COMMON BIOMEDICAL WASTE TREATMENT FACILITIES

Transcription

1 DETAILED PROJECT REPORT FOR COMMON BIOMEDICAL WASTE TREATMENT FACILITIES AT VILLAGE- KARAWARA MANAKPUR, TEHSIL - REWARI, DISTRICT- REWARI HARYANA PREPARED BY: B-6, 337 SEC. 17, ROHINI NEW DELHI

2 1. INTRODUCTION In recent years, there has been a growing awareness of the need for safe management of hospital/ biomedical waste for effective health service delivery. Hospital Associated Infections (HAI) is estimated to affect approximately 5% of hospitalized patients. Hospitals are reservoirs for infectious micro-organisms which include bacteria (multi drug resistant), viruses and protozoan which adversely affect human health and the environment. Also, toxic metals like lead, mercury and organics generated from biomedical wastes are potential threat to living organisms and the environment if it is not properly disposed. To prevent the spread of such infectious wastes and toxic chemicals that finds its genesis in biomedical waste (from Hospitals, Clinics, Laboratories, Dispensaries, etc.), a scientific approach is required from the beginning and it is essential that professionally trained personnel should handle the wastes. In the constitution of India, it is clearly stated that it is the duty of every state to protect and improve the environment and safeguard the Forests and Wildlife of the Country and it also imposes duty on every citizen to protect and improve the natural environment including forests, lakes, rivers and wildlife. To prevent the degradation of environment and consequential health of people, environmental laws are the corner stones of environmental protection. Environment Protection Act of 1986 came into force and is considered umbrella legislation as it fills many gaps in existing laws such as Air and Water Acts. With aim to protect environment, there are different legislations to protect water, air, and other aspects of environment. Biomedical waste being part of solid waste has direct impact on environment. Biomedical waste was defined under Biomedical Waste management and Handling Rules, 1998 which notified on 20 th July, The rules were amended time to time and latest draft rules have been published in the Gazette of India on 3 rd June, The main features of the rules are: 1. Segregation of biomedical waste from other waste. 2. Biomedical waste should not be stored for more than 48 hours. 3. Waste shall be stored in following colour coded bins: Yellow : Incineration waste Red : Autoclave/Microwave Chemical Treatment Blue/White : Autoclave/Microwave Chemical Treatment

3 Black : Disposal to secured landfill site 4. The biomedical waste generator will take authorization from State Pollution Control Board. Every occupier or operator involved in generating or collecting or receiving or storing or transporting or treating or disposing treated biomedical waste, irrespective of the quantum of bio-medical waste shall make an application in Form I to the prescribed authority for grant of authorization in Form V. In case of the occupier providing treatment or service to more than thousand patients per month or the operator of common biomedical waste treatment facility, the first authorization shall be granted for a trial period of one year, to enable them to demonstrate the adequacy of their waste management system and on satisfactory performance, the authorization may be renewed up to a period of five years at a time. 5. There will be a provision of common biomedical waste treatment facility About Common Biomedical Waste Treatment Facility (CBWTF) Central Pollution Control Board (CPCB) has made guidelines for common biomedical waste treatment facility (CBWTF) which has defined following criteria: 1. CBWTF should be located away from residential and sensitive areas. 2. CBWTF should have a minimum 1 acre land. 3. CBWTF should at least cater 10,000 beds. 4. CBWTF should have following equipment for following process: Incineration Autoclave/ microwaving/ hydroclaving Shredder Sharp pit/ Encapsulation Vehicle/ Container washing facility Effluent treatment plant 5. CBWTF should have following infrastructure: Treatment equipment room Raw waste storage room Treated waste storage room Administrative room D.G. Set room

4 Site security Green Belt Sign board 6. CBWTF should have proper record keeping. 7. CBWTF should have proper waste collection and transportation facility 8. CBWTF needs to dispose the treated waste in following manner Categories of Biomedical waste: Table 1: Categories of Biomedical Waste Option Treatment & Disposal Waste Category Cat. No. 1 Incineration /deep burial Human Anatomical Waste (human tissues, organs, body parts) Cat. No. 2 Incineration /deep burial Animal Waste Animal tissues, organs, Body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals / colleges, discharge from hospitals, animal houses) Cat. No. 3 Local autoclaving/ micro Microbiology & Biotechnology waste waving/ incineration (wastes from laboratory cultures, stocks or specimens of micro-organisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biological, toxins, dishes and devices used for transfer of cultures) Cat. No. 4 Disinfections (chemical Waste Sharps (needles, syringes, scalpels treatment /autoclaving/ blades, glass etc. that may cause puncture micro waving and and cuts. This includes both used & unused mutilation shredding sharps) Cat. No. 5 Incineration / destruction & Discarded Medicines and Cyto-toxic drugs

