Bio-medical Waste Management Rule & Your Obligations

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3 Voice From The Past the wild things of this earth are not ours to do, as we please! they have been given to us in trust, and we must account for them to the generation which will come after us and audit our accounts!!

4 Bio-medical Waste Management Rule & Your Obligations D R. R. H A R S V A R D H A N M B B S, M D ( H A - A I I M S ), D N B, M P H, D M L E, D G M, M N A M S A S S T T. P R O F., H O S P I T A L A D M I N I S T R A T I O N S G P G I M S, L U C K N O W

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6 Here is How I Propose to Go... Introduction Background/Historical Perspective Need/Importance Statutory Provisions Bio-medical Waste (Management and Handling) Rules 2016 Key Obligations Administrative Framework UPHSSP District Hospitals Operational Management Generation Collection /Segregation Storage Transportation Treatment/Disposal Conclusion Take Home Message

7 Introduction

8 Introduction Medical care is vital for our life and health, but the waste generated from medical activities represents a real problem of living nature and human world. Improper management of waste generated in health care facilities causes a direct health impact on the community, the health care workers and on the environment. Every day, relatively large amount of potentially infectious and hazardous waste are generated in the health care hospitals and facilities around the world. Indiscriminate disposal of BMW or hospital waste and exposure to such waste is a serious threat to environment and to human health that requires specific treatment and management prior to its final disposal.

9 Historical Perspective The essence of waste management was aptly captured by the Dravidians, who in 5000 BC laid due emphasis on immaculate town planning and safe & effective drainage system. As has been evidenced from excavation of Mohanjo-daro and Harappan Civilization.

10 Background In the writ petition - B. L. Wadhera vs Union of India, 1996 (2) SCC 594, Honorable Supreme Court adjudicated that - Hospitals which are having bed above 50 beds or more need to provide incinerators or other alternate treatment systems for safe disposal of hospital wastes. Verdict compelled union govt. to legislate, drawing its authority from the Environment Protection Act (1986), Ministry of Environment & Forest came out with Bio- Medical Waste (Management & Handling) Rules Bio-Medical Waste (Management & Handling) (Amendment) Rules 2000, 2003 & 2011, came thereafter.

11 Need of Biomedical Waste Management Injuries from sharps leading to infection to all categories of hospital personnel and waste handler. Healthcare Associated Infections in patients from poor waste management. Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals. Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels. Drugs & Disposable being repacked and sold by unscrupulous elements. Risk of air, water and soil pollution - directly due to waste.

12 Need of Biomedical Waste Management In Hospitals A 1990 report by the U.S. Agency for Toxic Substances and Disease Registry concluded that the general public is not likely to be adversely affected by biomedical waste generated in the traditional healthcare setting. They found, however, that biomedical waste from those settings may pose an injury and exposure risks via occupational contact with medical waste for doctors, nurses, housekeeping & laundry workers. Further, there are opportunities for the general public to come into contact medical waste, such as needles used illicitly outside healthcare settings, or biomedical waste generated via home health care.

13 Statutory Provisions

14 Statutory Provisions Draft of certain rules, which the Central Government proposes to make in exercise of the powers conferred by sections 6, 8 and section 25 of the Environment (Protection) Act, 1986 (29 of 1986), and in supersession of the Bio-Medical Waste (Management and Handling) Rules, 1998, was published in These rules have been promulgated now as the Bio- Medical Waste (Management and Handling) Rules, 2016.

15 Application These rules shall apply to All Persons who generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste in any form and Shall NOT apply to : Radioactive wastes covered under the provisions of the Atomic Energy Act, 1962 (33 of 1962) and the rules made there under; Hazardous chemicals covered under the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989 made under the Environment (Protection) Act, 1986, (29 of 1986) (herein referred to as the Act); Waste covered under the E-Waste (Management and Handling) Rules, 2011

16 Application Wastes covered under the Municipal Solid Wastes (Management and Handling) Rules, 2000 The lead acid batteries covered under the Batteries (Management and Handling) Rules, 2001 Hazardous wastes covered under the Hazardous Wastes (Management, Handling and Transboundary Movement) Rules, 2008 Hazardous microorganisms, genetically engineered microorganisms and cells covered under the Manufacture, Use, Import, Export and Storage of Hazardous Micro organisms, Genetically Engineered Microorganisms or Cells Rules, 1989

17 Definitions Authorization : Means permission granted by the authority for the generation, collection, reception, storage, transportation, treatment, disposal or any other form of handling of bio-medical waste in accordance with these rules and guidelines issued by the Central Government, the Central Pollution Control Board or, as the case may be.

