Biomedical Waste Management Rules in Hospitals 2014 PDF or PPT

By Dr Neil
Biomedical Waste Management
Rules in Hospitals 2014
1

BIOMEDICAL WASTE SOLUTIONS
Hospital Waste Management
Biomedical Waste Solutions (BMWS) Hospital Waste
Management discusses how to effectively manage waste
disposal in hospitals, healthcare facilities, medical facilities,
infirmary, or any organizations or establishments that deals
with medicines. As we all know, the waste materials from these
establishments need to be disposed properly because it puts us
at a great risk not only for our health but for the environment
as well. The wastes from hospitals as we all know are mostly
non-biodegradable which will really destroy our environment if
not disposed of properly. Most also may have the possibility of
containing transmittable diseases that may affect our health
especially those waste that involves needles.
2www.BioMedicalWasteSolutions.com

This will basically tell us why we need to manage wastes coming
from hospitals properly, and the process of how to effectively
perform such task. The hospital waste management problem is not
only happening in selected places but all nations have this problem;
thus, the need to address this growing problem and start to analyze
and plan on how to effectively manage the waste disposal of these
establishments. The government authority of a certain locality
where hospitals are present should deal with this first-hand and
make sure that the heads of these hospitals or medical facilities
know their responsibilities on properly managing their waste.
Communication is necessary to achieve success in endeavors to
properly a age a o u ity’s aste espe ially those o the
healthcare department. Without some sort of agreement among
public, private and government sectors, there is always the
possibility of failure on whatever system a community is adapting to
properly dispose their wastes. Hopefully, with good communication
and with vigilance and strict compliance to rules and regulations for
waste disposal, we would not have the fear of destroying our
environment as well as our health.

The necessity for scheduling
Formulation of goals and setting up for their
fulfilment are priceless for boosting medical trash
management at the general, regional, and local
level. Planning needs the definition of a plan that
will facilitate very careful carrying out of the
important procedures and the proper
appropriation of supplies relating to the known
main concerns.
This is noteworthy for the motivation of authority,
healthcare-care workers, and the community, and
for defining even more activities that may be
recommended.
Research on the production of waste will be the
basis for distinguishing options and establishing
goals for waste minimization, reuse and recycling,
and price lowering. A nationwide program of
sound health-care waste management is attainable
through an action plan.

Global Guidelines for Garbage Management
The United Nations Conference on the Environment and Development (UNCED) in
1992 led to the use of Agenda 21, which offers a fix of measures for trash handling.
The instructions may be summarized as follows:
• Prevent and lower trash output.
• Reuse or recycle the garbage to the magnitude possible.
• Handle trash by safe and eco-friendly sound methods.
• Dispose of the finalized elements by garbage dump in confined and correctly made
sites.

Agenda 21 also highlights that any waste product producer is liable for the remedies
and complete disposal of its own rubbish; where possible, every neighborhood should
get rid of its waste within its own borders. The European Union has developed a
common European Community Technique on trash Management; other regional
groupings of countries may put together related policies in the outlook.

National Projects For Medical-Care
Waste Administration
Objective of a national control
management
A national administration plan will enable
health-care garbage management
possibilities to be optimized on a national
measure. A national survey of healthcare
garbage will offer the appropriate
institution with grounds for pinpointing
approaches on a district, regional, and
national basis, taking into account
conditions, demands, and methods at
each level. An excellent, safe and secure,
and affordable method will be concerned
principally with remedies, reusing,
transport, and disposal picks.

Action plan for the development of a national program
A national program of sound health-care waste management can be put together with
a seven-step action program. The seven steps, their suggested time frame are defined
in Figure 1 and in more facts in the implementing words.

Step 1. Create policy devotion and accountability
for wellness-care trash control
Before an action plan is implemented there must
be desire to the advancement of a national policy,
and accountability must be assigned to the
appropriate government council. The ministry of
health or the ministry of environment will
commonly assist as the main authority, and should
function accurately with other appropriate
ministries. The specific authority will collaborate
with other ministries, the private sector,
nongovernmental agencies (NGOs), and
professional organizations, as required, to assure
implementation of the action plan. Policy desire
should be declined in recommended budgetary
allocations at distinctive government levels.
Guidance from central government should turn to
max efficiency in the use of readily available
resources from health-care places.

