Hospital Waste Management An Insight Approach: Ntroduction

HOSPITAL WASTE MANAGEMENT An insight approach
AUTHORS Dr. Yashpal Sharma is at present serving as Medical Superintendent of Shree Maharaja Gulab Singh Hospital, Govt. Medical College Jammu (J&K). Well known in the field of Hospital Administration, he has almost two decades of varied experience behind him. Passed his M.B.B.S from Govt. Medical College Jammu and was conferred with Masters Degree in Hospital Administration (MHA) from A.I.I.M.S, New Delhi. Awarded W.H.O fellowship in Health Economics at Chulalongkorn University, Bangkok, Thailand. An Alumni of AIIMS, New Delhi and Indian Institute of Management, Ahmedabad, he has been visiting faculty for training of Medical Superintendents and senior Medical Officers at Indian Institute of Coal Management, Ranchi and Administrative Training Institute, Nainital. Life member of many institutions at Delhi including Academy of Hospital Administration, Indian Hospital Administration, Indian Society of Hospital Waste Management & AIIMSONIANS. Member of Expert Committee of Central Pollution Control Board, Delhi. Has successfully completed various research projects of Central Pollution Control Board, Delhi like development of an ideal system for segregation of Hospital Waste at Govt. Medical College Jammu and Vivekanand Polyclinic, Lucknow; Documentary film of 40 minutes duration on Hospital Waste Management ; Development of website for Govt. Medical College & Associated Hospitals Jammu (www.gmcahjammu.org), has written many books including Manual on Disaster Management 2001; Manual on Hospital Waste Management 2001, Fire manual 2002; Book on job functions of Health Care professionals 2002; Book on Hospital and Medical Gases 2002 and Handbook on Hospital Administration Making a difference 2003; Awarded with Rashtriya Gaurav Award and Bharat Excellence Award & Gold Medal for out standing work in Health & Medical Education Department (J&K) by Friendship forum of India, New Delhi. Has many research publication in the field of Health & Hospital Administration to his credit. Dr. Poonam Mahajan is at present working as Gynecologist and Obstetrician at Model E.S.I Hospital Bari Brahmana, Jammu (J&K). Passed her M.B.B.S from Govt. Medical College Jammu and was awarded Gold Medal in Pharmacology for securing first position. Conferred with Masters Degree (M.D) in Gynaecology & Obstetrics from the same institution. During this period, a hospital based clinico pathological, calposcopic and cytogenetic study on Human Papilloma virus testing in cervix of high risk women was conducted. Worked in the Department of Health and Medical Education in various capacities and has varied experiences of almost sixteen years. She has also been associated with a project of Department of Science & Technology, J&K. Besides Academics, she is an avid reader and pursues her interest in Hindi Literature in her free time.
1. Introduction
An old saying says Cleanliness is next to Godliness. The essence of this was aptly captured by Dravidians, who, in 5000 BC laid due emphasis on immaculating town planning and safe and effective sewerage systems to get rid of all solid and liquid wastes generated by the population. They were indeed the pioneers as far as scientific waste management is concerned ; which is borne out from excavation of Mohenjo-daro and Harappa The modern hospitals and health care institutions including research centres use a wide variety of drugs including antibiotics, cytotoxics, corrosive chemicals, radio active substances, which ultimately become part of hospital waste. The advent of disposables in the hospitals has brought in its wake, many ills i.e. inappropriate recycling, unauthorised and illegal re-use and increase in the quantum of waste. All round technological progress has lead to increased availability of health related consumer goods, which have the propensity for production of increased wastes.
The issue of improper Hospital Waste Management in India was first highlighted in a writ petition in the Honble Supreme Court; and subsequently, pursuant to the directives of the court, the Ministry of Environment and Forests, Govt. of India notified the Bio-Medical Waste (Management and Handlings) Rules on 27th July 98; under the provisions of Environment Act 1986. These rules have been framed to regulate the disposal of various categories of Bio-Medical Waste as envisaged therein; so as to ensure the safety of the staff, patients, public and the environment. The health institutions of Govt. Medical College and Health Departments of Jammu / Srinagar are carrying out different patient care activities related to OPD, Indoor, theatres, Intensive Care Units, Emergency Lab Research and so on. During the process and procedures, lot of hospital waste is generated which, if not segregated scientifically and treated as per the guidelines issued by the Central Pollution Control Board over the years, can lead to a lot of health hazards for each one of us. Bio-Medical Waste Management in Healthcare Institutions of State of Jammu & Kashmir : In order to ensure the safety of staff, patients, attendants/ general public and the environment, the waste generated in the hospital/ healthcare institutions should be properly segregated at the source of production, transported in covered trolleys or wheels barrows and then scientifically disposed off as per the available treatment technology. The proper Bio-Medical Waste Management in the hospital is not only the statuary (legal) obligation because of the Bio-Medical Waste (Management and Handling) Rules of 1988 and 2000 but also associated with many health and environment hazards, if not managed properly. On an average, hospital generates 1.5-2 kg waste per bed/ day. Out of this, 80% of the waste is general waste/ garbage which is just like the domestic waste and can be disposed off in municipal bins. 10-15% is the infectious waste which includes dressing material, sharps/ disposables etc. and it requires the attention of the health care professionals for its proper management. The management of infectious waste is the responsibility of the health care institutions generating the same. If this 10-15% of waste is not properly segregated at the source of generation, whole of the waste then gets mixed up, and then it is a Herculean task to dispose off the same. The mixed waste which has now become infected cannot be thrown in a municipal bin. At present, most of the health care institutions in our state except for some associated hospitals of Medical Colleges and some district hospitals are not able to do the proper/ scientific disposal of the hospital waste. The main reason for this is not the financial crunch or lack of resource but, is the lack of awareness/ knowledge of scientific waste management practices. The deadline issued for Govt. hospitals to conform Bio-Medical Waste (Management & Handling) Rules of 1998 and 2000 is already over and now we are liable for legal action for improper waste management in our hospitals. What is required. The staff working in various health care institutions of our state should be made aware of the scientific management of Bio-Medical Waste through various training programmes / work shops, etc. at various levels (Block/ District). The stress has to be laid down on proper segregation practices, which is the core of success for implementation of this programme. Upto District hospitals, proper Bio-Medical Waste Management will require the following : i) Different coloured (Black/yellow/blue) bins lined with same coloured polythene bags. ii) Trolleys/ wheel barrows for transportation of waste from point of generation to final disposal. iii) Needle destroying units/ tailor scissors for disposal of needles/ syringes and catheters etc. iv) Hypochlorite (1%) for chemical disinfection. The infectious waste generated in such hospitals which cannot be chemically disinfected like organs, placenta and amputated parts should be sent in yellow bags for deep burial or an incinerator of the capacity of 50 kg per hour can be provided for the purpose which can also cater to the needs of various other Govt./ Private institutions at the district level. A.
To implement this system upto district hospital level, we require only a few commodities like bins, polythene bags, needle destroying units/ scissors and hypochlorite solution which will not cost much. The requirement of bins, bags and NDUs can be calculated on the basis of bed strength of the particular hospital. B. At the level of Govt. Medical College and their associated hospitals, the Bio-Medical Management at present requires : i) Implementation of scientific segregation practices as discussed earlier which will hardly require any investment but for the purchase of bins, polythene bags, hypochlorite solution, wheel barrows etc., the recurring cost should be kept in mind for such bigger hospitals. ii) Some of the associated hospitals have the Incinerators for final disposal of the Bio-Medical Waste but the rubber/ polythene and other similar infected disposable items which cannot be burnt in the incinerator, still require some other alternate treatment technologies like Microwave/Autoclave or Hydroclave for their final disposal. iii) Till such technologies are made available, the infectious waste after scientific segregation, should be chemically disinfected and then transported for final disposal. iv) The IEC activities for creating the awareness amongst the various categories of staff working in such hospitals is also the need of the hour. v) Trolleys/ wheels barrows for transportation of waste from point of generation to final disposal.
For Cities like Jammu and Srinagar These two capital cities of Jammu and Kashmir state which have many big and premier hospitals as well as Nursing Homes should be provided with Common Bio-Medical Waste Treatment Facility (CBWTF). This means that the scientific segregation should be the responsibility of the hospitals/ nursing homes where as the final treatment of disposal should be done at common treatment facility. CBWTF shall be located at a place reasonably away from the residential and sensitive areas with a minimum one acre of land, allowed to cater to health care units situated within 150 kms radius and upto 10,000 beds. A common Bio-Medical Waste Management Treatment Facility (CBWTF) shall have all the facilities like Incinerator, Autoclave/ Microwave/Hydroclave, Shredder and Effluent Treatment plant etc. The municipal Corporation/ Municipal Boards or Urban Local Bodies as the case may be shall be responsible for providing suitable site for common disposal/ incineration of bio-medical waste generated in the area under their jurisdiction. The setting up of incinerators for individual hospitals have to be discouraged as the incinerator can be a source of pollution. The need of the hour is setting up of CBWTF. Approximate cost of setting for common Bio-Medical Waste Treatment facility (CBWTF) is Rs. 75.00 lacs to Rs. 100.00 lacs. The hospitals / Nursing Homes utilizing the services of this CBWTF can be charged at the rate of per bed after conducting the costing procedures as is being done in other states, where such facilities have already been provided.
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2. Frequently Asked Questions (FAQ)

