Guided by

BIOMEDICAL WASTE Mrs. Prasanna Kumari mam

MANAGEMENT Presentation by
Peterson
BSc(N) lll year SCON
INTRODUCTION
The wastes produced in the course of health care activities
carries a higher potential for infection and injury than any
other type of wastes.
Therefore, it is essential to have safe and reliable method for
its handling. Inadequate and inappropriate handling of health
care wastes may have serious public consequences and
significant impact on the environment.
INTRODUCTION
As per the Bio-medical Waste (Management and Handling)
Rules, proper management of biomedical waste is a statutory
requirement and these rules have been elaborated in the
Gazette notification of the Ministry of Environment and
Forests, Government of India, dated July 20, 1998, which has
been subsequently superseded by the new Gazette notification
issued in March 2016 and amended in 2018.
INTRODUCTION
In India, from the data available from regional or local
studies, it is presumed that most hospitals generate roughly up
to 1-2 kg/bed/day of biochemical waste. Most of the waste
generated in a hospital is non- hazardous (85%), while 10% is
infective; including sharps and pathological waste, and the
remaining 5% is non-infectious, but hazardous such as
chemical, pharmaceutical, or radioactive wastes.
DEFINITION
The Bio-medical Waste (Management and Handling) Rules of
the year 2016 has defined BIOMEDICAL WASTE as

“Any waste which is generated during the Diagnosis,

Treatment and/or Immunization of human beings or animals,
or Research activities, or in the production and testing of
Biologicals, or in Health camps.”
 HEALTH HAZARDS OF BIOMEDICAL WASTE

 Exposure to hazardous health-care wastes can result in disease or

injury due to one or more of the following characteristics.
1) Genotoxic e.g.: Cytotoxic drugs, Genotoxic chemicals
2) Infectious e.g.: Lab cultures, tissues, wastes from isolation wards.
3) Chemical e.g.: Lab reagents, Disinfectants, Solvents
4) Radioactive e.g.: Beta Particle and Gamma ray emitters in
diagnostic nuclear medicine.
5) Pathological e.g.: Body parts, Blood and other fluids.
 HEALTH HAZARDS OF BIOMEDICAL WASTE