Step 2. Make a national review of
health-care waste techniques
The national institution liable for the disposal of health-care waste
should be completely careful of present levels of waste production
and of national waste management procedures. A detailed research
is ideal for planning an amazing waste management method. It is
suggested that a wide-ranging questionnaire be finalized for all
health-care establishments in order to produce the following:
• number of hospital beds and bed occupancy rate for every
single health-care establishment;
• kinds and volumes of garbage produced;
• employees’ i ol ed i the a age e t of health-care waste;
• current health-care waste disposal procedures, including
sequestration, collection, transportation, storage, and disposal
strategies.
The review should also comprise site observations and interviews
with health or support staff (waste workers, cleaners, etc.) at a
variety of levels. The facts built-up will incorporate a basis for
forming approach for district, regional, and national levels.
13

Step 3. Cultivate national guidelines
The foundation for a national program for health-care waste management is the
technical guidelines plus the appropriate platform that assists them. Step 3 thus
consists of the formulation of a national policy document and technical guidelines
based on the results of the national survey; the two may be brought with each other
in one thorough document. Their content, should offer the technical foundation on
which health-care establishments can create their unique management programs.

Step 4. Develop a policy on regional and collaborative
methods of health-care waste treatment
The selected government organization
should understand resources that will
guarantee a national network of disposal
features for health-care waste, accessible
by clinics and other health-care facilities.
The national (or regional) policy should
also offer technical requirements for the
processes and gears involved in
appropriate treatment selection. There
are three practical picks for managing the
treatment of health-care waste:
• Option 1: an on location treatment
service in each health-care institution.
• Option 2: regional or collaborative
health-care waste treatment facilities,
supplemented by in depth facilities for
outlying medical facilities.

• Option 3: treatment of health-care waste in existing industrial or municipal treatment
features (e.g. municipal incinerators), where these can be found.
Each option has characteristics and down sides. The national or regional planning policy
will count on local conditions such as the administrative mechanisms for activating
proper waste management procedures, the number, place, dimensions, and enter of
health-care places, high of road network, and financial and technical resources.

On-site health-care waste treatment
service
The good points of providing each health-care
organization with on-site treatment amenities
include the following:
• benefits;
• minimization of issues to public health and the
environment by confinement of deadly wastes
to the health-care premise.
On-site treatment facilities are especially ideal in
areas where hospitals are established far from
each other and the street system is weak. They
must be handled by the medical facilities where
they are found and may accept health-care waste
gathered from distributed little sources in the
environment areas.

The negatives of on-site disposal
include the following:
• Costs may be substantial if
there are many clinics.
• General, a lot more technical
personnel may be involved to
operate and keep the
facilities.
• It may be overwhelming for
the pertinent authorities to
monitor the show of many
small facilities; this may cause
in poor compliance with
operating standards,
depending on the enter of
facilities, and increased
environmental pollution.
18

State-wide and combined treatment
centers
On location waste disposal techniques, which may
be desired for giant healthcare places, may not be
feasible or economical for smaller institutions, for
which regional or cooperative disposal may be the
better way to go. Such systems are in use in varied
international locations, running on either a
voluntary or a statutory basis. For example, a group
of medical facilities may work together to set up a
regional health-care waste treatment facility (e.g. a
high-capacity incinerator) at one healthcare facility
which will then receive waste items from others
within the team. In other instances, the local
authority or a private waste disposal company may
create a centered plant to accept waste from
health-care centers inside its region.

