Introduction to biomedical waste management

 Hospital infections can occur due to improper BMW mgmt

 “Sharps” cause maximum damage if improperly disposed
 Statutory provision, hence mandatory
 Segregation of BMW is crucial for success of program
 Reputation of hospital can be affected
Historical Background
The evolution of a separate category of medical waste within the municipal
waste stream dates back to the late 1970s, when medical wastes, including
syringes and bandages were washed up on beaches in the East Coast of
the USA. The public outcry that followed led to the formulation of the US
Medical Waste Tracking Act (MWTA), which finally came into force on
1st November 1988.

India
Medical waste was considered a part of the municipal waste till
the problems associated with medical waste were realized. There
was no legislation on Medical waste till the Ministry of
Environment and Forest (MoEF) proposed the first draft rules in
1995.

Supreme Court order

The rules recommended on-site incinerators for all hospitals with
more than 50 beds. At the same time, in a public interest case,
the Supreme Court of India, in March 1996, ordered the
inclusion of alternate technologies and their standards in the
Rules.

Second draft rules

 The second draft rules were notified in 1997. The final rules
were notified on 20th July 1998 and were called Bio-Medical
Waste (Management & Handling) or BMW Rules 1998
SECOND AMENDMENT
 BIO-MEDICAL WASTE (MANAGEMENT AND
HANDLING)  (SECOND AMENDMENT) RULE came in 2000
MINISTRY OF ENVIRONMENT AND FORESTS
NOTIFICATION New Delhi, the 2nd June, 2000

Purposes For BWM

 To prevent infection transmission

 To prevent Illegal disposal of medical- related waste into the
garbage and sewers
 To prevent Reuse & recycling of bags, syringes and other
waste materials
 To spread awareness among the various categories of health
workers itself.
 To prevent exposure of highly toxic and variable
radioactivity in addition to the infectivity of waste

Definitions
Waste
 Waste is viewed as discarded materials, much of which can
be reused or recycled or generate fertilizer by composting waste
Biomedical Waste

 It is the waste generated in the diagnosis, treatment or

immunization of human beings or animals, in research or in the
production of testing of biological products including all categories
of infected and toxic waste that is potential threat to human being
and environment (Govt. of India 1998).

Health hazards
 HAI- needle stick injuries(NSI)
 Evidence:
 USA:6-8 lakh/year, half unreported
 About 30 NSI/100 beds/year
 Sero conversion rates after single exposure
 HIV- 0.3% i.e 1 out of 300
 HCB- 1-10% i.e 1 out of 30
 HBV- 6-30% i.e 1 out of 3

Health hazards…(HAI)…
 Viruses viable upto 7days in blood droplet
Shirato S
 Microbes isolated from 56% samples of “disposable” items
Pal et al, IJPH’98:42(4),131-2.
 Bacillus micrococcus
 Staph epidermidis
 Serratia
 Ps aeruginosa

Legal Principles of BMW mgmt

APPLICATION:
These rules apply to all persons who generate, collect, receive,
store, transport, treat, dispose, or handle bio medical waste in
any form
DEFINITIONS :
 Act means the Environment (Protection) Act
 Animal House means a place where animals are reared/kept
for
experiments or testing purposes
 Authorisation means permission granted by the prescribed
authority for the generation, collection, reception, storage,
transportation, treatment, disposal
 Authorised person means an occupier or operator authorised
by the prescribed authority to generate
 Bio-medical waste means any waste, which is generated
during the
diagnosis, treatment or immunisation of human beings or animals
or in
research activities.
 Biologicals means any preparation made from organisms or
micro-organisms
 Bio-medical waste treatment facility means any facility
wherein
treatment

 Occupier in relation to any institution generating bio-

medical
waste, which includes a hospital, nursing home.
 Operator of a bio-medical waste facility means a person who
owns or controls or operates a facility
 Schedule means schedule appended to these rules
 DUTY OF OCCUPIER
 TREATMENT AND DISPOSAL
 SEGREGATION, PACKAGING, TRANSPORTATION
AND STORAGE
 Shall not be mixed
 Segregated into containers/bags
 Container shall, be labelled
 Transport vehicle should be authorised for the purpose by the
competent authority
 Untreated bio-medical waste shall be kept stored beyond a period of
48 hours
 Municipal body of the area shall continue to pick up and transport
segregated non bio-medical solid waste

