Introduction and Status of Biomedical Waste In Himachal Pradesh. Dr. Sanjay Sood Member Secretary HP State Pollution Control Board

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1 Introduction and Status of Biomedical Waste In Himachal Pradesh Dr. Sanjay Sood Member Secretary HP State Pollution Control Board

2 How Biomedical Waste is defined Biomedical Waste can be broadly defined as: Any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals.

3 Hospital Waste is Biomedical Waste? Noninfectious medical waste medical waste Biomedical Waste Hazardous waste Others 2 November,

4 Hospital Waste is not only Biomedical Waste Recyclable waste Common refuse Hospital Waste Biomedical waste Regulated medical waste Biomedical Waste Noninfectious medical waste Hazardous waste Others Universal waste 2 November,

5 Characteristics of Hospital waste 80% of the waste generated in HCF is non-hazardous and Non-toxic BMW generated from medical activities are hazardous, toxic and even lethal Possess high potential for diseases transmission Rag pickers and waste workers are worst affected 15% is infectious waste and 5% is hazardous waste Segregation at Source reduces the problem proportionately Organizational set up, training and motivation and compliance to the rules improve the situation considerably

6 Average composition of Hospital waste in India Material Percentage (Wet weight basis %) General waste 53.5 (food waste, sweepings from hospital premises) Paper 15.0 Rags 15.0 Plastics 10.0 Glass 4.0 Infectious wastes 1.5 Metal (sharps etc) 1.0 Source : NEERI.

7 Introduction about Bio-Medical Waste (Management & Handling) Rules, 1998 BMW (M&H) Rules, 1998 came into force vide S.O.630(E), dated to regulate the biomedical waste generated from the Health Care Facilities.

8 Major Short coming of BMW Rules 1998 Silent about the unbeded HCFs and OPDs less than 1000 patient per month. Biomedical Waste Storage Point at HCF Level Segregation of liquid chemical waste at source and its treatment before mixing with other effluent not covered. Pre treatment of liquid waste generated from the hospital No check during the transportation of the bags or containers containing Biomedical waste No provision to review and monitor the activities of BMW at HCF level

9 Introduction about BMWM Rules 2016 Ministry of Environment, Forest and Climate Change, Govt. of India vide notification GSR. 343(E), dated 28th March, 2016 has notified Bio-medical Waste Management Rules, 2016 in supersession of the BMW Rules, 1998 More emphasis on improve the collection, segregation, processing, treatment and disposal of bio-medical waste in an environmentally sound manner thereby reducing the biomedical waste generation and its impact on environment. These rules shall apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle biomedical waste in any form

10 Issues to be addressed during the Workshop BMW Storage point Segregation/treatment of Liquid Chemical Waste and Liquid Waste Use of Non chlorinated bags Training and workshops Bar code system BMW Committee at HCF level State/district level advisory committee

11 Status of Biomedical Waste in Himachal Pradesh

12 Comparison of No of HCfs covered under BMW Rules 1998 and to be covered under BMW Rules 2016 Sr. No Name of District No of HCFs covered under BMW Rules 1998 No of HCFs to be covered under BMW Bilaspur Chamba Kangra Mandi Kullu L & S Sirmour Hamirpur Una Solan Shimla Kinnaur Total

13 No of HCFs covered under BMW Rules Bilaspur Chamba Kangra Mandi Kullu L & S Sirmour Hamirpur Una Solan Shimla Kinnaur

14 Status of Bio-Medical Waste generation in Himachal for the year 2015 Name of district No. of HCF s Total waste Kg/day Incinerable waste Kg/day Deep burial waste Kg/day Plastic waste Kg/day Bilaspur Chamba Kangra Mandi Kullu L&S Sirmour Hamirpur Una Solan Shimla & Kinnaur Total

15 Status of Biomedical Waste in Himachal Pradesh During the year Incinerable waste Kg/day Deep burial waste Kg/day 1101 Plastic waste Kg/day 149

16 Disposal Status Through Common Biomedical Waste Treatment Facilities Through Captive Incinerators (3 Nos) Through Deep Burial

17 CBWTFs in Himachal Pradesh 1. CBWTF at Sandli Arki District Solan: Covering Area: Solan, Parwanoo, Baddi, Barotiwala, Dharampur and Nalagarh area of Solan district. Shimla town, Rampur of Shimla district. Nahan, Paonta and Kala Amb area of Sirmour district

18 CBWTFs in Himachal Pradesh Cont 2. CBWTF at Pirdi, District Kullu: Covering: Bilaspur and Ghumarwin area of Bilaspur district. Mandi, Sundernagar, Ner Chowk and Sarkaghat area of Mandi district. Kullu and Manali area of Kullu district.

19 CBWTFs in Himachal Pradesh Cont 3. BMWT Facility, Pathankot (Punjab): Covering : Kangra, Palampur, Jawalji, Baijnath, Nurpur, Jassur and Nagrota area of Kangra district. Chamba, Kakira and Surgani area of Chamba district. Hamirpur, Nadaun, Badsar and Bhota area of Hamirpur district. Una, Mehatpur, Santokhgarh, Amb and Daulatpur Chowk area of Una district.

20 Deep Burial Practices in Himachal Deep Burial : In rest of the areas where Common Biomedical Waste Treatment Facilities not available, deep burial practices is being adopted as per the provisions of BMW rules.

21 Number of Show Cause Notices issued under BMW Rules January to till date Sr. No Name of District No of HCFs Show Cause Notices on non compliance 1 Bilaspur Chamba 35 Nil 3 Kangra Mandi 137 Nil 5 Kullu 59 Nil 6 L & S 19 Nil 7 Sirmour Hamirpur Una Solan Shimla Kinnaur 10 Nil Total

22 7 6 Show Cause Notices on non compliance Bilaspur Chamba Kangra Mandi Kullu L & S Sirmour Hamirpur Una Solan Shimla Kinnaur

23 Let The Wastes Of The Sick NOT Contaminate The Lives Of The Healthy

24

25 Outcome of the workshop Dr. Sanjay Sood Member Secretary HP State Pollution Control Board

26 How Biomedical Waste is defined Biomedical Waste can be broadly defined as: Any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals.

27 Hospital Waste is Biomedical Waste? Noninfectious medical waste medical waste Biomedical Waste Hazardous waste Others 2 November,

28 Hospital Waste is not only Biomedical Waste Recyclable waste Common refuse Hospital Waste Biomedical waste Regulated medical waste Biomedical Waste Noninfectious medical waste Hazardous waste Others Universal waste 2 November,

29 Introduction about Hospital waste BMW generated from medical activities are hazardous, toxic and even lethal Possess high potential for diseases transmission Rag pickers and waste workers are worst affected 80% of the waste generated in HCF is non-hazardous and Non-toxic 15% is infectious waste and 5% is hazardous waste Segregation at Source reduces the problem proportionately Organizational set up, training and motivation and compliance to the rules improve the situation considerably

30 Average composition of Hospital waste in India Material Percentage (Wet weight basis %) General waste 53.5 (food waste, sweepings from hospital premises) Paper 15.0 Rags 15.0 Plastics 10.0 Glass 4.0 Infectious wastes 1.5 Metal (sharps etc) 1.0 Source : NEERI.

31 Introduction about Bio-Medical Waste (Management & Handling) Rules, 1998 BMW (M&H) Rules, 1998 came into force vide S.O.630(E), dated to regulate the biomedical waste generated from the Health Care Facilities.

32 Major Short coming of BMW Rules 1998 Silent about the unbeded HCFs and OPDs less than 1000 patient per month. Biomedical Waste Storage Point at HCF Level Segregation of liquid chemical waste at source and its treatment before mixing with other effluent not covered. Pre treatment of liquid waste generated from the hospital No check during the transportation of the bags or containers containing Biomedical waste No provision to review and monitor the activities of BMW at HCF level

33 Bio-medical Waste Management Rules, The key highlights: The 2016 Regulation have expanded the ambit by including all HCFs, and simplified procedure of getting an authorisation. Non-bedded HCFs will be granted one-time authorisation and in case of bedded HCFs the authorisation now will be synchronised with the Consents. The new features of Bar Code System for bags and containers containing bio-medical waste is expected to eliminate pilferage and restrict the entry of waste in the illegal recycling market. The purview of the new rules has been expanded to include vaccination camps, blood donation camps, surgical camps and other healthcare activities. Simplified the categorization. Schedule I & II clubbed. This will ease the waste segregation process at the source of generation

34 Bio-medical Waste Management Rules, the key highlights: It mandates pre-treatment of liquid waste i.e. lab waste, blood samples, microbiological waste and blood bags through disinfection or sterilisation on-site in the manner as prescribed by WHO or NACO. Use of chlorinated plastic bags, gloves and blood bags will be phased out within two years. This will be a good step as burning of chlorinated plastics often leads to emission of dioxin-furan, a Persistent Organic Pollutant (PoPs). The standards for emissions from incinerators have also been made more stringent. Training and regular immunization of all healthcare workers.

