The waste generated in the hospitals, unless disposed off in the prescribed manner, can lead to not only unhygienic and unsanitary conditions, but can also be a serious health hazard to the patients, staff and public because of infections and environmental pollution with toxic chemicals, fumes and radiation.

Biomedical waste, therefore, is a serious safety hazard and needs to be collected, segregated, neutralized/treated and disposed off as per the Rules. Important safety measures are discussed, in brief, below.

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1. Important Safety Measures:

1. Availability of license for generation, management and handling of biomedical waste with a mechanism for timely renewal. 2. Availability of a Waste Management Manual in accordance with the rules and regulations and including SOPs on all aspects and activities related to management of all types of waste.

3. Right quality and adequate quantity of equipment such as the color coded containers, the syringe and needle destroyers (including some spare as standby), covered trolleys for transportation of waste, the personal protection equipment (gloves, goggles, gum boots, aprons), the autoclaves/hydroclave/incinerator, etc. 4. Availability of waste bags and containers of authorized pattern, suitable sizes and printed warnings, (at all points of waste generation in the hospital) and disinfectants, detergents, insecticides, pesticides for cleaning and disinfection. 5.

Availability of a proper insect /animal proof On-site Waste Storage (enough for 48 hours waste load) with appropriate sized enclosures for all categories of waste and fitted with exhaust system. 6. Availability of an effluent treatment plant and also the facility for deep burial/secure land fill in case the centralized off-site final disposal facility is not available. 7. Continuous meticulous training of all staff about the correct ways of handling and disposal of BM waste and a policy for not allowing any new staff to handle the waste without proper initial training.

2. Handling of Waste at the Point of Generation:

8. Category-wise segregation of waste at the point of generation and collection of waste in the waste bags/containers of the prescribed color, by the staff generating the waste.

9. Destruction and disinfection of used needles/syringes at the point of generation in the manner prescribed. 10. Availability of SOPs/”Do’s” and “DON’Ts” at every point of waste generation. 11. Disinfection of infected waste, excreta, body fluids at the point of generation.

12. Disinfection and disposal of highly infective waste in the pathology laboratory such as culture media and lab samples. 13. Disposal of chemical liquid waste in the drain after proper neutralization/dilution.

3. Transportation of Waste to the On-site Storage:

14. Safe transportation of closed and securely tied waste bags from the departments to the on-site storage by dedicated covered trolleys, through the shortest designated routes without passing through other departments and without any spillage en route, by trained HK staff as per the fixed time schedule.

4. Handling of Waste at the On-site Storage:

15. Observance of all personal protection measures including the use of personal protection equipment while handling the biomedical waste. 16. A procedure for safe and secure storage (from animals/insects) in sealed bags, of human anatomical parts, placenta, etc. and safe disposal as per the regulations. 17. Category wise storage of waste at the on-site-storage.

18. Category wise and department wise weighing of waste bags at the on-site-storage and maintenance of up to date records of waste generated. 19. Cleaning, washing and disinfection of the storage space and waste trolleys after disposal of waste.

5. Final Disposal of Waste:

20. Final disposal of waste as per the regulations.

If the waste disposal is outsourced to a waste disposal agency, the hospital must ensure that the agency is duly licensed and have adequate arrangement for safe disposal. 21. The waste bags should be labeled/tagged appropriately such as: i. Hazardous—Infectious waste ii. Hazardous—Chemical waste. 22. The waste should be transported safely from the on-site to the off-site storage in proper closed vehicles with warning signs as prescribed.

23. There should be a laid down procedure for efficient operation of the effluent treatment plant as required by the law. 24. Periodic inspection and maintenance program for the equipment used such as needle destroyers, shredder, and autoclave/hydroclave/incinerator being used, to ensure efficient functioning. 25. It is the responsibility of the administrators to ensure, through periodic checks, that the procedures described above are actually implemented in letter and spirit. 26.

Incinerators are not recommended for individual hospitals because most of the incinerators available are not able to meet the pollution control criteria. They may, however, be an acceptable option for waste disposal at the centralized disposal facilities located outside the inhabited areas. Biomedical waste if not managed safely can become a very serious hazard to the health of patients, staff and public in and around the hospital. A system for its safe disposal has been spelt out in the BMW Management Rules. It requires some initial capital and nominal recurrent expenditure.

But the benefits far outweigh the investment. What is required is training of staff in implementing the laid down procedures and monitoring by the management that the procedures are being correctly implemented.