Figure 1. Action plan for the development of a
national program of good healthcare and waste
management

Survey questionnaire for hospital waste management
QUESTIONNAIRE
Hospital (name, location): _______
______________________________
_____________ _
Type of hospital (tick one):
Specialist
General
University (training/provincial)
Regional
District
Sub-district
No. of inpatients: /day
No. of outpatients: /day
No. of beds (total): /day
including ______________________________ _
________ in _______________ ward
(no.) (type of ward )
________ in _______________ ward
________ in _______________ ward
________ in _______________ ward

Survey questionnaire for hospital waste management (continued )
Safe management of wastes from health-care activities
22

Waste segregation, collection, storage, and handling
Describe rieﬂy hat happe s et ee segregatio if a y a d fi al disposal of:
Sharps _______________________________________________________________
Pathological waste _____________________________________________________
Infectious waste ________________________________________________________
Radioactive waste ______________________________________________________
Chemical waste ________________________________________________________
Pharmaceutical waste ___________________________________________________
Pressurized containers __________________________________________________

Personnel involved in the management of hospital solid waste
1. (a) Designation of person(s) responsible for organization and management of waste collection,
handling, storage, and disposal at the hospital administration level.
_____________________________________________________________________________________
(b) General qualification and level of education of designated person.
_____________________________________________________________________________________
(c) Has he/she received any training on hospital waste management? Yes No
If yes, what type of training and of what duration?
_____________________________________________________________________________________
2. Indicate the number of persons involved in the collection, handling, and storage of hospital
waste, their designation, their training in solid waste handling and management, and the number of years of experience
of this type of work.
Number Designation Training Experience
3. Do the waste management staff have job descriptions detailing their tasks? Yes No
4. Are instructions/training given to newly hired waste management staff? Yes No
Hospital waste management policy
1. Are you aware of any legislation application to hospital waste management? Yes No
If yes, please list the legislative Acts:

2. Are you aware of a document outlining the hospital waste management policy? Yes No
If yes, give title of document (and attach a copy if possible):
____________________________________________________________________________________
3. Is there a manual or guideline document on management of hospital wastes available:
(a) In the Ministry of Health? Yes No
If yes, give title of document:
____________________________________________________________________________________
(b) In your hospital? Yes No
If yes, give title of document:
____________________________________________________________________________________
4. (a) Does your hospital have a Waste Management Plan? Yes No
If yes, please attach a copy.
(b) Does your hospital have a Waste Management Team (or Teams)? Yes No
If yes, please list the members by designation

Designation No.
Team leader _________________________________ ________________
Team members: _________________________________ ________________
Waste handling staff: _________________________________________________
5. Are there clearly defined procedures for collection and handling of wastes from specified
units in
the hospital? Yes No
6. Are there waste management responsibilities included in the job descriptions of hospital
supervisory staff (Head of Hospital, Department Heads, Matron/Senior Nursing Officer,
Hospital
Engineer, Infection Control Officer, Pharmacist, Laboratory Supervisor, etc.)? Yes
No
If yes, provide sample copies.
7. How are the present waste collection, handling, and disposal responsibilities defined in
the job
descriptions of the staff involved? (Cite appropriate statement or provide copies.)

Centralized regional features could
create the following strengths:
• improved cost-effectiveness for larger sized units, through economies of scale;
• spare capacity can be offered more cheaply;
• potential changes or expansions (relating to flue-gas cleaning systems of
incinerators, for example) are probably to be more economical;
• where privatization of services is observed as a desired option, this can be realized
more perfectly on a regional basis than for multiple tiny units; in addition, it will be
smoother for the important government agencies to oversee and supervise the
facilities;
• excellent operation can be more easily guaranteed in one centralized facility than
in several plants where skilful staff may not be easily available;
• air pollution may be more effortlessly kept to a minimum at a centralized plant
(costs of monitoring and surveillance and of flue-gas cleaning, for example, will be
limited);
• hospitals will not have to spend time and workers to managing their personal
installations. The location of regional facilities for the treatment of health-care
waste should be meticulously selected.

Catchment areas should be recognized on the basis of approximated waste production
by the health-care facilities involved, and the site of the treatment plant within each
catchment area should then be based on the following considerations:
• availability for the hospitals and health-care facilities to be served (road
conditions, distances, and transportation times);
• quantities of health-care garbage expected from some places within the
distinguished catchment region;
• whether or not transfer channels are required (daily transfer of waste direct from
clinics to the regional facility, with no need for transfer stations, would be
excellent, keeping away from double control of waste);
• probably modifications in the capacity or characteristic of each hospital and hence
in the amount or nature of its waste;
• preliminary environmental thoughts, based on a complete environmental and
health impact appraisal (the assessed impact may be lower if the facility is located
inside an industrial "park" manufactured exclusively for hazardous companies);
• adequacy of the land area for the facility at a recommended place;
• public attitude towards the treatment system.
Minimizing overall times for transportation of health-care wastes to the regional
facility should be an worthwhile advantage in the options of place and in knowing
recommended transportation channels. Allotting complete numbers of collection
motor vehicles to the many routes in the region will make sure day to day collection of
waste and give to in general cost-effectiveness.