18 Bio-medical Waste Means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, including the categories mentioned in Schedule I to these rules.

19 Biologicals Means any preparation made from organisms or micro-organisms or product of metabolism and biochemical reactions intended for use in the diagnosis, immunisation or the treatment of human beings or animals or in research activities pertaining thereto.

20 Occupier Means a person having administrative control over the institution and the premises generating biomedical waste, which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank, health care facility and clinical establishment, irrespective of their system of medicine and by whatever name they are called.

21 Duties of the Occupier Take all necessary steps to ensure that bio-medical waste is handled without any adverse effect to human health and the environment in accordance with these rules; Provide training for all its health care workers involved in handling of bio medical waste at the time of induction and at least once a year thereafter; Immunise all health care workers involved in handling of bio-medical waste for protection against diseases including Hepatitis B and Tetanus; Ensure occupational safety of all its health care workers involved in handling of bio- medical waste by providing appropriate and adequate personal protective equipment;

22 Duties of the Occupier Conduct health check up at the time of induction and at least once in a year for all its health care workers involved in handling of bio- medical waste and maintain the records for the same; Install necessary equipment and regular supply of materials required for proper in house handling of biomedical waste; Maintain the bio-medical waste management register according to the bio-medical waste generated in terms of colour coding as specified in Schedule-I; Ensure segregation of bio-medical waste at the point of generation;

23 Duties of the Occupier Develop a system of reporting of unintended accidents like sharp injuries, mercury spills, fire hazards, and the records relevant thereto shall be maintained and reported (including nil report) in Form IV to the prescribed authority along with the annual report; Inform the prescribed authority immediately in case the operator of a facility does not collect the bio-medical waste within the intended time or as per the agreed schedule; Establish a bio-medical waste management committee, if the health care facility has thirty or more than thirty beds, to review and monitor the activities related to bio-medical waste management, which shall meet once in six months and the record of the minutes of such meetings shall be submitted along with the annual report to the prescribed authority.

24 Treatment and Disposal Bio-medical waste shall be treated and disposed of in accordance with Schedule I, and in compliance with the standards provided in Schedule IV. Every occupier, shall either set up his own requisite biomedical waste treatment equipment like autoclave, shredder for treatment of bio-medical waste generated in his premises as a part of on-site treatment, or ensure requisite treatment of bio-medical waste through an authorised common biomedical waste treatment facility or any other authorised bio-medical waste treatment facility. Provided that the prescribed authority may authorise the occupier having five hundred or more bed capacity to install an incinerator, depending on the recipient environment and the location warranting such a course of action, where the services of common bio-medical treatment facility are not available.

25 Treatment and Disposal Use of chlorinated plastic bags for handling of bio-medical waste shall be prohibited and the occupier or operator of a common biomedical waste treatment facility shall not dispose of such plastics by incineration. The occupier or operator of a CBMWTF shall dispose of the treated recyclable bio-medical wastes such as plastics and glass through recyclers having valid consent, authorisation or registration from the respective State Pollution Control Board, after ensuring treatment by autoclaving followed by shredding. The occupier shall maintain a record of recyclable wastes which are auctioned or sold and the same shall be submitted to the prescribed authority. In the event of breakage of mercury containing medical instruments, necessary precautions shall be taken by the occupier to segregate such waste to the extent possible and also for its proper collection, storage and disposal as per rules and the guidelines issued by the Central Government.

26 Segregation, Packaging, Transportation & Storage No untreated bio-medical waste shall be mixed with other wastes. The bio-medical waste shall be segregated into containers or bags at the point of generation in accordance with Schedule I prior to its storage, transportation, treatment and disposal. The containers or bags referred to shall be labeled as specified in Schedule II. The transporter shall transport the bio-medical waste from the premises of an occupier to any off-site bio-medical waste treatment facility only with the label as provided in Schedule II along with the necessary information as specified in Schedule III. Untreated bio-medical waste shall be transported only in such vehicle as may be authorised for the purpose by the competent authority specified by the Government.