1. What is Biomedical Waste? In a laymans language - Bio-Medical Waste is any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals. These wastes are also generated during research activities or in the production or testing of biological material. Redefining it scientifically, Biomedical waste is defined as any solid, fluid or liquid waste, including its container and any intermediate product, which is generated during its diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biological and the animal wastes from slaughter houses or any other like establishments. What is Health Care Waste or Medical Waste? Any waste that is generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals. Who comes under the purview of the BMW Rules? Every occupier of an institution generating, handling, collecting, receiving, storing, treating and disposing biomedical waste, is compelled under law to comply with the Biomedical Waste (Management and Handling) Rules 1998, within the stipulated time. This includes all hospitals, clinics, dispensaries, laboratories, blood banks, veterinary and research institutions anywhere in the country. Is Biomedical Waste Management a serious issue? Does improper biomedical waste management cause hazards to health care personnel? Why is there so much hue and cry about hospital waste? All over the country, unsegregated and untreated biomedical waste is being indiscriminately discarded into municipal bins, dump sites, on roadsides, in water bodies or is being incompletely and improperly burnt in the open. All this is leading to rapid proliferation and spreading of infectious, dangerous and fatal communicable diseases like hepatitis, AIDS and several types of cancers. In urban and rural areas alike, incidence and prevalence of several such human diseases has increased and the per capita medical expenditure has also gone high several folds. Although, yet to be proven, morbidity or illness amongst both urban and rural dwellers has increased albeit for different reasons. The Ministry of Environment and Forests, Govt. of India has notified the Biomedical Waste (Management and Handling) rules 1998 with subsequent amendments (June 2nd 2000 and September 2003). However, only 5-10% of institutions in the country have implemented the Rules or are following them at present. Unfortunately, some western countries, in the garb of managing their biomedical wastes, are adding to our problems by exporting their wastes to poorer countries. The improper handling, treatment, storage, transport and disposal of waste can lead to serious problems like: The entire waste from a healthcare establishment, which includes non-infectious as well as infectious waste, if unsegregated and untreated is mixed with the rest of the waste in a healthcare establishment, will convert the entire non infectious general waste (75-80%) also into infectious waste. The indiscriminate disposal of sharps within and outside institutions leading to occupational hazards like needle stick injuries, cuts, and infections among hospital employees, municipal workers and ragpickers. Injuries due to the sharp especially among ragpickers and hospital / municipal workers increases the incidence of Hepatitis B, C, E and HIV among these groups who transmit these diseases to others in the community and also succumb to such fatal diseases.
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Undestroyed needles and syringes being circulated back to us (Recycling), through unscrupulous traders who employ the poor and the destitute to collect such waste for repackaging and selling in the market. Reuse of disposable like syringes, needles, catheters, IV and dialysis sets are causing spread of infection from healthcare establishments to the general community. Disposal of hospital waste and veterinary hospital waste in municipal dumpsite resulting in animals especially cows feeding on the blood soaked cotton and plastics, and this in turn leading to diseases like bovine tuberculosis which through milk can infect humans. The indiscriminate dumping of untreated hospital waste in municipal bins increasing the possibility of survival, proliferation and mutation of pathogenic microbial population in the municipal waste. This leads to epidemics and increased incidence and prevalence of communicable diseases in the community. Incidence and prevalence of diseases like AIDS, Hepatitis B&C tuberculosis and other infectious diseases increasing due to inappropriate use, storage, treatment, transport and disposal of biomedical waste. Chances of vectors like cats, rats, mosquitoes, files and stray dogs getting infected or becoming carriers which also spread diseases in the community. What are the benefits of proper biomedical waste management? Scientific Waste management leads to cleaner and healthier surroundings. reduction in the incidence of hospital acquired and general infections. reduction in the cost of infection control within the hospital. reduction in the possibility of disease and death due to reuse and repackaging of infectious disposables. low incidence of community and occupational health hazards. reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste. improved image of the healthcare establishment and increase the quality of life. Why should I segregate waste? There is an urgent need to keep the infectious waste separate from non-infectious waste. This is because the infectious waste which is only 10-15%, if mixed with non-infectious waste which is 80-85% can render the entire waste infectious. Segregation of waste at the source of generation also helps in minimizing the amount of waste to be treated besides enabling more efficient treatment of each category of waste. For example, the anatomical waste and animal carcasses, if segregated, are the only types of waste which need to be incinerated according to the Biomedical Waste Rules. Similarly, biomedical plastics can be autoclaved if separated at source just like biomedical glass and metal sharps. The last three categories, in fact, can be sold to recyclers if properly sterilized, shredded and washed. Such a management is possible only if biomedical waste is segregated at source. General waste too can be managed effectively within healthcare establishments if separated into dry, non-infectious waste for recycling and wet waste for composting. Are there colour codes for segregation? Yes, the waste has to be segregated in colour coded liners placed in bins of appropriate size. Yellow for infectious waste, like anatomical, pathological, soiled dressings like gauze, cotton, linen, etc. contaminated with blood or other body fluids. Red for infected plastics like IV sets, tubings, catheters micro-biological waste etc. Stainless steel or Translucent puncture proof container for metal sharps. Blue for Glass Black for cytototoxic drugs, incinerator ash, chemical waste and expired medicines. White for all sorts of non-infected general waste which are dry and recyclable.
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Green for collecting and transporting of food waste from wards, canteens and dining halls. What are Sharps? Sharps consist of Needles, Scalpels, Blades, Broken Glass, etc., which have the capability to injure by piercing and cutting through the skin. What is Needle Stick Injury? Injuries caused by used or unused needles while treating patients or performing related activities which can lead to infection, are generally known as Needle Stick Injuries (NSI). What are Infectious waste? Infectious wastes are those biomedical wastes which contain sufficient population of infectious agents that are capable of causing and spreading infections among people, livestock and vectors. Infectious wastes include human tissues, anatomical waste, organs, body parts, placenta, animal waste (tissue / cell cultures), any pathological / surgical waste, microbiology and biotechnology waste (cultures, stocks, specimens of micro-organism, live or attenuated vaccines, etc.), cytological, pathological wastes, solid waste (swabs, bandages, mops, any item contaminated with blood or body fluids), infected syringes, needles, other sharps, glass, rubber, metal, plastic disposables and other such wastes. What are Infected / Infectious plastics? Infected plastics are those biomedical plastics which have been used for administering patient care or for performing related activities and may contain blood or body fluids or are suspected to contain infectious agents in sufficient number which may lead to infections among other humans or animals. These generally include IV tubes / bottles, tubings, gloves, aprons, blood bags / urine bags, disposable drains, disposable plastic containers, endo-tracheal tubes, microbiology and biotechnology waste and other laboratory waste. What is cytotoxic waste? Cytotoxic substances, as the word suggests are toxic to cells and are often anti-neoplastic which inhibit cell growth and multiplication. These drugs when come in contact with normal cells can damage them and cause severe disability or even death of those affected. These drugs could be present in the waste generated from the treatment of cancer patients or from other work related to testing and control of cancerous cells. How do I dispose sharps? Sharps should not be recapped or bent. The best way to treat sharps is to first clean them, aspirate the syringe and needle with 1% bleach solution, then keep them horizontally in a tray containing 1% bleach for 2 hours. Thereafter, the syringe with the needle can be expunged of liquid and the needle cut or cauterized in a mechanical / electrical needle cum syringe cutter / destroyer wherein the nozzle of the disposable syringe is also cut. Thereafter, the cut needles or sharps can be disposed in a sharp pit, or could be encapsulated in Plaster of Paris, concrete etc. The disposable syringes can be sent for recycling while the glass syringes can be sterilized and reused. Which is the ideal dustbin to dispose waste? The bin should essentially have a lid preferably the one which closes automatically, should be coloured coded or wherein a coloured liner can be placed, non-perforated and of a proper size. Should I use plastic liners for separate collection of source segregated wastes in my healthcare establishment? Yes, you could, especially if the waste being collected is infectious waste and you want to prevent leakage. The bag or liner should be made of non-chlorinated plastics especially if it is to be incinerated. Alternatively, sturdy boxes with inner lining could be used such, for example, cardboard boxes and latex lining or sturdy paper or draw sheet bags which are leak proof or having a lining of degradable wax, latex, etc. which may also prevent leakage effectively. General waste could be disposed off in ordinary cardboard boxes and kitchen wastes can be collected in sturdy containers without liners and later composted. How long am I allowed to store waste in my healthcare establishment?
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You are allowed to store infectious waste in your HCE only for 48 hours during which period the waste should be treated and made non-infectious. What is a Common Waste Treatment Facility? A common Medical Waste Treatment Facility ensures safe collection, transportation, treatment and disposal of biomedical waste by either an entrepreneur, a co-operative or the government on a pay and use basis. The Common Medical Waste Treatment Facility is normally established in the outskirts of the city or town and the medical waste collected from different healthcare establishments is brought to the facility for treatment and disposal in a cold storage van. Can waste be transported in any vehicle? Wastes have to be transported according to the Motor Vehicle Act which prescribe standards for the transport of hazardous wastes. This specifies that the vehicle should be a covered one with proper markings to indicate that infectious bio-medical wastes are being transported in it. Besides, the vehicle may have to be refrigerated in case the ambient temperature is very high as in the summers and the wastes have to be transported over long distances for a substantial period of time. It may also be useful to have different compartments to separate infectious wastes from general wastes and to avoid contamination. What is the service fee that I have to pay to the Common Facility provider? The service charge collected ranges from Rs. 2.50 - 4.00/bed/day in most places in the country when the service provider caters to about 10,000 beds irrespective of the bed occupancy. In some cases, charging on kilogram basis has been tried out but this often leads to illegal burning of wastes to reduce quantity. The service provider has to be consulted for further details. After handing over the waste to the Common Facility provider, does my responsibility end? No, if there is any negligence in the waste collection, transport, treatment or disposal, the occupiers still have to own the responsibility for it. Can I hand over the General Waste of the hospital to the Municipal Authorities? Yes, you can but only if you have segregated it at source and it is not contaminated. Remember, even food waste can be contaminated. So, if you suspect that any kind of waste is contaminated and infectious, first treat it appropriately - not just routinely but make sure the waste is actually decontaminated and no longer a health hazard. Thereafter, you can hand over the same to the municipal authorities. Normally infectious waste cannot be so easily decontaminated within the healthcare establishment and thats the reason the common facility operator picks up your infectious waste and transports it in a safe way to an offsite facility and treats and decontaminates the waste. However, if your HCE is remote and has been allowed to have onsite facility / facilities to properly decontaminate and treat the different kinds of wastes generated in your HCE, then you can hand over the treated hospital waste to the municipal authorities for secured land filling and to recyclers for recycling. From where do I get the list of equipment manufacturers for biomedical waste management? The list could be available with the pollution control boards, NGOs, Regional Indian Medical Association (IMAs) and other individuals and institutions active in the field in your respective regions or States. Who is permitted to use deep burial for infectious wastes? According to the BMWM rules, only towns having a population of less than five lakhs are permitted to use deep burial as an option for treating their infectious wastes. The deep burial pit must be about 6.5 feet (2 meters) deep and every time wastes are put into it, it must be covered with a layer of soil. When the pit is three-fourths full, lime is added and again covered with soil. The pit should be away from aquifers and the depth of the pit is governed by the height of the water table in the particular area. The pit should be covered with a meshed door to keep it protected from animals and birds. How do I minimize waste? By source reduction (avoiding wastage)
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By using sterilizable reusables wherever possible (e.g. using sterilizable glass ware, stainless steel, etc.), changing purchasing policy (purchasing non-PVC health care equipment), segregating at source (separating biomedical plastics, glass, metal at source for autoclaving and shredding each category separately before recycling), stock management (inventoring regularly and replacing IV fluids, blood and drugs so that there is no wastage due to spoilage). How do I treat the wastes with multiple characteristics? There are some wastes with multiple characteristics that fall into more than one category e.g. Radioactive sharps, plastic IV tubes with cytotoxics etc. They need to be managed with caution. These wastes should be treated first for the hazardous waste component and once the hazard is removed, then it can be categorized as infectious metal sharps, glass, plastic, pathological etc., and treated accordingly. Where and how do I dispose the insulin syringes used in my home? A small manual needle and syringe cutter could be used for cutting the needles and the nozzle of the syringe. The cut needles could be put into any used puncture proof container available in homes and the cut syringes stored in a cardboard box with preferably a red liner or a red coloured sticker outside any liner. Both the puncture proof container and the cardboard box should be handed over to the nearest clinic or nursing home for handling over to a common waste treatment facility collector. What do I do when there is spillage of mercury? Mercury is a hazardous substance which should not be incinerated or disposed in water bodies. Hence if there is a spillage of mercury, the spill should be sucked into a syringe without needle and stored under water in a test tube or vial. Mercury being heavier will sink to the bottom. The water may be drained off and the mercury can be sent for recycling or reuse in manufacture of thermometers etc.
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What happens if Plastics are dumped in an Incinerator? Plastics, especially chlorinated plastics, when incinerated at low temperature release toxic carcinogenic gases like Dioxins and Furans which can be estimated by the amount of HCL gas in the emissions. Are there standards of liquid wastes / effluents generated from hospitals? Yes, the standards for liquid wastes and effluents are described in the BMWM rules and all healthcare establishments are required to follow these rules. Disinfect / decontaminate liquid wastes before discharge into sewers. Health Care Establishments are connected to ETPs or sewage treatment plants. What if my healthcare establishment does not comply with the BMWM Rules? In case of failure to comply with the rules, the Administrator is punishable, with an imprisonment for a term which may extend upto 5 years or with a fine which may amount to One lakh rupees, or both, and in case the failure of compliance continues, with additional fine which may amount to 5000 rupees for every day during which the failure or contravention continues, after the conviction for the first such failure or contravention. If failure or contravention continues beyond a period of one year, the Health Care Establishments shall be punishable for a (imprisonment) term, which may extend upto 7 years. What about Government healthcare establishments? Fixed criminal liability lies on the Heads of Department of Government hospitals where an offence is committed by the concerned department and the Head of the Department is not able to prove that the offence was committed without his/her knowledge or that he/she exercised all due diligence to prevent the commission of such offence. Also any officer, other than the Head of Department shall be liable to be prosecuted against and punished accordingly if found negligent. Apart from the segregating and disposing aspects, do I have to maintain any records? Yes.
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An Annual Report has to be submitted to the State Pollution Control Board by 31st of January every year, which includes the categories of waste generated and their quantities. So this involves daily quantification of waste. The Air and Water consent forms should also be filed every year. 2. Every authorized person has to maintain records related to generation, collection, reception, storage, transportation, treatment, disposal and / or any form of handling of biomedical waste, and be subject to inspection and verification at any time. 3. If any accident occurs in any institution or the common facility site, the authorized person is required to report and maintain records in the stipulated form. 4. Payment of authorization fee should be prompt and regular. Receipt should be maintained too. What is authorization fee? This is for grant of authorization for generating waste, which has to be treated onsite or in a common facility. The authorization fee to the tune of Rs. 7,500/- has to been deposited alongwith form, then authorization is granted for a period of three years, or as the case may be, including an initial trial period of one year from the date of issue, by the State Pollution Control Board or Committee. Who is a Prescribed authority? An authority prescribed by the Central / State government for implementing the biomedical waste management rules is the designated prescribed authority in that state. The State Pollution Control Board is the Prescribed Authority in case of States and the Pollution Control Committee in case of Union Territories. Who is responsible for Hospital Waste Management? It anyway doctors, Nurses or cleaning staff? It is a collective initiative and shared responsibility of all viz. doctors, nurses, paramedical staff, cleaning staff, all employees and administrators. What safety precautions one should take ? All personnel should be made aware and trained regarding biomedical waste. Prophylactic immunization to staff against Hepatitis B and Tetanus. Accident reporting should be on the proper proforma to the authorities. Spillages should be investigated and recurrence prevented. Personal should be protected with gloves, caps, masks, gum boots and preferably aprons.
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What is sharp injury and how to tackle it ? Accidental injury or break in skin produced by any sharps. The commonest cause are improper segregation and improper local treatment. The easy ways to tackle it are stop procedure and wash with soap and water, encourage bleeding and apply antiseptic, immediately report to designated person, retain the source of tracking.
3. Waste Management Policy

