How Should Hospitals Tackle Biomedical Waste?

Introduction

Biomedical waste is a potential health hazard to the public, healthcare officials, the environment, and to the plants and animals living in that area. Hospitals are known to generate abundant quantities of biomedical waste, garbage, and filth while treating sick people, which can cause problems if not disposed of properly. Hospitals are needed to adhere to the protocols laid out by the Ministry of Environment and Forests act in 1986 and the Bio-Medical Waste (Management and Handling) Rules from July 1998, and follow the guidelines specified therein as they treat biomedical waste.

Key Definitions:

1. What is Hospital Waste?

It is the biological or non-biological waste that is not be re-used in the future and should be immediately discarded

2. What is Biomedical Waste?

Waste generated during the treatment, diagnosis, or immunization of human beings or animals is called biomedical waste. It also includes waste generated out of research activities while producing or testing biologicals and includes all categories as mentioned in Schedule I.

3. What is Infectious Waste?

Any waste that can quickly cause diseases is infectious waste. Infectious waste generally contains pathogens in a quantity that could be hazardous. For example, waste generated from infectious patients, waste from surgery, or stocks of infectious agents from hospital laboratories can be treated as infectious waste.

4. What is Incineration?

Incineration is a process that turns combustible and organic waste into incombustible inorganic matter using high-temperature dry oxidation procedures. This method is used for the waste that cannot be recycled, reused, or disposed of in landfill sites. Hospitals must install an incinerator following the BMW rules 1998 for categories 1, 2, 3, 5, and 6. A certificate must be obtained from CPCB or the State Pollution Control Board to get biomedical waste incinerated.

Classification of Biomedical Waste

Let us take a quick look at the categorization of Biomedical waste and its recommended treatment and disposal:

Category 1 – Human Anatomical Waste like human organs, tissues, organs, or body parts that should be incinerated or deeply buried.
Category 2 – Animal Waste like animal organs, tissues, blood, carcasses, body parts, waste generated by colleges, veterinary hospitals, or animal houses which should be incinerated or deeply buried.
Category 3 – Microbiology & Biotechnology Waste from human and animal cell culture used in research, laboratory cultures, specimens or stocks of micro-organisms, wastes from the production of biologicals, live/attenuated vaccines, or infectious agents from research and industrial laboratories, dishes, and devices used for transfer of cultures, or toxins, which should be incinerated, locally autoclaved, or microwaved.
Category 4 – Waste sharps like syringes, glass, scalpels, needles, blades, etc. that may be used or unused that may cause puncture, infections, and cuts which should be locally autoclaved, chemically treated, mutilated, shredded, or microwaved.
Category 5 – Discarded Medicines and Cytotoxic drugs like contaminated, outdated, and discarded medicines which should be incinerated or destroyed in secured landfills.
Category 6 – Soiled Waste like items contaminated with blood, or body fluids including soiled plaster casts, dressings, linens, cotton, beddings, other material contaminated with blood that should be incinerated, autoclaved, or microwaved.
Category 7 – Solid Waste generated from disposable items besides the waste sharps like catheters, tubings, intravenous sets, etc which should be locally autoclaved, chemically treated, mutilated, shredded, or microwaved.
Category 8 – Liquid Waste generated from laboratory and cleaning, housekeeping, washing, and disinfecting activities which should be discharged into drains or disinfected by chemical treatment.
Category 9 – Incineration Ash generated from any bio‐medical waste which should be disposed of in a municipal landfill.
Category 10 – Chemical Waste generated from the production of biologicals, chemicals used in disinfection, as insecticides, etc. should be discharged into drains for liquids and secured landfills for solids.

How to Tackle Biomedical Waste in Hospitals

Step 1 – Segregation

According to Rule 1998, schedule II, waste categories should be color-coded and disposed of in the prescribed type of container:

Yellow – Waste of Category 1 human anatomical waste, Cat 2 Animal Waste, Cal 3 Microbiological Waste, and Cat 6 Solid Waste, to be disposed of in Plastic bags.
Red – Waste of Category 3 Microbiological, and Cat. 6 Soiled Dressing to be disposed of in Disinfected container plastic bags.
Blue or White – Waste of Category 4 Waste sharp, and Cat.7 Plastic disposable to be disposed of in Plastic bags, or puncture-proof containers.
Black – Waste of Category 5 Discarded medicine, Cat. 9 Incineration ash, and Cat 10 Chemical Waste to be disposed of in Plastic bags, or puncture-proof containers.