5 drugs disposal in secured landfills Cat. No. 6 Incineration, autoclaving/ micro waving Cat. No. 7 Disinfections by chemical treatment autoclaving/ micro waving & mutilation shredding. Cat. No. 8 Disinfections by chemical treatment and discharge into drain Cat. No. 9 Disposal in municipal landfill Cat. No. 10 Chemical treatment & discharge into drain for liquid & secured landfill for solids (wastes comprising of outdated, contaminated and discarded medicines) Solid Waste (Items contaminated with blood and body fluids including cotton, dressings, soiled plaster casts, line beddings, other material contaminated with blood) Solid Waste (waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets etc.) Liquid Waste (waste generated from laboratory & washing, cleaning, housekeeping and disinfecting activities) Incineration Ash (ash from incineration of any bio-medical waste) Chemical Waste (chemicals used in production of biological, chemicals, used in disinfect ion, as insecticides, etc) 1.3. Colour coding and type of container for disposal of biomedical waste. Table 2: Colour Coding Colour Coding Type of Containers Waste Category Treatment Options as per Schedule 1 Yellow Plastic bag 1,2,3,6 Incineration/deep burial Red Blue/ translucent White Disinfected Container/ Plastic bag Plastic proof container bag/puncture 3,6,7 Autoclaving/Micro waving/ Treatment 4,7 Autoclaving/Micro waving/ treatment destruction/shredding Chemical chemical and

6 Black Plastic bag 5,9,10 (Solid) Disposal in secured landfill In exercise of the powers conferred by sub-section (1) and clause (v) of sub-section (2) of section 3 of the Environment (Protection) Act, 1986 (29 of 1986) read with sub-rule/ 4) of rule 5 of the Environment (Protection) Rules, 1986, the Central Government hereby makes the following further amendments to the notification of the Government of India, in the Ministry of Environment and Forests number S (E), dated the 14 th September, 2006 after dispensed with the requirement of notice under clause(a) of sub-rule(3) of the said rule 5 in public interest, namely:- In the Gazette of India notification (i.e. dated 17 th April, 2015), in the Schedule, after item 7(d) and the entries relating thereto, the following item and entries shall be inserted i.e. 7(da) has been designated for Bio Medical Waste Treatment Facilities. And all such projects fall under Category B projects. 2.0 STANDARDS FOR TREATMENT AND DISPOSAL OF BIO MEDICAL WASTE 2.1. OPERATING AND EMISSION STANDARDS FOR INCINERATORS: All incinerators shall meet the following operating and emission standards: A. Operating Standards 1. Combustion efficiency (CE) shall be at least 99.00%. 2. The Combustion efficiency is computed as follows: %C02 C.E. = X 100 %C02 + % CO 3. The temperature of the primary chamber shall be a minimum of 800 C and the secondary chamber shall be minimum of 1050 C. 4. The secondary chamber gas residence time shall be at least two seconds.

7 B. Emission Standards Table 3: Emission Standards Sl. No. Parameter Standards Limiting concentration Sampling Duration in minutes, in mg/nm 3 unless stated (1) Particulate matter or 1NM 3 of sample volume (2) Nitrogen Oxides (or for sample online sampling or grab NO and NO 2 sample (3) HCl or 1NM 3 of sample volume, (4) Total dioxins and furans** (5) Hg and its compounds whichever is 0.1ngTEQ/Nm 3 (at 8 hours or 5NM 3 of 11% O 2 ) sample volume, hours or 1NM 3 of sample volume, whichever C. Stack Height: Minimum stack height shall be 30 meters above the ground. Note: (a) ** The existing incinerators shall comply with the standards for Dioxins and Furans as 0.1 ngteq/nm 3 within two years from the date of commencement of these rules. (b) Suitably designed pollution control devices shall be installed or retrofitted, if necessary, with the incinerator to achieve the emission limits. (c) Wastes to be incinerated shall not be chemically treated with any chlorinated disinfectants. (d) Chlorinated plastics shall not be incinerated. (e) Ash from incineration of biomedical waste shall be disposed off through common hazardous waste treatment and disposal facility. However, it may be disposed off in municipal landfill, if the toxic metals in incineration ash are within the regulatory quantities as defined under the Hazardous Waste (Management and Handling and Transboundary Movement) Rules, 2008.

8 (f) Only low sulphur fuel like Light Diesel Oil or Low Sulphur Heavy Stock or Diesel shall be used as fuel in the incinerator. (g) The occupier or operator of a common bio-medical waste treatment facility shall monitor the stack gaseous emissions (under optimum capacity of the incinerator) once in three months through a laboratory approved under the Environment (Protection) Act, 1986 and record of such analysis results shall be maintained and submitted to the prescribed authority. In case of dioxins and furans, monitoring should be done once in a year. (h) All monitored values shall be corrected to 11% oxygen on dry basis. (i) Incinerators (combustion chambers) shall be operated with such temperature, retention time and turbulence, as to achieve Total Organic Carbon (TOC) content in the slag and bottom ashes less than 3% or their loss on ignition shall be less than 5% of the dry weight. (j) The occupier or operator of a common bio-medical waste incinerator shall use combustion gas analyzer to measure CO 2, CO and O STANDARDS FOR WASTE AUTOCLAVING The autoclave should be dedicated for the purposes of disinfecting and treating bio-medical waste. 1. When operating a gravity flow autoclave, medical waste shall be subjected to: i. A temperature of not less than 121 C and pressure of 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes; or ii. A temperature of not less than 135 C and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes; or iii. A temperature of not less than 149 C and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes. 2. When operating a vacuum autoclave, medical waste shall be subjected to a minimum of three pre-vacuum pulses to purge the autoclave of all air. The air removed during the prevacuum, cycle should be decontaminated by means of HEPA and activated carbon

