Manual For Bio Medical Waste Management


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ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
AIIMS Bio-medical Waste Management Manual
Dedication: For sure, to AIIMS we dedicate this document, but to those as well, who serve and breath life into the monument:
Authors: - Dr. Parmeshwar Kumar, Assistant Professor
Department of Hospital Administration
- Dr. K.Vamsi Krishna Reddy, Senior Resident
Department of Hospital Administration
- Dr. Siddharth Mishra, Junior Resident
Department of Hospital Administration
MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
It is indeed a matter of great collective pride for the staff at AII India Institute of Medical Sciences, New Delhi that we are the first tertiary Hospital to be provided the authorization under the Bio-medical Waste Management Rules 2016 as well as Consent to Operate under Air and Water Act. The rules describe the Director as the Occupier; for an Institution as large as AIIMS, the role brings with it the responsibility and accountability to implement the mandatory rules effectively.
I find this manual, timely and essential. Though rules define practices, their implementation is always a challenge and institutional adaptability and adjustment needs a ready guide. The Department of Hospital Administration has effectively and efficiently implemented all the aspects of the rules, the authorization being the validation. The AIIMS manual for Bio Medical Waste management completes the picture.
I am aware of challenges that Bio-medical Waste Management entails; need for constant reiteration, turnover of staff, to a few, a fringe element in clinical care, covert ill effects of poor practices and a large hospital with varied cadre of staff are all a reality. Thus, against such a backdrop, I am confident that this manual will be very handy. I am delighted by the ready-reckoner-like feel of the manual, with illustrations, diagrams and fact bubbles. I am also happy to observe that all cadre of staff have been addressed since segregation involves all the staff at AIIMS.
AIIMS through its Clean & Green AIIMS campaign and guideline booklet has always been a torch bearer of Sanitation. The awards and accolades have helped it to strive for even greater heights. Bio medical waste management is an important key result area of the campaign and I am sure that this manual is another feather in its already crowded cap.

Prof. Randeep Guleria
Director AIIMS

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MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
From the Desk of
the Medical Superintendent:
A Foreword on an afterthought:
The Bio-medical Waste Management Rules 2016 has been a long-awaited updated version of the 1998 rules; the mushrooming of health care industry within the milieu of the country coinciding with the drift towards greater environmental consciousness and greater accountability. The new rules bring in several significant changes, primarily at reducing errors (by decreasing the number of categories from 10 to 4), increasing the accountability of both the occupier and the common Bio Medical Waste treatment facility operator and bringing the concept of reduce, recycle & reuse to the fore. Some of the significant changes include phasing out of chlorinated material, training, immunization, bar-coding of waste, pre-treatment of laboratory waste and stricter norms for treatment and disposal.
Occupational safety finds its rightful place in these rules as also accountability through bar-coding systems, web-site based reporting and a well-defined section of Occupier & CBTFW operators’ responsibilities. A much-needed thrust to environmental protection has been provided through a section that elucidate such standards in disposal through incinerators and autoclaves to be followed by the common Bio Medical Waste treatment and disposal facility operators.
In a significant development, the consent to operate has been linked to the Bio Medical Waste Rules thereby viewing the healthcare organization as a single entity from the prospective of the pollution control board. However, this makes procedures such as authorization, renewals and consent to operate a bit more challenging with Bio Medical Waste linked to functioning of the sewage treatment plant, effluent treatment facilities as well as the operation of equipment such as diesel generator and boilers. Due importance has been given laboratory waste by mandating onsite treatment. Cytotoxic waste, an important issue in the content versus container debate, has also been addressed.
This is what makes this manual a contemporary requirement to a hospital as vast as AIIMS. It is with a certain sense of pride that I wish to state that AIIMS is the first public hospital in India to have obtained its consent to operate and the renewal of Bio-medical Waste authorization under the new rules.
The paradigm shift brought about by the new rules makes this manual an important ready reckoner for all the health care workers of the hospital. Indeed, this manual is designed in a format to help all cadre of Healthcare workers at AIIMS.

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MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
The manual thus progresses from a topical view of AIIMS from the perspective of BMW mgmt to the salient features of the rules and its implication to AIIMS. The next chapter deals with the subtler processes and procedures unique to Bio medical waste management AIIMS. An illustrative guide is an easy way for a lay reader to under the most important part of the rules-segregation. The section for sanitation staff is drafted appropriately, in Hindi. Finally, the last chapter delineates clearly the roles and responsibilities of each cadre of healthcare worker, including sanitation staff, infection control nurses and Hospital Administrators. Bio Medical Waste is often considered as an afterthought, an overlooked by product of healthcare, physically and metaphorically relegated to the sidelines. However, I am confident that this manual will significantly contribute to the greater visibility brought about by the new rules by assigning bio medical waste management its rightful place, as an important facet of effective patient care management with far reaching healthcare and legal implications. As the Medical Superintendent of a premier healthcare organisation, I am aware that appropriate Bio Medical Waste management practice need constant reiteration to move it from the realm of practice to the zone of a habit. I am confident that this Bio Medical Waste manual would be an effective tool to that end.
Dr. D.K. Sharma
Medical Superintendent