OBJECTIVES The Bio-Medical Waste Management policy at an institution has to be framed to meet the following broad objectives : (i) (ii) (iii) (iv) (v) (vi) Changing an age old mind set and attitude through knowledge and training. Defining the various categories of waste being generated in the hospital/health care institution. Segregation and collection of various categories of waste in different containers, so that each category is treated in a suitable manner to render it harmless. Identifying and utilizing proper treatment technology depending upon the category of waste. Creating a system where all categories of personnel are not only responsible, but also accountable for proper waste management. Changing the use patterns from single usage to multiple usage whenever possible.
POLICY STATEMENT Summing up, the policy statement aims to provide for a system for management of all potentially infectious and hazardous wastes in accordance with the Bio-Medical Waste (Management and Handling) Rules 1998. NEED FOR BIO-MEDICAL WASTE MANAGEMENT (a) (Statutory) Legal Obligation : In accordance to the provisions of the Bio-Medical Waste (Management and Handling) Rules 1998, deadline for bigger hospitals was set up for 31st December 1999, by which the rules must be conformed with, failing which legal action could be initiated. Health hazards associated with improper hospital waste management: A number of hazards and risks are associated with this viz. Injuries from sharps to all categories of hospital personnel and waste handlers. Nosocomial infections in patients from poor infection control and poor waste management. Risks of infections outside hospitals for waste handlers, scavengers, and (eventually) the general public. Risks associated with hazardous chemicals, drugs, being handled by persons handling wastes at all levels. Environmental hazards : Improper hospital waste management also results in air, water and soil pollution, especially due to imperfect treatment and faulty disposal methods.
(b)
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DEFINITIONS It is important to know the definitions so to understand the categorization and other steps of waste management subsequently. (a) Bio-Medical Waste : May be defined as any solid, fluid or liquid waste, including its container and any intermediate product, which is generated during its diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the
production or testing of biological and the animal wastes from slaughter houses or any other like establishments. (b) Medical Waste : Is a term used to describe any waste that is generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals. Clinical Waste: Is defined as any waste coming out of medical care provided in hospitals or other medical care establishments, but does not include waste generated at home. Hospital Waste: Refers to all waste, biological or non-biological that is generated from a hospital, and is not intended for further use. Pathological Waste: Is defined as waste removed during surgery/autopsy or other medical procedures including human tissues, organ, body parts, body fluids and specimens along with their containers. Infectious Waste: Refers to that portion of Bio-Medical Waste which may transmit viral, bacterial or parasitic diseases, if concentration and virulence of pathogenic organisms is sufficiently high. Hazardous Waste: Refers to that portion of Bio-Medical Waste which has a potential to cause hazards to health and life of human beings. Radioactive Waste : Which includes waste contaminated with radio nucleotides. It may be solid, liquid or gaseous waste. These are generated from in-vitro analysis of body fluids and tissues, in-vitro imaging and other therapeutic procedures. Pressurized Waste : include compressed gas cylinders, aerosol cans and disposable compressed gas containers. General Waste : includes general domestic type of waste from offices, public areas, stores, catering areas, comprising of newspapers, letters, documents, cardboard containers, metal cans, floor sweepings and also includes kitchen waste. Recyclable Waste : includes the items like Glass after cleaning and disinfection, paper, corrugated cardboard, aluminum, X-ray film, reclaimed silver from X-ray developing solution, Plastics after disinfection and shredding.
(c) (d) (e)
(f) (g) (h)
(i) (j)
(k)
CATEGORIZATION OF BIO-MEDICAL WASTES Bio-Medical waste have been categorized into ten different categories as mentioned in the table below : OPTION WASTE CATEGORY WASTE CONTENT No.1 No.2 Human Anatomical Animal Wastes (human tissues, organs, body Wastes parts) (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, discharge from hospitals, animals houses) (waste from laboratory cultures, stocks or specimens of microorganisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, waste from production of biologicals, toxins, dishes and devices used for transfer of cultures) (needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps).
No.3
Microbiology & Biotechnology Waste
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Waste Sharps
No. 5 No. 6
Discarded Medicines Solid Waste (a)
(waste comprising of outdated, contaminated and discarded medicines) (items contaminated with blood, and body fluids including cotton, dressings, solid linen, plaster casts, linen, beddings, other material contaminated with blood) (Wastes generated from disposable items other than the waste sharps such as tubings, catheters, intravenous sets etc.) (waste generated from laboratory washing, cleaning, house-keeping and disinfecting activities) (ash from incineration of any bio-medical waste)
No. 7 No.8 No.9 No.10
Solid Waste (b) Liquid Waste Incineration Ash Chemical Waste
(chemicals used in production of biological, chemicals used in disinfection, as insecticides, etc.) HOSPITAL WASTE MANAGEMENT COMMITTEE
A Hospital Waste Management Committee has to be established in each hospital with a view to improve and streamline Waste Management in hospitals and for proper implementation of Bio-Medical Waste Management Rules 98, under the chairmanship of the Medical Superintendents. It is a broad based committee with representatives from hospital administration, clinical departments, pathology and microbiology departments and has powers to take decisions on all matters relating to Bio-Medical Waste Management in their respective hospitals. This smaller core group is responsible for implementation of these rules. The responsibilities of the various categories of the staff involved in the generation, transportation, collection, treatment and disposal of wastes are formulated and implemented by this committee. OPERATIONAL ASPECTS The practical operational aspects regarding the proper management of Bio-Medical Wastes has been described as under:-
EC activities Board displaying messages in Hindi and English in patient care areas.
(A) Generation of Wastes : The following table depicts wastes generated at GMC Hospitals : Type (i) Non-Hazardous (General) Site of Generation Disposal by
Office, Kitchen Municipal/ Cafeteria, Billing, Civic Authorities Administration, Cashier, Rest rooms Hostels, Residential areas, Pantries in wards, Stores, etc.
(ii) Hazardous station, toxic)
Wards, Treatment GMC-as per Bio-Infectious and Medical Waste Rules Isolation rooms, Operation theatres, Intensive Care Units & post operative recovery room, Minor OTs, Blood Bank, Pharmacy & Medical Stores, All laboratories, Pharmacology OPDs Injection rooms and procedure rooms, Dialysis and Endoscopy rooms, CT Scan, MRI rooms & various followup clinics
room, nursing
Quantum of Wastes : Studies carried out have indicated that about 2 Kg. of wastes are generated per bed per day which gives an idea about the tremendous volume of waste generated on a day to day basis. (B) Segregation of Wastes : Segregation or the separation of different types (categories) of waste by sorting out at the point of generation, has been considered as the key for the entire process as it allows special attention to even the relatively small quantities of infections and hazardous waste, thus reducing the risks and cost of waste management. Conversely small errors at this stage can create lot of subsequent problems. It is now universally accepted that segregation is the responsibility of the generator of wastes i.e. the doctor, nurse or para-medical personnel. However, in reality, this job is always relegated to the sanitation staff; and it becomes a truly Herculean task to segregate or sort out various categories, once they have been mixed up.
Placement of black bins (50 lts, 100 lts) in the wards
Infectious waste
segregate the waste generated at source and put in appropriate container. Sharps like needles should be destroyed by using the needle destroyer. Syringes should be put in puncture proof container with 1% Sod. Hypochlorite Solution.
Nurse demonstrating functioning of Needle destroying unit.

