BIOMEDICAL WASTES
MANAGEMENT
By,Dr. Priyanka SharmaII Year MDSDept of Public Health Dentistry
Bio-
weapons of
Mass
Destruction
!!Lets Make This World
A Better Place to Live in!!
CONTENTS
Introduction History Definitions Types of wastes Classification of healthcare wastes Waste management Solid waste management Biomedical waste management Dental waste management Conclusion References
INTRODUCTIONINTRODUCTION
Medical and dental care is vital in our life.
Biomedical waste – emerged as an issue of concern.
Biomedical waste is the real problem for the
MAN,COMMUNITY,ENVIRONMENT
Safe, scientific, cost-effective method for biomedical
waste management – need of hour.
HISTORY
• In the late 1980’s– Items such as used syringes washed up on several
East Coast beaches USA – HIV and HPV virus infection – Lead to development of Biomedical Waste
Management Law in USA.
• However in India the seriousness about the management came into lime light only after 1990’s.
WHO has estimated that
• In 2000
• Injections with contaminated syringes caused:
• 21 million hepatitis B virus (HBV)
infections (32% of all new infections);
• Two million hepatitis C virus (HCV)
infections (40% of all new infections);
• 260 000 HIV infections (5% of all new)
Laws of Biomedical Waste Management
On 20th July 1998• Ministry of Environment and
Forests (MoEF), Govt. of India, Framed a rule known as ‘Bio-medical Waste (Management and Handling) Rules, 1998,’
• Provides uniform guidelines and code of practice for Bio-medical waste management.
BIOMEDICAL RULES 1998
• The Government of India as contemplated under Section 6,8 and 25 of the Environment (Protection) Act,1986, has made the Biomedical Wastes (Management & Handling) Rules, 1998.
• The rules are applicable to every institution generating biomedical waste which includes hospitals, nursing homes, clinic, dispensary, veterinary institutions, animal houses, laboratory, blood bank.
• The rules are applicable to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio medical waste in any form.
BIOMEDICAL WASTE(MANAGEMENT & HANDLING) RULES by Govt. of India, 1998
Revised in 2011Now known as BMW Rules, 2011
2011 1998
Every occupier generating BMW, irrespective of the quantum of wastes comes under the BMW Rules and requires to obtain authorisation
Occupiers with more than 1000 beds required to obtain authorisation
Duties of the operator listed Operator duties absent
Treatment and disposal of BMW made mandatory for all the HCEs
Rules restricted to HCEs with more than 1000 beds
A format for annual report appended with the Rules
No format for Annual Report
Form VI i.e. the report of the operator on HCEs not handing over the BMW added to the Rules
Form VI absent
Duty of the Occupier • It is the duty of every occupier i.e. head of an institution generating
bio-medical waste, to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment.
• Provides training to HCW engaged in handling BMW
Duty of the Operator
The operators now have to ensure that the BMW is collected from all
the HCEs and is transported, handled, stored, treated and disposed in
an environmentally sound manner. The operators also have to
inform the prescribed authority in form VI if any HCEs are not
handing the segregated BMW as per the guidelines prescribed in the
rules.
Setting up BMW treatment facility
Occupier set up adequate treatment facilities like autoclave / microwave / incinerator / hydroclave, shredder prior to commencement of its operation or ensure that the wastes are treated at a common bio medical waste treatment facility or an authorized waste treatment facility.
The new Rules have omitted incinerator as one of the pre requisites for on-site treatment of BMW. The omission is owing to the various environmental impacts of incineration.
Promotion of new technologies for treatment and disposal of waste
Deep burial for disposal of BMW has also been removed from the Rules. The Rules says it can be an option only in rural areas with no access to CTF with prior approval from the prescribed authority.
Biomedical waste Statistics
• Developed Countries- Developed Countries- 1-5 kg/bed/day, with variations among countries.In India- In India- 1-2 kg/bed/day with variation among
Govt. and Private establishments.