Step 2 – Collection, Storage, and Transportation

The waste may be temporarily stored at a centrally appointed storage area of the hospital. Then, depending upon the quantum of waste, it should be finally disposed of in bulk to the site once or twice a day. During transportation, the hospital management must ensure that:

The waste bags/containers are properly sealed and labeled.
They should not be filled so that they can be carried by the neck.
The hand should not be put under the bag.
Only one bag should be lifted at a time.
Manual handling of waste bags should be minimized.
Biomedical waste should be kept only in the prescribed storage area.
The container plus the lid should be thoroughly cleaned with a disinfectant after the removal of the bag.
Waste bags and containers should be removed daily from wards, OPDs, ICUs, labor rooms, Operation Theatres, etc.
Waste bags should be transported in large bins in covered trolleys or a covered wheeled container.
No untreated biomedical waste should be stored beyond a timeline of 48 hours.

Step 3 – Treatment and Disposal

Transportation from hospitals to the site of final disposal should be done in a closed motor vehicle like a tractor-trolley or a truck, to prevent spillage of waste on the way. Vehicles used for the transport of biomedical waste (BMW) must not be used for any other purpose and must have the “Bio‐Hazard” symbol. The label should be visible and non‐washable.

Safety Measures to be taken by Health Care Officials

All the health or cleaning officials handling biomedical waste should adopt appropriate safety measures and universal precautions like:

The drivers, collectors, and other handlers should be educated and made aware of the nature and risk of the waste.
Written instructions should be provided regarding the procedures in case there is any accident o spillage.
Protective gears and masks should be provided and relevant instructions regarding their use should be given.
Workers should be protected by vaccination against tetanus and hepatitis B.

1. Training

Every hospital must conduct a training and awareness program for all categories of personnel in an appropriate language or medium and in an acceptable manner. All the medical professionals and health care officials must be trained by the Biomedical Waste (Management and Handling) Rules 1998.

2. The Role of Management and Administration

The management of every hospital must form a formal hospital waste management committee, which should be headed by the leader of the Institute. It should have active participation from all representatives of major departments. This committee should make Hospital specific action plans, ensure its monitoring, controlling, supervision, and implementation. The committee will also be responsible for submitting accident reports and annual reports to the concerned authorities, as suggested under the BMW rules.

Measures To Minimize Waste:

Hospitals should limit the purchase of reusable items made of glass, instead, metal should be encouraged.
They should select non-PVC plastic items.
Hospitals must adopt procedures and policies for proper management of waste generated and proper segregation to reduce the quantity of waste to be treated.
The health care institutes must establish an effective and sound recycling policy for plastic recycling and get in touch with authorized manufactures.

Coordination Between Hospitals And Outside Agencies

Hospitals should constantly interact with municipal authorities so that the relevant category of waste is regularly taken out of the hospital premises for landfill or other treatment.
Interaction with Pollution Control Boards will help hospitals to:

Search for better methods of technology.
Search for suitable materials to be used as containers for bio‐medical waste that should be microwaved, incinerated, or autoclaved.
Provision of facilities for testing.
Search for cost-effective and environmentally friendly technology for the treatment of bio‐medical and hazardous waste.

Conclusion

According to the prescribed rules and regulations, hospitals are liable to take all necessary actions to handle, manage, and effectively dispose of any kind of waste generated without allowing it to have any contrary effect on the environment and human health. Every hospital needs to follow the steps, procedures, and relations detailed in this blog to maintain a safe and healthy standard for its workers, patients, and the surrounding environment. At Rare Hospitality and Facility Management, we endavour to striclty follow all protocols laid down by hospitals to manage biomedical waste. Click here to speak to our consultants to understand more.

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