• Step 5. Rules: limitations and guidelines
for health-care waste management
Once developed, the policy and
guidelines should be secured by legislation
that controls their application. This law is
customarily based on international legal
agreements and underlying principles of
sound trash management.
• Step 6. Start a national training system
In order to achieve appropriate
procedures in health-care waste
management and compliance with
requirements, it is vital for all managers and
other workers engaged to receive proper
instruction. To this end, the central
government should help in groundwork of
"train the trainer" techniques, and
professional institutions or centers for the
trainers' program should be identified.
30

Step 7. Review the national health-care waste
management program upon execution
The national program for management of health-care garbage should be
considered as an on-going process with regular monitoring and appraisal by the liable
national government agency. In addition, the instructions on treatment techniques
should be consistently current to keep pace with new improvements.
The national agency will base its analysis basically on reports from the health-
care establishments on their triumph in following waste management programs. It
should compare yearly reports presented by the heads of the establishments and make
occasional visits to carry out reviews of the waste management systems. Any sort of
inadequacies in the waste management system should be pointed out to the head of
the establishment in writing, together with instructions for remedial ways. The time
limit for carrying out of restorative ways should be chosen and the head of the
establishment should be knowledgeable of the re-examination date.
In the case of off-site waste treatment centers, incinerator workers, road
haulage providers, and landfill workers should also be checked. Regular analysis of
waste management ways by both the national government agency and the health-care
establishments should result both in top-quality protection of work-related and public
health and in increased cost- effectiveness of waste disposal.
31

Appraisal of waste release
In order to establish a waste management plan, the waste
management team ought to make an analysis of all waste
produced in the healthcare facility. The WMO should be
trusted for organizing such a review and for scrutinizing the
outcome. The garbage should be grouped with respect to
the category system specified in the national guidelines (or
as described in this handbook if no such guidelines are
available). The research should determine the average daily
amount of trash in each category generated by each medical
facility department. Special care should be utilized to analyze
the possibility of highest production and the periodic
generation of fantastic amounts of waste products. For
example, the effect of epidemics and other issues that
affects the volumes of waste generated should be projected.
Account should also be taken of interested slack intervals or
other strange conditions that may factor extensive variations
in garbage amounts. Survey results should incorporate a test
of any future modifications in hospital status, departmental
progress, or the establishment of new departments.

Development of a trash management plan
During formation of the waste management
plan, any member of the waste management group
(WMT) should carry out a review of present trash
management arrangements in his or her area of
obligation. Established methods should then be evaluated
in the light of the national guidelines and instructions
made to the WMO on how the guidelines can be executed
in each spot. On the basis of the waste production survey
and these guidelines, the WMO should prepare a draft
discussion document for the WMT. This discussion
document should incorporate points of the new waste
management system. It should be divided up into portions
covering the following challenges:
• present situation (waste management procedures,
employees and equipment involved)
• levels of waste produced
• possibilities for trash minimization, reuse, and
recycling
• waste segregation

• on-site handling, transport, and storing tactics
• recognition and evaluation of waste cures and disposal types (on- and off-site)
• recognition and analysis of the possibilities, and linked expenses
• record-keeping
• training
• evaluation of expenses relating to trash management (exact state and suggested
options)
• strategy for execution of the plan.

The draft discussion record should be
prepared in consultation with all members of the
WMT and their staff. Officials from the local
authority and from the national government
agency liable for the disposal of health-care
wastes should be asked to aid in the development
of the garbage management plan (WMP). The
WMP should be based on the discussion
document and should be delivered to a meeting
of the WMT for approval. The WMO should
amend the draft discussion document in the light
of comments made by the WMT. When full
agreement has been attained, the document
should be specific as the medical institution WMP.
The WMO should now complete the
WMP with a diagram that describes the line
management framework and the liaison paths,
and a list of names and telephone numbers of
liable personnel to be alerted in the occasion of a
disaster.