(C)
Staff Nurse cutting the dripset to prevent the recycling.
Collection of Waste : Collection of Bio-Medical Wastes should be done in colour coded plastic bags as mentioned in the earlier table as per rules. There is a need to be vigilant so that intermixing of different categories of the dire waste does not occur inadvertently by the patients, attendants or visitors. The containers for collection should be strategically located at all points of generation as mentioned in the earlier table.
Operational Aspects: From these sites, the sanitation staff of the centralized gang should collect the waste during morning and afternoon, under supervision of the staff nurse and sanitation supervisor.
The process of collection should be documented in a register, the coloured polythene bags replaced and the garbage bin should be cleaned with the disinfectant regularly. (D) Storage of Waste : Storage refers to the holding of Bio-Medical Waste for a certain period of time, after which it is sent for treatment and disposal. In other words it means the duration of time for which waste is kept at the site of generation and transit treatment and final disposal is done.
Annexure - I
THE BIO-MEDICAL WASTE (MANAGEMENT & HANDLING) RULES, 1998 MINISTRY OF ENVIRONMENT AND FORESTS
NOTIFICATION New Delhi, the 20th July, 1998 S.O. No. 630...(E).... - Whereas a notification in exercise of the powers conferred by Sections 6, 8 and 25 of the Environment (Protection) Act,1986 (29 of 1986) was published in Gazette vide S.O. 746 (E) dt. 16th October, 1997 inviting objections from the public within 60 days from the date of the publication of the said notification on the Bio-Medical Waste (Management and Handling) Rules, 1998 and whereas all objections received were duly considered. Now, therefore, in exercise of the powers conferred by section 6, 8 and 25 of the Environment (Protection) Act,1986 the Central Government hereby notifies the rules for the management and handling of bio-medical waste. 1. SHORT TITLE AND COMMENCEMENT : (1) (2) 2. These rules may be called the Bio-Medical Wastes (Management and Handling) Rules, 1998 They shall come into force on the date of their publication in official Gazette.
APPLICATION These rules apply to all persons who generate, dispose, or handle bio medical waste in any form. collect, receive, store, transport, treat,
3.
DEFINITION In these rules unless the context otherwise requires : i. Act means the Environment (Protection) Act, 1986 (29 of 1986) ii. Animal House means a place where animals are reared/kept for experiments or testing purposes; iii. Authorisation means permission granted by the prescribed Authority for the generation, collection, reception, storage, transportation, treatment, disposal and/ or any other form of handling of bio-medical waste in accordance with these rules and any guidelines issued by the Central Government. Authorised person means an occupier or operation authorised by the prescribed authority to generate, collect, store, transport, treat, dispose and/or handle bio-medical waste in accordance with these rules and any guidelines issued by the Central Government. Bio-medical waste means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories mentioned in Schedule-I. Biologicals means any preparations made from organisms or micro-organisms or products of metabolism and biochemical reactions intended for use in diagnosis, immunization or the treatment of human beings or animals in research activities pertaining thereto;
iv.
v.
vi.
vii. viii.
Bio-medical waste treatment facility means any facility wherein treatment, disposal of bio-medical waste or processes incidental to such treatment or disposal is carried out. Occupier in relation to any institution generating bio-medical waste, which includes a hospital nursing home, clinic dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called, means a person who has control over that institution and/or its premises; Operator of a bio-medical waste facility means a person who owns or controls or operates a facility for the collection, reception, storage, transport, treatment, disposal or any other form of handling of bio-medical waste; (16) Schedule means schedule annexed to these rules;
ix.
4.
DUTY OF OCCUPIER It shall be the duty of every occupier of an institution generating bio-medical waste which includes a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank by whatever name called to take all steps to ensure that such waste is handled without any adverse effect to human health and the environment.
5.
TREATMENT AND DISPOSAL 1. 2. Bio-medical waste shall be treated and disposed off in accordance with Schedule I and in compliance with the standards prescribed in Schedule-V. Every occupier, where required, shall set up in accordance with the time-schedule in Schedule-VI, requisite bio-medical waste treatment facilities like incinerator, autoclave, microwave system for the treatment of waste, or ensure requisite treatment of waste at a common waste treatment facility or any other waste treatment facility.
6.
SEGREGATION, PACKAGING, TRANSPORTATION AND STORAGE 1. 2. Bio-medical waste shall not be mixed with other wastes. Bio-medical waste shall be segregated into containers/ bags at the point of generation in accordance with Schedule-II prior to its storage, transportation, treatment and disposal. The containers shall be labelled according to Schedule-III. If a container is transported from the premises where bio-medical waste is generated to any waste treatment facility outside the premises, the container shall, apart from the label prescribed in Schedule-III, also carry information prescribed in Schedule-IV. Notwithstanding anything contained in the Motor Vehicles Act, 1988, or rules thereunder, untreated bio-medical waste shall be transported only in such vehicle as may be authorised for the purpose by the competent authority as specified by the government. No untreated bio-medical waste shall be kept stored beyond a period of 48 hours.
3.
4.
5.
iii.
7. PRESCRIBED AUTHORITY 1. The Government of every State and Union Territory shall establish a prescribed authority with such members as may be specified for granting authorisation and implementing these rules. If the prescribed authority comprises of more than one member, a chairperson for the authority shall be designated. The prescribed authority for the State or Union Territory shall be appointed within one month of the coming into force of these rules. The prescribed authority shall function under the supervision and control of the respective Government of the State or Union Territory.
2. 3.
4.
The prescribed authority shall on receipt of Form-I make such enquiry as it deems fit and if it is satisfied that the applicant possesses the necessary capacity to handle bio-medical waste in accordance with these rules, grant or renew an authorisation as the case may be. An authorisation shall be granted for a period of three years, including an initial trial period of one year from the date of issue. Thereafter, an application shall be made by the occupier/operator for renewal. All such subsequent authorisation shall be for a period of three years. A provisional authorisation will be granted for the trial period, to enable the occupier/operator to demonstrate the capacity of the facility. The prescribed authority may after giving reasonable opportunity of being heard to the applicant and for reasons thereof to be recorded in writing, refuse to grant or renew authorisation. Every application for authorisation shall be disposed of by the prescribed authority within ninety days from the date of receipt of the application. The prescribed authority may cancel or suspend an authorisation, if for reasons, to be recorded in writing, the occupier/operator has failed to comply with any provision of the Act or these rules; Provided that no authorisation shall be cancelled or suspended without giving a reasonable opportunity to the occupier/ operator of being heard.
5.
6.
7. 8.
AUTHORISATION (1) Every occupier of an institution generating, collecting, receiving, storing, transporting, treating, disposing and/or handling bio-medical waste in any other manner, except such occupier of clinics, dispensaries, pathological laboratories, blood banks providing treatment/ service to less than 1000 (one thousand) patients per month, shall make an application in Form I to the prescribed authority for grant of authorisation. (2) Every operator of a bio-medical waste facility shall make an application in Form-I to the prescribed authority for grant of authorisation. (3) Every application in Form-I for grant of authorisation shall be accompanied by a fee as may be prescribed by the Government of the State or Union Territory.
ADVISORY COMMITTEE The Government of every State/Union Territory shall constitute an advisory committee. The committee will include experts in the field of medical and health, animal husbandry and veterinary sciences, environmental management, municipal administration, and any other related department or organisation including non-government organisations. The State Pollution Control Board/Pollution Control Committee shall be represented. As and when required, the committee shall advise the Government of State/Union Territory and the prescribed authority about matters related to the implementation of these rules. 10. ANNUAL REPORT Every occupier/operator shall submit an annual report to the prescribed authority in Form-II by 31st January every year, to include information about the categories and quantities of bio-medical wastes handled during the preceding year. The prescribed authority shall send this information in a compiled form to the Central Pollution Control Board by 31st March every year. 11. MAINTENANCE OF RECORDS (1) Every authorised person shall maintain records related to the generation, collection, reception, storage, transportation, treatment, disposal and/or any form of handling of biomedical waste in accordance with these rules and any guidelines issued. (2) All records shall be subject to inspection and verification by the prescribed authority at any time.
9.
12.
ACCIDENT REPORTING
When any accident occurs at any institution or facility or any other site where bio-medical waste is handled or during transportation of such waste, the authorised person shall report the accident in Form-III to the prescribed authority forthwith. APPEAL Any person aggrieved by an order made by the prescribed authority under these rules may, within thirty days from the date on which the order is communicated to him, prefer an appeal to such authority as the Government of State/Union Territory may think fit to constitute; Provided that the authority may entertain the appeal after the expiry of the said period of thirty days if it is satisfied that the appellant was prevented by sufficient cause from filing the appeal in time. SCHEDULE-I (See Rule - 5) Categories of Bio-Medical Wastes
Option Category No. 1 Category No. 2 Waste Category Human Anatomical Wastes (Human tissues, organs, body parts) Animal Waste (Animal tissue, 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) Microbiology & Biotechnology Waste (Wastes from laboratory, culture stocks incineration specimens of microorganisms, 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 dishes and devices used for transfer of cultures) Waste Sharps (Needles, syringes, scalpers, blades, puncture and cuts. This includes both used and unused sharps) Category No. 5 discarded medicines) Category No. 6 cotton, dressings, landfills Solid Wastes (Items contaminated with blood, and and drugs disposal in other material contaminated with blood) Category No. 7 Solid Waste (Wastes generated from disposable items other than the waste sharps such as tubings, catheters, intravenous Disinfection by chemical treatment@@ autoclaving/ micro waving and mutilator Discarded Medicines and Cytotoxic drugs (Wastes comprising outdated, Treatment & Disposal incineration@ deep burial* incineration@ deep burial*
13.
Category No.3@
local autoclaving microwaving
Category No. 4 capable of causing
Disinfection(chemical treatment @/@ autoclaving/microwaving and mutilation/shredding Incineration@ /destruction drug disposal in secured
glass etc.
that are
contaminated landfills.
and
incineration@ /destruction body fluids including solid plaster casts, lines, beddings, secured
sets etc.) shredding
Category No. 8
Liquid Wastes (Wastes generated from laboratory and washing cleaning, house-keeping and charge into drains. Incineration ash (Ash from incineration of any fill. Chemical Wastes (Chemicals used in production of liquid and secured landfill
Disinfection by chemical treatment @@ and dis-
disinfecting
activities.
Category No. 9
Disposal on municipal landChemical treatment@@ and discharge into drain for disinfection, insecticides etc.)
bio-medical wastes)
Category No. 10
biologicals, chemicals used in for solids
@@ == @ *
Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection. Mutilation/shredding must be such so as to prevent unauthorised reuse. There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas.
SCHEDULE - II (See rule 6) COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIO-MEDICAL WASTES ------------------------------------------------------------------------------------------Colour Coding Type of Container Waste Category Treatment Options as per Schedule-I ------------------------------------------------------------------------------------------Yellow Plastic bag Cat.I,2,3 & 6 Incineration deep burial Red Disinfected Cat.3, 6 & 7 Autoclaving/ container/plastic Microwaving bag Chemical Treatment Blue/White translucent Plastic bag puncture proof container Cat.4 & 7 Autoclaving/ Microwaving Chemical Treatment & destruction/ shredding
Disposal in secured landfil ------------------------------------------------------------------------------------------Note : 1. Colour coding of waste categories with multiple treatment options as defined in Schedule-I shall be selected depending on treatment option chosen, which shall be as specified in Schedule-I. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics. Categories 8 and 10 (solid) do not require containers/bags. Category 3 if disinfected locally need not be put in containers/bags. SCHEDULE-III
Black
Plastic bag
Cat. 5,9 & Cat. 10 (solid)
2. 3. 4.
(See Rule 6) LABEL FOR BIO-MEDICAL WASTE CONTAINERS BIOHAZARD SYMBOL CYTOTOXIC HAZARD SYMBOL
HANDLE WITH CARE Note : Lable shall be non-washable and prominently visible. SCHEDULE-IV LEGAL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS BAGS Day.......... Month......... Year.............................. Date of genertion.......... Waste category no........ Waste class.............. Waste description........ Senders name and address Phone no................. Telex no................. Fax no................. Contact person........... In case of emergency please contact: Name and address : Phone No.: Note :
Receivers Name & address Phone no.............. Telex no.............. Fax no................ Contact person........
Label shall be non-washable and prominently visible SCHEDULE-V STANDARDS FOR TREATMENT AND DISPOSAL OF BIO-MEDICAL WASTES STANDARDS FOR INCINERATORS All incinerators shall meet the following operating and emissions standards: A. Operating Standards : 1. 2. Combustion efficiency (CE) shall be atleast 99.99% It is computed as follows : % CO2 C.E. = x 100 % CO2 + % CO The temperature of the Primary chamber shall be 800 + 50C The secondary chamber gas residence time shall be at least 1 (one) second at 1050 + 50C with minimum 3% oxygen in the stack gas formation.
3. 4. B.
Emission standards : Parameters Concentration mg/Nm3 1. Particulate matter 100 2. Nitrogen Oxides 400 3. HCl 050 4. Minimum stack height shall be 30 meters above ground
5. Note:
Volatile organic compounds in ash shall not be more than 0.01% Suitably designed pollution control devices should be installed/ retrofitted with the incinerator to achieve the above emission limits. All wastes to be incinerated shall not be chemically treated with any chlorinated disinfectants. Toxic meals in incineration ash shall be limited within the regulatory quantities as defined under the Hazardous Waste (Management and Handling Rules), 1989. Only low sulphur fuel like L.D.O./L.S.H.S./Diesel shall be used as fuel in the incinerator.
STANDARDS FOR WASTE AUTOCLAVING The autoclave should be dedicated to the purpose of disinfecting and treating bio-medical waste. I. When operating a gravity flow autoclave, medical waste shall be subjected to: i. ii. iii. II. a temperature of not less than 1200C and pressure of 15 lbs per square inch (psi) for an autoclave residence time of not less than 60 minutes; or a temperature of not less than 1350C and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes; or a temperature of not less than 1490C and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes.
When operating a vacuum autoclave, medical waste shall be subjected to a minimum of one prevacuum pulse to purge the autoclave of all air. The waste shall be subjected to the following: i. ii. a temperature of not less than 1210C and pressure of 15 psi per an autoclave residence time of not less than 45 minutes; or
III.
IV.
V.
VI.
a temperature of not less than 1350C and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes. Medical waste shall not be considered 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. 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. Validation test: 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 Bacillus stearothermophilus spores using vials or spore strips, with at least 1 x 10" spores. Under no circumstances, will an autoclave haveminimum operating parameters less than a residence time of 30 minutes, regardless of temperature and pressure, a temperature less than 1210C or a pressure less than 15 lbs psi. Routine test: A chemical indicator strip 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 location to ensure that the inner context of the package has been adequately autoclaved.
STANDARDS FOR LIQUID WASTE The effluent generated from the hospital should conform to the following limits:
Parameters Permissible limits pH 6.5 - 9.0 Suspended solids 100 mg/1 Oil and Grease 10 mg/1 BOD 30 mg/1 COD 250 mg/1 Bio-assay test - 90% survival of fish aster 96 hours in 100%effluent * the limits are applicable those hospitals which are connected with sewers without terminal sewage treatment plant or not connected to public sewers. For discharge into public sewers having terminal facility, the general standards as notified under the Environment (Protection) Rules, 1986 shall be applicable. STANDARDS OF MICROWAVING 1. Microwave treatment shall not be used for cytoxic, hazardous or radioactive wastes, contaminated animal carcasses, body parts, and large metal items. 2. The microwave system shall comply with the efficacy test/routine tests and a performance guarantee may be provided by the supplier before operation of the unit. 3. The microwave should completely and consistently kill the approved biological indicator at the maximum design capacity of each microwave unit. Biological indicators for microwave shall be Bacillus subtilis spores using vials or spore strips, with at least 1 x 10 spores per milliliter. STANDARDS FOR DEEP BURIAL 1. A pit of trench should be dug about 2 meters deep. It should be half filled with waste, then covered with limit within 50 cm of the surface, before filling the rest of the pit with soil. 2. It must be ensured that animals do not have any access to burial sites. Covers of galvanized iron/wire meshes may be used. 3. On each occasion, when wastes are added to the pit, a layer of 10 cm. of soil shall be added to cover the wastes. 4. Burial must be performed under close and dedicated supervision. 5. The deep burial site should be relatively impermeable and no shallow well should be close to the site. 6. The pits should be distant from habitation, and sited so as to ensure that no contamination of any surface or ground water occurs. The area should not be prone to flooding or erosion. 7. The location of the deep burial site will be authorised by the prescribed authority. 8. The institution shall maintain a record of all pits for deep burial. SCHEDULE - VI (See rule 5) SCHEDULE FOR WASTE TREATMENT FACILITIES LIKE INCINERATOR/ AUTOCLAVE/MICROWAVE SYSTEM A. B. Hospitals and nursing homes in towns by 31st December 99 with population of 30 lakhs and above or earlier Hospitals and nursing homes in towns with population of below 30 lakhs: a. with 500 beds and above by 31st Dec.99 or earlier b. with 200 beds and above but less by 31st Dec.2000 than 500 beds or earlier c. with 50 beds and above but less by 31st Dec.2001 than 200 beds or earlier d. with less than 50 beds by 31st Dec.2002
C.
All other institutions generating biomedical waste not included in A and B above
or earlier by 31st Dec.2002 or earlier
FORM - I (See rule 8) AUTHORISATION APPLICATION (To be submitted in duplicate) To, The Prescribed Authority, (Name of the State Govt./UT Admn.) Address 1. Particular of Applicant (i) Name of the Applicant (In block letters and in full) (ii) Name of the organisation Full address: (Tel no. Fax no. Telex no.) 2. Activities for which authorisation is sought : (i) Generation (ii) Collection (iii) Reception (iv) Storage (v) Transportation (vi) Treatment (vii) Disposal (viii) Any other form of handling Whether applying for fresh authorisation or for renewal: (In case of renewal previous authorisation number & date) Treatment and disposal facility (i) Address of the institution handling of bio-medical waste (ii) Address of the place of treatment facility (iii) Address of the place of disposal of the waste (i) (ii) Mode of transportation (in any) of bio-medical waste Mode(s) of treatment
3. 4.
5. 6. 7. 8.
Brief description of method of treatment and disposal (attach detail) (i) Category (see schedule-I) of waste to be handled (ii) Quantity of waste (category-wise) to be handled per month. Declaration :
I do hereby declare that the statements made and information given above are true to the best of my knowledge and are belief and that I have not concealed any information. I do also hereby undertake to provided any further information sought by the prescribed authority in relation to these rules and to fulfill any conditions stipulated by the prescribed authority.
Date : Place: FORM - II (See rule 10) ANNUAL REPORT
Signature of the Applicant Designation :
(To be submitted to the appropriate authority by 31st January every year) 1. Particulars of the applicant (i) Name of the authorised person (occupier/operator) (ii) Name of the institution - Address - City - State - Tel No. - Telex no. - Fax no. Category of wastes generated quantity monthly average Brief details of the treatment facility : In case of off-site facility i) Name of the operator ii) Name and address of the facility Tel : No., Telex no., Fax no.
2. 3.
4. Category-wise quantity of waste treated: 5. Mode of treatment with details. 6. Any other information 7. Certify that the above report is for the period from Date : Place :
Signature .......................... Designation .......................
FORM - III (See rule 12) ACCIDENT REPORTING 1. 2. 3. 4. 5. 6. 7. Date : Place: The date and time of accident : Sequence of events leading to accident : The waste involve in accident: Assessment of the effects of the accidents on health and the environment Emergency measures taken: Steps taken to alleviate the effects of accidents : Steps taken to prevent the recurrence or such an accident Signature............. Designation.............