35 Comparison of No of HCfs covered under BMW Rules 1998 and to be covered under BMW Rules 2016 Sr. No Name of District No of HCFs covered under BMW Rules 1998 No of HCFs to be covered under BMW Bilaspur Chamba Kangra Mandi Kullu L & S Sirmour Hamirpur Una Solan Shimla Kinnaur Total

36 Presentations on the various aspects of the provisions of previous and new BMW rules by the following: Central Pollution Control Board Health Department Himachal State Pollution Control Board Operators of the Transport facilities

37 Major outcome of the Workshop Issues Action to be taken by Time Frame Provision of Biomedical Waste Storage Point with in the premises of HCF from where Biomedical waste handed over to the CBWTF Provision for the segregation of liquid chemical waste at source and its treatment before mixing with other effluent Pre treatment of liquid waste (Laboratory Waste, microbiological waste, blood samples and blood bags) before sending to the CBWTF Use of Non Chlorinated bags, gloves and blood bags Health Department Health Department Health Department Up to Up to Up to *

38 Major outcome of the Workshop Issues Action to be taken by Time Frame Organisation of Training and workshops on Biomedical Waste Management Activities Health Department, PCB and CBWTF Operators On going process Immunisation of Health Care Workers involved in handling of Biomedical waste Bar-code system for the bags or containers containing Biomedical waste Health Department Operators of CBWTF/Health Department On going process Up to *

39 Major outcome of the Workshop Issues Action to be taken by Time frame Establishment of a committee at HCF level having more than 30 beds Constitution of State or District level Advisory Committee Revised online application module on HIMXGN for the authorisation under BMW Rules 2016 Strengthening of Biomedical waste wing and delegation/re-delegation of powers to the officers/officials of the State Board under these Rules Health Department State Government PCB PCB Up to Up to Up to Up to

40 In case of Non Violation of above said Rules Powers under Section 5 of EPA Act: The closure, prohibition or regulation of any industry, operation or process; or Stoppage or regulation of the supply of electricity or water or any other service. Powers under Section 15 of EPA Act: Imprisonment for a term which may extend to five years with fine which may extend to one lakh rupees, or with both.

41 Let The Wastes Of The Sick NOT Contaminate The Lives Of The Healthy

42

43 ISSUES IN IMPLEMENTATION OF BMW MANAGEMENT RULES IN HEALTH CARE FACILITIES Dr SONAM G. NEGI (OSD) HEALTH SAFETY & REGULATION DEPT. OF HEALTH GOVT.OF H.P.

44 BMW MANAGEMENT RULES-2016 Bio-medical waste (BMW) Waste generated during the diagnosis, treatment or immunisation of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps, including the categories mentioned in Schedule I appended to these rules.

45 THESE RULES SHALL NOT APPLY TO RADIOACTIVE WASTES HAZARDOUS CHEMICALS SOLID WASTES LEAD ACID BATTERIES HAZARDOUS WASTES E-WASTE GENETICALLY ENGINEERED MICRO ORG.

46 CURRENT SCENARIO BMW MANAGEMENT STILL A NEGLECTED AREA IMPACTING HUMAN HEALTH ADVERSELY. SEGREGATION NOT PROPER AT GENERATION POINTS. INFECTIOUS WASTE & SHARPS GET MIXED UP WITH DOMESTIC WASTE AFFECTING POPULATION AT LARGE.

47 SUGGESTIONS FOR IMPROVEMENT 1. Investment Person, Place & Finance. 2. Formation of BMW Management Committee. 3. BMW Generation Survey. 4. Evaluation of Existing Practice. 5. Training as per need. 6. SEGREGATION AT THE POINT OF GENERATION. 7. Reporting and Feed Back. 8. Periodical Review & Planning as per requirement.

48 CATEGORY TYPE OF WASTE TYPE OF BAG OR CONTAINER TO BE USED TREATMENT AND DISPOSAL OPTIONS Y E L L O W (A) HUMAN ANATOMICAL WASTE: Human tissues, organs, body parts and fetus below the viability period (as per the Medical Termination of Pregnancy Act 1971, amended from time to time). (B) 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 YELLOW COLOURED NON-CHLORINATED PLASTIC BAGS INCINERATION OR PLASMA PYROLYSIS OR DEEP BURIAL*

49 CATEGORY TYPE OF WASTE TYPE OF BAG OR CONTAINER TO BE USED (C) SOILED WASTE: Items contaminated with blood, body fluids like dressings, plaster casts, cotton swabs and bags containing residual or discarded blood and blood components. TREATMENT AND DISPOSAL OPTIONS INCINERATION OR PLASMA PYROLYSIS OR DEEP BURIAL* In absence of above facilities, autoclaving or microwaving /hydroclaving followed by shredding or mutilation or COMBINATION OF STERILIZATION AND SHREDDING. TREATED WASTE TO BE SENT FOR ENERGY RECOVERY.

50 CATEGORY TYPE OF WASTE TYPE OF BAG OR CONTAINER TO BE USED TREATMENT AND DISPOSAL OPTIONS (D) EXPIRED OR DISCARDED MEDICINES: Pharmaceutical waste like antibiotics, cytotoxic drugs including all items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc. Yellow coloured non-chlorinated plastic bags or containers Expired `cytotoxic drugs and items contaminated with cytotoxic drugs to be returned back to the manufacturer or supplier for incineration at temperature >1200 0C or to common biomedical waste treatment facility or hazardous waste treatment, storage and disposal facility for INCINERATION AT >12000C OR ENCAPSULATION OR PLASMA PYROLYSIS AT >12000C. ALL OTHER DISCARDED MEDICINES SHALL BE EITHER SENT BACK TO MANUFACTURER OR DISPOSED BY INCINERATION.

51 CATEGORY TYPE OF WASTE TYPE OF BAG OR CONTAINER TO BE USED TREATMENT AND DISPOSAL OPTIONS (e) CHEMICAL WASTE: Chemicals used in production of biological and used or discarded disinfectants. (F) CHEMICAL LIQUID WASTE : Liquid waste generated due to use of chemicals in production of biological and used or discarded disinfectants, Silver X-ray film developing liquid, discarded Formalin, infected secretions, aspirated body fluids, liquid from laboratories and floor washings, cleaning, house-keeping and disinfecting activities etc. Yellow coloured containers or non-chlorinated plastic bags SEPARATE COLLECTION SYSTEM LEADING TO EFFLUENT TREATMENT SYSTEM Disposed of by INCINERATION OR PLASMA PYROLYSIS OR ENCAPSULATION in hazardous waste treatment, storage and disposal facility. After resource recovery, the chemical liquid waste shall be pre-treated before mixing with other wastewater. THE COMBINED DISCHARGE SHALL CONFORM TO THE DISCHARGE NORMS GIVEN IN SCHEDULE-III.

52 CATEGORY TYPE OF WASTE TYPE OF BAG OR CONTAINER TO BE USED TREATMENT AND DISPOSAL OPTIONS (G) DISCARDED LINEN, MATTRESSES, BEDDINGS CONTAMINATED WITH BLOOD OR BODY FLUID. Non-chlorinated yellow plastic bags or suitable packing material Non- chlorinated chemical disinfection followed by incineration or Plazma Pyrolysis or for energy recovery. In absence of above facilities, shredding or mutilation or combination of sterilization and shredding. TREATED WASTE TO BE SENT FOR ENERGY RECOVERY OR INCINERATION OR PLAZMA PYROLYSIS.