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MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
Acknowledgement
Drafting the acknowledgement section of any document is often a risky preposition, fraught with the danger of excluding the names of people whose contribution has been significant and deserves a mention. Thus a disclaimer is an order.
However, a manual of this nature would remain incomplete without a note of gratitude. The authors are indebted to the Director, AIIMS for lending his guiding hand in implementation of the rules. We are indeed delighted that this manual is being released by the Director, AIIMS in the capacity of the occupier, and we hope the manual has shaped up to his expectations.
The Medical Superintendent as a key stakeholder in implementation of the Bio-medical Waste Management Rules 2016 had first conceived the idea of a manual as a handbook for all AIIMS staff. Thus we are grateful to him for not only sowing the seeds of the idea in our minds, but also helping us nurture it. Personifying an ideal boss, he has allowed ideas to be generated and empowered his subordinates to implement the rules and positively influencing its outcome, this manual.
The faculty and residents of Department of Hospital Administration have always been at the forefront of effective implementation of practices. Needless to say, this manual is a culmination of their efforts in implementation of the rules. To that end, this manual, is a documented testimony to the correct practices that are already in place. These practice are thus a reflection of the efforts of the department.
Thus, Bio Medical Waste management practices have been honed, corrected, reiterated, improved and implemented over several years of hard work. Therefore, gratitude should also be expressed to the Officer In-Charges of Bio-medical Waste Management in the past for passing on a better and more refined baton to their successors. We would like to express our gratitude to Officers – in-charge Bio-medical Waste Management. in the years gone by, Prof. Sidhartha Satpathy, Prof. Sanjay Arya and Dr. Amit Lathwal for having handled Bio Medical Waste management adroitly at some of the crucial stages of implementation resulting in the current status of Bio Medical Waste management culminating in this manual.
We thank the infection control committee and in particular, the infection control nurses who are an important stakeholder of the implementation structure and have made valuable contribution to this manual. Finally, we also like to express our gratitude to all the healthcare workers at AIIMS who have made this manual a reality and to whom this manual is dedicated as an intended reading and handy companion.

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MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
FIRST AMONG EQUALS!! AIIMS, New Delhi is the first public hospital in India to be authorized under the Bio-medical Waste Management Rules-2016 !

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MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

Index

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI

1 Chapter I:

7

The Bio-medical Waste Management manual: A sneak preview…..

2 Chapter II:

10

Introduction

3 Chapter III:

15

Bio-medical Waste Management rules 2016,

salient features and its implication on AIIMS

4 Chapter IV:

26

Bio-medical Waste Management at AIIMS

5 Chapter V:

35

Segregation : An illustrative guide

6 Chapter VI:

40

Bio-medical Waste Management in Hindi

7 Chapter VII:

46

Roles and Responsibilities of Stake holders

8 Annexure:

51

a. Authorisation of AIIMS under Bio-medical Waste Management rules

b. Consent to Operate under the Air (Prevention & Control of Pollution) Act 1981, and Water

(Prevention & Control of Pollution)1974

c. Complete list of bio medical wastes (area wise) and the appropriate disposal bag/container

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MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI

Chapter I:

The Bio-mmeeddiiccaall wWaasstteemMaannaaggeemmeennttmmaannuuaal:l:AAssnneeaakkpprreevvieieww

“A sneak curiosity

preview to read

should be like a good book the book without giving the

review, generating plot away!

enough

A manual on Bio-medical Waste Management must tread the fine path of not becoming a text book



while imparting knowledge in a ready- to-use customized manner and manage to keep the reader

engaged. Thus, not all portions are relevant for all cadre of staff , though staff such as residents of

Deptt. of Hospital Admn., and Infections control nurses must be aware of all the aspects on the

manual. A brief preview will aid the reader:-

Chapter II: Introduction
The first Chapter provides a brief introduction to AIIMS and gives global perspective on Bio-medical Waste and its burden. An organogram from the perspective of BMW mgmt. provides a visual understanding the reporting channel under the Occupier–the AIIMS Director. The important aspect of Environmental impact and legal implications of Bio medical waste is briefly touched upon to lay emphasis on these important aspects.

Chapter III: Bio-medical Waste Management rules 2016, salient features and its implication on AIIMS
As the Bio-medical Waste Management rules 2016 are bedrock of correct practices, this chapter enumerates the salient features of rules 2016 and its implication on AIIMS. Thus, clauses such as change in colour, cardboard boxes of glassware, hub cutter, bar coding, lab waste mgmt, and linking of Consent to Operate & Bio-medical Management have a far reaching impact as well as are a challenge in implementation.
Chapter IV: BMW management at AIIMS
This chapter elucidates the Institutional machinery. A illustrative flow diagram of generation to disposal schema intends to provide a snapshot of the system. Laboratory waste management needing onsite treatment is described. The Sewage Treatment Plant is related to both Consent to Operate as well as liquid waste management and the features of STP at AIIMS is briefly described.
Chapter V: Segregation: An illustrative guide
Possibly the most important component in the manual, this entirely illustrative chapter deals exclusively with the biggest challenge of effective Bio medical waste management – segregation, in a simple what –goes-where format.

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MANUAL FOR BIO MEDICAL WASTE MANAGEMENT

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Manual For Bio Medical Waste Management