Approximately 506.74 tons/ day wastes generated
Out of which only 57% waste undergoes proper disposal
Health waste Characterization
Hospital waste
Non Hazardous(≈ 75-90%)
Hazardous waste(≈ 10-25%)
InfectiousOthers
( Radioactive,Cytotoxic )
DEFINITIONS DEFINITIONS
• Acc 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 beings or animals or in research activities pertaining there to or in the production or testing of bio medicals.
Hospital waste: refers to all waste, biological or non biological, that is discarded and is not intended for further use.
Medical waste: refers to materials generated as a result of patient diagnoses, treatment, immunization of human beings or animals.
Infectious waste: are the portion of medical waste that could transmit an ‘infectious disease’.
Pathological waste : waste removed during surgery/ autopsy or other medical procedures including human tissues, organs, body parts, body fluids and specimens along their containers.
• Health care Waste: means all the waste generated by Hospital establishments, research facilities, and laboratories. In addition, it includes the waste originating from "minor" or scattered sources such as that produced in the course of health care undertaken in the home (dialysis, insulin injections, etc.)
• [Pruss, A., Giroult, E., and Rushbrook P. et. al; " Safe Management of Wastes from Health-Care activities", World Health Organisation, , Geneva, 1999. ]
TYPES OF WASTES
Sewage
• Waste water from a community containing solid and liquid excreta , derived from houses , streets and factories.
Sullage
• Waste water which does not contain human excreta .
Categories of Bio-Medical Wastes
Classification of health care wastes
Waste categoryWaste category Infectious wasteInfectious waste
Pathological wastePathological waste
Description And ExamplesDescription And Examples• Lab culturesLab cultures• Waste from isolation wardsWaste from isolation wards• Tissues(swabs)Tissues(swabs)• Materials/equipments of infected Materials/equipments of infected
patientspatients• ExcretaExcreta• Human tissues/fluidsHuman tissues/fluids• Body partsBody parts• Blood or body fluidsBlood or body fluids
Pathological waste
Pathological Waste
Blood bags found in the municipal waste stream in violation of rules for such waste.
Sharp wasteSharp waste
Pharmaceutical Pharmaceutical wastewaste
Genotoxic wasteGenotoxic waste
• NeedlesNeedles• Infusion SetsInfusion Sets• ScalpelsScalpels• Knives Blades Knives Blades • Broken GlassBroken Glass• Expired PharmaceuticalsExpired Pharmaceuticals• Contaminated PharmaceuticalsContaminated Pharmaceuticals• Banned PharmaceuticalsBanned Pharmaceuticals• Waste Containing Cytotoxic Waste Containing Cytotoxic
Drugs(often Used In Cancer Theraphy)Drugs(often Used In Cancer Theraphy)• Genotoxic ChemicalsGenotoxic Chemicals
Pharmaceutical Waste
SharpWaste
Chemical wasteChemical waste
Waste with high Waste with high content of heavy content of heavy metals metals
Pressurized Pressurized containerscontainers
Radioactive wasteRadioactive waste
• Lab reagentsLab reagents• Film developerFilm developer• Expired disinfectantsExpired disinfectants• Expired solventsExpired solvents• BatteriesBatteries• Broken thermometersBroken thermometers
• Blood pressure guages etcBlood pressure guages etc• Gas cylinders, Gas catridgesGas cylinders, Gas catridges
• Aerosol cansAerosol cans• Radiotherapy/lab research liquidsRadiotherapy/lab research liquids• Contaminated glass wares, packages, absorbent papersContaminated glass wares, packages, absorbent papers
Cytotoxic drugs
Lab reagents
Genotoxic waste
Chemical waste
Waste with high content of heavy metals
Worn out batteries
Blood pressure guages
Radioactive wastes
WASTE MANAGEMENT Let the waste of the “sick” not contaminate the lives
of “The Healthy”
• Waste management is the collection ,transport,
processing ,recycling or disposal of waste materials.