53 CATEGORY TYPE OF WASTE TYPE OF BAG OR CONTAINER TO BE USED TREATMENT AND DISPOSAL OPTIONS (H) MICROBIOLOGY, BIOTECHNOLOGY AND OTHER CLINICAL LABORATORY WASTE: Blood bags, Laboratory cultures, stocks or specimens of microorganisms, live or attenuated vaccines, human and animal cell cultures used in research, industrial laboratories, production of biological, residual toxins, dishes and devices used for cultures. Autoclave safe plastic bags or Containers PRE-TREAT TO STERILIZE WITH NONCHLORINATED CHEMICALS ON-SITE, AS PER NATIONAL AIDS CONTROL ORGANISATION OR WORLD HEALTH ORGANISATION GUIDELINES. THEREAFTER FOR INCINERATION.

54 YELLOW SEGREGATION OF WASTE BAG OR CONTAINER INFECTIOUS WASTE Human/Animal waste Soiled bandages Dressings Cotton Swabs Sanitary Pads No Plastics In this bag

55 RED CONTAMINATED WASTE (RECYCLABLE) (a) 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. RED COLOURED NON- CHLORINATED PLASTIC BAGS OR CONTAINERS Autoclaving or microwaving/hydroclaving followed by shredding or mutilation or combination of sterilization and shredding. TREATED WASTE TO BE SENT TO REGISTERED OR AUTHORIZED RECYCLERS OR FOR ENERGY RECOVERY OR PLASTICS TO DIESEL OR FUEL OIL OR FOR ROAD MAKING, WHICHEVER IS POSSIBLE. PLASTIC WASTE SHOULD NOT BE SENT TO LANDFILL SITES.

56 SEGREGATION OF WASTE RED BAG OR CONTANIER No Sharps PLASTIC WASTE IV Sets Tubing's Blood & Urine bags Syringes In this bag

57 WHITE (TRANSLUCENT) WASTE SHARPS INCLUDING METALS: Needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, or any other contaminated sharp object that may cause puncture and cuts. This includes both used, discarded and contaminated metal sharps PUNCTURE PROOF, LEAK PROOF, TAMPER PROOF CONTAINERS Autoclaving or Dry Heat Sterilization followed by shredding or mutilation or encapsulation in metal container or cement concrete; combination of shredding cum autoclaving; and sent for FINAL DISPOSAL TO IRON FOUNDRIES (HAVING CONSENT TO OPERATE FROM THE STATE POLLUTION CONTROL BOARDS OR POLLUTION CONTROL COMMITTEES) OR SANITARY LANDFILL OR DESIGNATED CONCRETE WASTE SHARP PIT.

58 SEGREGATION OF WASTE Needles /Sharps in the TRANSPARENT puncture proof bin/container.

59 BLUE (A) GLASSWARE: Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic wastes. CARDBOARD BOXES WITH BLUE COLORED MARKING DISINFECTION (BY SOAKING THE WASHED GLASS WASTE AFTER CLEANING WITH DETERGENT AND SODIUM HYPOCHLORITE TREATMENT) OR AUTOCLAVING OR MICROWAVING OR HYDROCLAVING AND THEN SENT FOR RECYCLING. (B) METALLIC BODY IMPLANTS CARDBOARD BOXES WITH BLUE COLORED MARKING -do-

60 SEGREGATION OF WASTE

61 DO S Segregate waste as per category at point of generation. Put waste in correct bins. Ensure colour bags of the same colour as bins. Ensure containers has Bio-hazard symbol. Remove plastic bags when ¾ full, tie the bags properly. Ensure bag is properly tied / sealed to avoid spilling. Ensure spillage free transportation to the storage site. Cut/mutilate the needles / disposables before disposal. Wear protective gears while handling BMW. Keep record book on BMW activity up dated.

62 DON TS Put wrong bags in wrong bins. Put the BMW indiscriminately. Fill the bags till neck. Handle BMW without PPE. Drag the bags during transportation Mix BMW with non infectious wastes

63 REMEMBER ENSURE COMPLIANCE OF BMW MANAGEMENT RULES,2016 BY :- o SEGREGATION AT SOURCE o PRE-TREAT BMW (BEFORE DISPOSAL) SO THAT IT BECOMES NON INFECTIVE o SAFE RECOVERY OF RESOURCES

64

65 Intrductory Workshop on Bio-medical Waste Management Rules, 2016 Bio-medical Waste Management Rules 2016 J. Chandra Babu, M.E ( Envi. Engg.) Senior Envi. Engineer (Scientist D ) Central Pollution Control Board Parivesh Bhawan, East Arjun Nagar DELHI M: jcb.cpcb@nic.in or jathikartha@yahoo.com

66 National Scenario on Bio-medical Waste Management ( As per 2014) National Scenario on BMWM-2014.ppt

67 Bio-medical Waste Management Scenario in the State of H.P H.P Scenario on BMWM-2014.ppt

68 Effects of Improper BMW Management World Health Organization (WHO), study in 2000, estimated that injections from 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); and atleast 260,000 HIV infections (5% of all new infections).

69 Bio-medical Waste Management Rules, 2016 Actions shall be taken against HCFs/CBWTFs for violation of the provisions Directions under Section 5 of The Environment (P) Act, 1986 as follows: Closure, prohibition or regulation of any operation or process. Stoppage or regulation of the electricity or water supply Closure of the HCFs/CBWTFs.

70 Bio-medical Waste Management Rules, 2016 Actions against HCFs/CBWTF Violation of the Provisions: for Liable for punishment under Section 15 of The Environment (P) Act, 1986 which include Imprisonment up to five years or fine up to one lakh rupees or both. In case of violation continues: additional fine which may extend to five thousand rupees for every day. If the contravention continues beyond a period of one year after the first date of contravention, the offender shall be punishable with imprisonment for term which may extend to seven years.

71 Types of waste generated in HCFs: Infectious or bio-medical waste Municipal Solid Waste Hazardous Waste Used Lead Acid Batteries Electrical and Electronic Waste Hazardous Chemicals Plastic Waste Radio Active Waste Liquid Waste ( from Lab, Laundry etc.,) Emissions from Boilers, DG Sets etc.,

72 Environmental Statutes 1. Water (Prevention and Control of Pollution) Act, Water (Prevention and Control of Pollution) Cess Act, Air (Prevention and Control of Pollution) Act, Environment (Protection) Act, Umbrella Act 5. The Manufacture, Storage and Import of Hazardous Chemicals Rules, Hazardous Waste ( Management & Handling) Rules, 1989 replaced by Hazardous and Other Waste (Management and Transboundary Movement) Rules, 2016.

73 Rules and Notifications 8. The Biomedical Waste (Management and Handling) Rules, 1998 as amended BMW Rules, 1998.ppt 9. Recycled Plastics Manufacture and Usage Rules, 1999 (and further rules issued in 2016). 10. Municipal Solid Wastes (Management and Handling) Rules, 2000 and (further rules issued in 2016). 11. The Noise Pollution (Regulation and Control) (Amendment) Rules, Batteries (Management and Handling) Rules, 2001 and further amendments issued from time to time. 13. EIA Notification, 1994 replaced with the EIA Notification, 2006 and further amendments made thereof. 14. e-waste Management Rules, 2016

74 Environmental Statutes NEW BMWM RULES Bio-medical Waste Management Rules, 2016 BMWM Rules, 2016 ( ).docx May be downloaded from MoEF & CC Website:

75 Evolution of BMW Rules in India CWP filed by Dr BL Wadhera in 1995 in Supreme Court against Union of India to forthwith stop the dumping by Civic Authorities of hospital waste of Safdarjung at Bhalswa dump as the river Yamuna could be contaminated during rainy season. Plea upheld & directives issued. In 1996, Hon ble Supreme Court s direction to 50 & above bedded hospitals in Delhi to have treatment and disposal facilities. Bio-medical Waste (Management & Handling) Rules, 1998 notification under Environment (Protection) Act, Bio-medical Waste Management Rules, 2016 notified vide GSR 343(E) on , in supersession of the BMW Rules, 1998

76 Bio-medical Waste Management Rules Provisions 1. Short Title and Commencement 2. Application 3. Definitions ( from a to p) 4. Duties of the Occupier 5. Duties of the Operator of a CBWTDF 6. Duties of Authorities 7. Treatment and Disposal 8. Segregation, Packing, Transportation and Storage 9. Prescribed Authority 10. Procedure for Authorization 11. Advisory Committee 12. Monitoring of Implementation of the rules in HCFs 13. Annual Report 14. Maintenance of Records 15. Accident Reporting 16. Appeal 17. Site for CBWTDF 18. Liability of the occupier, operator of a facility 04 Schedules 05 Forms

77 Bio-medical Waste Management Rules, 2016 Rule 1. Short Title and Commencement These rules may be called the Bio-Medical Waste Management Rules, Came into force with effect from

78 Bio-medical Waste Management Rules, 2016 contd Rule 2. Application : These rules shall apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio medical waste in any form including Hospitals, Nursing Homes, Clinics, Dispensaries and Ayush hospitals. Veterinary institutions, animal houses. Pathological, Forensic and Research Labs. Blood Banks. Research or Educational Institutions. Camps:-relating to health/medical/ surgical/vaccination or blood donation. Schools with first aid rooms.

