INTRODUCTION:

Biomedical waste are the waste generated from medical procedures within healthcare facilities (WHO, 2014). It includes human and animal anatomical waste and treatment apparatus that are used and generated during diagnosis, treatment or immunization in hospitals, nursing homes, pathological laboratories etc. The scientific disposal of biomedical waste through segregation, collection and treatment is called as biomedical waste management. The proper management of biomedical waste decreases the spread of infection by preventing the mixing of hazardous and non-hazardous biomedical waste¹. Government of India has drafted rules and regulations related to biomedical waste management since 1998 and its recent amendments has undergone on 2016^2-4.

The present article is an orientation of the recent rule (Biomedical Waste Management Rules, 2016) and awareness and practices of biomedical waste management as per Indian scenario.

Biomedical waste management rule (2016) excluded certain types of waste under the category of biomedical waste. These include lead acid batteries, radioactive wastes, hazardous wastes, E- waste, hazardous microorganisms. The generation, collection, receiving, storing, transporting, treating, disposing, or handling of such wastes are covered under its respective rules. For example the management of radioactive wastes are covered under the Atomic Energy Act, 1962. Moreover the present rule included all the biomedical wastes generated from inside or outside the healthcare activities such as vaccination camps, blood donation camps, and surgical camps etc⁴.

As compared to 10 categories of biomedical waste listed in the previous rule (BMW rule, 2011), the present rule (BMW rule, 2016) classify biomedical waste into 4 categories. This is majorly revised for improving the segregation of biomedical waste as per colour coded containers. Also as per the new rule, untreated human and animal anatomical waste, soiled waste and biotechnology waste shall not be stored beyond a period of forty – eight hours.

The biomedical wastes to be included in the four colour coded bags are as follows⁴.

Yellow bag waste:

Human and animal anatomical waste such as body tissues, organ etc. Soiled waste such as dressing, cotton swabs, discarded bags containing blood products, plaster casts etc. Expired or discarded medications such as antibiotics, cytotoxic drugs etc. Chemical waste including chemical liquid waste such as discarded formalin, aspirated body fluids, disinfectants etc. Clinical laboratory wastes such as laboratory cultures. Discarded linen, mattress and beddings contaminated with blood or body fluids

Red bag waste:

All the recyclable contaminated biomedical waste such as tubing, bottles, IV sets, catheters, urinary bags, syringes without needles etc. are included in this category.

Blue bag waste:

All the broken or discarded glassware such as medicine vials, ampoules except those contaminated with cytotoxic wastes and metallic body implants are included in this category.

White bag waste:

All the waste sharps including metals such as used or discarded needles, scalpels, blades etc. are included in this category.

Biomedical waste management rule (2016) provide more emphasis on the safe management of biomedical wastes without causing any deleterious impact on human health and environment. The revised rule redefines that the health care facility should make a common bio-medical waste treatment facility within the premises (within 75 km) of the health care facility for the safe segregation and storage of biomedical waste in order to prevent possible mishandling. However, if the institute fails to set up such facility, they should get prior permission for establishing bio-medical waste on-site treatment and disposal facility.

The revised rule focus more on the pre-treatment of biomedical waste before its final disposal as per WHO or NACO guidelines in order to avoid possible microbial contamination. The use of chlorinated plastic/blood bags are discontinued as per the latest rule (BMW,2016) as it may results in burning such wastes with emission of dioxin and furans. There should be a provision of training health care workers involved in biomedical waste management at the time of their joining and continued at least once every year. The recent rule also given much importance in the protection of biomedical waste handlers and added the duty of the health care facility in ensuring proper immunization against diseases such as Hepatitis B, Tetanus etc. The bar coding of the containers containing biomedical waste are recommended as it may help in improving the segregation, transportation and disposal system. The health care facility should also ensure the availability of a system for immediate report and actions in case of accidents such as fire hazards. The existing incinerators should also achieve for retention time as per the basic standards. The operator involved in common bio-medical waste management facility should ensure timely collection of bio-medical waste from the health care facility and provide assistance in conducting training related to biomedical waste management.

Standards for emission from incinerators has been changed in the following aspects in order to decrease the environmental pollution. Apart from the specification of standards related to Dioxin and furans, the present rule modified the limits of SPM level from 150 mg/nm³ to 50 mg/nm³ and the residence time in secondary chamber of incinerators has increased from 1 sec to 2 sec. The present rule also specified the responsibility of state governments in allocating the land for providing a common biomedical waste treatment and disposal facility. As per the BMWM (2016) rule, Ministry of Environment, Forest and Climate Change shall review the monitoring of implementation of biomedical waste management rules every year and the district level monitoring committee will be formed which will submit the report to state advisory committee for every six months.