Advice for inclusion in the trash management plan
• Location and organization of collection and storage facilities
1. Pictures of the business demonstrating selected bag-holder sites for
each and every ward and department in the hospital; each bag site
shall be appropriately designated for health-care waste or other waste.
2. Drawings exhibiting the central storage site for health-care waste
and the isolate site for other garbage. Details of the type of containers,
security merchandise, and arrangements for washing and
decontaminating waste-collection trolleys (or other transport devices)
should be determined. The document should also address eventual
wants for refrigerated storage facilities.
3. Blueprints detailing the paths of waste-collection trolleys through
the hospital, with definitely noticeable individual collection routes.
4. A collection schedule for each trolley route, the method of waste to
be collected, the range of wards and departments to be checked out
on one round. The central storage point in the establishment for that
particular waste should be identified.

• Design criteria
5. Blueprints showing the kinds of bag holder to be used in the wards
and departments.
6. Drawings exhibiting the type of trolley or wheeled bin to be used for
bag collection.
7. Images of sharps bins, with their requirements. Need material and
human resources
8. An approximation of the amounts and cost of bag holders and
collection trolleys.
9. An approximation of the amount of sharps containers and health-
care garbage barrel bins forced annually, classified into countless
options if suitable.
10. An estimate of the total and fee of yellow and black plastic bags to
be used yearly.
11. An estimate of the host of personnel forced for trash collection.

• Responsibilities
12. Definitions of commitments, duties, and norms of practice for each of the
a variety of kinds of workers of the hospital who, through their regular work,
will establish trash and be involved in the segregation, storage, and control of
the waste products.
13. A definition of the obligations of hospital attendants and additional
personnel in collecting and maneuvering wastes, for each ward and
department; where special practices are required, e.g. for radioactive waste
or hazardous chemical waste, the stage at which attendants or ancillary staff
become involved in waste handling shall be clearly defined.
• Procedures and practices
14. Basic drawing (flow chart) demonstrating procedure for waste
segregation.
15. The procedures for segregation, storage, and handling of wastes needing
unique preparations, such as autoclaving.

16. Define of checking techniques for waste areas
and their resort.
17. Backup tactics, formulated with manual on
storage or evacuation of healthcare garbage in
case of malfunction of the treatment unit or
during closure down for scheduled maintenance.
18. Emergency procedures.
• Training
19. Training instruction and programs.

Implementation of the waste management plan
Implementation of the WMP is the duty of the Head of Hospital. It involves the
following steps:
1. Interim ways, to be introduced as a predecessor to full execution of the new trash
management system, should be designed by the WMO, in partnership with the WMT,
and be appended to the plan. A bar chart should also be included, detailing dates of
application of each part of the new system.
2. Provision for upcoming expansion of the hospital or of waste storage facilities
should be done.
3. The Head of Hospital installs personnel to the posts with accountability for garbage
management. Notices of these appointments should be frequently distributed and
changes should be released when changes happen.
4. The Infection Control Officer should sort out and supervise coaching programs for
all staff, in collaboration with the WMO and other members of the WMT. Initial
training sessions should be attended by key staff members, including medical staff,
who should be advised to be aware in checking the overall performance of waste
disposal duties by non-medical staff. The Infection Control Officer should buy the
speakers for training lessons and determine the content and type of training given to
each group of staff.

5. As soon as the actions in 1-4 have been
achieved and required equipment for garbage
management is around, the operations defined
in the WMP can be put into practice.
6. The WMT should look at the WMP yearly and
start alterations important to upgrade the
system. Temporary modifications may also be
made as and when essential.
7. The Head of Hospital should prepare an
annual report to the national government
agency reliable for the disposal of health-care
waste products, providing reports on waste
generation and disposal, workers and equipment
criteria, and fees. Downfalls in the waste
maneuvering, segregation, storage, transport, or
disposal system, or garbage management
reports that result in injury should be reported
as soon as feasible to the Infection Control
Officer.