79 Rule 2: Application contd (2) These rules shall not apply to the waste as covered under other regulations such as : a) radioactive wastes - as per provisions of the Atomic Energy Act, 1962 (33 of 1962); b) hazardous chemicals- as per Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989 notified under Environment (Protection) Act, 1986; c) Solid wastes as per Solid Waste (Management and Handling) Rules, 2016; d) The Lead Acid Batteries - as per Batteries (Management and Handling) Rules, 2001 or revised; e) Hazardous wastes as per Hazardous & Other Wastes (Management and Transboundary Movement) Rules, 2016; f) E-waste as per e-waste Management Rules, 2016; and g) hazardous microorganisms, genetically engineered microorganisms and cells as per Manufacture, Use, Import, Export and Storage of Hazardous Microorganisms,Genetically Engineered Microorganisms or Cells Rules, 1989 or amendments thereafter;

80 Rule 3: Main Definitions Rule 3 (C) : Authorisation means permission granted by the prescribed authority (SPCB/PCC) for the generation, collection, reception, storage, transportation, treatment, processing, disposal or any other form of handling of bio-medical waste in accordance with these rules and guidelines issued by the Central Government or Central Pollution Control Board (CPCB) as the case may be; Rule 3(f): Bio-medical waste "bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps, including the categories mentioned in Schedule-I appended to the BMWM Rules, 2016.

81 Rule 3: Main Definitions contd Rule 3 (g): Bio-medical Waste Treatment and Disposal Facility means any facility wherein treatment, disposal of bio-medical waste or processes incidental to such treatment and disposal is carried out, and includes common bio-medical waste treatment facilities; Rule 3 (j): health care facility means a place where diagnosis, treatment or immunisation of human beings or animals is provided irrespective of type and size of health treatment system, and research activity pertaining thereto; Rule 3(m): Occupier means a person having administrative control over the institution and the premises generating bio-medical 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.

82 Rule 3: Main Definitions contd Rule 3 (n): Operator of a Common Bio-medical Waste Treatment Facility means a person who owns or controls a Common Bio-medical Waste Treatment Facility (CBWTF) for collection, reception, storage, transport, treatment, disposal or any other form of handling of bio-medical waste; Rule 3 (o): prescribed authority means the State Pollution Control Board in respect of a State and Pollution Control Committee in respect of an Union Territory;

83 Bio-medical Waste Management Rules, 2016 Rule 4: Duties of the Occupier: To take all necessary steps as per rules Segregation of waste at source as per Schedule I and to make a provision for safe and secured location for storage of segregated BMW. No secondary handling/pilferage of recyclables/ inadvertent scattering/ spillage and directly transport waste to treatment facility; Pre-treat the laboratory waste, microbiological waste, blood samples and blood bags by disinfection or sterilization on-site as per WHO or NACO Guidelines and then for final disposal. Phase out : use of chlorinated plastic bags, gloves and blood bags within two years; Training: To provide training to all its HCWs-at the time of induction & thereafter atleast once in a year. Maintaining records w.r.to the training programmes and submit along with the Annual Report to SPCB/PCC.

84 Rule 4: Duties of the Occupier contd Immunize all HCWs including Hepatitis & Tetanus as per NIP or MoH & FW Bar Code: Establish a Bar-Code System for bags or containers within one year; Pre-treatment of Liquid Chemical waste: Ensure segregation and pre-treatment or neutralization of liquid chemical waste at source prior to mixing with other effluent. Pre-treatment of Liquid Chemical waste Ensure treatment & disposal of liquid waste in accordance with Water Act, 1974 Occupational safety: Ensure occupational safety of HCWs-by providing PPEs. Health Checks: Conduct health checks to the HCWs- at the time of induction and atleast once in a year. Existing incinerators shall have to achieve the standards as specified in Schedule II for retention time in secondary chamber and Dioxin and Furans within two years.

85 Rule 4: Duties of the Occupier contd Report major accidents including fire in Form I Form-I, BMWM Rules, 2016.docx) to SPCB/PCC; Dissemination of Information: Maintain register and update records on day-to-day basis in respect of BMW Generation as per Schedule -I & display monthly record on website as per Schedule. I. All the HCFs should have own website within 2 years and make available the AR on web-site. Inform SPCB/PCC immediately in case the CBWTF does not collect the BMW within the intended time; Maintain all records for operation of captive treatment equipment for a period of five years; Review and monitor the BMW activities- through existing Committee or by a new Committee. Committee - meet once in every six months and submit record of the minutes of the meetings along with the AR to the SPCB/PCC. HCF having < 30 no. of beds shall designate a qualified person to review and monitor.

86 Bio-medical Waste Management Rules, 2016 Rule 4: Duties of the Operator of a CBWTFs To take all necessary steps as per rules and as per guidelines; To ensure timely collection of BMW from the HCFs including on holidays as prescribed under the rules. Establish a Bar-Code System and GPS for handling of BMW within one year; Inform SPCB/PCC immediately regarding the occupiers which are not handing over the segregated BMW as per BMW Rules; To provide training to all its workers-at the time of induction and thereafter atleast once in a year. Assist the occupier in training conducted by them for bio- medical waste management; To undertake appropriate medical examination of the workers at the time of induction and at least once in a year. To ensure occupational safety of workers by providing appropriate and adequate PPEs

87 Rule 4: Duties of the Operator of a CBWTF contd.. To immunise all its workers for protection against diseases, including Hepatitis B and Tetanus and maintain the records; To report major accidents including fire hazards, blasts in Form I to the SPCB/PCC along with the annual report; To maintain a log book for each of its treatment equipment, for a period of five years ; To allow occupier, who are giving waste for treatment to the operator, to see whether the treatment is carried out as per rules; Shall display details of authorisation, treatment, annual report etc. on its web-site; After ensuring treatment of BMW, such as plastics and glass, shall be given to recyclers having valid consent or authorisation or registration from the respective SPCB/PCC; Supply non-chlorinated plastic coloured bags to the occupier on chargeable basis, if required; To upgrade existing incinerators to achieve the standards for retention time in secondary chamber and Dioxin and Furans within two years.

88 Bio-medical Waste Management Rules, Duties of Authorities:- The Authority specified in column (2) of Schedule-III shall perform the duties as specified in column (3) thereof in accordance with the provisions of these rules. Schedule -III, BMWM Rules, 2016.docx

89 Bio-medical waste Management Rules, 2016 Rule 7: Treatment and Disposal : (1) Bio-medical waste shall be treated & disposed of by HCF/CBWTF in accordance with Schedule-ISchedule-I, BMWM Rules, 2016.docx, and as per the standards stipulated under Schedule-II Schedule-II, BMWM Rules, 2016.docx. (2) Occupier shall hand over only segregated waste as per Schedule-I as well as only pre-treated laboratory and highly infectious Waste to CBWTF for treatment and final disposal: (3) No occupier shall establish on-site treatment and disposal facility, if a service of a CBWTF is available at 75 KM distance. (4) In case where a CBWTF is not available, the Occupiers shall set up captive Treatment facility prior to commencement of its operation. (5) Any person/an occupier or operator of a CBWTF intend to use new technologies for treatment of BMW-request the Central Govt. for laying down the standards or operating parameters published in Gazette. (6) Every operator of CBWTF shall set up requisite BMW Treatment equipment, prior to commencement of operation.