 PRESCRIBED AUTHORITY
 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
 AUTHORISATION
 An authorisation shall be granted for a period of three years
 ADVISORY COMMITTEE
 committee will include experts in the field of medical and health
 ANNUAL REPORT
 Every occupier/operator shall submit an annual report to the
prescribed authority in by 31 January every year
 MAINTENANCE OF RECORDS
 ACCIDENT REPORTING
 APPEAL
 thirty days from the date on which the order is communicated
 Common disposal/incineration sites
 Municipal Boards or Urban Local Bodies, as the case may be, shall be
responsible for providing suitable common disposal/incineration sites
Biomedical Waste Management
Steps in the management of hospital waste include:
 generation,
 segregation/separation,
 collection,
 transportation,
 storage,
 treatment,
 final disposal.
Waste management Hierarchy

BMW Treatment
 Important from environmental aspect
 Modalities vary depending on category of waste and
chemical composition
 Most methods are capital intensive
 Use of thermal energy is common
 Clearance from appropriate authority is mandatory before use

Operational aspects…General
 Making the logistics & supplies available
 Needs to be done at all points / areas
 All categories of personnel should be made aware & trained
 Categorization of BMW- as per hospital policy
 Infrastructure and logistics to be provided by the administration
 Colour coding of BMW bags & container– as per rules

Segregation
 Definition- “Separation of different categories of waste by
sorting”

 Importance-
 “HEART” of scientific BMW management
 Most important pre-requisite
 Allows special attention to be given to less quantity of BMW
 Decreases costs and risks

Colour Coding for BMW

 Maximum 5 colours– Red, Blue, Yellow, Black & White
Colour Coding for BMW contd
 Minimum 4 colours – Red / Blue, Yellow, Black & White
(AIIMS)
 Ideally should be same all over the state / region

Yellow colour code

Type of Container
 Plastic bags (Non chlorinated)
and bins
 Waste Categories: 1,2,3,6
 1.Human Anatomical
 2.Animal
 3.Microbiology & Biotechnology
 6.Soiled (Contaminated with Blood
& Body Fluids
 Treatment Options
 Incineration / Deep burial

Details of items to be put in yellow container

• Items contaminated with blood and body fluids e.g. Cotton dressings,
soiled plaster cast etc.
 Human tissues, organs e.g. amputated limbs etc.
 Laboratory wastes e.g. stock / culture solutions, live attenuated
vaccines etc.
 Waste from animal houses / experimental laboratories.
Blue/red colour code
 Waste Categories
4, 7 (for red only)
 4.Sharps
 7.Solid (Disposable Items
other than Sharps)

Treatment Options
 Autoclaving or
 micro waving shredding

Details of items to be put in blue/red container

Waste Items
 Solid waste generated from disposable items e.g. catheters,
IV sets, BT sets, tubing, blood bags etc.(except sharps)

 Glassware from laboratories used for transfer of cultures,

stock solutions, vaccines sera etc (which cannot be incinerated)

Black colour code

 Waste Categories
5, 9 & 10 (solids)
 Discarded Medicines &
Cytotoxic Drugs
 Incineration
 Chemical
Type of Container
 Plastic bags and bins
Treatment Options
 Municipal authority 
Secure landfills
Details of items to be put in black container
Waste Items
 Discarded medicines/drugs– outdated, contaminated,
 Ash from incinerators
 Chemical wastes – expired insecticides, chemicals used in
laundry etc.
 All non-hazardous – “general” waste from kitchen, offices,
cafeteria, computer facility etc

White colour code

 Waste Category : 4
 Sharps
 Type of Container
 Puncture proof plastic /
metal containers
 Treatment Options
 Needle destroyer (direct)
1% bleach soln.
 Contact period 30 mins
 Change solution daily
 From solution to blue bag