9 filtration, steam treatment, or any other method to prevent release of pathogen. The waste shall be subjected to the following: i. A temperature of not less than 121 C and pressure of 15 psi per an autoclave residence time of not less than 45 minutes; or ii. A temperature of not less than 135 C and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes; 3. Medical waste shall not be considered as properly treated unless the time, temperature and pressure indicators indicate that the required time, temperature and pressure were reached during the autoclave process. If for any reasons, time temperature or pressure indicator indicates that the required temperature, pressure or residence time was not reached, the entire load of medical waste must be autoclaved again until the proper temperature, pressure and residence time were achieved. 4. Recording of operational parameters: Each autoclave shall have graphic or computer recording devices which will automatically and continuously monitor and record dates, time of day, load identification number and operating parameters throughout the entire length of the autoclave cycle. 5. Validation test: The validation test shall use four biological indicator vials or strips; one shall be used as a control and left at room temperature, and three shall be placed in the approximate center of three containers with the waste. Personal protective equipment (gloves, face mask and coveralls) shall be used when opening containers for the purpose of placing the biological indicators. At least one of the containers with a biological indicator should be placed in the most difficult location for steam to penetrate, generally the bottom center of the waste pile. The occupier or operator shall conduct this test three consecutive times to define the minimum operating conditions. The temperature, pressure and residence time at which all biological indicator vials or strips for three consecutive tests show complete inactivation of the spores shall define the minimum operating conditions for the autoclave. After determining the minimum temperature, pressure and residence time, the occupier or operator of a common biomedical waste treatment facility shall conduct this test at least once in three months and records in this regard shall be maintained.

10 Spore testing: The autoclave should completely and consistently kill the approved biological indicator at the maximum design capacity of each autoclave unit. Biological indicator for autoclave shall be Geobacillus stereothermophilus spores using vials or spore Strips; with at least 1X10 4 spores per ml. Under no circumstances will an autoclave have minimum operating parameters less than a residence time of 30 minutes, regardless of temperature and pressure, a temperature less than 121 C or a pressure less than 15 psi. The occupier or operator of a common bio medical waste treatment facility shall conduct this test at least once in three months and records in this regard shall be maintained. 6. Routine Test A chemical indicator strip or tape that changes colour when a certain temperature is reached can be used to verify that a specific temperature has been achieved. It may be necessary to use more than one strip over the waste package at different locations to ensure that the inner content of the package has been adequately autoclaved. The occupier or operator of a common bio medical waste treatment facility shall conduct this test during autoclaving of each batch and records in this regard shall be maintained STANDARDS FOR LIQUID WASTE The effluent generated or treated from the premises of occupier or operator of a common bio medical waste treatment facility, before discharge should conform to the following limits. PARAMETERS PERMISSIBLE LIMITS ph : Suspended solids : 100 mg/l Oil and grease : 10 mg/l BOD : 30 mg/l COD : 250 mg/l Bio-assay test : 90% survival of fish after 96 hours in 100% effluent.

11 2.4. STANDARDS OF MICROWAVING i. Microwave treatment shall not be used for cyto-toxic, hazardous or radioactive wastes, contaminated animal carcasses, body parts and large metal items. ii. The microwave system shall comply with the efficacy test or routine tests and a performance guarantee may be provided by the supplier before operation of the limit. iii. The microwave should completely and consistently kill the bacteria and other pathogenic organisms that are ensured by approved biological indicator at the maximum design capacity of each microwave unit. Biological indicators for microwave shall be Bacillus atrophaeus spores using vials or spore strips with at least 1 x 10 4 spores per milliliter. The biological indicator shall be placed with waste and exposed to same conditions as the waste during a normal treatment cycle STANDARDS FOR DEEP BURIAL i. A pit or trench should be dug about 2 meters deep. It should be half filled with waste, and then covered with lime within 50 cm of the surface, before filling the rest of the pit with soil. ii. iii. iv. It must be ensured that animals do not have any access to burial sites. Covers of galvanised iron or wire meshes may be used. On each occasion, when wastes are added to the pit, a layer of 10 cm of soil shall be added to cover the wastes. Burial must be performed under close and dedicated supervision. v. The deep burial site should be relatively impermeable and no shallow well should be close to the site. vi. vii. The pits should be distant from habitation, and located so as to ensure that no contamination occurs to surface water or ground water. The area should not be prone to flooding or erosion. The location of the deep burial site shall be authorised by the prescribed

12 authority. viii. ix. The institution shall maintain a record of all pits used for deep burial. The ground water table level should be a minimum of six meters below the lower level of deep burial pit. 3. About Project 3.1. Location of Project, Size and Nature of the Project The proposed project is to treat and dispose the Bio medical waste generated in the state of Haryana. The proposed project will be under Upkar Waste Solutions. The facility shall obey the rules of Bio-Medical Waste (Management & Handling), 1998 and subsequent amendments. The revised draft published on 3 rd June, 2015, guidelines for handling common bio medical waste treatment facilities shall be followed once the rules gets finalized. The proposed site is establishing in a total land area of m 2 at Village- Karawara Manakpur, Tehsil-Rewari, District- Rewari. The features of the site are given in Table 4 below. Table 4: Site Features Land Area m 2 ( Acre) Category of Project 7 (da) Bio Medical Waste Treatment Facilities Project Address Village- Karawara Manakpur, Tehsil-Rewari, District- Rewari Haryana Project Cost Rs lakhs Land Coordinates 28 18'28.7"N & 76 37'35.0"E Elevation 715 meters above MSL Nearest Railway Station Rewari Railway station-12 km; South Nearest City in Km Rewari 14 km; South State, National boundaries Haryana Rajasthan Border- 21 km Existing Land Use Agricultural Land Soil Type Silty Clay type Sensitive areas No archeologically sensitive structure exists within 10 km from Wild Life Sanctuaries No wild life sanctuary, protected forest, are found within 10 km Habitation No habitation near the vicinity of site.