• Term usually relates to materials produced by human
activity and is generally undertaken to reduce effect
on health, the environment and aesthetics.
The Waste Management Hierarchy
The 5 R’s of Waste Management
Refuse – Do not use non bio-degradable materials is the process in the first place
Eg. No Plastic bags as packaging for consumer products.
Reduce – don’t manufacture goods that will be discarded in the first place.
Eg. Reduced packaging for consumer products.
Re-use – use materials over again for the original intended purpose or for a new purpose.
Eg. Plastic grocery bags can be reused for groceries or you can use them as a lunch bag or something else.
Recycle – break down materials and reform them into new products. Requires much less energy than manufacturing products from raw materials.
Eg. Pop cans. Aluminum is melted down and made into new pop cans, storm doors,etc.
Recover – recover as much energy as possible before a material is discarded.
Eg. Some places will burn garbage, then use the heat to generate electricity before disposing of the ash.
SOLID WASTE DISPOSAL
Dumping
• Easy method of disposal of “dry refuse”
• Dumped in low lying areas
• Decomposes: bacterial action, decreased in
volume & converted to humus.
Dumping
Dumping
Disadvantages
Refuse exposed to flies & rodents
Source of nuisance (smell & unsightly appearance)
Loose refuse dispersed by the action of wind
Pollution of surface & ground water.
Controlled tipping (or) Sanitary land fill
• Method:
• Material placed in trench
• Adequately compacted
• Covered with earth at the end of the day
• “Modified sanitary land fill”
- Compaction & covering once or twice a week
Controlled tipping
• Three methods used:
1. Trench method: 2-3 meter deep trench dug out 4 -12 meter
wide. Refuse upto a depth of 2meters - 1 acre of land /yr for
10000 popln
2. The ramp method: used in sloping terrain
3. The area method: used for filling land depressions, disused
quarries & clay pits
Controlled tipping
• Changes in the buried refuse:
Physical, chemical & bacteriological changes
During decomposition temp rises to 60 deg
In 7 days. Kills all the pathogens
2 – 3 weeks to cool down
4-6 months for decomposition
Incineration
• Burning the refuse
• More hygienic
• Hospital refuse
• Disadv: production of harmful gases &
chemicals (carcinogenic)
• Used: where suitable land is not available
• Not suitable in India
Composting
Composting is a method of combined disposal of
refuse and nightsoil or sludge.
Process of nature whereby organic matter breaks
down under bacterial action resulting in the relatively
stable humus like material called compost.
Composting
• Principle by products are:
Carbon dioxide, water & heat.
Heat produced is 60 deg
Destroys eggs & larvae of flies, weed seeds &
pathogenic agents.
The end product - compost - contains few or no disease
producing micro organisms, contains plant nutrients -
nitrates & phosphates
Composting • Principle methods:
1.Bangalore method
(Anaerobic method / Hot fermentation process)
2. Mechanical composting (Aerobic method)
Composting
1. Bangalore method:
Indian council of Agricultural research at Indian
institute of Science, Bangalore.
Anaerobic compositing
Trenches are:
• 3 feet deep, 5-8 feet broad, 15-30 feet long
• Located ½ mile away from the city limits
Composting
Bangalore method:
• Method:
• First a layer of refuse about 6 inches thick
• Over this night soil is added 2 inch thick
• Alternate layers of night soil & refuse added
• Till the heap rises to 1 feet above the ground level.
• Top layer - refuse at least 9 inches thickness.
• Heap covered with excavated earth.
Composting
Bangalore method:
• Within 7 days heat generated
• Heat persists for 2 or 3 weeks
• Destroy all pathogenic & parasitic organisms
• End of 4-6 months decomposition is complete
• Manure: well decomposed, odourless, innocuous material, high manurial value, ready for application to the land.