27 Segregation, Packaging, Transportation & Storage Untreated bio-medical waste shall not be stored beyond a period of forty-eight hours. Provided that in case for any reason it becomes necessary to store such waste beyond such a period, the authorised person shall inform the reasons for doing so in writing to the prescribed authority, obtain permission of the prescribed authority and take appropriate measures to ensure that the waste does not adversely affect human health and the environment. The municipal body of the area shall continue to pickup and transport segregated non bio-medical solid waste generated in hospitals and nursing homes, as well as duly treated bio-medical wastes, for disposal in accordance with the rules notified by the Central Government for management of municipal solid wastes.

28 Prescribed Authority The prescribed authority for implementation of the provisions of these rules shall be the State Pollution Control Boards in respect of States and Pollution Control Committees in respect of Union territories. The prescribed authorities shall comply with the responsibilities as stipulated in Schedule V of these rules.

29 Annual Report Every occupier or operator of common bio-medical waste treatment facility shall submit an annual report to the prescribed authority in Form II and III, respectively, by the 31st day of January of every year, to include information about the categories and quantities of bio-medical wastes handled during the preceding year.

30 Maintenance of Records Every authorised person shall maintain records related to the generation, collection, reception, storage, transportation, treatment, disposal or any other form of handling of bio-medical waste in accordance with these rules and guidelines issued by the Central Government/CPCB/SPCB. All records shall be subject to inspection and verification by the prescribed authority at any time.

31 Accident Reporting When any accident occurs at any institution or facility or any other site, where bio-medical waste is handled or during transportation of such waste, the authorised person shall intimate in writing to the prescribed authority about such accident forthwith. The authorised person shall forward a report on the accident in Form IV within one month from the date of the accident to the prescribed authority. The relevant information about the accidents shall be included in the Annual Report.

32 Liability of the Occupier/Operator of a Facility The occupier or operator of a common bio- medical waste treatment facility shall be liable for all the damages caused to the environment or the public due to improper handling of bio-medical wastes or disposal of bio- medical wastes. The occupier shall be liable to pay user fee to municipal corporation, municipal council or other similar local bodies for collection and disposal of solid waste as notified by the urban local bodies in accordance with rules for solid waste management notified under the Act.

33 Additional Notes of Caution Chemical treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. Mutilation/shredding must be such that it prevents unauthorized reuse. There will be no chemical pretreatment before incineration. Chlorinated plastics/bags shall not be incinerated. Disposal by deep burial is permitted only in rural areas where there is no access to common bio-medical waste treatment facility, with prior approval from the prescribed authority. Liquid waste generated from laboratory, washing, cleaning, house keeping and disinfecting activities shall be treated along with other effluent generated from premises of the occupier or the facility operator so as to meet the discharge standards stipulated under these rules.

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35 Operational Management

36 Hospital Waste - An Analysis Biomedical 20% 15% 5% Infectious 15% Non infectious 05% General 80% 80% Infectious Non Infectious Non Hazardous

37 Life Cycle of BMW GENERATION SEGREGATION COLLECTION TREATMENT & DISPOSAL STORAGE TRANSPORTATION

38 Generation Who generates waste? Doctor, nurse & paramedic - YES Housekeeping staff - NO Only the one who Generates, has to Segregate!

39 Segregation Key to reduction of Bio-medical waste and most important step in Biomedical waste management. But, most difficult to implement. Doctor and paramedics only have this responsibility Housekeeping Staff segregation has no role in

40 Objective Of Segregation Non Plastic BMW Sharps WASTE Plastic General

41 Pre-requisites Knowledge - which waste to go where. Availability - of appropriately colored bags/bins/containers is a must, for segregation. Supervision & reinforcement

42 Key Obligations......

43 Cate gory Yel low SCHEDULE I Bio-medical Wastes Categories : Their Treatment & Disposal Options Type of Waste Human Anatomical Waste Human tissues, organs and body parts. Animal Anatomical Waste Experimental animal carcasses, body parts, organs, tissues, including the waste generated from animals used in experiments or testing in veterinary hospitals or colleges or animal houses. Soiled Waste Items contaminated with blood, body fluids like gloves, dressings, plaster casts, cotton swabs and bags containing residual or discarded blood and blood components. Expired or Discarded Medicines including all items contaminated with Cytotoxic drugs. Chemical Waste Chemicals used in production of biologicals and used/discarded disinfectants. Type of Bag/Conta iner to be used Yellow coloure d nonchlo rinated plastic bags or contain ers Treatment and Disposal options Incineratio n Liquidchemical Ster then Drain Solid- Incineration