THE GAZETTE OF INDIA EXTRAORDINARY Part II -Section 3 -Sub-Section (ii) MINISTRY OF ENVIRONMENT AND FORESTS NOTIFICATION New Delhi, the 2nd June, 2000 S.O. 545(E).- In exercise of the powers conferred by sections 6,8 and 25 of the Environment (Protection) Act, 1986 (29 of 1986), the Central Government hereby makes the following rules further to amend the Bio-Medical Waste ( Management and Handling) Rules, 1998, namely:1. (1) These rules may be called the Bio-Medical Waste ( Management and Handling) (Second Amendment) Rules, 2000. (2) They shall come into force on the date of their publication in the Official Gazette. 2. In the Bio- Medica! Waste (Management and Handling) Rules, 1998 (hereinafter referred to as the said rules), in rule 3,(i) in clause (7), after the words carried out, the words and includes common treatment facilities, shall be added; (ii) after clause (7) , the following clause shall be inserted, namely:- (7a) Form means Form appended to these rules; In the said rules, in rule 6, after sub-rule (5), the following sub-rule shall be inserted, namely:- (6) The Municipal body of the area shall continue to pick up and transport segregated non bio- medical solid waste generated in hospitals and nursing homes, as well as duly treated bio-medical wastes for disposal at municipal dump site. In the said rules, in rule 7, for sub-rule (1), the following sub-rule shall be substituted, namely:(1) The prescribed authority for enforcement of the provisions of these rules shall be the State Pollution control Boards in respect of States and the Pollution control Committees in respect of the Union territories and all pending cases with a prescribed authority appointed earlier shall stand transferred to the concerned State Pollution Control Board, or as the case may be, the Pollution Control Committees. In the said rules, in rule 8 after sub-rule (3), the following sub-rule shall be inserted, namely:- (4) the authorization to operate a facility shall beissued in Form IV, subject to condition laid therein and such other condition, as the prescribed authority, may consider it necessary. In the said rules, in rule 9, words The State Pollution Control Board/Pollution Control Committees shall be represented shall be omitted. In the said rules, in rule 13, after the words prefer an appeal, the words and letter in form V shall be inserted. In the said rules, after rule 13, the following rule shall be inserted, namely:- Common Disposal/ Incineration sites.-14. Without prejudice to rule 5 of these rules, the Municipal Corporations, Municipal Boards or Urban Local Bodies, as the case may be, shall be responsible for providing suitable common disposal/incineration sites for the bio-medical wastes generated in the area under their jurisdiction and in areas outside the jurisdiction of any municipal body, it shall be the responsibility of the occupier generating bio-medical waste/ operator of a bio-medical waste treatment facility to arrange suitable sites individually or in association, so as to comply with the provisions of these rules. In the said rules, in Schedule 1,-
3.
4.
5.
6. 7. 8.
9.
(i) (ii) (iii)
(iv) (v) 10. 11.
in the sub-heading, for the word option, the words Waste Category No, shall be substituted: in the sub-heading, after the words, Waste Category the word Type shall be added; in the sub-heading, for the words Treatment and Disposal, the following shall be substituted, namely:Treatment and Disposal Option+ + Options given above are based on available technologies. Occupier/operator wishing to use other State-of-the-art technologies shall approach the Central Pollution Control Board to get the standards laid down to enable the prescribed authority to consider grant of authorisation, against Category No.6, in the second column, for the word Solid the word Soiled shall be substituted; against Category No.7, in second column, for the word Shaprs. the word Sharps shall be substituted.
In the said rules, in FORM1, for the heading, the following heading shall be substituted namely:Application for Authorisation/ Renewal of Authorisation In the said rules, after FORM III and the entries relation thereto, the following FORMS shall be added, namely:FORMS IV & V (attached) FORM IV [see rule 8(4)]
(Authorisation for operating a facility for collection, reception, treatment, storage, transport and disposal of bio-medical wastes.) 1. 2. File number of authorisation and date of issue _________________. ___________of _____________ is herby granted an authorisation to operate a facility for collection, reception, storage, transport and disposal of bio-medical waste on the premises situated at ______________. This authorisation shall be in force for a period of _____________Years from the date of issue. This authorisation is subject to the conditions stated below and to such other conditions as may be specified in the rules for the time being in force under the Environment (Protection) Act, 1986. Date ____________ Signature __________________ Designation_________________
3. 4.
Terms and Conditions of Authorisation* 1. 2. 3. 4. 5. The authorisation shall comply with the provisions of the Environment (Protection) Act, 1986, and the rules made thereunder. The authorisation or its renewal shall be produced for inspection at the request of an officer authorised by the prescribed authority. The person authorised shall not rent, lend, sell, transfer or otherwise transport the bio- medical wastes without obtaining prior permission of the prescribed authority. Any unauthorised change in personnel, equipment or working conditions as mentioned in the application by the person authorised shall constitute a breach of his authorisation. It is the duty of the authorised person to take prior permission of the prescribed authority to close down the facility.
Additional terms and conditions may be stipulated by the prescribed authority.
FORM V [see rule (13)] Application for filing appeal against order passed by the prescribed authority at district level or regional office of the Pollution Control Board acting as prescribed authority or the State/Union Territory; level authority. 1. 2. 3. 4. Name and address of the person applying for appeal: Number, date of order and address of the authority which passed the order against which appeal is being made (certified copy of order to the attached) Ground on which the appeal is being made List of enclosers other than the order referred in para 2 against which appeal is being filed.
Date
Signature _________________ Name & Address _______________
Note:-
The Principal rules were published in the Gazette of India vide number S.O. 630 (E) dated 20.07.98 and subsequently amended vide S.O. 201(E) dated 06-03-2000.
Annexure - II
GUIDELINES OF CENTRAL POLLUTION CONTROL BOARD DELHI FOR DESIGN AND CONSTRUCTION OF BIO-MEDICAL WASTE INCINERATOR AUGUST 2003 1. General 1. These guidelines shall be applicable only to the new installation of incinerators. However, the existing incinerator shall be retrofitted with Air Pollution Control Device as mentioned in these guidelines. 2. Incinerator shall be allowed only at Common Bio-Medical Waste Treatment Facility. 3. Installation of individual incineration facility by a healthcare unit should be discouraged as far as possible but approval may be granted only in certain inevitable situations where no other option is available. Incinerator Following design criteria may be adopted for better performance: I) The incinerator shall be designed for capacity more than 50 kg/hr. for 50 kg/hr capacity, the minimum hearth area shall be 0.75 sq.m (8 sq. feet) and the minimum flow of the flue gas in the secondary chamber shall be 0.6 m3/sec at 10500 C. Each incinerator must be installed with an air pollution control system (as specified in the section 3). The size of the opening through which the waste is charged shall be larger than the size of the waste bag to be fed. The volume of the primary chamber shall be atleast five times the volume of one batch. The double chamber incinerator shall preferably be designed on controlled air incineration principle, as particular matter emission is low in such incinerator. Minimum 100 % excess air shall be used for overall design. Air supply in the primary and secondary chamber shall be regulated between 30%-80% and 170%-120% of stoichiometeric amount respectively. Primary air shall beadmitted near/ at the hearth for better contact. Flow meter/ suitable flow measurement device shall be provided on the primary & secondary air ducting. The combustion air shall be supplied through a separate forced draft fan after accounting for the air supplied through burners. Optional: For higher capacity incinerators, typically above 250 kg/ hr, other Design e.g Rotary Kiln shall be preferred. IV) A minimum negative draft of 1.27 to 2.54 mm of WC (water column) shall be maintained in the primary chamber to avoid leakage of gaseous emissions from the chamber and for safety reasons. Provision shall be made in the primary chamber to measure the water column. The waste shall be fed into the incinerator in small batched after the mixed interval of time in case of fixed hearth incinerator and continuous charging using appropriate feeding mechanism in case of rotary kiln incinerator or as recommended by the manufacturer. The size of the hearth i.e. primary chamber shall be designed properly. The sides and the top portion of the primary and secondary chambers shall preferably have rounder corner from inside to avoid possibility of formation of black pockets/ dead zones.
2.
II)
III)
V)
VI)
VII) The size of the secondary chamber shall be properly designed so as to facilitate a minimum of one second of residence time to gas flow. For the estimation of residence time in the secondary chamber its volume shall be calculated starting from the secondary burner tip to the thermocouple.
VIII) The refractory lining of the chamber shall be strong enough to sustain minimum temperature of 10000C in the primary chamber and 1200 0 C in the secondary chamber. The refractory & insultated bricks shall have minimum 115 mm thickness each & conform to IS: 8- 1983 & IS: 2042-1972 respectively. IX) The incinerator shell shall be made of mild steel plate of adequate thickness (minimum 5 mm thick) & painted externally with heat resistant aluminum paint suitable to withstand temp. of 2500C with proper surface preparation. Refractory lining of the hot duct shall be done with refractory castable (minimum 45 mm thick) & insulating castable (minimum 80 mm thick) Ceramic wool shall be used at hot duct flanges & expansion joints. The thermocouple location shall be as follows : In Primary chamber - Before admission of secondary air. In secondary - At the end of secondary chamber or before admission of dilution medium to cool the gas. There shall be separate burner each for the Primary & Secondary Chamber. The heat input capacity of each burner shall be sufficient to raise the temperature in the primary and secondary chambers as 800 + 50 0C and 1050 + 500C respectively with a maximum of 60 minutes prior to waste charging. The burners shall have automatic switching Off/On control to avoid the fluctuations of temperature beyond the required temperature range. a) Each burner shall be equipped with spark igniter and main burner. b) Proper flame safeguard of the burner shall be installed. c) Provide view ports to observe flame of the burner. d) Flame of the primary burner :i) shall be pointed towards the centre of the hearth. ii) Shall be having a length such that it touches the waste but does not impinge directly on the refractory floor or wall. e) The secondary burner shall be positioned in such a way that the flue gas passes through the flame.
X)
XI)
XII) There shall not be manual handling during charging of waste in to the primary chamber of the incinerator. The waste shall be charged in bags through automatic feeding device at the manufacturers recommended intervals avoiding direct expose of furnace atmosphere to the operator. The device shall prevent leakage of the hot flue gas & any backfire. The waste shall be introduced on the hearth in such a way so as to prevent the heap formation. Suitable raking arrangements shall be provided for uniform spreading of waste on the hearth. XIII) A tamper proof PLC (Programme Logic Control ) based control system shall be installed to prevent : Waste charging until the required temperature in the chambers is attained during the beginning of the operation of the incinerator. Waste charging unless primary & secondary chambers are maintained at the specified temperature range. Waste charging in case of any unsafe conditions such as very high temperature in the primary & secondary chamber; failure of the combustion air fan, ID fan, recirculation pump; low water pressure & high temperature of the flue gas at the outlet of air pollution control device. XIV) XV) The incineration system must have an emergency vent. The emergency vent shall remain closed i.e. it shall not emit flue gases during normal operating of the incinerator. Each incineration system shall have graphic or computer recording devices which shall automatically and continuously monitor and record dates, time of day, batch sequential
number and operating parameters such as temperatures in both chambers CO, CO2, O2, in gaseous emission shall also be measured daily ( atleast hours at one minutes interval). XVI) XVII) The possibility of providing heat recovery system/ heat exchanger with the incinerator shall also be considered wherever possible. Structural design of the chimney/ stack shall be as per is 6533-1989. The chimney / stack shall be lined from inside with minimum of 3 mm thick natural hard rubber suitable for there duty conditions and shall also conform to IS: 4682 Part I-1968 to avoid corrosion due to oxygen and acids in the flue gas. The location and specifications of porthole, platform ladder etc. shall be as per the Emission Regulations, Part -3 (COINDS/20/1984-85), published by CPCB.
XVIII) 3.
AIR POLLUTION CONTROL DEVICE: It is not possible to comply with the emission limit of 150 mg/Nm3 (corrected to 12% CO2) for particulate matter, without Air Pollution control Device (APCD). Therefore, a bio-medical waste incinerator shall always be equipped with APCD. i) ii) No incinerator shall be allowed to operate unless equipped with APCD. The incinerator shall be equipped with High Pressure Venture Scrubber System as ordinary APCD such as wet scrubber or cyclonic separator cannot achieve the prescribed emission limit. For the facilities operating for 24 hrs a day, APCD in terms of dry lime injection followed by bag filter can be considered. The incinerator structure shall be built in a room with proper roofing and cross ventilation. There shall be minimum of 1.5 m clear distance in all the directions from the incinerator structure to the wall of the incinerator room. Adjacent to the incineration room, there shall be a waste storage area. It shall be properly ventilated and so designed that waste can be stored in racks and washing can be done easily. The waste storage room shall be washed and chemically disinfected daily. The floor and inner wall of the incinerator and storage rooms shall have outer covering of impervious and glazed material so as to avoid retention of moisture and for easy cleaning. The incineration ash shall be stored in a closed sturdy container in a masonry room to avoid any pilferage. Finally, the ash shall be disposed in a secured landfill. A skilled person shall be designated to operate and maintain the incinerator. The operator shall have adequate qualification in relevant subject and shall be trained and certified by the incinerator supplier in operation & maintenance of the incinerator. There shall be at least one assistant designated at the incinerator plant to keep the track of the waste, records of incinerator, cleanliness of the surrounding area and incinerator & waste storage room. He should also take care of waste charging and incineration ash disposal. All the staff at the incinerator plant shall put on protective gears such as gumboots, gloves, eye glasses etc. for safety reasons. Any accident occurred shall be immediately be reported to the facility operator. The facility operator shall have well defined strategies to deal with such accidents / emergencies.
4.
INCINERATOR ROOM AND WASTE STORAGE ROOM: i)
ii)
iii) iv) 5.
OPERATOR OF THE INCINERATOR i)
ii)
iii) iv)
(The guidelines will help in selection/ installation of better incinerator system. However, it shall be ensured that the incinerator shall comply with standards stipulated in Bio-Medical Waste (Management & Handling) Rules 1998.)
Annexure - III
GUIDELINES OF CENTRAL POLLUTION CONTROL BOARD DELHI FOR COMMON BIO- MEDICAL WASTE TREATMENT FACILITY (CBWTF) - AUGUST 2003
A.
INTRODUCTION
A common- Bio-Medical Waste Treatment Facility (CBWTF) is a set up where bio-medical waste generated from a number of health care units, is imparted necessary treatment to reduce the adverse effects that this waste may produce. The treated waste may finally be sent for disposal in a landfill or for recycling purpose. Installation of individual treatment facilities by small health care units requires comparatively high capital investment. In addition, it requires separate manpower and infrastructure development for proper operation and maintenance of treated systems. The concept of CBWTF not only addresses such problems but also prevents proliferation of treatment equipment in a city. In turn, it reduces the monitoring pressure on regulatory agencies. By running the treatment equipment at CBWTF to its full capacity, the cost of treatment gets significantly reduced. Its considerable advantages have made CBWTF popular and proven concept in many developed countries. CBWTF as an option has also been legally introduced in India. The Bio-Medical Waste (Management & Handling) Rules, 1998, gives an option to the bio-medical waste generator that, such waste can also be treated at the common bio-medical waste treatment facility. The Second Amendment of the Rules in June 2000, further eased the bottleneck in upbringing the CBWTF by making Local authority responsible for providing suitable site within its jurisdiction. The concept of CBWTF is also being widely accepted in India among the health care units, medical associations and entrepreneurs. In order to setup a CBWTF to its maximum perfection, care shall be taken in choosing the right technology, development of CBWTF area, proper designing of transportation system to achieve optimum results etc. These key features of CBWTF have been addressed in the following sections and will form the guidelines for establishment of CBWTF throughout the country. B. LOCATION A CBWTF shall be located at a place reasonably far away from the residential and sensitive area so that it has minimal impact on these areas. The CBWTF shall be located as near to its area of operation as possible in order to minimize the travel distance in waste collection, thus enhancing its operational flexibility. The location shall be decided in consultation with the State Pollution Control Committee (SPCC). C. LAND REQUIREMENT Sufficient land shall be allotted for CBWTF to provide all requisite systems. It is felt that a CBWTF will require minimum of 1 acre land area. So, preferably, a CBWTF be set up on a plot size of not less than one acre. D. COVERAGE AREA OF CBWTF In any area only one CBWTF may be allowed to cater upto 10,000 beds at the approved rate by the Prescribed Authority. A CBWTF shall not be allowed to cater health care units situated beyond a radius of 150 Km. However, in an area where 10,000 beds are not available within a radius 150 km; another CBWTF may be allowed to cater to the health care units situated outside the said 150 km. E. TREATMENT EQUIPMENT As per the provision of Bio-Medical Waste ((Management & Handling) Rules, waste falling in most of the categories can be treated in systems based on non- burn technologies. Such waste accounts for about 90% of the total waste streams in a healthcare unit. In a brain storming session held during the
workshop at Hyderabad (Feb. 25-26, 2003) it was unanimously decided that CBWTF should emphasize more on non-burn technologies. It is mandatory to impart incineration/ deep burial (depending upon the pollution of town) to anatomical and other types of waste falling under categories 1 and 2. Therefore, an incinerator of adequate capacity to cater only categories 1 and 2 waste shall be installed. (If secured landfill is not available, category 5 may also be incinerated). The waste falling under the category 5 i.e. Discarded medicines, cytotoxic drugs and category 10 i.e. chemical wastes (solids) can be disposed in a secured landfill. A CBWTF shall have the following treatment facilities. i) Incineration : It is controlled combustion process where waste is completely oxidized and harmful microorganisms present in it are destroyed/ denatured under high temperature. The guidelines for Design & Construction of Bio-Medical Waste Incinerators prepared by CPCB shall be followed for selecting/ installing a better bio-medical waste incinerator. ii) Autoclaving / Microwaving/ Hydroclaving Autoclaving is a low-heat thermal process where steam is brought into direct contact with waste in a controlled manner for sufficient duration to disinfect the waste. For ease and safety in operation, the system should be horizontal type and exclusively designed for the treatment of bio-medical waste. For optimum results pre-vacuum based system be preferred against the gravity type system. It shall have tamper proof control panel with efficient display and recording devices for critical parameters such as time, pressure, date and batch number etc. In microwaving, microbial inactivation occurs as a result of the thermal effect of electromagnetic radiation spectrum lying between the frequencies 300 and 300,000 MHz. Microwave heating is an inter-molecular heating process. The heating occurs inside the waste material in the presence of steam. Hydroclaving is similar to that of autoclaving except that the waste is subjected to indirect heating by applying steam in the outer jacket. The waste is continuously tumbled in the chamber during the process. Though chemical disinfection is also an option for the treatment of certain categories of biomedical waste but looking at the volume of waste to be disinfected at the CBWTF and the pollution load associated with the use of disinfectants, the use of chemical disinfection for the treatment of bio-medical waste at CBWTF is not recommended. iii) Shredder : Shredding is a process by which waste are de-shaped or cut into smaller pieces so as to make the waste unrecognizable. It helps in prevention of reuse of bio-medical waste and also acts as identifier that the waste has been disinfected and is safe to dispose off. A shredder to be used for shredding bio-medical waste shall confirm to the following minimum requirements: 1. The Shredder for bio-medical waste shall be of robust design with minimum maintenance requirement. 2. The shredder should be properly designed and covered to avoid spillage and dust generation. It should be designed such that it has minimum manual handling. 3. The hopper and cutting chamber of the shredder should be so designed to accommodate the waste bag full of bio-medical waste. 4. The shredder blade should be highly resistant and should be able to shred waste sharps, syringes, scalpels, glass vial, blades, plastics, catheters, broken ampoules, intravenous sets/ bottles, blood bags, gloves, bandages etc. It should be able to handle/ shred wet waste, specially after microwave/ autoclave/ hydroclave. 5. The shredder blade shall be of non-corrosive and hardened steel. 6. The shredder should be so designed and mounted so as not to generate high noise & vibration.