Composting
2. Mechanical composting:• Aerobic method Method:• Refuse first cleared of salvable material• Then pulverized in the pulverizing equipment• Reduce the particle size to 2 inches• Mixed with sewage, sludge or night soil in rotating
machine & incubated• 4-6 weeks composting completed.
Manure pits
• Rural areas
• Garbage, cattle dung, straw & leaves
• Covered with earth after each days dumping
• 2 pits required
• 5-6 months time refuse converted to manure
• Effective and simple.
Burial
• Suitable for small camps
• Trench:
• 1.5m wide , 2 meters deep
• At the end of the day refuse is covered with 20-30cms
of earth
• 40cms from ground level, new trench is dug out.
• Contents removed after 4 -6 months
Sanitation barrier
Concept found wide acceptance.Diseases due to insanitary conditions can be
prevented by blocking the channels/modes of transmission namely the 5 F’s.
Segregate the faeces & arrange for its proper disposal
water
Fingers
Flies
Soil
Food
Protected host
Faeces
San
itatio
n b
arrier
water
Fingers
Flies
Soil
Food
Protected host
Faeces
San
itatio
n b
arrier
Sanitation barrier
Simple terms:
• Sanitary latrine & a Disposal pit
More elaborate schemes: Installation of a
sewerage system & Sewage treatment plans
Water Carriage System
Duct systemExcrements are safely disposed off by carrying those
along with water.Sewage = 99.9% water & only 0.1% solidsSanitary sewage : waste water from residences and
industries and is also called DRY WEATHER FLOW (D.W.F).
Combined system of sewerages allows rainwater during monsoons.
Water Carriage System
These are all carried through underground sewerages.
The amount of sewage produced per person is directly related to the water supplied per capita and ranges from 1.15 litres per day in small towns to 180 litres per day in large cities.
WARNING!!!
Sewage gas is a mixture of gases in sewers and manholes comprising of CO2, methane, hydrogen sulphide and a little oxygen.
This is generated by putrefying bacteria and is combustible.
This is an important information should be kept in mind before anybody attempts to go into a manhole or a septic tank for repair works.
Sea outfall
• Sea coast town and cities
• Nearly two-third of sewage of greater mumbai
• Purification by dilution and oxidation
• Drawback: offensive solid waste back to coast.
• Sewage outfall designed to discharge it deep into the
sea at many points.
BIOMEDICAL WASTE MANAGEMENT
S.NO
WASTE CATEGORY
WASTE TYPE TREATMENT & DISPOSAL
1 Category No.1 Human Anatomical waste (human tissues, organs, body parts
Incineration/deep burial
2 Category No.2 Animal Waste: Animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from hospitals, animal houses
Incineration/deep burial
3 Category No.3 Microbiology & Biotechnology Wastes: Wastes from laboratory cultures, stocks of specimens of micro-organisms live or attenuated vaccines etc.
Autoclave/ Microwave/ Incineration
4 Category No.4 Waste Sharps (needles, syringes, scalpels ,blades, glass etc.) that may cause puncture and cuts.
Disinfection (chemical treatment/autoclavE/microwavE and
mutilation/shredding
CATEGORIES OF BIO-MEDICAL WASTE
S.No WASTE CATEGORY
WASTE TYPE TREATMENT AND DISPOSAL
5 Category No.5 Discarded Medicines and Cytotoxic drugs Wastes comprising of outdated, contaminated and discarded medicines
Incineration/destruction
and drugs disposal in
secured landfills
6 Category No.6 Soiled Waste (Items contaminated with
blood, and body fluids including cotton,
dressings, soiled plaster casts, linens,
beddings, other material contaminated
with blood)
Incineration
autoclaving/ microwaving
7 Category No.7 Solid Waste (waste generated from
disposable items other than the waste
(sharps) such as tubing's, catheters,
intravenous sets etc.