13 Table 5: Geographical Specification Parameter Criteria Observation Lake or pond (Distance from SW body) Should not be within 200 m No water body within 1 km from the plot/site River Should not be within 100 m No water body within 1 km from the plot/site Flood plain Should not be within 100 Not in the flood plain year flood plain High way State or National Should not be within 500 m NH-71 at a distance of approx. 1.5 km. Habitation Notified Should not be within 500 m None in Study area habituated area Public Parks Should not be within 500 m No public parks within 500 m Critical habitat area area in which one or more endangered species live Not suitable There are no endangered species in the site Reserved Forest area Not suitable Not belong to RF Wet lands Not suitable Not a wet land Air Port Should not be within zone around the airport(s) No airport is nearby the site. Upkar Waste Solutions is registered company established with the primary objective to Design, Supply, Install and operate Bio-Medical Waste Management Devices, Systems and Plants. Upkar Waste Solutions intends to set up an integrated Bio-Medical Waste Management Facility, technically reliable and commercially viable. The facility includes a disinfecting unit and a disposal unit. The intended facility shall operate on a User-pays principle. The charges shall be nominal which will be required for the operation and maintenance of the equipments.

14 To accomplish the services, Upkar Waste Solutions intends to establish a facility with an incinerator of 200 kg/hr (operating for about 16 hr) an autoclave and a shredder operating about 3-4 batches per day for the required capacity. Each user shall compensate Upkar Waste Solutions in proportion to the quantity of Waste generated by them that is processed at the facility. Upkar Waste Solutions has highly and trained and experienced professionals in the management and handling of the Bio-Medical Wastes. 3.2 WASTE QUANTITIES The proposed facility shall cater for about 10,000 beds strength spread over approximately 250 Healthcare establishments spread about an area falls within 150 km radius ' with Jhajjar as its centre. Because of non availability of any facility, these areas are not pursuing Bio- Medical Waste Rules. A study performed to assess the Waste quantities reveals that an average of about 2 kg of waste is generated per bed per day. However, about 0.5 kg/ bed-day of the total waste generated is estimated to be Infectious in nature and needs effective management under the Bio-Medical Waste (Management and Handling} Rules 1998, amounting to a quantity of about 5000 kg of Infectious Waste per day. Out of the 5,000 kg Infectious Wastes generated (Incinerable Wastes) and wastes can be classified into Wastes requiring Incineration and Wastes requiring Disinfection. The purpose of segregating the Wastes into these categories is to ensure that certain materials that should not be incinerated are properly segregated and Management of Wastes would become effective. The result of this study indicates that about 300 kg of this Waste would require incineration and the balance 2000 kg would require Disinfection. This would be the requirement of Waste Management Services required as estimated by Upkar Waste Solutions. To accomplish the services, Upkar Waste Solutions intends to establish a facility with an Incinerator of 200 kg / Hr (Operating for about 16 Hrs) and an Autoclave / batch and operating about 3-4 batches per day for the required capacity. An Effluent Treatment Plant with Total Capacity 15 m 3 /day as per requirement of the Haryana State Pollution Control Board. The E.T.P will work for all 365 days and sewage will be collected at one sump, treated and treated water will be stored in a tank and then used by pumping for horticulture purpose. 3.3 OBJECTIVE

15 Options considered for effective management and handling of the Bio-Medical Wastes need to incorporate legal, technical and financial constraints that will be imposed on such practices. The primary objective for providing such a system shall be to ensure safe, efficient and economic and collection incorporating segregation at source, transport, disaffection destruction and disposal of the residue, while ensuring that the system is reliable for now and for the foreseeable future. The overall objective encompasses the following specific Objectives: To reduce the health effect/ risks associated with the proposed activities: To minimize the Environmental impacts. To ensure the technical reliability of the adopted technology in the terms of safety, flexibility and sustainability under local conditions. To maximize resource productivity. To ensure the techno-economic feasibility of the proposed scheme. 3.4 C O M P O N E N T O F I N T E GR A T E D BIO-MEDICAL WASTE MANAGEMENT An Integrated Waste management system for Bio-Medical Wastes must look into various stages of the process. These key components can be broadly classified into the following. Waste Segregation: As explained in above, waste segregation will reduce the load of Bio-Medical Wastes from about 2 kg of bed-day to about 0.5 KCS / bed / day and this also minimizes the Environmental Impacts associated with further processing. Wastes will have to be segregated into Domestic Refuse, Hazardous Wastes and infectious Wastes separately. Further the Infectious Wastes will have to be segregated into plastics, metals, and other Infectious Wastes generated. Segregation is done effectively if performed at source. Waste storage is an applicable option for effective storage of certain Hazardous Wastes like mercury is cyto-toxins that do not have a cost effective treatment technologies as yet. Waste Disposal is primarily performed by deep burial of Wastes into secure landfills. Waste disposal is an option which remains to exit irrespective of treatment options, in case of Disinfection of Waste material, post disinfection needs to be land filled and in