If hopper lid or drop of collection box is opened, the shredder should stop automatically for safety of operator. 8. In case of shock-loading (non-shreddable material in the hopper), there should be a mechanism to automatically stop the shredder to avoid any emergency/ accident. 9. In case of overload or jamming, the shredder should have mechanism of reverse motion of shaft to avoid any emergency/ accident. 10. The motor shall be connected to the shredder shaft through a gear mechanism, to ensure low rpm and safety. 11. The unit shall be suitably designed for operator safety, mechanical as well as electrical. 12. The shredder should have low rotational speed (maximum 50 rpm). This will ensure better gripping and cutting of the bio-medical waste. 13. The discharge height (from discharge point to ground level) shall be sufficient (min 3 ft) to accommodate the containers for collection of shredder material. This would avoid spillage of shredder material. 14. The minimum capacity of the motor attached with the shredder shall be 3 kw for 50 kg/hr, 5 kW for 100 kg/hr & 7.5 KW for 200 kg/ hr and shall be 3 three phase induction motor. This will ensure efficient cutting of the bio-medical wastes prescribed in the Bio-Medical Waste (Management & Handling) rule. Sharp Pit/ Encapsulation : A sharp pit or a facility for sharp encapsulation shall be provided for treated sharps. An option may also be worked out for recovery of metal from sharps in a factory. Vehicle/ Container Washing Facility: Every time a vehicle is unloaded, the vehicle and empty waste containers shall be washed properly and disinfected. It can be carried out in an open area but on an impermeable surface and liquid effluent so generated shall be collected and treated in an effluent treatment plant. The impermeable area shall be of appropriate size so as to avoid spillage of liquid during washing. Effluent Treatment Plant: A suitable Effluent Treatment Plant shall be installed to ensure that liquid effluent generated during the process of washing containers, vehicles, floors etc. is disposed off after treatment. The treated effluent shall comply with the stipulated regulatory requirements. All the treatment equipment installed at the CBWTF shall comply with the standards stipulated in the Bio-Medical Waste (Management & Handling) Rules 1998.
7.
F.
INFRASTRUCTURE SET UP : The CBWTF shall have enough space within it to install required treatment equipment, incoming and out going waste storage area, vehicle- parking and washing area, Effluent Treatment Plant (ETP), staff room etc. the required area for CBWTF would depend upon the projected amount of bio-medical waste to be handled by it. A CBWTF shall have the following infrastructure. Treatment Equipment Room : A separate housing may be provided for each treatment equipment at the CBWTF such as incinerator room, autoclave room, microwave room etc. as applicable. Each room shall have well designed roof and walls. Such room shall be well ventilated and easy to wash. The floor and interior finishing of the room shall be such that chances of sticking/ harbouring of microorganisms are minimized. This can be attained by providing smooth & fine floor and wall surfaces (to a height of 2 meters from floor) preferably of tiles. The number of joints in such surface shall be minimal. The equipment room shall also have a separate cabin to supervise the operation of the equipment and to record the waste handling and equipment operational data. Attached to each equipment room, there shall be two waste storage rooms, one for storage of untreated wastes and another for treated wastes. The
storage room shall have provisions similar to that of equipment room being well- ventilated with easy to wash floors & walls, smooth and fine surfaces etc. Main Waste Storage Rooms : This shall be provided near the entry point of the CBWTF to unload and store all bio-medical wastes, that have been transported to the facility by vehicle. The size of the rooms shall be adequate to store all the wastes transported to the CBWTF. The front portion of the room shall be utilized for unloading the wastes from the vehicle and back or side portion shall be utilized for shifting the wastes to the respective treatment equipment. In the front of the room, where vehicle is parked for unloading, the floor shall be made impermeable, so that any liquid spilled during unloading does not percolate into the ground. The liquid generated during handling of wastes and washing, shall be diverted on the inlet of ETP. In the main storage room, wastes shall be stacked with clear distinction as per the color coding of the containers. From here, the coloured containers may be sent to the respective treatment equipment. The main storage room too shall have provisions similar to that of equipment room as roofing, well ventilated, easy to wash floors & walls, smooth and fine surface etc. Treated Waste Storage room: This is the room where wastes treated in different treatment units shall be stored. The wastes shall be stored in separate group as per the disposal options. Other provisions in the room shall be similar to the main storage room. Administrative Room: This room shall be utilized for general administrative, record keeping, billing etc. Generator Set: Every CBWTF shall have generator set as standby arrangements for power, with sufficient capacity to run the treatment equipment during the failure of power supply. The generator set shall comply with the necessary requirements under the Environment (Protection) Rules 1986. Site Security: High walls, fencing and guarded gates shall be provided at the facility to prevent unauthorized access to the site by humans and livestock. Parking: Provision shall be made within the confines of the site for parking of required number of vehicles, loading and unloading of the vehicles meant for transporting waste to and from the facility etc. Sign Board: An identification board of durable material and finish shall be displayed at the entrance to the facility. This shall clearly display the name of the facility, the name, address and telephone number of the operator and the prescribed authority, the hours of operation and the telephone numbers of the personnel to be contacted in the event of an emergency. Green Belt: The open area within the CBWTF shall be developed into green belt. Washing Room: A washing room shall be provided for eye washing/ hand washing/ bathing etc. Besides above following provisions should be made in a CBWTF: A telephone shall be provided and maintained at the facility. A First Aid Box shall be provided and maintained at the CBWTF. Proper lighting shall be provided at the facility.
Proper care shall be taken to keep the facility and surrounding free from odours. Proper fire fighting facilities and emergency alarm shall be installed. Measures shall be implemented to control pests and insects at the site. Measures shall be implemented to control escape of litter from the site. Necessary provision shall be made to prevent and control noise generated, if any due to the activities at the site. Necessary protective gear for the waste handlers shall be provided.
Every CBWTF operator shall submit a work plan to the prescribed authority. The work plan should include the details of facilities at the CBWTF, the collection, transportation & storage of the biomedical wastes, operational details etc. RECORD KEEPING: Maintenance of records for all operations carried out at the CBWTF is very important to monitor overall operation of the CBWTF. It also helps in submission of the required information to be submitted to the prescribed authority by the 31st January of every year. A well maintained record of all the activities at the CBWTF also enables the facility operator to produce all information of the activities on demand of the concerned authority. The record should include all information related to each activity at the CBWTF site; however, minimum requirement has been outlined below: Records of Waste Movements: Daily records shall be maintained for the waste accepted and treated waste removed from the site. This record shall include the following minimum details: i) Waste Accepted: - Waste Collection Date, Name of the healthcare unit, waste category as per Rules Quantity of waste, vehicle number and Receiving date (at site). ii) Treated Waste Removed: Date, Treated waste type, Quantity, Vehicle number and location of disposal. Logbook for the Equipment: A logbook shall maintain for each treatment equipment installed at the site and shall include the following: i) ii) iii) The weight of each bath. The categories of waste as per the rules. The time, date and duration of each treatment cycle and total hours of operations. G.
iv) The complete details of all operational parameters during each cycle. Site Records: i) Details of construction or engineering works. ii) iii) iv) v) Maintenance schedule, breakdowns/ trouble shooting and remedial actions. Emergencies. Incidents of unacceptable waste received and the action taken. Details of site inspections by the officials of the regulatory Agency and necessary action on the observations.
Daily monthly and annual summary records of all the above shall be maintained and made available at the site for inspection whenever required by an authorized officer of regulatory Agency. H. COLLECTION AND TRANSPORTATION OF BIO-MEDICAL WASTES:
The collection and transportation of bio-medical waste shall be carried out in a manner so as to avoid any possible hazard to human health and environment. Collection and transportation are the two operations where the chances of segregated bio-medical waste coming in contact with the public, rag
pickers, animals / birds etc are high. Therefore, all care shall be taken to ensure that the segregated bio medical waste handed over by the healthcare units reach CBWTF without any damage, spillage or unauthorized access by public, animals etc. A responsible person from the CBWTF operator shall always accompany the vehicle to supervise the collection and transportation of bio-medical waste. H.1 Collection of Bio-Medical Waste:
Generator of the bio-medical waste is responsible for providing segregated waste to the CBWTF operator. The waste shall be segregated as per the provisions of the Bio-Medical Waste (Management & Handling) Rules, 1988. The CBWTF operator shall not accept the non- segregated waste and such incident shall be reported to the Prescribed Authority. Temporary storage at health care units shall be designated. The coloured bags handed over by healthcare units shall be collected in similar coloured containers with cover. Each bag shall be labeled as per the Schedule III & IV of the Bio-Medical waste (Management & Handling) Rules, so, that at any time the health care units can be traced back that is not segregating the bio-medical wastes as per the rules. The coloured containers should be strong enough to withstand any possible damage that may occur during loading, transportation or unloading of such containers. These containers shall also be labeled as per the schedule III of the rules, sharps shall be collected in puncture resistant container. The person responsible for collection of bio-medical wastes shall also carry a register with him to maintain the records such as name of the health care unit, the type and quantity of waste received, signature of the authorized person from the health care unit side, day and time of collection etc. H.2 Transportation of the collected bio-medical waste to the CBWTF: The bio-medical waste collected in colored containers shall be transported to the CBWTF in a fully covered vehicle. Such vehicle shall be dedicated for transportation of bio-medical waste only. Depending upon the volume of the wastes to be transported, the vehicle may be a three wheeler, light motor vehicle or heavy duty vehicle. In either case, the vehicle must process the following: i) Separate cabins shall be provided for driver/ staff and the bio-medical waste containers. ii) The base of the waste cabin shall be leak proof to avoid pilferage of liquid during transportation. iii) Thewastecabinmaybedesignedforstoringwastecontainersintiers. iv) The waste cabin shall be so designed that it is easy to wash and disinfect. v) The inner surface of the waste cabin shall be made of smooth surface to minimize water retention. vi) The waste cabin shall have provisions for sufficient openings in the rear and / or sides so that waste containers can be easily loaded and unloaded. vii) The vehicle shall be labeled with the bio-medical waste symbol (as
SETTING UP AND OPERATION OF CBWTF Setting up and operating a CBWTF requires compliance with a number of regulatory requirement/ provisions. The important requirements/ provisions are listed below: i) Municipal Corporations, Municipal Boards or Urban Local Bodies, as the case may be, shall be responsible for providing suitable common disposal./ incineration sites for the biomedical waste generate in the area under their jurisdiction and in areas outside the jurisdiction of any municipal body, it shall be the responsibility of the occupier generating bio-medical waste/ operator of a bio-medical waste treatment facility to arrange for suitable sites individually or in association, so as to comply with the provisions of these rules ( BioMedical Waste (Management & Handling) Rules.
ii)
iii) iv)
v)
vi)
vii)
The local body such as Municipal Body or any private Entrepreneur, whoever wishes to set up a CBWTF shall submit a detailed work plan of proposed CBWTF to the concerned State Pollution Control Board/ Pollution Control Committee for evaluation and issue of consent to establish. The work plan should include complete details of the project such as site details, coverage area, infrastructure set up, transportation of bio-medical waste, operating procedure etc. The SPCB/PCC upon receipt of such work plan shall, review the proposal and Consent to Establish shall be issued to the proponent with the required conditions. Once the proponent establishes the necessary infrastructure, the site and the resources shall be inspected by the SPCB/PCC for the adequacy of the facility/ equipment. Upon satisfactory recommendation, the authorization under the Bio-Medical Waste (Management & Handling) Rules shall be issued with necessary condition to the proponent. The SPCB/PCC shall ensure the operation of the CBWTF as per the stipulated conditions and work-plan submitted by the proponent. The SPCB/PCC shall also ensure regular inspection of CBWTF. It is the duty of the healthcare units to handover the segregated bio-medical waste to the CBWTF operator as per the bio-medical waste (Management & Handling), Rules, as well as compatible with treatment facilities at CBWTF as suggested by the operator. The CBWTF operator shall list out such healthcare units that are not handing over the segregated biomedical waste daily and the same shall be communicated to the SPCB/PCC every week. The SPCB/PCC shall take an immediate action against the defaulter healthcare units for such violations. The CBWTF operator shall carry out following tests at least quarterly from the approved laboratory and submit the quarterly report of the same to the SPCB/PCC: a) Stack Emission Monitoring Test of the incinerator for parameters such as Particulate Matter, HCI, NO x, CO, CO2, O2, and combustion efficiency as required under the BioMedical Waste (Management & Handling) Rules. The test for VOC in incineration ash shall also be carried out. b) Validation test of autoclave/ microwave/ hydroclave. c) The applicable parameters of any effluent being discharged from the CBWTF.
CHECK LIST FOR DEVELOPMENT OF COMMON BIO-MEDIAL WASTE TREATMENT FACILITY The criteria for development of CBWTF have been discussed in detail. However, following checklist for development of CBMWTF is reproduced for convenience: 1. Treatment Facility (I) Following treatment facilities shall be provided in any common facility: a) b) c) d) e) f) g) Autoclave (Pre-vacuum horizontal feeding) / Hydroclave/ Microwave. Incineration (for waste belongings to categories 1, 2 and 5 only) Shredder Sharp pit (with drawing details)/ Encapsulation/ Recovery of metal in some factory may be looked into. Facility for bin washing, floor washing, vehicle washing Effluent Treatment Plan. Secured landfill (Until a secured landfill comes up in the area, space within the CBWTF facility shall be used.)
Only waste category 1 & 2 shall be incinerated (if secured landfill is not available, waste category 5 may also be incinerated). (III) All other infected waste shall be imparted autoclaving/ hydroclaving/ microwaving as applicable under the Bio-Medical Waste (Management & handling) Rules 1998. (IV) Incinerator, Autoclave/ Hydroclave / Microwave shall be PLC based with tamper proof control panel and recording devices. 2. 3. 4. Location (I) Reasonably away from the residential and sensitive area. Land (I) Preferably not less than one acre land may be required to set up all the requisite facilities. Coverage Area: (I) In any area, only one CBWTF may be allowed to cater upto 10,000 beds at the approved rate by the prescribed authority. A CBWTF shall not be allowed to cater healthcare units situated beyond a radius of 150 km. However in an area where 10,000 beds are not available within a radius of 150 km, another CBWTF may be allowed to cater the healthcare units situated outside the said 150 km. Segregation: (I) Segregation hall be as per the Bio-Medical Waste (Management & Handling) rules as well as compatible with the treatment facilities at CBWTF as suggested by the operator. (II) Generator is responsible for providing segregated waste to the operator. (III) The operator shall not accept in-segregated waste and report the matter to the prescribed authority. Collection: (I) Respective colored bags should be kept in similar colored container i.e. colored bags shall not be directly kept in vehicle. (II) Sharps shall be collected in puncture resistant containers. (III) Temporary storage at healthcare unit shall be designated. Transport Vehicle: i) Dedicated vehicle for the collection of Bio-Medical Waste is required. ii) Separate cabins shall be provided for driver/ staff and the bio-medical waste containers. iii) The base of the waste cabin shall be leak proof to avoid pilferage of liquid during transportation. iv) The waste cabin may be designed for storing waste containers in tiers. v) The waste cabin shall be so designed that it is easy to wash and disinfect. vi) The inner surface of the waste cabin shall be made of smooth surface to minimize water retention. vii) The waste cabin shall have provisions for sufficient openings in the rear and / or sides so that waste containers can be easily loaded and unloaded. viii) The vehicle shall be labelled with the bio-medical waste symbol (as per schedule III of the Rules) and should display the name, address and telephone number of the CBWTF. Storage : (I) Sufficient ventilated storage space for untreated and treated bio-medical waste shall be provided. (II) The flooring and walls (to a height of 2 M from floor) shall be finished with smooth and fine material. There shall be minimum numbers of joints. Record Keeping
(II)
5.
6.
7.
8.
9.
(I) (II) 10.
Documents such as collection advice taken from health care units for each category of waste, records of waste movements, logbook for the equipment and site records shall be maintained. All the record shall be available at the CBWTF site for inspection.
Disposal (I) Incineration Ash- Secure Landfill (II) Treated Solid waste Municipal landfill. (III) Plastic waste after disinfection and shredding - Recycling or municipal landfill. (IV) Sharps, after disinfection (if encapsulated) Municipal landfill. (V) Treated wastewater- sewer/ drain or recycling. (VI) Oil & grease incineration.
11.
Setting up and operation of CBWTF (I) The proponent shall submit detailed work-plan of the proposed CBWTF to the Prescribed Authority for issuance of Consent to Establish. The work plan should include complete details of the project such as site details, coverage area, infrastructure setup, transportation of bio-medical waste, operating procedure etc. (II) The CBWTF operator shall carry out stack emission test of incinerator, incineration ash test, validation test of autoclave/ microwave/ hydroclave and applicable parameters of any effluent being discharged from the CBWTF, atleast quarterly from the approved laboratory and submit the quarterly report of the same to the SPCB/PCC.
Annexure - IV
SUBJECT 1. 2. Installation/ Commissioning of common Biomedical Waste Management Treatment facility on turn- key basis. Operation & Maintenance of the Biomedical Waste Management Treatment facility.
INTRODUCTION Govt. of India under Bio-Medical Waste (Management & Handling) Rules 1998 has notified that all Health Care Institutions are required to handle Bio-Medical Waste in a specified manner. Some of the major Hospitals have their own arrangements for treating Bio-Medical Wastes, but most of the Hospitals/ Nursing Homes and clinics which cannot make their own arrangements due to high cost involved in treatment facilities, require some alternative modalities. Keeping in view the difficulties faced by the hospitals/ Nursing homes/ Clinics/ blood Banks/ Diagnostics Lab. Etc., Govt. is taking initiative to establish Common Bio-Medical Waste Treatment facility on turn key basis. The party that is able to offer the services to the Hospitals/ Nursing Homes/ Clinics etc shall be selected for the joint venture. As the land and the cost of setting up of Common Bio-Medical Waste Management Treatment facility will be provided by the Govt. of Jammu & Kashmir, Bio-medical Waste generated in Hospitals and Dispensaries under Govt. of J&K will be transported and treated free of cost by the entrepreneur. The interested party engaged in response to this enquiry would be required to submit the best available option (a state of the art technology) using automated systems with online monitoring of the parameters. SCOPE OF WORK i) Setting up of centralized Waste treatment facilities (consisting of Incinerator, Autoclave with Shredder/ other Non-burn technology with Effluent treatment plant) in accordance to BioMedical Waste (Management & Handling) rules 1998.
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To collect and transport Bio-Medical waste from the Hospitals/Nursing Homes/ Diagnostic Centres/ Laboratories/ Blood Banks/ Medical/ISM colleges to the Centralized treatment facilities in the vehicle as per the specifications annexed. The Govt. of Jammu & Kashmir shall be free to assign the demarcation, if needed regarding the operational areas between the two centralized treatment facility centres, if any, in near future. Treatment and Disposal of Bio-Medical Waste collected from various Health care Institutions in accordance with Bio-Medical Waste (Management & Handling) Rules, 1998 and amendments thereof.