44 Cate gory Yell ow Red Whit e (Tra nslu cent ) SCHEDULE I Bio-medical Wastes Categories : Their Treatment & Disposal Options Type of Waste Discarded linen, beddings contaminated with blood or body fluid. Microbiology, Biotechnology and other clinical laboratory waste Laboratory cultures, stocks or specimens of micro-organisms, live or attenuated vaccines, human and animal cell cultures, residual toxins, dishes and devices used for cultures. Contaminated Waste (Recyclable) Wastes generated from disposable items such as tubings, bottles, intravenous tubes and sets, catheters, urine bags, syringes (without needles). Metallic Sharps Needles, syringes with fixed needles, scalpels, blades, or any other contaminated sharp object that may cause puncture and cuts. This includes both used, discarded and contaminated sharps Type of Bag/Contai ner Yellow coloured nonchlorin ated plastic bags or containers Red coloured nonchlorinat ed plastic bags or containers Puncture proof containers Treatment and Disposal options Incineration Autoclaving/ followed by shredding then final disposal in through authorized recyclers Blue Glass Sharps Broken or discarded and contaminated glass Chemical sterilisation then, disposal through recyclers

45 Do s & Do not s Tissues, organs & contaminated solid waste Only in YELLOW container/bag Contaminated Plastics Only in RED container/bag Metallic Sharps Only in WHITE puncture proof container Glass Sharps Only in BLUE puncture proof container General waste Only in Black container/bag No tissues/organs in Red No contaminated in Black

46 Storage Mixing of waste must be prevented. Bags should not be filled more than 2/3 rd of the capacity. No untreated waste to be stored beyond 48 hours. Ensure that the waste bag is properly tied and labeled.

47 Non-chlorinated Bag for Bio-medical Waste A Sample

48 Black Traditionally used for general waste. The bag is to be handed over to municipal authorities. No Bio-hazard symbol if used for household waste.

49 Personnel Protective Equipments The use of protective gears should be made mandatory for all the personnel handling waste.

50 Waste Bag - Labeled & Tied

51 Bio Medical Waste Collection & Transport

52 Label For Bio-medical Waste Containers/Bags

53 Waste Generated at SGPGIMS No. of beds in SGPGI : 1000 Category Waste generated kg/day Waste% General % Bio-medical % Total Approx kg/day

54 NEW ADDITIONS

55 NEW ADDITIONS Pre-treat the laboratory waste, microbiological waste, blood samples and blood bags through disinfection or sterilisation on-site in the manner as prescribed by the World Health Organisation (WHO) or National AIDs Control Organisation (NACO) guidelines and then sent to the common bio-medical waste treatment facility for final disposal Establish a bar- code system for bags or containers containing bio-medical waste to be sent out of the premises or place for any purpose within one year from the date of the notification of these rules Ensure segregation of liquid chemical waste at source and ensure pre-treatment or neutralisation prior to mixing with other effluent generated from health care facilities

56 NEW ADDITIONS Existing incinerators to achieve the standards for treatment and disposal of bio-medical waste as specified in schedule II for retention time in secondary chamber and dioxin and furans within two years from the date of this notification CBMWTF to assist the occupier in training conducted by them for biomedical waste management CBMWTF shall display details of authorisation, treatment, annual report etc on its web-site CBMWTF shall supply non-chlorinated plastic coloured bags to the occupier on chargeable basis, if required Lab and highly infectious bio-medical waste generated shall be pretreated by equipment like autoclave or microwave

57 NEW ADDITIONS Every occupier shall phase out use of non-chlorinated plastic bags within two years from the date of publication of these rules and after two years from such publication of these rules, the chlorinated plastic bags shall not be used for storing and transporting of bio-medical waste The handling and disposal of all the mercury waste and lead waste shall be in accordance with the respective rules and regulations Bar code and global positioning system shall be added by the Occupier and common bio-medical waste treatment facility in one year time Microbiology waste and all other clinical laboratory waste shall be pre-treated by sterilisation to Log 6 or disinfection to Log 4, as per the World Health Organisation guidelines before packing and sending to the common bio-medical waste treatment facility

58 NEW ADDITIONS After resource recovery, the chemical liquid waste shall be pretreated before mixing with other wastewater Pre-treat to sterilize with non-chlorinated chemicals on-site as per National AIDS Control Organisation or World Health Organisation guidelines thereafter for Incineration Wastes generated from disposable items such as tubing, bottles, intravenous tubes and sets, catheters, urine bags, syringes (without needles and fixed needle syringes) and vaccutainers with their needles cut) and gloves Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic wastes