16 case of incineration, the non-combustible residue and ash needs to be disposed off into a land fill and thus landfilled remains to be an integral part of an integrated Bio Medical Waste management facility. 3.5 ALTERNATE OPTIONS FOR LOCATION OF THE FACILITY As discussed earlier, in Bio-Medical Waste Management Facility would be most effective if incorporated as an integrated facility with disinfecting units, destruction units and disposal units. The option for locating such a unit shall be to have centralized facility that will cater to a group of Hospitals or a localized facility with each of the Hospitals having an integrated management system. The advantage of centralized facility over localized facility in each of the components of Waste management is elaborated below: Waste minimization would require the same effort in both the options. Waste Segregation would be more efficient in a centralized facility as the Waste stream would be sorted at the management facility in addition to the segregation at the source. Collection and transportation of the Wastes would be low in localized facilities compared to that of a centralized facility. Efficient management of treatment option would be low in localized facilities, as this would require a group of trained professional to handle. Disposal facility would be available at centralized facility while localized facilities, as this would have to send the residue to designated landfills. Social Acceptability for a localized facility is very low, as most of the Hospitals are located in the heart of the residential areas with high population density. As a centralized facility would be located away from residential areas having low population density, it would be more acceptable. Impacts on Human and the Environment would be much higher in case of localized facilities as the number of individuals exposed to the various pathways would be much higher, while at the centralized facility it would be lower.

17 Commercial Aspects can be broadly grouped into capital and operational costs. The capital costs would be significantly higher in case of localized facility. Installation of an integrated Bio-Medical Waste management facility would incur cost that would not be commercially viable for most institutions. The operating cost would also be higher at the localized facility as this would require professional supervision and manpower and the actual operating cost of the machinery. A holistic view of the Bio-Medical Waste management clearly indicates that operating Waste management facility should be left to trained professions that are experienced in that area. To have trained and experienced professionals in this area at each individual Health care establishment would be cost prohibitive. Summary of the advantage and disadvantage of two options is presented in table below. Aspect Localized Facility Centralized Facility Waste Minimization ND ND Waste Segregation Efficient Higher Efficiency Collection and Transportation Minimal Medium High Disinfection Variable Efficiency Guaranteed Landfill ND ND Social Acceptability Very low Higher Human Health Impacts High Low Environmental Impacts High Low Commercial Impacts High Low Capital Costs Very High Minimal Operating Costs High Low Thermal Treatment Variable Efficiency Guaranteed ND- No Difference 4. PROCEDURES 4.1. INTRODUCTION As described earlier, Hospital Wastes once generated need to be segregated, collected, transported and safely treated and disposed-off without causing damage to the Human Health and the Environment. To redress this problem and provide the Healthcare establishment, a cost-effective solution to the Waste Disposal dilemma, Upkar Waste Solutions proposed to setup an integrated Bio-Medical Waste Management Facility catering to the Health case establishment of Village- Karawara Manakpur, Tehsil-Rewari, Distt. Rewari Haryana State

18 Upkar Waste Solutions, Karawara Manakpur has identified the following as the major steps involved in making the system efficient: A Waste Audit Training and Awareness- the Doctors, Nurses, Administrators and the ward boys. Waste Minimization. Segregation at Source. Collection and Transport Disinfection / Destruction Disposal Record Keeping Log book for the Equipments. Site Records 4.2. WASTE AUDIT Upkar Waste Solutions, Village- Karawara Manakpur, Tehsil-Rewari shall undertake Waste Audit to assess the Waste quantities, present management and handling practices anti subsequent treatment and disposal of the waste. The audit shall include a survey of representative healthcare establishment and cover all aspects related to Bio-Medical Wastes including Occupational Health and safety TRAINING AND AWARENESS Our experience indicates that the awareness level of most Healthcare Establishment in respect to Bio-Medical Waste management is very low. The Healthcare workers are not completely aware of the impacts of the improper Waste Handling and Management. Our first step towards our endeavour would be to create awareness among all the shareholders involved Subsequent to this. Upkar Waste Solutions shall provide a thorough training to all the team members on aspects of Bio-Medical Waste Management. This training shall include Segregation of waste into proper Colourcoded Bags, Identification of Containers required for collection for the waste, precautions to be taken in respect of handling Waste with special reference to Sharps management. There shall be specific focus towards Occupational Safety of Healthcare workers.

19 4.4. WASTE MINIMIZATION Waste minimization, though focus from the Environmental angle, shall be recommended only at point sources where there is no scope of cross-infection SEGREGATION OF WASTE AT SOURCE Segregation of Waste is the key to the success of Bio-Medical Waste Management, as indicated above, thought about 2 kg of Hospital Waste is generated per bed per day only about 0.5 kg per bed per day is the infectious portion of the Waste. This is a clear indication that only about 20 25% of the total Waste generated at Healthcare Establishment is infectious in Nature. Thus, Segregation of Waste at Source would firstly reduce the Waste Management problem to 25%. Further to this, Segregation of Wastes (Infectious) is integral in terms of further Waste Handling and Management COLLECTION AND TRANSPORTATION Upkar Waste Solutions should collect the Waste from each Healthcare Establishment. Wastes shall be segregated as per the colour-coding, properly packed and placed at a secure designated point by the Healthcare Establishment from where Upkar Waste Solutions shall collect the Waste. MoEF Rules indicates that Wastes couldn't be stored for more than 45 hours, in order to accomplish the same; Upkar Waste Solutions shall pickup the segregated waste daily. Upon collection Wastes shall be placed into closed containers enclosed in a containerized vehicle. Transportation of the Wastes shall also be the responsibility of the Upkar Waste Solutions DISINFECTION AND DESTRUCTION Upon receipt at the facility, Waste containers shall be unloaded. Wastes based on their Colour-codes shall be separated and properly treated and disposed off. Categories 1, 2, 3 and 6 (as per MoEF rules) shall be directly loaded into the Incinerator, while categories 4 and 7 shall be loaded into the Autoclave for Disinfection. Residue from these units shall be disposed into a Landfill. Detailed process description of the treatment technologies is presented in the subsequent sections.