90 Rule 7: Treatment and Disposal contd.. (7) Every occupier shall phase out use of chlorinated plastic bags within two years. After two years i.e. from onwards Chlorinated plastic bags shall not be used by HCF/CBWTF. HCF having captive treatment facility and a CBWTF shall not dispose of such plastics by incineration. The bags used for handling of BMW should be as per BIS Specifications ( to be formulated) till such time as per PWM Rules, 2016 (i.e., = or > 50 µ thick) (8) After ensuring treatment followed by mutilation or shredding, the recyclable wastes (plastics and glass) shall be given to recyclers having valid authorisation or registration from the respective SPCB/PCC. Such records need to be maintained by the HCF/CBWTF. (9) The handling and disposal of all the mercury waste and lead waste shall be in accordance with the respective rules and regulations

91 Bio-medical waste Management Rules, 2016 Rule 8: Segregation, packaging, transportation and storage.- (1) No untreated BMW shall be mixed with other wastes. (2) The BMW 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. Schedule-I, BMWM Rules, 2016.docx (3) The containers or bags shall be labeled as specified in Schedule IV. Schedule- IV, BMWM Rules, 2016.docx (4) Bar code and global positioning system shall be added by the Occupier and CBWTF within one year time. (5) The operator of CBWTF shall transport the BMW from the premises of an occupier to any off-site BMWTF only in the vehicles having label and along with the information as provided in part A and part B of the Schedule IV.

92 Rule 8: Segregation, packaging, transportation and storage contd (6) The Vehicles used for transportation of BMW should be: as per conditions of authorisation issued by SPCB/PCC and registered under Motor Vehicles Act, (7) Untreated human anatomical waste, animal anatomical waste, soiled waste and, biotechnology waste shall not be stored beyond a period of 48 hours. Otherwise, the occupier shall take appropriate measures and inform the prescribed authority along with the reasons for doing so. (8) Microbiology waste and all other clinical laboratory waste shall be pre-treated by sterilisation (Log 6) or disinfection (Log 4) as per the WHO guidelines before giving to the CBWTF.

93 Bio-medical waste Management Rules, 2016 (9). Prescribed authority:- In States- State Pollution Control Board (SPCB) In UT - Pollution Control Committees (PCC) In case of AFHCEs-DGAFMS The prescribed authorities shall comply with the responsibilities as stipulated in Schedule III of these rules. Schedule -III, BMWM Rules, 2016.docx

94 Bio-medical waste Management Rules, 2016 (10) Procedure for authorisation.- (1) Every HCF/CBWTF handling BMW, irrespective of waste generation quantity: shall make an application in Form II to SPCB/PCC. Form-II, BMWM Rules, 2016.docx SPCB/PCC shall grant the provisional authorisation in Form III Form-III, BMWM Rules, 2016.docx with validity of authorisation for bedded HCF/a CBWTF synchronised with the validity of the consents, within 90 days. (2) The authorisation shall be one time for non-bedded occupiers and the authorization in such cases shall be deemed to have been granted, if not objected by the prescribed authority within 90 days from the date of receipt of duly complete application.

95 Procedure for authorisation (3) In case of refusal of renewal/cancellation/ suspension of authorisation by the SPCB/PCC, reasons shall be recorded in writing: after giving an opportunity of being heard. (4) Every complete application for authorisation shall be disposed of by the prescribed authority within a period of ninety days failing which it shall be deemed that the authorisation is granted under these rules. (4) In case of any change in the bio-medical waste generation, handling, treatment and disposal for which authorisation was earlier granted, the occupier or operator shall submit a fresh application in Form II for modification of the conditions of authorisation.

96 Bio-medical waste Management Rules, 2016 (11) Advisory Committee.- (1) Every State Government or Union Territory Administration shall constitute an Advisory Committee under the Chairmanship of respective Health Secretary. To oversee the implementation of the rules and to advice the State Government. The Advisory Committee shall include representatives from: Departments of Health, Environment, Urban Development, Animal Husbandry and Veterinary Sciences. Urban or local bodies or Municipal Corporation representatives from IMA, CBWTF and NGO.

97 (11) Advisory Committee contd (2) MoD shall constitute the Advisory Committee (Defence): Chairman of the Advisory Committee: DGAFMS Other members of the Committee: representatives from MoD, MoEF & CC, CPCB, MoH & FW, AFMC or Command Hospital. (3)The Advisory Committee constituted shall meet at least once in six months and review all matters related to implementation Rules. (4) The MoD may co-opt representatives from the other Govt. and NGOs having expertise in the field of BMW Management.

98 Bio-medical waste Management Rules, 2016 (12) Monitoring of implementation of the rules in health care facilities.- Every State Government or Union Territory Administration : to monitor compliance to the BMWM Rules by the HCF/CBWTF Constitute District Level Monitoring Committee (DLMC) in the District under the Chairman of District Collector or District Magistrate or Dy. Commissioner or Add. District Magistrate. The District Level Monitoring Committee shall submit its report once in six months to the State Advisory Committee and a copy thereof shall also be forwarded to SPCB/PCC concerned for taking further necessary action. (6) The District Level Monitoring Committee shall comprise of District Medical Officer (as Member Secretary), Representatives from SPCB/PCC, Public Health Engineering Department, Local bodies or municipal corporation, IMA, CBWTF and registered NGOs working in the field of BMW Management

99 Bio-medical waste Management Rules, Annual Report: (1) Every Occupier or Operator of a CBWTFs : Annual Report to be submitted to SPCB/PCC in Form IV by 30 th of June every year; (2) SPCB/PCC: Shall submit the compiled information to CPCB by 31 st of July of every year. (3) CPCB: CPCB shall compile, review and analyze the information and send alongwith comments or recommendations to the MoEF & CC by 31 th of August of every year. (4) The Annual Reports shall also be available online on the websites of HCFs, SPCBs and CPCB.

100 Bio-medical waste Management Rules, Maintenance of records.- Every authorised person shall maintain records related to handling of BMW for a period of five years, as per BMW Rules. 15. Accident reporting.- (1) In case of any major accident while handling BMW, intimate immediately and forward a report within 24 hours in writing regarding the remedial steps taken in Form I. (2) Information regarding all other accidents and remedial steps taken shall be provided alongwith the annual report.

101 Bio-medical Waste Management Rules, Appeal.- (1) Any person aggrieved by an order of SPCB/PCC: File an appeal in Form V Form-V, BMWM Rules, 2016.docx within 30 days from the date of the order to The Secretary (Environment) of the State or UT. (2) Any person aggrieved by an order of the DGAFMS File an appeal in Form V within 30 days from the date of the order to The Secretary, MoEF & CC. (3) The authority, may entertain the appeal: after expiry of the said period of thirty days and the appeal shall be disposed of within 90 days from the date of its filing.

102 Bio-medical waste Management Rules, Site for common bio-medical waste treatment and disposal facility.- (1) the department in the business allocation of land assignment shall be responsible for providing suitable site for setting up of CBWTF in the State or UT. (2) The selection of site for setting up of CBWTF shall be made in consultation with the SPCB/PCC, other stakeholders and in accordance with guidelines published by the MoEF & CC or CPCB.

103 Bio-medical waste Management Rules, Liability of the occupier, operator of a facility.- (1) The occupier or operator of a CBWTF shall be liable for all the damages caused to the environment or the public due to improper handling of BMW or disposal of bio-medical waste. (2) The occupier or operator of a CBWTF shall be liable for action under Sections 5 and Section 15 of the E (P) Act, 1986 in case of any violation.

104 Bio-medical Waste Management Rules, 2016 Schedule-I: Schedule-I, BMWM Rules, 2016.docx Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options Schedule-II: Schedule-II, BMWM Rules, 2016.docx Standards for Treatment and Disposal of Bio-medical Wastes Schedule-III: Schedule -III, BMWM Rules, 2016.docx List of Prescribed Authorities and the Corresponding Duties Schedule-IV: Schedule-IV, BMWM Rules, 2016.docx Part A : Label for Bio-medical Waste Containers or Bags Part B : Label for Transporting Bio-medical Waste Bags or Containers

105 Bio-medical Waste Management Rules, 2016 Schedule-I: Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options (Part-1) Category Type of Waste Type of Bag/Container to be used Yellow (a) Human Anatomical Waste Yellow coloured (b) Animal Anatomical Waste non-chlorinated (c) Soiled Waste plastic bags or (d) Expired or Discarded containers or Medicines (e) Chemical Waste (f) Chemical Liquid Waste : (g) Discarded linen, mattresses, beddings contaminated with blood or body fluid. (h) Pre-treated Microbiology, Biotechnology and other other suitable packing material or as suggested under the Rules Treatment and Disposal Options Incineration or Plasma Pyrolysis or deep burial or as suggested under the Rules.