6) Pharmaceutical e.g.: Expired and no longer needed

pharmaceuticals.
7) Pressurised containers e.g.: Aerosol cans, Cartridges, Gas
cylinders.
8) Wastes with heavy metal content e.g.: Batteries, broken
thermometers, Blood pressure gauges.
9) Sharps e.g.: Needles, Infusion sets, Scalpels, Knives, and
Blades.
•All individuals exposed to such hazardous health-care wastes are
potentially at risk, including are exposed to careless management.
HEALTH HAZARDS FROM
WASTES
1. HAZARDS FROM INFECTIOUS WASTES:
Pathogens in the infectious wastes may enter the human body through a
puncture, abrasion or cut in the skin, through mucous membranes or by
inhalation or by ingestion. There is particular concern about infection with HIV
and Hepatitis virus B and C, for which there is a strong evidence of
transmission via health-care wastes.
2. HAZARDS FROM CHEMICAL AND PHARMACEUTICAL WASTES:
Many of the chemicals and Pharmaceuticals used in health-care
establishments are toxic, genotoxic, corrosive, inflammable, reactive, explosive
or shock-sensitive. Disinfectants are particularly important members of this
group. They are used in large quantities and are often corrosive, reactive
chemicals may form highly toxic secondary compounds.
HEALTH HAZARDS
3. HAZARDS FROM GENOTOXIC WASTES
Genotoxicity describes the properties of a chemical agent that damages
genetic information within a cell causing mutations, which may lead to cancer.
All mutagens are genotoxic; however, not all genotoxic substances are
mutagenic.
The severity of the hazards for health-care worker responsible for handling
or disposal of genotoxic waste is governed by a combination of the substance
toxicity itself and the extent and duration of exposure. Exposure may also occur
during the preparation of or treatment with a particular drug or chemical.
The main pathway of exposure is inhalation of dust or aerosols, absorption
through the skin, ingestion of food accidentally contaminated with cytotoxic
drugs, chemicals or wastes.
HEALTH HAZARDS
4. HAZARDS FROM RADIOACTIVE WASTES:
Radioactive wastes includes any material that is either intrinsically
radioactive, or has been contaminated by radioactivity, and that is deemed to
have no further use.
Medical Radioactive wastes include waste generated by nuclear medicine,
radiation oncology and PET. Radioactive wastes must be segregated form other
waste materials in clearly marked containers. When practical, minimize the
amount of radioactive waste generated by surveying items before putting them
into waste.
The type of disease caused by radioactive wastes is determined by the type and
extent of exposure. Because it is genotoxic, it may also affect genetic material.
HEALTH HAZARDS
5. PUBLIC SENSITIVITY:
Apart from health hazards, the general public is very sensitive to visual
impact of health care wastes particularly health-care waste particularly
anatomical wastes.
STEPS IN THE MANAGEMENT
OF BIOMEDICAL WASTE
 The biochemical waste generated in a health care establishment is
required to be disposed of in an appropriate manner to prevent health
hazard to the healthcare providers and the general community.
 As a prerequisite to a good hospital waste management plan, it is
essential to ensure availability of safe and reliable supply of water,
sanitation facilities, maintenance of cleanliness, and demarcation of vital
areas that need stricter sterility norms.
 After ensuring the availability of these basic facilities, the steps
discussed below should be followed for the management of biochemical
waste.
STEP 1
1. Survey of Waste Generated:
•A survey of waste generated in a health care establishment
determines the quantity, type, and source of waste generation
inside the premises.
•Because of survey, proper attention can be paid to the disposal
of different categories of waste safely and correct improper
waste disposal practices through appropriate training to the staff.
STEP 2
2. Segregation of Hospital waste:
•Segregation could be defined as “separation of different types of
wastes by sorting.”
•The best course of action is to segregate the wastes into various
categories at the source/ point of generation itself. The provider
himself/herself best undertakes the activity.
STEP 3
3. Collection and Categorization of wastes:
•The wastes generated should be collected in proper containers, for
example, sputum mugs, urinals, and plastic containers for sharps. It is a
good practice to colour code the containers holding different types of
hospital wastes.
DANGER YELLOW VECTOR SIGNS:
RADIATION SIGN, BIOHAZARD SIGN, TOXIC SIGN
BMWM PROCESS
CLASSIFICATION OF BIOMEDICAL WASTES
AS PER THE REVISED BIOMEDICAL WASTE MANAGEMENT RULES, 2016

 Under the revised rules, biomedical wastes have been classified into
four categories, based on colour codes (Yellow, Red, Blue and White
translucent) as shown below.
 CLASSIFICATION OF
BIOMEDICAL
Colour Type of Waste
WASTES
Type of Bag or Treatment and disposal
Category Container to be options
used
YELLOW a) Human anatomical wastes: Non-chlorinated Incineration or plasma
Human tissues, organs, body plastic bags. pyrolysis or deep burial
parts, and the foetus.

YELLOW b) Animal anatomical wastes: Non-chlorinated Incineration or plasma

including the waste plastic bags. pyrolysis or deep burial
generated from animals used
in experiments in Veterinary
hospitals
YELLOW
 YELLOW c) Soiled waste: Non-chlorinated plastic Incineration or plasma
Items contaminated with blood, bags. pyrolysis or deep burial. In the
body fluids such as dressings, absence of above facilities,
plaster casts, cotton swabs and autoclaving followed by
bags containing residual or shredding or mutilation or
discarded blood and blood combination of sterilization
components. and shredding. Treated waste
to be sent for energy recovery.