20 Operator of the Incinerator: A Skilled and proper qualified person shall be designated to operate and maintain the incinerator. There shall be one assistant designated at the incinerator Plant to keep track of the Wastes, operation of the Incinerator, cleanliness and as handling. They shall be provided with protective gears such as gumboots, gloves, eyewear, etc. He shall also be reported to the facility operator in case of any accident DISPOSAL Ash, residue from high temperature incineration and other material residues from the process shall be collected into containers and shall be disposed into a secure landfill RECORD KEEPING Record of Maintenance and Operations carried out shall be kept in order to submission of the required information to be submitted to the prescribed Authority by the 31 st of every month RECORDS OF WASTE MOVEMENT Daily records of quantity of Waste collected, moved, date, vehicle no., Category of waste and the same for treated waste shall be kept LOGBOOK FOR THE EQUIPMENT A logbook shall be maintained for each equipment, which includes weight of each batch, categories of waste, time, date, parameters and duration of each treatment cycle SITE RECORDS Detail of construction, maintenance, shut down of equipments, emergency and details about the visits of the official of Prescribed Authority and their observations shall be kept. Above said records shall be kept on daily, Monthly and yearly basis and shall be shown on visit of officials of regulatory authority. 5. BIO-MEDICAL WASTE MANAGEMENT 5.1. INCINERATION Incineration incorporates the right technology featuring for a complete destruction of the Waste into completely safe end products. A process combination of Pyrolysis and controlled

21 air combustion, where heat and air for combustion is regulated in such a way to first volatilize/ gasify the Waste in condition of inadequate air, such that below Stochiometric air condition and heat and then totally destroy it inadequate heat and excess air, thereby making end products Environmentally safe. The process is not only safe but is also today% answer to the rampant problem to Biomedical Waste Management and Pollution. The primary purpose of incineration is to turn the waste to ashes through a combustion process. Upkar Waste Solutions intends to setup a 200 KG/Hr Incinerator. The unit shall be a double-chambered incinerator. The purpose of primary chamber would be combustion of the waste materials into safe era product (Ash). The temperature of the primary chamber would be 850 C above wherein waste shall be completely destroyed. The primary chamber would have an attached burner with auxiliary fuel supply to augment the fuel requirement and ensure maintenance of temperature. The purpose of the Secondary chamber would be to turn the off-gasses and ensure safe end products (gaseous). Tie secondary chamber would operate at a temperature of 1,050 C and above. The gases would be completely burnt and safe gases than shall be let out of the incinerator unit. Both the primary and secondary burners shall be imported. The incinerator will be completely automated with control panel and continuous recording of temperatures. The entire system vial be very simple and easy to operate. The system will be environmentally safe and without any hazards AIR POLLUTION CONTROL SYSTEM The gases after being burnt at 1050 C shall run into a high Pressure Venturi Scrubber having minimum pressure drop of 350 mm WC within water quenching arrangement. Inc scrubber shall be an alkaline scrubber to neutralize the gases and ensure trapping of any population escaping into the atmosphere; the purpose of water quenching is to reduce the heat of the gases, which are at high temperature. The high Pressure Venturi Scrubber shall be made of Stainless Steel of 316 Grade. The clean gases are let out in to the Environment. The scrubbed water shall be collected into a sump, where the water is neutralized and then sent into a cooling tower from where the water is recirculated into the scrubber after cleaning them of their particulates by way of pressure sand filter and activates carbon filter. The System is thus a zero discharge system in terms of water discharged and is pollution free.

22 5.3. AUTOCLAVE The primary purpose of autoclave is to sterilized / disinfected waste with Steam. Microorganisms that contribute to infection do not survive beyond 80 C. However, as a precaution MoEF has stipulated a temperature of 121 C with 15 PSI pressure to ensure distribution of temperature. At this temperature and pressure, microorganisms are completely destroyed and thus render the waste infection free. Upkar Waste Solutions intends to establish a Horizontal Type Autoclave with the above principles, thus rending the Waste free from infection. Autoclave shall have temper proof control panel. The Disinfected Waste shall than be segregated. The segregated materials shall be shredded completing the process of Disinfection ensuring non-cycling of the Waste material for Medical / Food Storage purposes 6. PROPOSAL Upkar Waste Solutions System has technically qualified and professionally trained and experienced personal to perform Waste Audits and capable or training the Healthcare personnel in Waste Minimization Practices, Segregation Packaging of the Waste. The identified process shall ensure the integrity of packaging and in occupational safety. Upkar Waste Solutions System also proposes to provide guidance in packaging of the Wastes. The identified process shall ensure the integrity of packaging through out its cycle including handling, transportation, treatment and disposal. Collection and Transport of the Wastes shall be performed by the Upkar Waste Solutions by their trained personnel at Collection Centres on a daily basis without causing inconvenience. Upon received of the waste at the facility, the Waste shall be property treatment and /or disposed of in accordance with the treatment technologies mentioned above MAJOR COMPONENTS AND INFRASTRUCTURE AT THE FACILITY Following are the components and Infrastructure proposed at the site: A mechanical loading Incinerator 200 kg/hr capacity with Wet Scrubber (Air Pollution Control Device) and 30 m High Stack. An Autoclave - for disinfection of Plastic, Rubber, Latex, Glass, Metal, etc. A Shredder A landfill for the disposal of residue.