106 Schedule I contd.. Category Type of Waste Type of Bag/Container to be used Red Contaminated Waste (Recyclable) (a) Wastes generated from disposable items such as tubings, bottles, intravenous tubes and sets, catheters, urine bags, syringes (without needles). Red coloured nonchlorinated plastic bags or containers Treatment and Disposal Options Autoclaving or microwaving/ hydroclaving followed by shredding or mutilation or combination of sterilization and shredding. Treated waste to be sent to registered or authorized recyclers or for energy recovery or plastics to diesel or fuel oil or for road making, whichever is possible. Plastic waste should not be sent to landfill sites.

107 Schedule 1 contd Category Type of Waste Type of Bag/Containe White (Transluce nt) Waste sharps including Metals Needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, or any other contaminated sharp object that may cause puncture and cuts. This includes both used, discarded and contaminated metal sharps r to be used Puncture proof, Leak proof, tamper proof containers Treatment and Disposal Options Autoclaving or Dry Heat Sterilization followed by shredding or mutilation or encapsulation in metal container or cement concrete; combination of shredding cum autoclaving; and sent for final disposal to iron foundries (having consent to operate from the SPCB/PCC) or sanitary landfill or designated concrete waste sharp pit. Blue Glass Ware (Broken or discarded and contaminated glass including medicine vials and ampules except those contaminated with cytotoxic drugs) and Metallic Body Implants Cardboard boxes with blue colored marking Disinfection (by soaking the washed glass waste after cleaning with detergent and Sodium Hypochlorite treatment) or through autoclaving or microwaving or hydroclaving and then sent for recycling

108 Bio-medical Waste Management Rules, 2016 Disposal by deep burial: only in rural or remote areas where there is no access to CBWTF and as approved by the prescribed authority, and as per the standards and guidelines issued by CPCB from time to time. Plastic bags specification: as per BIS standards ( at present no such standards), till then Plastic Waste Management Rules, 2016 shall be applicable Chemical treatment using at least 10% Sodium Hypochlorite having 30% residual chlorine for 20 minutes or any other equivalent chemical reagent that should demonstrate reduction efficiency as given in Schedule- II Mutilation or shredding must be to an extent to prevent unauthorized reuse.

109 Bio-medical Waste Management Rules, 2016 Incineration ash: shall be disposed through HWTSDF facility, if toxic or hazardous constituents are present. Cytotoxic drug vials shall be sent back to the manufacturer or these may be sent for incineration at CBWTF or TSDFs or plasma pyrolysis at temperature > C. Chemical Waste: Residual or discarded chemical wastes, used or discarded disinfectants and chemical sludge can be disposed at HW TSDF or to the TSDF through CBWTF. Syringes should be either mutilated, needles should be cut and or stored in tamper proof, leak proof and puncture proof containers for sharps storage. Final disposal through a CBWTF or it shall be the responsibility of the occupier to sterilize and dispose as per BMWM Rules, 2016

110 SCHEDULE II Schedule-II, BMWM Rules, 2016.docx Standards for Treatment and Disposal of BMW

111 SCHEDULE II Schedule-II, BMWM Rules, 2016.docx Standards for Liquid Wsate The effluents generated from the hospital or a CBWTF before discharge into sewers should conform to the following limits : Parameter Permissible Limit ph Suspended Solids Oil and Grease BOD COD 100 mg/l 10 mg/l 30 mg/l 250 mg/l Bio-assay test 90% survival of fish after 96 hours in 100% effluent Note: Sludge from ETP shall be given to CBWTF for incineration or to HW TSDF 47

112 SCHEDULE IV (Part-A: LABEL FOR BIO-MEDICAL WASTE CONTAINERS / BAGS) Note: Label shall be non washable and prominently visible 48

113 SCHEDULE IV : Part-B: LABEL FOR TRANSPORTING BIO-MEDICAL WASTE CONTAINERS/BAGS Waste Category No. : Waste Class : Day : Month : Year : Date of generation : Waste Description : Sender's Name & Address : Receiver's Name & Address: Phone No.: Telex No. : Fax No. : Contact Person: Phone No. : Telex No. : Fax No. : Contact Person : In case of emergency please Contact : Name & Address : Phone No. : 49

114 Bio-medical Waste Management Rules, 2016 Suggested Forms under the BMWM Rules, 2016 Form I: Form-I, BMWM Rules, 2016.docx Accident Reporting Form II: Form-II, BMWM Rules, 2016.docx Application for Authorisation or Renewal of authorisation to be submitted by the occupier or CBWTF operator Form III: Form-III, BMWM Rules, 2016.docx Authorisation (for Operating a facility for generation, collection, reception, treatment, storage, transport and disposal of biomedical waste Form IV: Form-IV, BMWM Rules, 2016.docx Annual Report Format to be submitted by the Occupier or Operator of a CBWTF to the SPCB/PCC, by 30 th June of every year Form V: Form-V, BMWM Rules, 2016.docx Application for filling appeal against order passed by the prescribed authority within 30 days.

115 Wrong Practices observed in HCFs

116 Mismatch Coloured Bags/Containers

117 Poor Segregation and the provision

118 Storing of waste not at the designated areas within the HCF Storing of waste in containers even after overflowing

119 Improper Transportation of BMW

120 Soiled linen left unattended, leading to spread of infections Infected items being sorted from general waste and Transfer of waste

121 Infectious waste is being allowed to mix with the MSW Open Tub being used for Disinfection

122 Mixing of food waste with that of the Infectious Bio-medical Waste Segregation and Storing of waste in designated colour coded containers at source of generation

123 Sorting /mutilation of mixed biomedical waste at the waste storage area Sorting of infected plastics for reuse Handling in person without PPEs

124 Open Burning of Waste which may lead to Dioxins and Furans Mixing of general and healthcare waste and animals feeding on it

125 Common Deficiencies in CBWTFs

126 Common Deficiencies in CBWTFs

127 Indulged in segregation of waste within CBWTF and Open Burning

128 Improper Wastewater Treatment Provision / Waste Sharp Pit/AshStorage Pit

129 Improper Dg Sets provided as backup ( No Encclosure and the suitable stack)

130 Suggested Steps for Effective Biomedical Waste Management in HCFs

131 Components of Bio Medical Waste Management Segregation at Source Collection and Safe storage Transportation Treatment & Disposal( On-site/Off-site)

132 Objectives Change mindset & attitude through knowledge & training Defining various categories of BMW generated in HCI Proper segregation, collection and transportation Identify & utilize proper treatment technology Creating a system of inter dependence, accountability & responsibility Evolving waste minimization / reduction policies

133 Waste Management Committee ( > 30 bedded Hospital) Hospital s Nodal officer Nursing Superintendent Sanitary supervisor Store In charge Continuing Education Epidemiology Nurse (Infection Control Nurse) Implementation of the system Waste Management Committee Medical Director & Administrative Head Regular Monitoring Policies & Regulations Members from other departments

134 Segregation at Source, labelling, Transportation and Storage

135 Sequential Steps for BMW Management in HCFs HCFs Identify Ward-Wise Activity Identify Ward-Wise BMW Generation as per Rules Categorise Ward Wise BM Waste Generation Decide: Required Colour coded containers and the bags with proper label (Ward-wise) Segregate at Source of Generation as per BMWM Rules Collect and Transport BMW in closed trolley away from patients to the temporary storage area Quantify Ward-Wise BMW Generation On-site treatment before 48 Hrs or Hand over to the CBWTF Operator as per BMWM Rules

136 Sign Boards with designated colour coded containers and bags labeled as per BMWM Rules and placed in wards Segregation at Source biohazards poster.pdf

137 Collection of Bio-medical Waste Establish a routine programmes for collection Collect ward waste - before every shift Waste bags should be sealed properly at source All containers/bags labeled as per BMWM Rules, 2016 ( Schedule-IV) Filled in designated containers/bags should be immediately replaced with empty containers or bags Shift waste to the temporary designated storage area (shift-wise) 73

138 Labeling : Containers / Bags Label should indicate the following: Lable in accordance with Schedule IV. Date of waste generation Place of waste generation (e.g. ward / establishment) Waste category and quantity Bar Code/ CBWTF membership number 74

139 Pre-Treat Bio-medical Waste on-site Pre-treat by disinfection or sterilization on-site as per WHO or NACO Guidelines and then for final disposal of the following waste. the laboratory waste, microbiological waste, blood samples and blood bags

140 Transportation of Bio-medical Waste Engage dedicated House Keeping workers For on-site transportation of bio-medical waste: Use wheeled and closed trolleys and Easy to load and unload; No sharp edges to avoid damage waste bags or containers during loading and unloading, easy to clean; Waste should be collected periodically at least before change of shift; No bags should be removed unless labeled; Bags should be immediately replaced with a bag of same colour. Specific routes must be planned to avoid exposure to patients and staff Leakages if any during transfer, need to be cleaned properly and immediately Clean and disinfect vehicles/containers in a designated washing area before use Keep a spill cleanup kit in all vehicles used to transport medical waste.