Disinfection by chemical
treatment/autoclaving/
Microwaving &
mutilation/shredding
8 Category No.8 Liquid Waste generated from laboratory and washing, cleaning, house keeping and disinfecting activities
Disinfection by chemical
treatment and
discharge into drains
S.No WASTE CATEGORY
WASTE TYPE TREATMENT AND DISPOSAL
9 Category No.9 Incineration Ash: Ash from incineration of any bio-medical waste
Disposal in municipal landfill
10 Category No.10 Chemical Waste
Chemicals used in production of
biologicals, chemicals used in
disinfection as insecticides etc.
Chemical treatment and
discharge
into drains for liquids and
secured landfill for solids
NOTE :
1. Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent.
2. Mutilation/shredding must be such so as to prevent unauthorized reuse.
3. There will be no chemical pretreatment before incineration. Chlorinated plastics should not be incinerated.
4. Deep burial shall be an option available only in towns with population less than five lakhs and in rural area.
COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTE
Color Color CodingCoding
Type of Type of ContainerContainer
WasteWaste
CategorCategoryy
Treatment Treatment options as peroptions as per
Schedule ISchedule I
YellowYellow Plastic bagPlastic bag Cat.1, 2,3,6Cat.1, 2,3,6 Incineration/deep Incineration/deep burialburial
RedRed Disinfected Disinfected container/Plasticontainer/Plastic bagc bag
Cat 3,6,7Cat 3,6,7 Autoclave/Microwave/ Autoclave/Microwave/ Chemical TreatmentChemical Treatment
Blue/White Blue/White translucenttranslucent
Puncture proofPuncture proof
containercontainer
Cat.4,7Cat.4,7 Autoclave/Microwave/ Autoclave/Microwave/ Chemical Treatment & Chemical Treatment & destruction/shreddingdestruction/shredding
BlackBlack Plastic bagPlastic bag Cat 5,9,10Cat 5,9,10 Disposal in secured Disposal in secured landfilllandfill
Segregation and Collection
Safe transportation and Storage
Treatment & Disposal of BMW
To ensure clean & healthy environment:
Use of plastic bags makes the transportation easier, it prevents the spillage and the
waste remains outside the view of others. This also keeps the original containers
clean. The plastic bags are not to be reused.
When bag or container, as the case may be, is three fourth full, it should be sealed
by tying it. The disposable sharps container should be sealed by tape. All bags or
containers must be labeled which shall be non washable/prominently visible
SAFE TRANSPORTATION &
STORAGE
TRANSPORT TO THE CENTRAL STORAGE AREA
While transporting the waste to the central storage area certain rules
must be followed:
1. Check that waste bags/containers are properly and effectively sealed.
2. Waste bag is properly labeled.
3. Bags should be picked up by the neck and placed, so that bags can be
picked up by the neck again for further handling. Hand should not be put
under the bag. At a time only one bag should be lifted.
4. Manual handling of waste bags should be minimized to reduce the risk of
needle prick injury and infection. Avoid close contact between body and bag
container. 5. Waste bag or container should not be thrown or dropped.
6.After removal of the bag, clean the container including lid with an appropriate disinfectant.
7.Bags or containers containing the waste should be transported in covered wheeled containers or large bins in covered trolleys dedicated for this purpose. The bags and containers should be replaced by fresh bag/container .
Bio- medical waste storage areas must be separate from general waste storage sites and should have clear signs indicating "For Biomedical Waste only".
8. In case, a lift is to be used during transportation of biomedical waste it should be designed and reserved for this purpose only.
To reduce the impact on the community
To reduce the chances of infection and accidental injury to
the workers
To support conservation of natural resources and preservation
of environmental quality.
To reduce the cost and handling time
CENTRAL STORAGE
The central storage area should be ideally situated on the ground floor and near the rear entrance. This will make the transportation of waste to the site of final disposal easier.
The central storage area should be big enough to store the required number of waste bags at a time. There should be sufficient storage capacity to store at least two day's waste.
It should have a good flooring, light, ventilation and water supply. There should be special drain to discharge the washing, which should go to the sewer.
