH HAZARDS OF HEALTH CARE WASTE:-

Exposure of hazardous health care waste can result in disease or injury

due to one or more of following characteristic

It contains infectious agents

It contains toxic or hazardous chemicals or pharmaceuticals

It contains sharps

It is genotoxic

It is radio active

All individuals exposed to such hazardous health care waste are potentially at

risk, including those who generate the waste or those either handle such waste

or are exposed to it as a consequence of careless management. The main

groups at risk are:-

Medical doctors, nurses, health care auxiliaries and hospitals

maintains personal

Patients in health care establishments

Visitors to health care establishments

Workers in support service allied to health care establishments

such as laundries ,waste handling and transportation

Workers in waste hospital facilities such as land fills or incinerators

including scavengers

a. Hazardous from infectious waste and sharps:-


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Pathogens in infectious waste may enter the human body through a puncture,

abrasions, or cut in the skin, through mucus membranes by inhalation or

ingestion

b. Hazardous from chemical and pharmaceutical waste:-

Many of the chemicals and pharmaceuticals used in health care

managements are toxic, genotoxic, corrosive flammable, reactive, explosive

or shocksensitive. Although present in small quantity they may cause in

toxification, either by or acute or chronic exposure and injuries including burns

c. Hazardous from genotoxic waste:-

The severity of the hazardous for the health care workers responsible for

handling or disposal of genotoxic waste governed by combination of the

substance toxicity itself and extent and duration of or treatment with particular

drug or chemical. The main pathway of exposure is inhalation of dust or

aerosol through the skin, ingestion of food accidentally contaminated with

cytotoxic drugs, chemicals or waste etc

d. Hazardous from radio active waste:-

The type disease caused by radioactive waste determined by the type and

extent of exposure. It can range headache, dizziness and vomiting to much

more serious problem. Because it is genotoxic, it may also affect genetic

material

e. Public sensitivity :-

Apart from health hazardous the general public is very sensitivity to visual

impact of health care waste particular anatomic waste

TERATMENT AND DISPOSAL TECHNIQUES FOR HEALTH CARE WASTE :-

Incineration used to be the method of choice for most hazardous health

care wastes and is still widely used. However recently developed alternative

treatment method are becoming increasingly popular. The final choice of

treatment should be made on the basis of factors, many of which depend on local

conditions

I. INCINERATION:-


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Incineration is a high temperature dry oxidation process that reduces

organic and combustible waste to incombustible matter and result in a very

significant reduction waste volume and weight .the process is usually

selected to treat waste that cannot be recycled ,reused or disposed off in a

land fill site

Incineration requires no pretreatment, provided that certain waste types

are not included in the matter to be incinerated.

Characteristics of the waste suitable for incineration are:-

Low healing volume above 2000k cal/kg for single chamber incinerators

and above 3500kcal/kg for pryolytic double chamber incinerators

Content of combustible matter above 60 %

Content of non-combustible solid below 5%

Content of non-combustible fines below 20%

Moisture content below 30%

Waste products not to be incinerated are:-

Pressurized gas containers

Large amount of reactive chemical waste

Silver salts and photographic or radiographic waste

Waste with high mercury or cadmium content such as broken

thermometers, used batteries, and lead-lined wooden panels

Sealed ampoules or ampoules containing heavy metals

Type of incinerators:-

Three basic kinds of incinerators technology are of interest for treating health

care waste

Double chamber pyrolytic incinerators which may be especially

designed to burn infectious health care waste

Single- chamber furnace with static great, which should be used

only if pyrolytic incinerators are not affordable.


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Rotary kilns operating at high temperature, capable of causing

decompositions of genotoxic substances and heat-resistant

chemicals

ii.CHEMICAL DISINFECTION:-

Chemicals are added to waste to kill or incinerate the pathogens it contains, this

treatment usually result in disinfection rather than sterilization.

Chemical disinfection is most suitable for treating liquid waste such as blood,

urine, and stool or hospitals sewage.

However solid waste including microbiological cultures, sharps etc may be also

be disinfected chemically with certain limitation.

iii. WET AND DRY THERMAL HEAT:-

Wet thermal heat: - wet thermal treatment or steam disinfection is based on

exposure of shredded infectious waste to high temperature, high pressure steam

and is similar to autoclave sterilization process. The process is inappropriate for

the treatment of anatomical waste and animal carcasses and will not efficiently

treat chemical and pharmaceutical waste

Screw feed technology:-screw feed technology is the basis of non burn, dry

treatment disinfection process in which waste is shredded and heated in a rotary

auger.The waste is reduced by 80% in volume and by 20-3% in weight. This process is

suitable for treating infectious waste and sharps. But it should not be used to

process pathological cytotoxic or radioactive waste

iv. MICROWAVE IRRADIATION

Most microorganisms are destroyed by the action of micro wave of a frequency

of about 2450 MHz and wave length of 12-24cm. the water contained within the

waste is rapidly heated by the microwaves and the infectious components are

destroyed by heat conduction. The efficiency of the microwave wave disinfection

should be checked routinely through bacteriological and virological test

v. LAND DISPOSAL

Municipal disposal site: - if a municipality or medical authority genuinely lacks

the means to treat waste before disposal, the use of a land fills has to regard as