141 Requirements of On-site Bio-medical Waste Storage (prior to the final disposal within 48 hrs) Good lighting and ventilation provision Cold storage provision (at temperatures below 4 0 C ( if waste is required to be stored more than 48 hrs). Good drainage provision Easy to clean (surfaces preferably glazed/tiled) Convenient water supply for daily cleaning and maintenance with disinfectants Protected from rodents, insects, birds and unauthorized entry Accessible only to the authorized staff Secure and lockable Washwater to be routed through ETP

142 Temporary Designated Storage Area of BMW before Treatment; Away from Patients

143 Vehicle to be Used for Collection of Waste from Member HCFs

144 Metal Sharps: Collection, Storage & Disposal

145 Shredder Needle Destroyers

146 Bio-medical Waste Disposal by Deep Burial (where no access to CBWTF) 82

147 Wastewater Treatment

148 Waste Water Treatment and Disposal Waste Water from HCFs Domestic Sewage Segregated contaminated Waste water from wards Segregated and treated or neutralized Liquid Chemical Waste n Direct Disposal through public sewer or drain Final Disposal in Public Drain or Sewer

149 Liquid Waste Treatment Facility provided in Karnataka Liquid Waste Treatment Facility: in Haryana & Delhi

150 Requisites for CBMWTFs

151 Requisites for CBMWTFs

152 Cytotoxic Waste Cytotoxics, are anti-neoplastic which inhibit cell growth and multiplication. If contacted, may damage normal cell and cause severe disability or even death. Disposal: Expired `cytotoxic drugs and items contaminated with cytotoxic drugs to be returned back to the manufacturer or supplier for incineration at temperature > C or to CBWTF or HW TSDF for incineration at > C or Encapsulation or Plasma Pyrolysis at > C.

153 Radioactive Waste According to AERB - Atomic Energy Regulatory Board Regulations: radioactive waste must be stored in lead containers until ten times the half life period of the waste is over before disposing. Expired radioactive needles, especially cobalt needles used in cancer therapy should be returned for further treatment and disposal in accordance with AERB. Liquid radioactive waste can be discharged into a drain after the half life period is over. Low-level radioactive waste resulting from administering radio-pharmaceuticals and performing nuclear medicine procedures and radio-immunology procedures has to be stored and then discharged into drains in accordance with AERB Norms.

154 Hypo Solution Hyposolution and Used X-Ray Films generated from X-Ray labs should be sold only to the recyclers registered under Rule 11 of the Hazardous Waste (Management, Handling and Transboundary Movement) Rules, 2008 with the Central Pollution Control Board (CPCB) or registered under Rule 9 of the Hazardous and Other Waste ( Management and Transboundary Movement) Rules, 2016, with the respective SPCB/PCC. For such recyclers list pl. refer to CPCB website i.e

155 Mercury Waste Management in HCFs Sources of Hg Waste Generation Thermometers Sphygmomanometers Dental amalgam; Esophageal dilators, Cantor and Miller Abbott Tubes Barometers X-Ray Machines Button Cells and Medical Batteries Thimerosal Laboratory chemicals Electrical equipment, fluorescent lamps Cleaning Solutions

156 Classification of Mercury Waste: Is it Hazardous Waste Mercury present as a part of the mercury based medical instruments : does not fall under the category of hazardous waste. When the mercury spillage due to accidental breakage of mercury based medical instruments or any items contaminated with mercury: then classified as Hazardous Waste as per Scheduled II of the Hazardous Waste and Other Waste (Management and Transboundary Movement) Rules, 2016.

157 HCF Mercury Spill Collection Procedure Is there mercury spill Evacuate patients ( if possible) Wear PPEs Identify Hg Spill Kit Identify large mercury beads, heap them using card board and collect in a plastic bottle half filled with water and store in a designated area. Allow the room for 24 hours before re-use Clean spill surface area with 10 % Sodium Thio-sulfate Solution Identify and collect small Hg beads and store in a plastic bottle half filled with water Spray Zinc/Sulphur powder to identify small Hg beads

158 Mercury Waste Disposal Options Store the Collected Hg spill in a designated area Shift to a Centralized/ Controlled Storage Area Hand over to the CBWTF Operator Disposal Options Return to Mercury based medical instrument manufacturers Sale or auction to the authorized mercury waste recyclers (to be encouraged) Dispose through HW Treatment Storage and Disposal Facility For fianl disosal

159 Guidelines on Environmentally Sound Management of Mercury Waste Generated from HCFs available at: Mercury Spill Collection.DAT

160 Used Lead Acid Battery Wastes: Has to be returned to the manufacturer concerned or to be disposed off only through the lead acid battery recyclers registered under the Batteries (Management and Handling) Rules, 2001 and further amendments made thereof, with the SPCB/PCC. E-Waste : Has to be returned to the manufacturer concerned or to be disposed off only through the authorized E- Waste recyclers under the E-Waste Management Rules, 2016.

161

162 Fire Protection and Safety Measures Adequate Fire Protection Equipments: (Smoke detectors, Water sprinklers, Fire extinguishers, Sand buckets, Fire alarm, spark arrester etc.) should be installed within the HCFs, at bio-medical waste storage area Fuel /Chemical storage areas in accordance with fire safety regulations. Fire safety aspects: Certificate from fire department Conditions to be imposed in the authorization to be issued by the SPCBs under the BMW Rules

163 Other measures: Training & Safety Aspects to the Staff

164 PERSONAL PROTECTIVE EQUIPMENT (PPEs) GLOVES MASK GOOGLES APRON HEAD CAP SAFETY SHOES

165 Records maintenance and its Submission (HCF/CBWTF) and to keep in web site within two years i.e., Maintain records (keep for five years) relating to: Bio-medical Waste Generation (Ward-wise as well as Centralized)- for compilation of AR Pre-treatment of Lab., Microbiology, Blood Bags and the Blood samples. Wastes treated and disposed through recyclers approved by SPCB/PCC. Waste disposed through CBWTF Accidents and remedial measures Immunisation of HC Workers Trainings organised to the HC Staff Health status of the workers Minutes of the meetings of the Committee Submit annual reports by June 30 th of every year ( By the HCFs) for the preceding Calendar year.

166 Periodic Monitoring of Compliance Verification - Constitute an Internal Surveillance Squad for assessment of BMW Management related aspects. - Assess and review the status of compliance - Sharing of knowledge - Initiate steps for improvements

167 Attention of the Prescribed Authority: Grant of authorisation to all the HCFs irrespective of the no. of patients treated or quantity of BMW generation; Phasing out of chlorinated plastic bags, gloves and blood bags within two years; Ensuring on-site pre-treatment of laboratory waste, microbiology waste, blood bags and blood samples by disinfection or sterilization, by HCFs. Bar code system and GPS establishment, within one year, by the Occupier or Operator of a CBWTFs whichever is applicable; Ensuring pre-treatment or neutralization of liquid chemical waste by HCFs. The liquid waste treatment and disposal by the HCFs or CBWTF in accordance with the Water Act, 1974; Records to be maintained on day to day basis and display the monthly record including annual report on its website, to be developed within two years from the date of notification, by the occupier or operator of a CBWTF and the prescribed authority;

168 Existing incinerators is required to achieve the standard as specified in schedule II for the retention time in secondary chamber and Dioxins and Furans within two years from the date of notification; Installation of continuous online monitoring system by the Occupier and CBWTF for monitoring of the parameters prescribed under the authorisation granted under the BMWM Rules, 2016 and transmit the data real time to the servers at SPCB/PCC and CPCB; Quarterly monitoring of bio-medical waste incinerator stack gaseous emission, by the occupier and operator of a CBWTF, through a laboratory approved under the E (P) Act, 1986 and such records maintained and its submission to the prescribed authority Constitution of State Level Advisory Committee (SLAC) by the State Government or UT Administration in the respective State or UT and the activities initiated by the SLAC; Constitution of the District Level Monitoring Committee (DLMC) by the State Government or UT Administration in the respective State/UT and the activities initiated by the SLAC; To comply with the responsibilities as per Schedule-III of the Rules.

