Amendments to Medical Waste law Pakistan, 2005
Current law deficiencies: Hospital Waste Management Rules, 2005
-Lack of clarity regarding incineration/waste disposal process.
-Rules only focus on waste collection and transportation.
-No mention of manner in which hospitals should coordinate and manage the incineration of medical waste.
Amend the above legislation by requiring hospitals / medical /surgical clinics which generate medical waste to contract with medical waste facilities for proper disposal.
These facilities may be owned and operated by Public/private partnerships and hospitals /clinics have to pay by estimated waste generated by each hospital bed or number of hospitalizations and outpatient clinics /surgical centers to pay for the actual waste generated per weight or type of waste generated. All waste has to be begged as specified by current legislation.
The operating standards should be spelled out and regularly thoroughly inspected for proper operations.
} Example of detailed legislation:
INDIA: BIO MEDICAL (MANAGEMENT AND HANDLING) RULES, 1998
◦ Requires Medical Facilities to possess Medical Waste Disposal equipment.
– -Incinerator
– -Autoclave
– -Microwave System
– -Common Waste Facility to be shared by hospitals
◦ STANDARDS FOR INCINERATORS (INDIA Legislation):
◦ All incinerators shall meet the following operating and emission standards:
◦ A. Operating Standards
◦ 1. Combustion efficiency (CE) shall be at least 99.00%.
◦ 2. The Combustion efficiency is computed as follows:
◦ %C02
◦ C.E. = ------------ X 100
◦ %C02 + % CO
◦ 3. The temperature of the primary chamber shall be 800 � 50 deg. C�.
4. The secondary chamber gas residence time shall be at least I (one) second at 1050 � 50 C�, with minimum 3% Oxygen in the stack gas
} STANDARDS OF MICROWAVING(INDIA legislation):
} 1 Microwave treatment shall not be used for cytotoxic, hazardous or radioactive wastes, contaminated animal car casses, 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 limit.
3. The microwave should completely and consistently kill the bacteria and other pathogenic organisms that is ensured by approved biological indicator at the maximum design capacity of each microwave unit
For far flung areas without access to medical waste facilities small tehsil hospitals in remote locations may use deep burial under controlled conditions as follows :
} STANDARDS FOR DEEP BURIAL (INDIA LEGISLATION)
} 1. A pit or trench should he dug about 2 meters deep. It should be half filled with waste, then covered with lime 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 galvanised iron/wire meshes may be used.
} 3. Burial must be performed under close and dedicated supervision.
} 4. The deep burial site should be relatively impermeable and no shallow well should be close to the site.
} 5. The pits should be distant from habitation, and sited so as to ensure that no contamination occurs of any surface water or ground water. The area should not be prone to flooding or erosion.
} 6. The location of the deep burial site will be authorized by the prescribed authority.
} 7. The institution shall maintain a record of all pits for deep burial.
Possible problems which need to be paid attention.
The government should gradually phase in these riles. Government may have to give incentives loans and others for construction of these facilities and may assist in formation of these public/private partnerships.
} Breakdown in disposal procedures due to lack of institutional control over waste segregation and transportation.
-Energy shortages impact ability of hospitals to run incinerator
Maqbool Arshad,MD
Chair, APPNA Hepatitis C Initiative
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