Management of health-care trash from spread out little sources
Basic principles
Improvement in health-care waste management should start
in giant healthcare facilities, then extend to smaller health-care places,
and lastly to the diverse sources of small volumes of waste. The heads
of health-care establishments are responsible for health protection
and safety at the work environment and take legal responsibility for
the safe disposal of health-care waste produced in their facilities. They
should therefore take all sensible strategies to:
• prevent health-care garbage from initiating environmental
contamination or unfavorable effects on human health;
• ensure that health-care waste is sufficiently segregated and safely
packed, especially in the case of sharps which should be loaded in
puncture- proof containers;
• ensure that bags or containers of health-care waste are handled
only by those technically licensed to transport and/or dispose of
such waste;

• guarantee that a transfer note describing the waste is
handed to the recipient when waste is transferred;
• check that the driver of the collection vehicle is conscious
of the rules governing transport of deadly products.
• The solutions for safe collection and disposal of health-
care waste from small sources, which do commonly not
treat their own waste, include the following:
• the local authority or an licensed private contractor
collects the waste for treatment at a local hospital
incinerator or other building;
• an licensed private contractor collects and treats the waste
at the o tra tor’s treat e t fa ility;
• the local authority or an licensed private contractor
collects the waste for treatment at a municipal waste
incinerator or for treatment by another disinfection or
confinement plan.

All waste should be clearly marked with
self-adhesive or tie-on labels signifying point of
production (hospital and department), content, and
in the case of transport off-site and certain additional
facts. Any agreement for collection by a private
authorized health-care waste provider should identify
the disposal or treatment facility to be used. The
carrier should, whenever possible, use specific
vehicles for the collection of transmittable trash.
Collection of health-care wastes from their source
should be average and frequent. Any storage of
garbage before destruction or collection for off-site
disposal should be in a protected area designated for
the reason. Private professionals, health-care
research establishments, haemodialysis centers,
veterinary practices, and nursing homes should
create infection control policies. All workforces
should be able to comprehend the policy, which
should include things of the procedures to follow in
case of a needle-stick harm or exposure to
contaminated blood.

Research activities
Waste material produced in research areas can extend from small
items such as culture dishes to large animal carcasses, and may also consist of
soiled beddings and sharps. The trash is often contagious or even highly
infectious. Heads of research units are trusted for the training of personnel
and for guaranteeing ideal segregation of garbage. Because of the nature of
the waste generated in research facilities, the following precautions should be
taken:
• Extremely infectious garbage should be autoclaved or incinerated on site
whenever possible and should be handled only by trained and authorized
staff.
• If on-site treatment is hard or wasteful, cooled storage facilities should be
offered and there should be a frequent collection by a contractor who has
appropriate incineration facilities.
• Animal carcasses that cannot be destroyed as soon as possible after
experimentation should be retained at a temperature below -20°C. Any
contractual plan for analysis by personnel outside the institution should
include right provisions for the safe handling and disposal of any waste.
Biotechnology laboratories may generate waste that presents special
dangers (such as genetically modified material) and that should in no
concerns be released into the environment. Management of such trash
needs additional precautions that are beyond the scope of this handbook.

References and suggested further reading
• Christen J (1996). Dar es Salaam Urban Health Project. Health-care waste
• management in district health facilities: situational analysis and system de-
velopment. St Gallen, Switzerland, Swiss Centre for Development Coopera- tion in
Technology and Management (SKAT).
• WHO (1995). Survey of hospital wastes management in South-East Asia Region.
• New Delhi, World Health Organization Regional Office for South-East Asia
(document SEA/EH/493).
• WHO (1997). Action plan for the development of national programme for sound
• management of hospital wastes. An outcome of the Regional Consultation on
Sound Management of Hospital Waste, Chiang Mai, Thailand, 28-29 Novem- ber
1996. New Delhi, World Health Organization Regional Office for South- East Asia.
• WHO/CEPIS (1994). Guìa para el manejo interno de residuos sòlidos
• hospitalarios. [Guide to the internal management of solid hospital waste.] Lima,
World Health Organization/Pan American Sanitary Engineering and Environmental
Sciences Center.

By Dr Neil
Biomedical Waste Management
Rules in Hospitals 2014
48

Biomedical Waste Management Rules in Hospitals 2014 PDF or PPT

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