 YELLOW d) Expired and discarded
medicines:
Pharmaceutical wastes like
antibiotics, cytotoxic drugs
including all items contaminated
with cytotoxic drugs along
with their glass or plastic
ampoules, vials, etc.
Non-chlorinated plastic Shall be either sent back to the
bags or containers manufacturer or supplier for
incineration at >1200 C or
encapsulation or plasma
pyrolysis at >1200 C or to a
common biomedical waste
treatment for disposal by
incineration
 YELLOW
 YELLOW e) Chemical solid waste: Non-chlorinated Disposed by incineration or
Chemicals used in the plastic bags. plasma pyrolysis or
production of biological encapsulation in hazardous
waste, discarded waste treatment.
disinfectants.
 YELLOW f) Chemical Liquid wastes: Separate collection The chemical liquid waste
Liquid wastes generated due and disposal into shall be pre-treated before
to use of chemicals, effluent treatment mixing with other
infectious secretions, system wastewater.
aspirated fluids, liquid from X
ray developing units,
laboratories and floor
washings, discarded cleaning
and disinfecting solutions.
 YELLOW
 YELLOW g) Discarded linen, mattresses,
beddings contaminated with
the blood or body fluids,
routine masks and gowns
 YELLOW h) Microbiology, biotechnology
and other clinical laboratory
wastes: including blood bags,
laboratory cultures, stocks or
specimens of microorganisms
used in research, live or
attenuated vaccines and cell
cultures.
Non-chlorinated, Non-chlorinated chemical
yellow plastic bags or disinfection followed by
suitable packing incineration or plasma
material. pyrolysis or for energy
recovery.
Autoclave or Pre-treat to sterilize with non-
microwave or chlorinated chemicals onsite,
hydroclave-safe plastic as per National AIDS control
bags or containers. organization or WHO
guidelines on the safe
management of wastes from
healthcare activities.
Thereafter undertake
incineration.
RED
RED Contaminated Red coloured, non- Autoclaving/Microwaving/
waste(Recyclable): Wastes chlorinated plastic Hydroclaving, followed by
generated from disposable bags or containers shredding or mutilation or
items such as tubing, combination of
bottles, intravenous tubes sterilization and shredding.
and sets, catheters, urine Plastic waste should not be
bags, syringes(without sent to the landfill sites.
needles), and vacutainers
with their needles cut and
gloves.
 WHITE/TRANSLUCENT
WHITE Waste sharps including Puncture proof, leak Autoclaving or dry heat
(TRANSLUCENT) metals: proof, tamper proof sterilization followed by
Needles, syringes with fixed containers. shredding, mutilation, or
needles, needles from encapsulation in metal
needle tip cutter or burner, container or cement
scalpels, blades, or any concrete; combinations of
other contaminated sharp shredding cum autoclaving;
objects that may cause and sent for final disposal
puncture and cuts. This to iron foundries or sanitary
includes both used, landfill or designated
discarded and concrete waste sharps pit.
contaminated metal sharps.
BLUE
BLUE a) Glassware: Broken or
discarded and contaminated
glass including medicine vials
and ampoules except those
contaminated with cytotoxic
wastes,
 
 
  b) Metallic body implants
Cardboard boxes Disinfection (by soaking the
with and leak proof washed glass waste after
boxes with blue cleaning with detergent
coloured marking. and Sodium hypochlorite
treatment) or through
autoclaving or microwaving
or Hydroclaving and then
sent for recycling.
Cardboard boxes  
with and leak proof
boxes with blue
coloured marking.
CATEGORIES OF BMW SCHEDULE AS PER WHO
STANDARDS
Category of waste Type of wastes Treatment and Disposal option
Category No.1 Human anatomical wastes Incineration/deep burial
Category No.2 Animal wastes generated by Veterinary hospitals Incineration /deep burial
Category No.3 Biotechnological and Microbiological wastes Local autoclaving/
microwaving/incineration
Category No.4 Sharp wastes Chemical treatment/
Microwaving/Mutilation
Category No.5 Discarded medicines and cytotoxic drugs Incineration/ destruction and
disposal in secured land fill

Category No.6 Soiled wastes (Plaster casts, beddings, dressings) Incineration/

autoclaving/Microwaving.
Category No.7 Solid wastes(generated from disposable items) Disinfecting by chemical
treatment/microwaving &
mutilation/ shredding

Category No.8 Liquid wastes(Laboratory and washings) Chemical/ discharge into drains
Category No.9 Incineration ash(Ash from biomedical waste) Disposal in municipal landfills.
Category No.10 Chemical wastes Chemical treatment & discharge
into drains for liquids & Secured
landfills for solid.
COLOUR CODING
COLOUR CODING, TYPE OF CONTAINER
AND TREATMENT OPTIONS FOR THE
DISPOSAL OF BIO-MEDICAL
Colour coding Type of container Waste Category
WASTES
Treatment options as per
Schedule 1
Yellow Plastic Bag 1, 2, 3, & 6 INCINERATION OR DEEP
      BURIAL
       