23 Administrative Quid nag Electricity, Telecommunication and Water Supply. A Generator to work as stand by for power supply with 10 KVA capacity Vehicle for Waste Transport Others as required for the support function INFRASTRUCTURE AT THE FACILITY The Common Facility shall have enough Space within it to install required Incinerator, Autoclave, Shredder, Untreated Waste Storage, Treated Waste Storage, Vehicle Parking, Washing Area, ETP, Staff Room, etc Treatment Equipment Room A Separate room shall be provided for each treatment equipment. Each room shall have well designed walls, roof and also well ventilated. There shall be Minimum 1.5 m clear distance in all directions from the equipments to the walls of the rooms. Floor and walls up to 2 meters height from floor shall be provided with tiles and also a supervision cabin shall be provided with each treatment equipment room. Attached to each equipment room there shall be two rooms one for storage of untreated Waste and second for Treated Waste like ash with all provisions-as in treatment equipment rooms Main Waste Storage Room Main Waste Storage room shall be constructed at the entry point of the facility. The size of storage room shall be adequate to store the total waste. Front side shall be utilizing for unloading and backside shall be utilized for shifting the waste to the respective equipment rooms. Front floor and floor of the room shall be made impermeable and the Wastewater after washing the room shall be diverted towards ETP for further treatment, Proper colour- Coding to containers of the different categories of the Wastes shall be provided in the Main Waste Storage Room and provisions similar to Treatment equipment Rooms shall be provided to the main Waste Storage Room Treated Waste Storage Room

24 Treated Waste from different Equipment Rooms shall be store in this room shall be similar to that of Main Waste Storage Administrative room This room shall be utilized for administration, record keeping, billing etc. TABLE 6.1: SEGREGATION AND COLOUR-CODING OF WASTES COLOR-COOING TYPE OF CONTAINER WASTE CATEGORY TREATMENT OPTIONS Yellow Nestle Bag 1, 2, 3, 6 Incineration Red Disinfected container 3,13, 7 Autoclaving Or Plastic Bag Blue Plastic Bag Or 4,7 Autoclaving Puncture Proof Container Black Plastic Bag 4,8,9 Disposal into Landfill 6.3. Collection of Biomedical Wastes from Hospitals Upkar Waste Solutions shall collect the Biomedical Waste regularly (daily) The H.C.E shall be advised to segregate the Waste and place them at place to enable H B personnel to pack up the waste. The Waste collected would be endorsed by issuing a Small Manifest. It is also realized that the Bio-Medical Waste has to be collected everyday and in case of delays not late than 48 hours because of the potential of 810- Medical Waste to give out odour and deteriorate on longstanding storage. 6.4.Transportation of Wastes

25 Waste transportation shall be carried out in bins, which are transported in Containerized tracks. The Waste segregated by Hospitals is expected to be in colour-coded bags, which are put into big plastic containers. These containers are placed in containerized vehicle for transportation from Hospitals to ;re disposal facility, The Waste bins are unloaded from these containerized trucks manually by personnel by wearing persona. Protective equipments, viz Overalls, Gloves, ask, Gum Boots ensuring that there are no Environmental or Human Health Impacts during the process, The Waste for incinerator shall be placed near the incinerator while the Waste for autoclaving shall be placed near the autoclave for further treatment. Incineration The incinerator shall be double chambered, Primary Chamber and Secondary Chamber. The capacity of the incinerator shall be of 200 kg/hr. Volume of the primary chamber shall be five times the volume of one batch Waste. Flow meter shall be provided on the primary and secondary air ducting. The Combustion air shall be supplied through a separate ED. fan. A minimum" negative draft of 1.27 to 2.54 mm of WC shall be maintained in the primary chamber fitted with WC measurement mechanism. The Waste shall be fed into the incinerator in small batches after fixed interval of time. The sides and top of the primary and secondary chamber shall have rounded corners from inside. The refractory and insulation bricks shall have minimum 115mm thickness each and conform to IS: and IS: standards respectively. The incinerator shall he made of M.S. (6 mm thick) and painted with heat resistance aluminium paint. The thermocouple shall be fitted at before admission of secondary air in Primary Chamber and at the end of Secondary Chamber. There shall be separate owners for both Primary and Secondary Chamber. The temperature of Primary and Secondary chambers shall be maintained 800 ± 50 C and C respectively. The burners shall have automatic switches. Each burner shall have spark igniters and main burner. View port shall be provided to both the chambers. The flame of the Primary chamber shall be pointing towards the centre of the hearth. The Secondary burner shah be positioned in such a way that the flue gas passes through the flame. The automatic feeding mechanism shall be provider with the Incinerator. A tamper proof Logic Control based system shall be provided with the Incinerator to prevent charging of Waste in case of