59 NEW ADDITIONS Chemical treatment using at least 10% Sodium Hypochlorite having 30 residual chlorine for twenty minutes Dead Fetus below the viability period (as per the Medical Termination of Pregnancy Act 1971, amended from time to time) can be considered as human anatomical waste. Such waste should be handed over to the operator of common bio-medical waste treatment and disposal facility in yellow bag with a copy of the official Medical Termination of Pregnancy certificate from the Obstetrician or the Medical Superintendent of hospital or healthcare establishment Cytotoxic drug vials shall not be handed over to unauthorised person under any circumstances. These shall be sent back to the manufactures for necessary disposal at a single point. As a second option, these may be sent for incineration at common bio-medical waste treatment and disposal facility or TSDFs or plasma pyrolysis is at temperature >1200 0C

60 NEW ADDITIONS Bio-medical waste generated in households during healthcare activities shall be segregated as per these rules and handed over in separate bags or containers to municipal waste collectors. Urban Local Bodies shall have tie up with the common bio-medical waste treatment and disposal facility to pickup this waste from the Material Recovery Facility (MRF) or from the house hold directly, for final disposal in the manner as prescribed in this Schedule. A temperature of not less than 121 C and pressure of 15 psi per an autoclave residence time of not less than 45 minutes, when operating a vacuum autoclave Microbial inactivation efficacy is equated to Log10 kill which is defined as the difference between the logarithms of number of test microorganisms before and after chemical treatment. Chemical disinfection methods shall demonstrate a 4 Log10 reduction or greater for Bacillus Subtilis (ATCC 19659) in chemical treatment systems

61 Your Obligations As CMO/CMS

62 Role of CMSs Authorisation of the HCF by UPPCB under BMW Management Rules, 2016 Regarding contract with CBWTF for BMW collection, transportation, treatment and disposal: Ensure that a contract is signed with CBWTF for BMW collection, transportation, treatment and disposal Ensure verification of services and timely release of payments of CBWTFs. Bio-medical waste is segregated and handled in accordance with BMW Management Rules 2016 Segregation of BMW from MSW, and not to give treated bio-medical waste with municipal solid waste

63 Role of CMSs Constitution of BMW Management Committee and appointment of NOs Monthly meeting of BMW Management Committee Ensure ToT training of NOs and Matron BMW Training for all healthcare personnel Development of BMW Plan Availability & placement of consumables Display of posters at appropriate locations On-site BMW storage facility is provided and maintained

64 Role of CMSs Internal Monitoring of BMW Plan implementation Maintenance, data entry and updation of BMW MIS for HCF Record keeping of BMW collection by CBWTF, trainings, consumables supply, meetings, accidents and remedial action taken, annual report Ensure submission of annual report to the prescribed authority Response on feedback/grievances Phase out of chlorinated plastic bags, gloves and blood bags within two years from the date of notification of the rules Immunisation and periodic health check-ups of all staff Occupational safety of all its health care workers and others involved in handling of bio-medical waste by providing appropriate and adequate personal protective equipment (PPE)

65 Role of CMOs Regarding contract with CBWTF for BMW collection, transportation, treatment and disposal: To enter into contract agreement with CBWTF for BMW collection, transportation, treatment and disposal To provide financial resources to the health facilities for payment of CBWTF services from allocated funds for the district. To ensure verification of services and timely release of payments of CBWTFs.

66 Role of CMOs As Member Secretary of District Monitoring Committee (DMC): The broad role of the DMC is to monitor the compliance of the provisions of the BMW Rules, 2016 in the health care facilities (HCFs) generating bio-medical waste and in the common biomedical waste treatment and disposal facilities (CBWTFs), where the bio-medical waste is treated and disposed of. As Member Secretary of the DMC, the CMO s role is to: Schedule and coordinate DMC meetings in consultation with the Chairman. Conduct periodic review meetings on the matter of BMW management in the district. Review status of authorisation (from UPPCB) of HCFs and CBWTFs. Review status of implementation of BMW Management Rules, Review status of contracts between HCFs and CBWTFs for collection, transportation, treatment & disposal of BMW and supply of consumables.