EQUIPMENTS i) Incinerator with capacity of 100 Kg/hr as per standard stipulated in the Bio-Medical Waste (Management & Handling) rules 1998 (The guidelines for design & construction of BioMedical waste Incinerator enclosed (Annexure VII). ii) Autoclave/Modified Rotary Dry Autoclave (200 ltrs) with capacity to reduce the weight/ volume as per standard stipulated in the Bio-Medical Waste (Management & Handling) rules 1998. iii) Shredder- Heavy duty shredder with conveyer (5 meter) as per standard stipulated in the Bio-Medical Waste (Management & Handling) rules 1998. All the above mentioned equipments should be approved by the Central Pollution Control Board, Delhi and Certificate in this regard for each equipment should be attached with the tender document. INFRASTRUCTURE SETUP : The following infrastructure setup will be required to be commissioned which will be in addition to the housing of the equipments mentioned above. The size of the rooms etc. shall be as per the guidelines/ norms and the work load of the CBWTF i) Sharp pit, ii) Effluent treatment plant iii) Vehicle/ Container waiting facility iv) Treatment Room v) Main Storage room vi) Treated waste storage room vii) Administrative Room viii) Washing Room ix) Generator set of appropriate capacity x) Record Keeping Room xi) Parking area xii) Green belt. The land required as per the norms will be provided by the concerned institutions. SPECIFICATIONS FOR TRANSPORTATION VEHICLE ISSUE OF TENDER DOCUMENT The Tender documents will be available for sale (on payment of Rs. 1000/- Non refundable) w.e.f _________ in the office of the Member Secretary CPC, Sub Committee, Medical Superintendent SMHS/ SMGS Hospital, Jammu. CLOSING DATE The sealed tenders in duplicate, complete in all respects, duly signed and stamped on each page, should be sent through registered post or to be put in box placed at the office of the Member Secretary, CPC Sub Committee, SMGS Hospital, Jammu on or before ___________. The tenders received after the deadline shall not be considered. EARNEST MONEY All tenders should be accompanied with the Earnest money deposits in the shape of FDR/CDR from Nationalized Bank valid for three years pledged in the name of Principal Govt. Medical College Jammu. Please note that the tender Number, its due date and complete address of the firms should also be written on the back side of the CDR/FDR so as to ensure its safe return to the unsuccessful or successful tenderers as the case may be. No interest shall be payable by the concerned department on the Earnest Money Deposits. (EMD)
EMD is refundable after the expiry of the validity of the tender. The EMD is liable to be forfeited if the tenderer withdraws or awards or impairs or derogate the bid in any manner. PROCEDURE FOR SUBMITTING APPLICATION FORM The tender on the prescribed proforma shall be submitted in a single big size envelope containing, two small envelopes, one each for original and duplicate with proper seal. The CPC sub committee will not be held responsible for any postal delay. Tenders not accompanied with the relevant latest documents and other requisite information at the time of submission of tenders are liable to be rejected at the appropriate level of the competent authority. The Tenders should be clearly super scribed with the words Technical Bid, Tender No._______ and Name of the Tenderer/ Party. The tenderer/ party isrequired to furnish the following documents in the above sealed cover: i) Profile of the applicant Party/ agency etc. along with Name of the Directors/ Partners/ Proprietor with infrastructure available. ii) Name with professional qualifications and experience of key persons employed by the applicant with the nature of the employment. iii) Financial position of the tenderer along with audited balance sheet of the last three years. iv) Detailed Project Report with all specifications with time schedules. v) Previous experience (minimum two years of handling CBWTF) of similar assignments undertaken in Govt. Sector with details. vi) Latest copies of latest Income Tax clearance certificate should be attached. Rates Quotations should be types/ printed and free from fluiding/cutting and overwriting. No hand written quotation will be accepted. All pages of the documents submitted should be numbered & total number of pages indicated in the index. Transparent tape/ lamination should be applied on the quoted rates. Details of documents enclosed with the tender forms should be mentioned in Proper Index serial wise duly flagged on the front page of your quotation/ reference letter. UNDERTAKING The undertaking ( Annexure- V ) duly signed by the tenderer must be enclosed with the applications forms, failing which such tenders shall not be considered. COMPLETION PERIOD The completion period will be up to FOUR MONTHS from the date of award of work. The task/ service shall actually be deemed to have been completed on the actual date of satisfactory completion/ commissioning of common facility for disposal of Bio-Medical Waste. In case of non-completion of the work within the stipulated period, penalty @1% per day of the bank guarantee amount shall be charged for, and further, maximum period of 10 days shall be given for the completion of the work. Thereafter, the client/ offerer shall be liable for the imposition of liquidated damage and termination of the contract for default. DISPUTES AND ARBITRATIONS With regard to any dispute, other than which have been taken as final decision in the foregoing clause of this agreement, regarding the interpretation of any of the clause or terms and conditions mentioned above, the dispute shall be referred to the head of the Institution. If either of the parties is dissatisfied with the verdict of the arbitrator, the same is refereed to the Principal Secretary, Health & Medical Education Department, J&K. If still dis-satisfied, Legal proceedings shall be subject to the jurisdiction of J&K Courts at Jammu only.
LIABILITY FOR ANY VIOLATION UNDER THE PROVISIONS OF ENVIRONMENT (PROTECTION) ACT 1986. The contractor shall start the work after obtaining consent from the J&K Pollution Control Board to establish and operate the common facility strictly as per provisions of Bio-Medical Waste (Management & Handling) Rules 1998 after obtaining authorization from the prescribed authority. The contractor has to undergo an agreement on stamp paper owning complete responsibility towards the violation of the provisions of the Bio-Medical Waste (Management & Handling) Rules 1998 enacted by Govt. of India in exercise of the provision conferred by section 6,8 and 25 of Environmental (Protection) Act 1986 CHARGES FROM THE PRIVATE NURSING HOMES/ HOSPITALS/ LAB. ETC. The firm/ tenderer shall provide service free of charge to Govt. Institutions where as charge @ Rs. 5/- per bed/day from the Private Health Institutions/ Nursing Homes with bed capacity of more than five beds. The Private Health Care institutions upto five beds, Labs., Blood Banks etc. where the BioMedical Waste is generated will pay @ Rs. 750/- per month. HEALTH CERTIFICATE OF WORKERS The contractor shall submit the health certificate of all the workers working at site or transportation fleet etc. to Head of the Institution/ Medical Superintendent. Annexure V UNDERTAKING/ LETTER OF ACCEPTANCE Sir, 1. 2. I / we do agree for all clauses, terms and conditions of the tender documents. I / we have necessary Infrastructure, Trained/ qualified Manpower for setting up of Centralized Treatment facilities ( like Infrastructure & equipments ) with latest available technology approved by CPCB. I / we agree to abide by our offer for a offer for a period of _____ years to provide the services from the date of award of the contract i.e. w.e.f __________________ . I / we declare that no legal / financial irregularities involving the Proprietor/ Partner of the applicant (s) / firm are pending. I / we declare that our financial position is sound and we are competent to set up Bio-Medical Treatment facilities. (proof enclosed). I/ we declare that we will not ask/ expect any financial assistance from the Govt. of Jammu & Kashmir State. I/ we declare that at the time of signing of Agreement/ Contract, I shall submit a performance guarantee from a Nationalised Bank which shall be valid for a period of the contract.
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In acceptance (Name of the signature of the tenderer Or Authorised Signatory) Annexure IV SPECIFICATIONS FOR TRANSPORTATION VEHICLE
The vehicles transporting Bio-Medical Waste must comply with requirements of the Environment Protection act 1986 and BMW (Management & Handling) rules 1998 at all times, accordingly the vehicle shall :i) ii) iii) iv) v) vi) Be dedicated and kept solely for the transport of bio-Medical Waste. Be so designed and fabricated that they can be cleaned and drained in a manner that waste matter do not get trapped on edges on services, so as to avoid harboring of insects or vermin. Be steam cleaned and clinically disinfected once in a week. Have separate containers for transporting different kinds of the waste bags. Have only one opening and fully enclosed, lockable body. All vehicles transporting bio-Medical waste carry a spill containment and cleanup kit inside the vehicle. The kit shall comprise of the following items : a. b. c. Material designed to absorb spilled liquids. The amount of absorbent material shall be rated by the manufacturer as having a capacity to absorb a minimum of 40 litres. Minimum 4 litres of disinfectant in a sprayer capable of dispersing its charge in a mist and in a stream. The disinfectant shall be hospital grade. Plastic bags to double enclose 15% of the maximum load accumulated or transported (up to maximum of 50 bags). These bags shall be large enough to over pack any box or other container normally. Two new sets of disposable overall, gloves footwear and goggles. Boots should be thick rubber and must be impermeable to liquids and gloves shall be of heavy neoprene or equivalent (boots, gloves and breathing devices may be reused if fully disinfected between uses) Protective breathing devices shall be approved for filtering particulates and mists, disposable High Efficiency Particulate Air (HEPA) masks will suffice, Tape for sealing openings at wrist and ankles shall also be in the kit.
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The vehicle used for carrying Bio-Medical Waste should carry a glass level as given in 6.3 infectious substances under rule 137 of the Central Motor Vehicles Rules, 1993.
viii) The vehicle used for carrying BMW should not, as far as possible. Ply during peak hours and avoid congested and busy roads in the interest of the public health in general. ix) The registered owners of the proposed transport vehicles should be directed to apply for permit as required u/s 66 of the Motor Vehicles Act 1988 to State Transport Authority, 5/9 Under Hill Road and also take the vehicles for inspection and fitness to Board of Inspection at the time of registration of new vehicle and there after every year after initial registration of two years. The vehicle used for transportation of Bio-Medical waste should not engaged/ hired before they have the requisite certificate of registration, certificate of fitness, insurance, permit and have paid the Motor Vehicle Tax, as provided under the law.
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TERMS & CONDITIONS 1. The contractor shall commission/ install the BMWTF at the provided land as per the list supplied in the tender document for collecting, transporting and treating Bio-Medical Waste from the health care establishments (all Associated Hospitals, CHCs & PHCs and dispensaries) under the Govt. of Jammu & Kashmir and dispose them in accordance with the Bio Medical Waste ( Management & Handling) Rules 1998 issued by the Govt. of India under the provisions of Environment (Protection) as 1986 ( herein after called the Rules) as per the terms & conditions. The bidder will also provide the services of the Bio-Medical Waste disposal.
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All services like approach road, electric connection/ Generator, Water supply/ water pump, Disposal of Incinerator ash/ Municipal waste etc. within the area of operation shall be arranged by successful bidder & he will make the payment for such installation and its running. The bidder shall be responsible for making arrangements for segregation, collection, storage, transportation, treatment and disposal of Bio-Medical Waste strictly as per the provisions of the Bio-Medical Waste (Management & Handling) Rules 1998 notified by Govt. of India. The Jammu & Kashmir Govt. shall hand over the CBWTF alonwith the equipments to the contractor for operations and maintenance through their authorized representatives as soon as the contractor finishes the job of commissioning of CBWTF and furnishes the authorization from the J&K State Pollution Control Board for undertaking all activities excluding the generation of BioMedical Waste. The Contractor and the Head of Institutions/ Authorized representative while taking over/ handling over the above facilities shall jointly prepare an inventory of the equipments with full technical details and other supporting facilities duly authenticated by both the parties. The inventory so prepared shall be deemed to form the part and parcel of this agreement. The contractor shall collect/ transport/ treat/ dispose the Bio Medical Waste from all the health care establishments under J&K Govt. on priority basis and theeafter shall utilize the available spare capacity for the treatment of bio-Medical Waste generated by the private health care establishments possessing proper authorization under the rules for generating waste on payment basis to the contractor. The contractor/ firm shall have the experience of running similar establishment for a period of minimum two years in any Govt. Institution of the country. The contractor shall be liable to receive, store, treat and dispose of the treated waste including incinerator ash as prescribed under rules. The contractor shall not store the untreated biomedical waste for more than 48 hours from the time of its generation and no untreated waste shall be stored at the facility site/ premises over the night. In case of default penalty of Rs. 5000/- per day will be imposed or will be deducted from the performance guarantee. The contractor shall not segregate the waste at the facility site or premises or anywhere within the hospital complex. The responsibility shall be that of the BMW generators thereof. The contractor would provide training to the staff of the Govt. Health Care institutions for segregation and also provide colour-coded material for segregation regularly. The contractor shall ensure that no unauthorized persons including scavengers are allowed by him. The contractor shall meet the total costs of operation, repairs, maintenance, replacement of parts and all other inputs including fuel, power and water consumption etc. The contractor shall meet all the statuary requirements of the treatment of Bio-Medical Waste as per the Bio-Medical Waste (Management &Handling) Rules 1998 and amendments, if any, and any further orders from time to time. The cost of setting up of the CBWTF on turn key basis will be borne by the Govt. of J&K. The lowest bidder agree to commission CBWTF as per guidelines in tender document will be considered. The operation & maintenance of the contract will be given to highest bidder. The contractor shall employ only qualified (up to level of ITI) and experienced personnel after their character and antecedents have been verified and list of such employees appointed for the work with their full particulars like name, address, qualification, designation, place of posting etc. along with the latest photographs shall be furnished. The Contractor shall be solely responsible for fulfilling all the statuary requirements governing private employment and labour laws like the Minimum Wages Act, ESI, EPF in respect of his employees. For Successful bidder, the machinery & equipment will be in the warranty period for three years, however, the operational cost will be borne by the successful bidder. He will provide service free of
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cost to all the Govt, Hospitals with a radius of 150 Kms & charge from the Private Hospitals/ Private Nursing homes @ Rs. 5/- per bed/ day. This amount shall be deposited with the concerned hospital every month before 15th day of the succeeding month along with a presecribed report/ statement giving details of Bio-Medical waste treated during the month and its source of receipt. 16. 17. The contractor shall ensure sanitation and hygiene of the site and health and safety of his employees by providing them prescribed personnel protective equipment / gears and regular health checkups at his own cost. The contractor shall report to the prescribed authorities under the rules in case of any accident while handling Bio-Medical Waste and shall be liable or prosecution if any Bio-Medical Waste is disposed of without treatment or rendering it unfit for reuse. The contractor shall suitably indemnify the Govt. against all liabilities that may acquire due to any dispute/ litigation with the employees appointed for the work. The contractor shall treat at the site only waste generated by the establishments possessing necessary authorization obtained under rules from the prescribed authority. The contractor shall furnish to the Govt. a copy of each contract/ agreement entered with any occupier/ generator of the Bio-Medical Waste within 15 days of signing such contract/ agreement. The contractor shall maintain daily record of Bio-Medical Waste received and treated generator/ occupier wise at the site and furnish monthly/ quaterly/ yearly report to the J&K Govt. on the prescribed format. The contractor shall ensure that the waste treatment equipment mainly incinerators are operated conforming to the emission standards prescribed under the Bio-Medical Waste rules. The contractor shall make necessary security arrangements at the site for securing all the equipments and the details thereof shall be furnished to the J&K govt. and Medical Superintendent of the concerned hospitals. Inspection : The contractor shall however, facilitate initial/ periodic inspection of the site, process, function and records at any time on demand by the Govt./ Civil Surgeon/ Medical Superintendents of the concerned hospitals/ authorized officers from the office Principal Medical Colleges/ J&K State Pollution Control. Performance : Performance of the firm for all process must be as per Bio-Medical Waste Management & handling rules 1998 with latest amendments in the Act otherwise liability for legal and penal action by State Pollution Control Board or any other National Body for environmental protection, will be of the firm Further the State can cancel the agreement/bid and will be free to make alternative arrangements at the risk and cost of the firm. This agreement shall remain valid for a period of 3 years from the date of award of the contract i.e. w.e.f. ________________, and shall be subject to review of the performance of the contractor after every 6 months by the J&K Government within those three years and extendable upto two years. The Contractor shall abide by all clauses, terms and conditions of the tender document, In case of any breach of the terms and conditions of the tender document and also if this contract or if the information submitted by the contractor with the tender documents are found to be false or erroneous, then Government shall be at liberty to terminate this contract without prejudice to its right to damages on accounts of such breach. The Government shall facilitate transfer of documents relating toincinerators/other equipment to the contractor on demand for entering into annual maintenance contract by the bidder for the said equipments. The Government shall reserve infrastructure for disposal of Bio-Medical Waste the right to bring in more entrepreneurs if need be, in case the set up by the contractor does not meet the requirements of the agreement and / or Contractor fails to set up the facilities within the stipulated time period or not provided services for more than one month continuously, show cause for seven days for winding up the contract and arrange with other bidder of second lowest rate at the bidders cost.
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Training: The Contractor shall arrange to train the medical/paramedical staff of all the health care establishments under J&K Health Department in the handling and segregation of Bio-Medical Waste generated in their respective institutions, at his cost periodically ( every six months or whenever required). The Generator shall provide segregated Bio-Medical Waste to the contractor in colour coded bags. The contractor shall make own arrangements for the transportation of the Bio Medical Waste generated by the occupiers of Govt. Health Care establishments, strictly in conformation with the Bio Medical Waste ( Management & Handling) Rules 1998. The contractor shall at the expiry of the terms of this agreement or he renewal thereof as the case may be or termination of this agreement quietly surrender and deliver the possession of the incinerators/ other equipment an accessories related thereto, in perfect working condition to the Principal Medical colleges/Medical Superintendent of the concerned hospital or any other facility established by him and remove all structures that might have constructed by him, at his own cost, within 07 days from the expiry/ termination of this agreement as mutually agreed and shall not effect the working of the equipments, if the contractor fails to do this within the prescribe period, the Govt. shall be entitled to demolish them at the risk an cost of the contractor. The J&K Govt. may at any time after assigning the reasons terminate this agreement after giving 15 days notice to the contractor or 3 months notice from the contractor. In the event of failure on the part of the contractor to perform, the contractor in terms of this agreement, Govt. may without prejudice to its right under any other clause of this agreement forfeit the said amount of performance guarantee furnished under clause 26 hereof in whole or in part. The contractor shall not sublet to assign the present contract or in any manner allow any other person or persons to work as a contractor or sub-contractor. The expenses towards stamp duty etc. shall be borne by the contractor. In the event of any dispute or difference arising out of or in any way touching or concerning this agreement (except those the decision whereof is otherwise herein before provided) shall be referred to the sole arbitrator i.e Principal Secretary to Govt. of J&K State Health & Medical Department or any other person nominated by the J&K Govt. for this work. The award of the arbitrator appointed shall find and binding on both the parties. The contractor shall furnish a performance guarantee of Rs. Five lacs only in the form of a Bank Guarantee or FDR from a Nationalized Bank for the entire contract period and shall be renewed by the contractor for the extended period of contract. The EMD submitted alongwith the tender shall be returned back. The firm should modify the existing incinerators in such a way so as to obtain the prescribed temperature of both chambers as prescribed under the Bio Medical Waste (Management & Handling) rules 1998.There should be standby arrangements for continuous power supply to run the incinerator. The Bio Medical Waste from other sates should not be brought to J&K State for disposal. the firm should submit regular monthly report. The firm will submit monthly analysis report to J&K Pollution control Board, for air emission and water discharge and comply with the standard laid down in the Bio Medical Waste Disposal & management Handling Rules 1998. the contractor will treat the affluent as per standard laid down by the J&K Pollution Control Board. The Contractor shall at the expiration of the terms of this agreement or renewal thereof as the case may be or termination of this agreement quietly surrender and deliver possession of the CBWTF, Incinerator in perfect working condition to the officer authorized on this behalf and shall remove all the structures that might have been constructed by him and may be existing there at the time at his own cost within seven days of the date of expiry or termination of this agreement. If the contractorfails to do so within this period the Govt. shall be entitled to demolish them at the risk and cost of the contractor.
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In case of delay of payment by the firm to the Health Department/ ____________________Bank guarantee of the firm may be enchased. Besides this firm will also face penal action as per provision of NIT.