26 any unsafe condition and shall also be fitted with emergency vent valve. The system shall have graphic recording device switch, which will automatically and continuously monitor and record the required parameters. Gaseous emission shall be measured daily. The Incinerator shall be provided with heat recovery system. The gases after being burnt at 1,050 0C shall be passed into a High Pressure Venturi followed by a water-flooded scrubber with quenching arrangement. The scrubber shall be an alkaline scrubber to neutralize the gases and ensure trapping of all pollutants escaping into the Environment. The purpose of Nate (quenching is to reduce the heat of gases, which are at high temperature. The clean gases are let out into the atmosphere. The scrubber water shall be corrected into a sump, where the water is neutralized and then sent into a cooling tower from where the water is re-circulated into the scrubber after cleaning them of their particulates by way of pressure sand filter and activated carbon filter. The system is thus a zero discharge system in terms of water discharges and is pollution free. Stack should be designed as per IS: and shall be lined from Inside 3 mm thick natural hard rubber. The location and specification of porthole, platform ladle- shall be as per Emission Regulation Act TABLE 6.2 EMISSIONS NORMS TO BE FOLLOWED FOR INCINERATOR BY R B WASTE MANAGEMENT All numerals are at 12 % CO Concentration Particulate matter : 150 rnginm 3 Nitrogen Oxides : 450 rng/nrn 1 Sulphur Oxides : 50 mg/ gym' Stack height : 30 meters Volatile Organic Compounds in ash snail not be more than 0.01% Autoclaving

27 The primary purpose of autoclave is to sterilize disinfect the waste with steam. Microorganisms, which contribute diseases, do not survive beyond 80 C. However as a precaution MoEF has stipulated a temperature of 1210 C with 15 PSI pressure to ensure distribution of temperature the Wastes Infection Free. Upkar Waste Solutions, intends to establish an autoclave with the above principles, thus rendering the Wastes free from infection, The Disinfected Waste shall then be segregated in HDPE, PP, Rubber, Latex, Glass and Metal containers. The segregated materials shall then to shred completing the process of Disinfection and ensuring non-recycling of the Waste materials for Medical / Food Storage purpose. Shredding Shredding is a process by which sterilized wastes are cut or de-shaped order to prevent reuse of Bio-Medical Waste. The Shredder shall be of robust designed and shall be covered to avoid spillage. The blade of the Shredder shall be of high carbon and non-corrosive so that it can easily shred the Waste Sharp, Scalpels, Glass Vials, wades, Plastics Glass Vials, Blades, Plastics, Catheters, Broken Ampoules, Intravenous Sets, Bl000 Bags, Glass, etc. The Shredder shall be noise and vibration free. The Shredder shall have all safety measures and have mechanism to automatically stop the Shredder to avoid any accident. The Shredder shall be of low rpm and shall have rotational speed less than 50 RPM. The discharge point shall be at minimum 3 feet above ground level, the electric motor attached to the Shredder shall be three-phase induction motor of 5 KW capacity. Sharp Pit A sharp pit shall be provided for treated sharps. OPTION WASTE CATEGORY TREATMENT AND DISPOSAL Category No.1 Human Anatomical Waste (Human tissues,organs, Body parts Incineration

28 Category No.2 Animal Waste (Animal tissue, organs, body parts, carcasses, bleeding parts, fluid Blood and experimental animals used in research, waste generated by veterinary Hospitals collages, discharge from Hospitals, animal houses) Category No.3 Microbiology and Biotechnology waste (Wastes from Laboratories, Cultures, stocks or specimens of micro organisms live or attenuated vaccines, Human and animal cell Culture used in research and infectious agents from research and laboratories, waste from production of Biological toxins dishes and devices use for transfer of Cultures.) Category No.4 Waste Sharps (Needles, syringes, scalpels, blades glass etc that may cause puncture and cuts. This include both used and unused sharps) Category No.5 Discarded Medicines and Cytotoxic Drugs (waste comprising of outdated contaminated and discarded medium) Category No.6 Solid Waste (Items contaminated with Blood and body fluids including cotton, dressing, soiled plaster casts, lines bedding other material contaminated with blood. Category No.7 Solid Waste (wastes generated from disposable items other than waste sharps such as tubing catheters, intravenous sets, etc. Category No.8 Liquid Waste (wastes generated from Laboratories and washing cleaning, housekeeping and disinfecting activities. Category No.8 Incineration Ash (Ash from any Incineration of any Bio-Medical Waste) Incineration Incineration Shredding. Incineration Incineration Shredding/Autoclaving Shredding/Autoclaving Disposal in Municipal landfill. COLOUR- TYPE OF WASTE TREATMENTOPTIONS CODING CONATINER CATEGORY Yellow Plastic Bag 1, 2, 3, 6 Incineration

29 Red Disinfected Container or plastic bag Blue Plastic bag or puncture proof container 3, 6, 7 Incineration Autoclaving 4, 7 Shredding Black Plastic Bag 5, 8, 9 Autoclaving FLOW CHART OF THE WORKING PROCESS Operating a common facility involves collection, transportation, storage, disinfection ultimate disposal in accordance with the Environment Protection Guidelines and Standards prescribed by the Pollution Control Authorities. The services will include supply of color coded bags/containers at collection points and transportation in specially closed vehicles from generating points. By becoming the member of common disposal facility, the entire responsibility of safe disposal of infectious waste in shifted from the generations to the common facility operators.