Details of items to be put in white container

 Waste Items
Waste sharps (any item which can cause cuts) e.g. needles,
syringes, scalpels, blades, venflon needle etc

Operational aspects….
 Storage: max for 48 hrs untreated
 Collection & Transportation: by a centralized gang, BMW-
Once Daily ; general - two time daily
 Documentation
 Source labeling with date
 Total generated & handed over
 Inspection: at any level
Container is transported from the premises
should be labelled
Safety Precautions
 All categories of personnel should be made aware & trained
regarding BMW
 Personal protection measure – gloves, caps, masks, gum
boots & preferably aprons
 Prophylactic immunisation to staff against Hepatitis B &
Tetanus
 Accidents reporting– in the proper proforma to the authorities
 Spillages– should be investigated and recurrence prevented

Waste management -- reasons for failure

 Absence of waste management policy at different levels.
 lack of awareness among the staff and general public about the health
Hazards
 Insufficient financial and human resources and poor control of waste
disposal
 Workers in hospital those are involved in collection and transport are
not trained and educated about importance and the issues related with
biomedical waste management.

Steps towards improvement

 The build-up of a comprehensive system, Addressing
responsibilities, resource allocation, handling and disposal
 Awareness raising and training
WASTE TREATMENT AND DISPOSAL
 Mechanical: Compacting, Shredding, Encapsulation, Landfill,
inertization.

 Thermal And Irradiation: Autoclaving, Micro waving, Incineration

 Chemical: Disinfectants, Antiseptics

 Biological: Vermiculture, Biodigestion

Compacting
 Waste compaction is the process of reducing the size of
waste material. Garbage compactors and waste collection vehicles
compress waste so that more of it can be stored in the same space.
It is compacted again, more thoroughly, at the landfill to preserve
valuable space and to make the landfill more stable.
Shredding:
 Shreder Used for shredding BMW after disinfection
 Shreds all blue/red bags
 Output is“confetti” like particles

Encapsulation
 Recommended as the easiest method for the safe disposal of sharps.
 Sharps are collected in puncture-proof and leak proof containers, such
as high-density polythene boxes, metallic drums, or barrels. When a
container is three-quarter full, a material such as cement mortar, bituminous
sand, plastic foam, or clay is poured in until the container is completely
filled.

Landfill
 A landfill vehicle has two main functions: to spread the waste
evenly in layers over the landfill and to compact waste in order to
reduce the volume it occupies and help stabilize the landfill
 Open dumps
 Sanitary landfill :Sanitary land filling is a method of disposing refuse
on land without creating nuisance or hazards to public health

Inertization
 The process of mixing of waste with cement & other
substances before disposal in order to minimize the risk of toxic
substances contained in the waste migrating into surface water or
groundwater. It is suitable for Incineration ashes with a high metal
content. Not for infected waste
Thermal and Irradiation
 Heat Disinfection
 Hot air oven: for sterilization of glassware, powders and oils
impermeable to steam at 160 degee celcius and cause mutilation
 Irradiation
 Gamma rays can be used for sterilization. Gamma rays from the
radioisotope cobalt–60 do penetrate to a greater depth, hence this technology
is applicable to infectious waste sterilization. However, it is now rarely used
for waste treatment.

Autoclave
 It is a pressurized low heat thermal process of disinfecting waste at 121oC for
30-60 mts.
 Here the steam comes directly in contact with the wastes.
Types
 Gravity type
 Vacuum type

Autoclave (contd)
Advantages
 Low capital & operating cost
 Air & liquid emissions are non toxic & minimal
Disadvantages
 Medium efficacy of sterilization
 Some micro-organisms still thrive
 Only partial reduction of volume of waste & hence land filling is
difficult.
 Odorous fumes

Hydroclave
 This is a low heat thermal process which is an
innovation of the autoclave
 Designed to apply steam as an indirect heating source,
allowing total dehydration of waste.
 The treatment/holding time is 15 min at 312°C or 30
min at 121°C.