169 Bio-medical waste Management Rules, 2016: Recollect Wastes other than BMW has to be managed in accordance with the respective rules notified under the E (P) Act, 1986 BMWM Rules, 2016 are applicable to all generators/ all HCFs and CBWTFs. Categories of bio-medical waste is based on 4 colour coding (Yellow, Red, White and Blue) Emphasizes segregation of BMW at source of generation. Storage of segregated waste in safe location in four colour coded non-chlorinated containers or bags and labeled as per Schedule IV. Ensure treatment & disposal of waste such as human, anatomical waste, soiled waste and microbiology waste: within 48 hrs. Permits on-site treatment to the HCFs, provided there is no CBWTF within a distance of 75 KMs. The Laboratory, microbiology waste, blood samples and blood bags need to be treated by on-site as per WHO or NACO guidelines and then for final disposal. Phaseout use of chlorinated plastic bags, gloves and blood bags within 2 years; Bar code system to be established by within one year. To provide training to all its HCW-at the time of induction and thereafter atleast once in a year

170 Recollect: Bio-medical waste Management Rules, 2016 All the HCWs need to be immunized as per NIP or MoH & FW Guidelines. Health of the HCW has to be ensured by providing adequate PPEs and conduct health checks at the time of induction and once in a year. Only trained workers need to be engaged for handling of BMW. Suggested Technologies: Incineration, Plasma pyrolysis, Autoclave/Hydroclaving, Dry Heat Sterilization, Microwave, Shredding, Combination of sterilization and shredding, treated plastics for for energy recovery/ recovery of diesel/fuel oil or for road making, Chemical Disinfection (10 % Sodium Hypochlorite Solution), Encapsulation, Ssanitary Landfill or disposal by deep burial (where there is no access to CBWTF) Any other technologies requires approval from Central Govt. and same will be notified under the E (P) Act, 1986 with relevant standards. HCF/CBWTFs is required to submit the annul report to SPCB/PCC by June 30 th of every year. SPCB to CPCB by 31 July every year. Make available the annual report on web-site within 2years and maintain records including operation of treatment equipment for a period of five years. In case CBWTF is not collecting the waste within the stipulated time, then HCF has to report immediately to SPCB/PCC.

171 Bio-medical Waste Management Rules, 2016 Recommend operating standards for incinerator: Primary : atleast 800 O C; Secondary : atleast 1050 O C Residence Time : 2 Seconds Stack emission Standards: Included parameters like Hg and Dioxins and Furans (0.1 ng TEQ/Nm 3 ) Stringent Standards : For PM ( 50 mg /Nm 3 ); NOx (400 mg /Nm 3 ), HCl (50 mg /Nm 3 ), Hg (0.05 mg /Nm 3 ) All the existing incinerator operators (both captive and CBWTF Operators) have to comply with the Dioxins & Furans within two years. All the incinerator operators have to install online monitoring systems for the parameters as per SPCB/PCC. All the HCFs and CBWTFs have to ensure treatment of liquid waste to comply with discharge limits as per the Rules. Responsible authorities for ensuring compliance to the BMW Rules: MoEF, & CC, MoH & FW, MoD, CPCB, SPCBs/PCCs, State Governments/UT Administration, State/UT Health Depts. Local Bodies. Local authorities: show suitable site for development of a CBWTF as per CPCB/MoEF&CC guidelines and in consultation with SPCB/PCC. Liabilities on Occupier or Operators of CBWTFs for violation of the provisions of BMW Rules (under Section 5 & 15 of E (P) Act, 1986.

172 Bio-medical Waste Management Compliance is possible only when: EKATCCP Education (92 %) Knowledge (96 %) Apart from above required is Attitude (100 %) Team Work (106 %) Commitment (125%) Creativity (132%) Punishment (139%)

173 Bio-medical Waste Management Save Earth for your patience and participation. For further information please contact by (or) Tel. (O) : ; M:

174 Gaps in the implementation of Biomedical Waste Rules 1998 Praveen Sharma Scientific Officer HP State Pollution Control Board

175 Best Practices adopted in Himachal Pradesh under BMW Rules Fully covered Biomedical Waste Storage Area/Room at IGMC Shimla and to control the unauthorized handling and littering of Biomedical waste this area is under E- surveillance. GPS system in the vehicles authorised transporters of the bio-medical waste for better co-ordination and movement tracking oftheir vehicles.

176 Deep Burial Pit

177 Segregation

178 Treatment

179 Internal Transportation

180 Storage

181 Gaps in the Implementation of BMW Rules Segregation 2. Treatment 3. Handling & transportation of BMW with in Hospital 4. Storage of Biomedical Waste 5. Mixing of Biomedical waste with general waste 6. Plastic Waste handling and disposal 7. Record Keeping 8. Awareness level 9. Lack of Co-ordination 10. Mismanagement of Black coloured Plastic Bags 11. Open Burning of Biomedical Waste along with general waste 12. Deep Burial Pits 13. Transportation of BMW by the CBWTF Operators

182 Segregation In most of the Health Care Facilities colour coded bins are available for the segregation of biomedical waste as per the requirement of BMW Rules, but there is mixing of biomedical waste with general waste.

183

184 Treatment In most of the Health Care Facilities practices of chemical treatment of Category 4 and Category 7 are being adopted, but in many cases the syringes were found stored without disinfection and mutilation.

185

186 Handling & transportation of BMW with in Hospital: Generally handling and transportation of biomedical waste to final storage point is being carried out manually in most ofthe hospitals. No dedicated trolleys used for the transportation of biomedical waste from the point of generation to the final storage room/point. During internal transportation all colour coded bags Mixed together.

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188 Storage of Biomedical Waste In most of the Health Care Facilities there is no specified or marked area for the final storage ofbiomedical waste. At the storage point all type of waste stored together

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191 Mixing of Biomedical waste with general waste In some of the Health Care Facilities, the Bio Medical Waste although segregated at the point of generation but there was mixing of the different categories of biomedical waste with generalwaste.

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194 Plastic Waste handling and disposal In most of the Health Care Facilities, plastic waste of category 4 and Category 7 generated in the hospitals are not being handed over to the respective CBWTF and is being sold to Kabaris.

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196 Record Keeping In the most of Health Care facilities, although the records of biomedical waste so generated are being maintained, however it does not match with the record of biomedical waste being handed over to the transporter.

197 Awareness level Awareness about the biomedical waste handling rules among medical officers and paramedical staff was adequate, but there is still need for educating the contractual/sanitation staff within the respective health care facility for proper handling and disposal ofbiomedical waste.

198 Lack of Co-ordination In most of the Government hospitals, the sanitation work is on contract and there is a lack of co-ordination between hospital staff and the contractor, resulting in mixing of biomedical waste with the general waste at final storage stage, there by defeating the very purpose of segregation & treatment of waste at source.

199 Mismanagement of Black coloured Plastic Bags In some of the health care facilities, the black coloured polythene bags with insignia of biohazard are being used for the storage/transportation of general waste and being dumped into the MC dumpers.

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201 Open Burning of Biomedical Waste along with general waste Practices of open burning of biomedical waste along with general waste at the backside of the health care facilities was observed in some Government as well as Private hospitals.

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204 Deep Burial Pits In the deep burial pits all type of biomedical waste found mixed with general waste and practices of burning of this mixed waste is being adopted.

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206 Transportation of BMW by the CBWTF Operators Overloading of the vehicle with biomedical waste so collected from the HCFs Time gap for the collection of biomedical waste by the CBWTF operators from the HCFs

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