Recent evidence on knowledge regarding biomedical waste management among Nurses:

Pullishery et al. (2016)⁵ conducted a study on awareness related to hospital waste management among 157 doctors, staff nurses, lab technicians and sanitary staffs. Results of the study revealed that knowledge related to basic aspects of biomedical waste management was higher among nurses as compared to other participants. Ananthachari KR et al. (2016)⁶ conducted a study on practice of biomedical waste management at a tertiary care hospital of Kerala by involving 567 health professionals such as doctors, staff nurses, lab technicians and medical interns. The results revealed that knowledge related to biomedical waste management waste was maximum among nurses and least among laboratory technicians. Anand P et al. (2016)⁷ conducted a cross sectional study on biomedical waste management at a tertiary care hospital of Haryana and found that around 80% of the nurses were aware about the process of segregation, collection, transport, storage and final disposal of infectious waste in the hospital setting.

A study reported that 87% of the nurses working at a tertiary care hospital of Maharashtra were aware about the proper colour coding related to biomedical waste management (Kaur et al. 2015)⁸. However the findings of an another study conducted at a tertiary care hospital of Karnataka revealed that knowledge regarding biomedical waste management was poor among around 70% of staff nurses recruited from the setting (Indupalli SA et al.2015)⁹. Similar results were also found in an another study conducted at Uttarakand in which 73% of the nurses working at a tertiary care hospital were unaware about the segregation and treatment aspects related to biomedical waste management (Kumar et al. 2015)¹⁰.

Recent evidence on practice regarding biomedical waste management:

Pandey et al. (2016)¹¹ conducted a study on the status of biomedical waste management at a tertiary care hospital of Rajastan and found that the most of the health care professionals were mixing infectious and non-infectious biomedical wastes. Similar results were also found in studies conducted at small health care facilities of Karnataka in which most of the hospitals were not following the standard practice related to biomedical waste management (Gadicherla et al., Chetana T et al., 2016)^12-13.

CONCLUSION:

Evidence on the knowledge and practice regarding biomedical waste management suggests a lacuna in proper segregation of biomedical waste in Indian setting. The classification of biomedical waste as per the colour coding system in the recent rule (Biomedical waste management, 2016) may help in reducing the mixing of biomedical waste in various health care system.

REFERENCES:

1. World health organization (2014). Safe management of wastes from health-care activities. [online] http://www.searo.who.int/srilanka/documents/safe_management_of_wastes_from_healthcare_activities.pdf?ua=1/ (last accessed 05 May 2017).

2. Bio-Medical Waste (Management and Handling) Rules, 1998. Ministry of Environment and Forests. [online] http://envfor.nic.in/legis/hsm/biomed.html, (last accessed 05 May 2017).

3. Bio-Medical Waste (Management and Handling) Rules, 2011. Ministry of Environment and Forests. [online] http://www.moef.nic.in/downloads/public-information/draft-bmwmh.pdf, (last accessed 05 May 2017).

4. Bio-Medical Waste Management Rules, 2016. National Accreditation Board for Hospitals and Healthcare Providers. [online] http://nabh.co/Announcement/BMW_Rules_2016.pdf, (last accessed 05 May 2017).

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8. Kaur CD. Pandey A. Tekwani D. Awareness of Bio-medical waste management among the health care workers in rural area. Indian Journal of Basic and Applied Medical Research. 2015;4(4): 351-357

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11. Pandey A, Ahuja S, Madan M. Bio-Medical Waste Managment in a Tertiary Care Hospital: An Overview. Journal of Clinical and Diagnostic Research. 2016; 10(11); 1-3.

12. Gadicherla S, Thapsey H, Krishnappa L, Somanna SN. Evaluation of Bio medical waste management practices in select health care facilities of Karnataka, India. Int J Community Med Public Health 2016; 3:2722-8

13. Chethana T, Thapsey H, Gautham MS. Situation analysis and issues in management of biomedical waste in select small health care facilities in a ward under Bruhat Bengaluru Mahanagara Palike, Bangalore, India. J Community Health. 2014 Apr;39(2):310-5. doi: 10.1007/s10900-013-9761-2.

Received on 17.05.2017 Modified on 20.10.2017

Asian J. Nursing Education and Research. 2018; 8(2): 304-306.

DOI: 10.5958/2349-2996.2018.00060.5