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an acceptable disposable route. There are two type of disposal they are open

dumps and sanitary landfills. Health care should not be deposited on or around

open dumps. The risk of either people or animals coming to contact with

infectious pathogens is obvious

Sanitary landfills are designed to have at least four advantages over open

dumps:-geological isolation of waste from the environment ,appropriate

engineering preparation before the site is ready to accept waste , staff personal

on site to control operations and organized deposit and daily coverage of waste

VI. INERTIZATION:-

The process of inertization involves mixing waste with cement and other

substance before disposal in order to minimize the risk of toxic substance

contained in the waste migrating in to the surface water or ground water. A

typical proportion of mixture is 65% pharmaceutical waste, 15%cent line,

15%cement and 5% water. A homogenous mass is formed and cubes or pellets

are produced on site and then transported to suitable site

The United Nations conference on the environment and development [UNCED]

in 1992 recommended the following measures:-

Prevent and minimize the waste production

Reuse and recycle the waste to the extent possible Treat waste by safe and environmentally sound method

Dispose off the final residue by landfill in contained and carefully

designated site


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MAIN ADVANTAGES AND DISADVANTAGES OF TREATMENT AND

DISPOSAL OPTIONS:-

Disposal method Advantages Disadvantages


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Rotary kilns

Pyrolytic incineration

Single chamber

incineration

Wet thermal

treatment

Micro wave

irradiation

Encapsulation

- Adequate for all infectious waste,

more chemical waste and

pharmaceutical waste

.

- very high disinfection efficiency

- adequate for all infectious waste

and most pharmaceuticals and

chemical waste

- good disinfecting efficiency

-drastic reduction of weight and

volume

-the residue may be disposed of in

land fills

-environmentally sound

-relatively low investment and

operating costs

- good disinfection efficiency under

operating condition

-drastic reduction in waste volume

-simple, low cost and safe may also

be applied to pharmaceuticals

- high investment and

operating costs

- incomplete destruction

of cytotoxins

-relativelyhigh investment

and operating costs

- significant emission of

atmosphere pollutions

- need for periodic

removal of slag and soot

- shredders are subject to

frequent breakdowns and

poor functioning

- operation requiresqualified technicians

-inadequate

anatomical

,pharmaceutical and

chemical waste is not

readily steam-permeable

-potential operation and

maintenance problems

-high investment

- not recommended for

non-sharp infectious


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Safe burying

Inertization

Drum and brick

incinerator

Chemical

disinfection

- low cost and safe

-relatively safe if access to site is

restricted and where natural

infiltration is limited

-relatively inexpensive

- no need of highly trained operators

-drastic reduction of weight and

volume of waste

-very low investment

-highly efficient disinfection under

good operating conditions

waste

- safe only if access to

site is limited and certain

precaution are taken

- insufficiency in

destroying thermally

resistant

- destroys only 99% of

microorganism

-massive emission of

black smoke ,fly ash toxic

gas

-uses hazardous

substances that require

comprehensive safely

measure


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COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIO-

MEDICAL WASTE:-

Color

coding

Type

of container

Waste

category

Treatment opinion as per

schedule

1)Yellow

2)Red

3)Blue/WhiteTranslucent

4)Black

Plastic bag

Disinfected

container/plastic

bag

Plastic bag/puncture proof

container

Plastic bag

Cat

1,2,3,6

Cat.3,6,7

Cat.4,7

Cat.5,9,10

Incineration/ deep burial

Autoclaving/microwaving

Autoclaving/microwaving/chemicaltreatment&

destruction shredding

disposal in secured land fill

CATEGORIES OF BIO-MEDICAL WASTE IN INDIA (AS PER THE

ENVIRONMENTAL&FOREST GUIDELINES)


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Category no Waste category

Category 1

Category2

Category3

Category4

Category5

Category 6

Category7

Category 8

Category 9

Category 10

Human anatomical waste [human tissues, organs, body parts]

Animal waste[animal tissues, organs ,body parts, carcasses,

bleeding ,fluids, experimental animals used in research, waste

generated by veteneriary hospitals colleges, discharges from the

hospital]

Microbiology &biotechnology waste [waste from laboratory

cultures, stocks or specimens of micro-organism, liver or attenuated

vaccines ,human and animal cell culture used in research and

infectious agents from research &industrial laboratories]

Waste sharps [needles, syringes scalpels, blades, glass etc, that

may cause puncture and cuts .this includes both used and unused

sharps]

Discarded medicines and cytotoxic drugs [waste comprising of

outdated, contaminated and discarded medicines ]

Solid waste [ item contaminated with blood &fluids including cotton

dressing solid plaster casts, linen, beddings, other material

contaminated with blood]

Solid waste [waste generated form disposable items other than the

waste sharps such as tubing, catheters, intravenous sets etc.]

Liquid waste[ waste generated from laboratorary and

disinfecting activities

Incineration ash [ash from incineration of bio-medical waste]

Chemical used in production of biological, chemicals used in

disinfection as insecticides etc

SUMMARY:-


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So far we went through the introduction, definition, classification, sources, health

care waste generation, health hazards, treatment and disposal techniques, main

advantages and disadvantages.

Bibliography:-

k.park, Text book of preventive and social medicines ,published by banaras

das, pp no567-574

Bruner &sidhartha, Text book of medical surgical nursing,7 th edition

Published by Lippincott, Pp no 1200-1212

R C Anand ,sidhartha sathapathy,Hospital waste management,2nd edition

Published by jaypee,Pp no 2-98

Potter &perry,Basic nursing,6th edition,published by mosby,Pp no 220-226

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Bio Medi Waste