 
Red Plastic bag/Disinfected 3, 6, & 7
AUTOCLAVING/MICROWAVI
  container   NG/ CHEMICAL
      TREATMENT
Blue/White Plastic bag/Puncture 4&7  
Translucent proof container  
      AUTOCLAVING/MICROWAVI
Black Plastic Bag 5, 9, & 10(solid) NG/ CHEMICAL
TREATMENT &
DESTRUCTION BY
SHREDDING

DISPOSAL IN SECURED
ACCORDING TO SCHEDULE 11
 ADDITIONAL IMPORTANT GUIDELINES
CONTAINED IN THE NEW BIOMEDICAL WASTE
MANAGEMENT RULES, 2016
 Some additional and important guidelines contained in the new BMW management
rules, 2016 and amended in 2018, which should be noted, are as follows:
1. For soiled wastes (category yellow ©, in absence of facilities for the incineration/
plasma pyrolysis/ deep burial, we should undertake
autoclaving/microwaving/Hydroclaving followed by shredding or mutilation or
combination of sterilization and shredding.
2. Disposal by deep burial is permitted only in rural or remote areas where there is no
access to common biomedical waste treatment facility.
3. Chemical treatment is by using at least 1-2% sodium hypochlorite solution having
30% residual chlorine for 20 minutes or any other equivalent chemical reagent that
should demonstrate an efficiency for microorganisms as given in the rules.
4. Mutilation or shredding must be done to an extent to prevent unauthorized reuse.
…
5. There will be no chemical pre-treatment before incineration, except for microbiological lab
and highly infectious waste.
6. Dead foetus below the viability period (as per the medical termination of pregnancy act,
1971, amended from time to time) can be considered as human anatomical wastes.
7. Onsite pre-treatment of laboratory wastes, microbiological wastes, blood samples, and
blood bags should be disinfected or sterilized as per the WHO guidelines on safe management
of wastes from health care activities and WHO blue book 2014 and then given to common
biomedical waste treatment and disposal facility.
8. Installation of an in-house incinerator is not allowed, however, in any case, there is no
common biomedical facility nearby, the occupier may install the same after taking
authorization from the State Pollution Control Board.
9. Either syringes and needles should be mutilated or should be cut and stored in tamper
proof, leak proof and puncture proof containers for the storage of sharps.
 STORAGE OF WASTE
It means “Holding of Biomedical waste for such a period of
time, at the end of which waste is treated and disposed of.”
It is absolutely essential that no biomedical wastes are stored
at any place where it is generated, beyond a period of 48
hours.
During the storage period the wastes must not be allowed to
decay or putrefy.
STORAGE CONTAINERS
The storage containers should have the following characteristics:
1. They should be made of sturdy, hard plastic or metal and should be leak proof
and puncture proof.
2. They should be of appropriate size to avoid overflow and have a secure lid and
handle; they should be colour coded.
3. They should not be easily destroyable by rodents and should have smooth,
rounded surfaces to hold plastic bags.
4. Plastic bags should be large, sturdy, and leak proof with no tears. They should
line the complete storage bin from inside and some portion should be outside.
 STORAGE CONTAINERS
5. The bags should be made of non-chlorinated plastics to avoid environmental
pollution.
6. Bags should be colour coded, labelled and marked with a biohazard symbol.
7. The storage containers holding sharps besides being leak proof should also
contain appropriate disinfectants such as sodium hypochlorite solution.
 STORAGE AREAS
1. Storage areas should be earmarked and protected from all sides, accessible
only to authorized persons.
2. Should have adequate storage space for at least two days’ wastes and proper
drainage system.
3. Radioactive wastes should be disposed of separately in a demarcated area
and labelled properly.
4. The timings of waste collection should be fixed for specific areas and all the
containers should be regularly cleaned and disinfected before reuse.
5. A Biohazard symbol should be used as a label on all containers and vehicles
meant for storage and transportation of waste.
 TRANSPORTATION OF
WASTES
It is the vital link between the site of waste generation and the final disposal point. It involves
movement of waste form interim storage point to its final disposal point as per its category.