67 Role of CMOs As Member Secretary of District Monitoring Committee (DMC): Review status of training and immunisation of personnel engaged in handling and management of BMW in HCFs, CBWTFs or any other. Review status of segregation of BMW at places of generation. Review of BMW MIS and action on significant alerts. Conduct quarterly inspection of CBWTFs treatment facilities located in their district. Details of the same are attached (Section 5). Promote establishment of new CBWTFs and facilitate allocation of land for the same. Review of complaints/feedback from HCFs, CBWTFs, local bodies, public or others. Documents proceedings of the meetings and present a six-monthly report to State Advisory Committee and copy of the same to CPCB, New Delhi and UPPCB, Lucknow

68 Role of CMOs At the CHC Level to ensure: Authorisation of the HCF by UPPCB under BMW Management Rules, 2016 Bio-medical waste is segregated and handled in accordance with BMW Management Rules 2016 Segregation of BMW from MSW, and not to give treated bio-medical waste with municipal solid waste Designate MOIC as NO BMW BMW Training for healthcare personnel Availability & placement of consumables Display of posters at appropriate locations

69 Role of CMOs At the CHC Level to ensure: On-site BMW storage facility is provided and maintained External and internal Monitoring of BMW Plan implementation Phase out of chlorinated plastic bags, gloves and blood bags within two years from the date of notification of the rules Immunisation and periodic health check-ups of all staff Occupational safety of all its health care workers and others involved in handling of bio-medical waste by providing appropriate and adequate personal protective equipments Record keeping of BMW collection by CBWTF, trainings, consumables supply, meetings, accidents and remedial action taken, annual report Ensure submission of annual report to the prescribed authority

70 Role of CMOs Maintenance, data entry and updation of BMW MIS for CHCs and DMC External Monitoring of HCF-level BMW Plan implementation: To monitor biomedical waste management in Healthcare facilities by periodic reporting as well as by site inspections of the facilities by officials deputed from CMO office.

71 Conclusion Medical wastes should be classified according to their source, typology and risk factors associated with their handling, storage and end disposal. The segregation of waste at source is the key step and reduction, reuse and recycling should be considered in proper perspective. We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules, as waste generation particularly biomedical waste imposes incremental direct and indirect costs on society. The challenge before us, therefore, is to scientifically manage growing quantities of biomedical waste that go beyond past practices. If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health management but also in the interest of community and for future generations......

72 Take Home Message Tissues, organs & contaminated solid waste Only in YELLOW container/bag Contaminated Plastics Only in RED container/bag Metallic Sharps Only in WHITE puncture proof container Glass Sharps Only in BLUE puncture proof container General waste Only in Black container/bag No tissues/organs in Red No contaminated in Black

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74 Resources for Reference Ministry of Environment Website CPCB Website BMW (M&H) Rules 2015

75 IJMR ICMR -ORIGINAL ARTICLE Year : 2014 Volume : 139 Issue : 1 Page : Bio-medical waste management: situational analysis & predictors of performances in 25 districts across 20 Indian States Background & objectives: A legislative framework for bio-medical waste management (BMWM) was established in the country more than a decade ago. Though some studies have identified gaps at local levels, no systematic effort was done to collect data from different parts of the country. The objective of this nationwide study was to document existing resources, infrastructure and practices related to BMWM across the study districts. Methods: The study was conducted in 25 districts spread over 20 States of India including urban and rural areas. Primary (n=388), secondary (n=25) and tertiary care (n=24) health facilities from public (n=238) and private (n=199) sector were assessed and scored for the state of BMWM through 9 items representing system capacity, availability of resources and processes in place. Health facilities were assigned into one of the three categories (Red, Yellow and Green) based on the cumulative median scores. Results: Around 82 per cent of primary, 60 per cent of secondary and 54 per cent of tertiary care health facilities were in the 'RED' category. Multivariate analysis indicated that charts at the point of waste generation, availability of designated person, appropriate containers and bags, availability of functional needle destroyers, availability of personal protective gears, segregation of waste at point of generation and log book maintenance were independently (OR-between ; P <0.03 or less) associated with better BMWM system in the health facilities. This was true for both rural-urban and public or private health facilities. Interpretation & conclusions: The study highlighted the urgent need for greater commitments at policy and program levels for capacity building, and resource investments in BMWM.

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77 Speaker Contact Information Your feedback and comments will be appreciated!

78 Voice For The Future Everything is connected to everything else

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