A full time storekeeper should be responsible to receive and dispatch the waste and maintain proper records.
Unauthorized people should not be
able to enter the storage area.
An accidental spillage should be
properly attended.
As per rules, biomedical waste cannot
be stored for more than 24 to 48 hours.
Refrigerated storage room (cold
rooms) can be considered where wastes
have to be stored in bulk for over 48
hours.
TRANSPORT TO THE FINAL DISPOSAL SITE
Transportation from the health care establishment to the site of final disposal
should preferably be done in a motor vehicle, as these sites are likely to be
situated at a distance from the hospital.
Closed transportation in these motor vehicles (truck, tractor, trolley, etc) is
desirable as it prevents the spillage on the way.
All these vehicle must have the biohazard symbol and they should not be used
for any other purpose.
Proper servicing is a must regular basis.
Temporary storage of biomedical waste may also be needed at the site of final
disposal. It should have all characteristics similar to that described for the central
storage area of the hospital.
To reduce the impact on the community
To reduce the chances of infection and accidental injury to
the workers
To support conservation of natural resources and preservation
of environmental quality.
To reduce the cost and handling time
Treatment is a term used for those processes that modify the waste in some
way before it is finally disposed off.
According to the draft Biomedical (Management and Handling) R 1995…..
Treatment means: "a method, technique, or process designed to change the
physical, chemical or biological characteristics or composition of any biomedical
waste so as to render such waste non-hazardous to health and environment".
The primary aim of treatment is to disinfect or decontaminate the waste to
eliminate the pathogens before it reaches the site of its final disposal.
Five technology options for treatment
Incineration
Chemical disinfectionWet and dry thermal treatment 1. Wet thermal treatment 2. Screw-feed technology
Micro wave irradiationLand disposal 1. Municipal disposal sites 2. Sanitary landfills
Inertization
INCINERATION
Incineration is the complete destruction of materials to their inert
constituents by a process of combustion.
Safe way of disposal
There is reduction of volume and weight by approximately--- 95%
Types of incinerators:
•Double-chamber pyrolytic incinerators: designed to burn infectious
health-care waste.
•Single-chamber furnaces with static grate, used only if pyrolytic
incinerators are not affordable.
•Rotary kilns operating at high temperatures, capable of causing
decomposition of genotoxic substances and heat-resistant chemicals.
Characteristics of the waste suitable for incineration are:
a) Low heating volume-above 2000 Kcal/kg for single-chamber
incinerators, and above 3500 Kcal/kg for pyrolytic double-chamber
incinerators
b) Content of combustible matter above 60%
c) Content of non-combustible solids below 5 %
d) Content of non-combustible fines below 20 %
e) Moisture content below 30%
Chemical treatment Plastic, rubber and metallic items (like IV sets, blood bags, gloves, catheters, syringes and needles must be chemically disinfected before they are sent for final disposal (landfill).
Chemical disinfection can be done in following steps:
1. Mutilate the syringes and needles with a needle destroyer. Cut all other plastic/rubber item with the help of scissors (so that they cannot be reused),
2. Make 1 per cent hypochlorite solution (fresh everyday) by dissolving 10 gms of this powder (approx 2 spoonfuls) in 1 litre of water in a plastic bucket.
3. Keep another, smaller bucket with perforations inside the main bucket (having the solution). Put all the items that are to be disinfected inside the perforated bucket and keep well- dipped for about 30-60 minutes.
4. After 30 to 60 minutes take out the disinfected items and put them in a proper waste bag. Sharps should be first kept in a tough cardboard box then only put in the plastic bag so as to avoid damage to the bags.
5. Change the solution every 12 hours. Commonly used – Sodium hypochlorite solution, Cresol, Savlon, Bleaching powder
Wet and dry thermal treatment
Wet thermal treatment:
•Based on exposure of shredded infectious waste to high temperature, high pressure steam.
•Similar to the autoclave sterilization process.
•Inappropriate for the treatment of anatomical waste and animal carcasses.