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HOSPITAL WASTE MANAGEMENT An insight approach

2. Frequently Asked Questions (FAQ)

3. Waste Management Policy

(c) (d) (e)

(f) (g) (h)

Microbiology & Biotechnology Waste

Discarded Medicines Solid Waste (a)

No. 7 No.8 No.9 No.10

Solid Waste (b) Liquid Waste Incineration Ash Chemical Waste

(ii) Hazardous station, toxic)

Placement of black bins (50 lts, 100 lts) in the wards

Nurse demonstrating functioning of Needle destroying unit.

Staff Nurse cutting the dripset to prevent the recycling.

local autoclaving microwaving

Category No. 4 capable of causing

sets etc.) shredding

Disinfection by chemical treatment @@ and dis-

biologicals, chemicals used in for solids

Cat. 5,9 & Cat. 10 (solid)

or earlier by 31st Dec.2002 or earlier

Date : Place: FORM - II (See rule 10) ANNUAL REPORT

Signature of the Applicant Designation :

Signature .......................... Designation .......................

(i) (ii) (iii)

(iv) (v) 10. 11.

Additional terms and conditions may be stipulated by the prescribed authority.

Signature _________________ Name & Address _______________

INCINERATOR ROOM AND WASTE STORAGE ROOM: i)

OPERATOR OF THE INCINERATOR i)

(I) (II) 10.

18. 19. 20. 21. 22. 23.

36. 37. 38.

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Signature ___ Name & Address _