The vehicle used for the transportation of wastes should be able to achieve the task with
minimal effort, spillage or disturbance to the waste.
Inside the premises, the health care establishments use pushcarts, waste trolleys and
wheelbarrows to transport waste inside the hospital premises. Outside the hospital, waste
van/lorry or cycle rickshaw is used to transport the wastes to its final site of disposal.
It should be ensured that transport used is leak proof, covered from all sides including the
top.
The hospital authorities should keep proper documentation of the frequency of waste
transportation.
DO’S AND DON’TS
TROLLEYS FOR IN HOUSE
TRANSPORT VEHICLE
GENERAL OR NON-
HAZARDOUS WASTES
1. These could be disposed of by landfilling at sites away from water source and
dwelling units and covered with suitable covering materials. The sites could be
trenches, sloping terrains or abandoned quarries and should be delimited with
secure fences and sign postings.

2. Mechanized equipment could be used for spreading the waste and trimming the
top soil.

3. Composting using night soil along with the biochemical waste could be done in
trenches.
NON-HAZARDOUS WASTES
4. Vermiculture methods for garbage from kitchen and cafeteria could also be
used.
5. Large quantities of general wastes could be disposed using technologies,
which convert biodegradable wastes into fuel pellets, incinerable matter or
biogas.
TREATMENT AND DISPOSAL
TECHNOLOGIES FOR HEALTH CARE
WASTE
LAND DISPOSAL:
Municipal Disposal sites:
If a municipality or medical authority genuinely lacks the means to treat waste
before disposal, the use of landfill has to be regarded as an acceptable disposal
route. There are two types of disposal on land- open dumps and sanitary landfills.
Health-care waste should not be deposited on or around open dumps. The risks of
either people or animals being exposed to infectious pathogens is obvious.
Sanitary landfills are designed to have at least four advantages over open dumps:
geological isolation of waste from the environment, appropriate engineering
preparation before the site is ready to accept waste, staff present on the site to
control operations, and organized deposit and daily coverage of waste.
LOCATION
METHODS OF LANDFILLS
LAND FILL TYPES
1. SANITARY LANDFILLS: Landfill that uses clay liner to isolate the trash form
the environment.
2. MUNICIPAL SOLID WASTE (MSW) LANDFILLS: Landfill that uses synthetic
liner to isolate the trash from the environment.
3. CONSTRUCTION AND DEMOLITION LANDFILLS: consists of debris
generated during the construction/demolition of buildings, roads, etc.
4. INDUSTRIAL WASTE LANDFILLS: non-hazardous wastes associated with
industries.
5. SECURE LANDFILLS: Landfills for disposal of hazardous wastes.
LANDFILL
DEEP BURIAL
Disposal by deep burial is permitted only in rural or remote areas where there is no
access to common biomedical waste treatment facility. The deep burial facility shall be
located as per the provisions and guidelines issued by Central Pollution Control board.
1. A pit or a trench should be dug about 2m deep. It should be half filled with waste
and then covered with lime within 50 cm from the surface, before filling the rest of the
pit with soil.
2. It should be ensured that animals do not have any access to the burial sites. Covers
of galvanized iron or 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. The pits should be distant from habitation and located to ensure that no
contamination occurs to the surface water or ground water.
DEEP BURIAL PIT FOR BMW
CHEMICAL DISINFECTION
Chemicals are added to waste to kill or inactivate the pathogens it contains,
this treatment usually results in disinfection rather than sterilization.
Chemical disinfection is most suitable for treating liquid wastes such as
blood, urine, stools or hospital sewage. However, solid wastes including
microbiological cultures, sharps, etc. may also be disinfected chemically with
certain limitations.