•Will not efficiently treat chemical and pharmaceutical waste.
Screw-feed technology
•Screw-feed technology is the basis of a non-burn, dry, thermal disinfection process in which
waste is shredded and heated in a rotating auger.
•The waste is reduced by 80 % in volume and by 20-35 % in weight.
•Suitable for treating infectious waste and sharps.
•Should not be used to process pathological, cytotoxic or radioactive waste.
Microwave irradiation
•Most microorganisms are destroyed by the action of microwave of a frequency of
about 2450 MHZ and a wavelength of 12.24 cm.
•The water contained within the waste is rapidly heated by the microwave and the
infectious components are destroyed by heat conduction.
• The efficiency should be checked routinely through bacteriological and virological
tests
STANDARDS OF MICROWAVE
•Not be used for cytotoxic, hazardous,/radioactive wastes, contaminated animal
carcasses, body parts, & large metal items.
Disposal means placing the biomedical waste in its final resting
place
According to the draft Biomedical Waste (Management and
Handling) Rules, 1995.
Disposal means : "burial, discharge, deposit, dumping, land filling or
placing on land of any biomedical waste".
Two types of disposal:- 1) Land open dumps. 2) Sanitary landfills.
Health-care waste should not be deposited on or around open dumps.
Advantages of sanitary landfill over open dumps:
Geological isolation
Appropriate engineering preparation of the site.
Staff present on site to control operations,
Organized deposit and daily coverage of waste.
Sanitary landfills
It is another choice for final disposal of biomedical waste and it can be quite
effective if practiced appropriately.
While open dumping of biomedical waste cannot be recommended for the reasons of
acute pollution problems, fires, higher risk of disease transmission and open access to
scavengers and animals.
Some essential elements for design and operation of a sanitary landfill are given below:
1. A specifically designated place should only be used for the landfill.
2. The site should preferably be away from the residential areas.
3. Location should be such that vehicles carrying waste can easily approach it in all weathers.
4. The area should be under constant supervision and security control. Unauthorized entry must be strictly prohibited.
5. It should not be in the vicinity of a drinking water source as pollution may result.
6. The site should be divided into various manageable phases and all of them should be adequately prepared before the actual and fill starts.
7. The site should be so organized that the waste can be spread, compacted and covered
daily.
8. A final cover should be constructed to prevent the rain water infiltration when each
phase of landfill is completed. A temporary cover should be provided if rains are
expected in between and before the site is completed.
9. Waste should be buried as rapidly as possible so as to minimize the exposure to
humans or animals.
Inertization
•The process of “Inertization” involves mixing waste with cement and other substances before disposal.
proportion of the mixture : •65% pharmaceutical waste, 15 % lime, 15% cement and 5 % water.
The purpose of treatment of biomedical waste
To reduce or eliminate pathogens so that they no longer pose a hazard to
persons exposed to it
It changes the physical appearance of waste to make it unrecognizable so
that it is not aesthetically offensive or frightening.
It also reduces the bulk volume of waste to reduce requirements for
storage and transport.
It makes recyclable items unusable so that unauthorized reuse is
prevented.
To reduce the cost and handling time
Statewise status of common Biomedical waste management facilities
(As per the informationprovided by the SPCBs/PCCs for the year 2008)
• There are a number of wastes typically generated by a dental office which,
if improperly handled may pose a risk to human health and the
environment. These are:
Mercury and silver residues from amalgam
Lead found in lead-foil packets and lead shields
Silver found in X-ray fixer solutions
Chromium, used in many X-ray cleaners
Chemical wastes, such as formaldehyde, acetones, and ketones
ADA Best Management Practices for Amalgam Waste
• Do’s :1. Do use precapsulated alloys and stock a variety of capsule sizes
2. Do recycle used disposable amalgam capsules
3. Do salvage, store and recycle non-contact amalgam (scrap amalgam)
4.Do salvage (contact) amalgam pieces from restorations after removal and recycle the amalgam
waste
5. Do use chair-side traps, vacuum pump filters and amalgam separators to retain amalgam and
recycle their contents.