Microwave
 Low heat thermal process
 Heat is generated within the waste with electromagnetic
waves.
 Electromagnetic radiation spectrum lies between 300-300,00
mega hertz.
 The friction of vibrating molecules results in disinfection.
 Treatment/ holding time is 95-100°C for 25 min.
Incinerator
 High thermal process by which combustible materials are rendered as gases &
non combustible materials are reduced to ashes
 Types
 Conventional
 Oil Fired
 Electrical

Incinaration
Incinerator-Treatment Process
 Stage1 (Primary Chamber)
 It is solid combustion phase
 Waste is thermally decomposed by maintaining temp. above 800o C
 It is a pyrolytic (no air) or a starved air cycle (less than 50% of combustion air)
 Stage 2 (Secondary Chamber)
 It is gaseous combustion phase
 Volatile chemicals & gases along with combustion gases are heated in this
chamber to a temp. 1050-1100o C with excess of air
 Chamber volume is large as this handles gases

Incinerator-Treatment Process (contd)

 Stage3 (Pollution Control Device)
 The gases emitted in primary & secondary chamber are treated here
 Particulate matter, Carbon Monoxide, HCL vapours, Dioxins, Lead,
Cadmium, Mercury tend to reform when gases are cooled below 400o C
 Venturi Scrubbers followed by packed bed towers are used to remove
gases of HCL, HF, Sulphur dioxide
 Wet scrubbers to remove dioxins & acid gases
Chemical process
 Treatment and disposal of sharp waste
 Needle cutter, Needle melter
 Disposal of dead body
 Glutaraldehyde, Mercury, Phenolics, xylene
 Radiactive waste disposal
 Liquid Waste

Biologic process
Vermiculture
 Artificial rearing or cultivation of worms (Earthworms) and the
technology is the scientific process of using them for the betterment of
human beings
 Pit composit
 Bio-digestion
 Gasification

The role of hospital waste management structure

 The Head of the Hospital:

 Forming a waste management team to develop a written waste
management plan for the hospital
 Designating a waste management officer
 Up to date planning
 Ensuring the monitoring processes
 Ensuring the adequate training for key staff members
 Immediately delegating the duty to other person in absence of the
actual worker
Waste management Officer
 Is directly responsible to the Head
 Control internal collection of waste containers & their transport
 Ensure correct use of central storage facility
 Directly supervise the hospital attendants & ancillary workers
assigned to collect & transport the wastes
 Coordinate & monitor all waste disposal operations

 Departments Heads
 Liaise with the WMO to monitor working practices for failures or
mistakes
 Matron and Hospital manager
 liaise with the department heads and WMO to ensure coordination of
training activities, other waste management issue specific to particular depts
 Infection control Officer
 Liaise with the department heads, the matron, and the hospital
manager to coordinate the training
 Chief Pharmacist
 Liaise with the department Heads, WMO, Matron and the hospital
manager, giving advice in accordance with the national policy and
guidelines
 Radiation Officer
 Liaise with the WMO to ensure a continuous supply of the items
required for waste management
 Hospital Engineer
Training

 Training and retraining of the all categories of the health care

staff in biomedical Waste management including health & safety
measures is essential
Training should include
 It should include following sessions:
 Purpose of training
 Information on problems of mismanagement of biomedical
waste and national and internationals concerns
 Legislations: biomedical waste (Management and handling)
rules
 Management processes involvement in biomedical waste
handling
 Interactive sessions
 Using AV-aids on different types of practices and best way to handle
the waste
 Visits to the incinerators, autoclaves, in the wards & O.T. to have idea
of waste management
 Demonstrations of how to make hypo chloride or bleaching powder
solutions, how to incinerate or mutilate needles etc.
 Feed back sessions
Conclusion
 Proper segregation is the ‘core’ of all functions & a change in the
mindset & attitude is the key to success.

 Collection & transportation forms the vital link between generation &
treatment of waste

 The human element is more important than technology; & well

trained, motivated staff can really work wonders