6. Do recycle teeth that contain amalgam restorations.
7. Do manage amalgam waste through recycling as much as possible
(Note: Ask your recycler whether or not extracted teeth with amalgam restorations require
disinfection.)
ADA Best Management Practices for Amalgam Waste
• Don’ts1. Don’t use bulk mercury
2. Don’t put used disposable amalgam capsules in biohazard containers, infectious waste containers (red
bags) or regular garbage.
3. Don’t put non-contact amalgam waste in biohazard containers, infectious waste containers (red bags) or
regular garbage
4. Don’t put contact amalgam waste in biohazard containers, infectious waste containers (red bags) or
regular garbage
5. Don’t rinse devices containing amalgam over drains or sinks
6. Don’t dispose of extracted teeth that contain amalgam restorations in biohazard containers, infectious
waste containers (red bags), sharps container or regular garbage
7. Don’t flush amalgam waste down the drain or toilet
Never dispose of scrap amalgam in the sharps container, red biohazard bag or the trash.
SHARPS
• Sharps waste is in the form of medical waste in the form of devices or objects used to puncture or lacerate the skin.
• Sharps waste is designated as biohazard and is to be carefully handled.
SHARPS Contaminated sharps are capable of transmitting the disease
from injection needles, orthodontic bands,burs, scalpel blades, sutures, instruments and broken glass.
Sterilization of sharp containers
• Use labeled and specified container
• Spore test the sterilizer.
• Label the disposable containers as to local regulations.
• Keep containers in upright position.
• Process containers for 40- 60 minutes.
• Leave containers vent open.
SHARPS
SHARPS CONTAINERS
Handling of Sharps
• Needles should not be bend, break, or manipulated for the avoidance of accidents in clinic
• Protective cap holdings devices capping sheath by scoop technique
• Size of sharp container also influence overall efficacy of sterilization
X-RAY FIXER AND DEVELOPER
• Separate fixer and developer solutions in the container provided by the approved waste carrier and supplier.
• Label the container.
• Once the container is full contact appropriate waste carrier for disposal.
CONTAMINATED LAUNDRY
• Contaminated laundry is to be placed and transported in bags containers that are color coded or labeled with a biohazard symbol.
• If the contaminated laundry is sent off site for cleaning, it must be placed in bags or containers that are color coded or labeled with a biohazard symbol, unless the laundry uses universal precautions in handling all soiled laundry.
CONCLUSION
• Safe and effective management of bio-
medical waste is not only a legal
necessity but also a Social
Responsibility.
• Bio-Medical Waste Management cannot successfully be implemented without the willingness, devotion, self-motivation, cooperation and participation of all sections of employees of any health care establishment.
• If we want to protect our environment and health of the community we must see ourselves to this important issue not only in the interest of health managers but also in the interest of community.
REFERENCES• Textbook of preventive and social medicines – Park-
Ed 21
• Text of essential of preventive and community
dentistry – Soben Peter – Ed 5
• “Infection Control & Management of Hazardous
Materials for Dental Team” Chris H.Miller,Charles
John Palenik.
REFERENCES
• http://www.moef.nic.in/downloads/public-information/salient-features-draft-bmwmh.pdf
• http://www.mercvt.org/PDF/nwfdentalguide.pdf
• http://www.cpcb.nic.in/wast/bioimedicalwast/CBWTF_Status_2008.pdf
• International journal of environmental science and development, Vol 1.No3,August 2010 ISSN:2010-0264
• http://dpcc.delhigovt.nic.in/bio-medical-waste.html
• An introduction of essentials of biomedical waste management : Sing et al: MJAFI,Vol 57.No.2 : 2001.
• Biomedical Waste Disposal - Singh Anantpreet, Kaur Sukhjit : Ed 1 : 2010