This method uses chemicals to destroy pathogenic organisms from any

inanimate object.
CHEMICAL DISINFECTION OF
BIOMEDICAL WASTES
CHEMICAL DISINFECTION
The following types of wastes are treated by this method:
1. Sharps contaminated with blood and body fluids.
2. Instruments and equipment used to cut, pierce, or enter the natural orifices,
such as needles, syringes and endoscopes.
3. Contaminated floors, surfaces, clothes, beds, bedding, enamel, crockery and
bed pans.
4. Wet mopping of intensive care units, operation theatres, wards and patient
waiting room areas.
CHEMICAL DISINFECTION
Note:
The choice of disinfectants would depend on factors such as effectiveness,
availability and cost. A contact period of 30 minutes is required for effectiveness
of disinfection by the disinfectants.
 Plastics, rubbers, and metals are to be treated by chemical disinfection, but not
all instruments/ waste should be treated in this manner. Some of the waste
materials such as blood, secretions, excreta and body fluids, which have been
spilled, require further disposal after chemical disinfection.
Wastes, which are to be incinerated, should be cleaned of chemical disinfectants,
especially halogen compounds to avoid environmental pollution.
Chemical disinfection methods should demonstrate a 4 log reduction or greater
for Bacillus subtilis in chemical treatment systems.
 MICROWAVE
This low heat system uses microwaves to heat up the waste material from inside,
unlike the external heat given in autoclave and hydroclave.
Microwaves are electromagnetic waves in the 300-300,000 MHz range in the
electromagnetic spectrum. They are able to penetrate materials and create vibrations
in all the dipolar molecules such as water in the waste materials.
Heat produced at 95-100 degree celsius for a holding period of 25 minutes kills all
microorganisms. Wastes such as tunings, syringes and needles are rendered harmless.
Most of the microorganisms are destroyed by the action of microwave of a frequency
of about 2450 MHz and a wavelength of 12.24 nm. The microwaves rapidly heat the
water contained within the waste and the infectious components are destroyed by the
heat conduction. The efficiency of the microwave disinfection should be checked
routinely through bacteriological and virological tests.
MICROWAVE FOR BMW
TREATMENT
Note:
Metallic wastes, cytotoxic wastes, hazardous wastes, radioactive wastes,
contaminated animal carcasses, body parts cannot be used in microwaves.
It requires a shredder for pre-treatment of wastes.
It renders the waste matter acceptable for landfill.
Biological indicators for microwaves shall be Bacillus atrophaeus spores.
AUTOCLAVE
 This is a low-heat process; steam at high pressure is brought into contact
with microorganisms for a specified period to sterilize the waste matter
completely.
Autoclaves are used to sterilize reusable medical instruments, microbiology
cultures and stock solutions.
Autoclaves are of the following types:
1. Gravity displacement type autoclave:
It operates at a temperature of 121 degrees Celsius and has a cycle time of
approximately 60-90 minutes. This system has a disadvantage that there may
be many pockets of air left within the waste layers, which may reduce the
temperature attained inside, thus reducing the efficiency of the system.
AUTOCLAVE
2. Pre-vacuum type autoclave:
To evacuate the air in the chamber of autoclave and steam
under pressure is pushed. This reduces the cycle time to 30-60
minutes, and the temperature attained is up to 132 degrees
Celsius.
The treatment process is monitored by placing spores of
Bacillus stearothemophillus at the center of waste load and
checking these after the treatment.
VERTICAL AND HORIZONTAL
AUTOCLAVES
AUTOCLAVE
Note:
 The process of autoclaving has the advantage of having low operating
costs, with minimal or non-toxic liquid or air emissions.
 The waste volume is not completely reduced.
 Cytotoxic wastes and pathological wastes cannot be treated by this
method. Moreover at times, malodorous fumes are generated which need
to be controlled.
 This method can be combined with shredding, grinding or compacting
to reduce the volume of the waste material substantially.
INCINERATION
 Incineration, used to be the method of choice for most
hazardous health care wastes, and is still widely used.
 Incineration is a high temperature dry oxidation process,
which reduces organic and combustible waste to inorganic
incombustible matter and results in a very significant
reduction of waste-volume and weight.
The process is usually selected to treat wastes that cannot be
recycled, reused or disposed off in a landfill site.
INCINERATOR
INCINERATION
Incineration requires no pre-treatment, provided that certain waste types
are not included in the matter to be incinerated. Characteristics of the
waste suitable for incineration are
a) Low heating volume-above 2000 kcal/kg for single-chamber
incinerators, and above 3,500kcal/kg for pyrolytic double-chamber
incinerators.
b) Content of combustible matter above 60 percent;
c) Content of non-combustible solids below 5 percent; and
d) Content of non-combustible fines below 20 percent; and
e) moisture content below 30 percent.
INCINERATION
 Waste types not to be incinerated are:
a) Pressurized gas containers
b) Large amount of reactive chemical wastes;
c) Silver salts and photographic or radiographic wastes;
d) Halogenated plastics such as PVC;
e) Waste with high mercury or cadmium content, such as broken
thermometers, used batteries, and lead-lined wooden panels; and
f) Sealed ampoules or ampoules containing heavy metals.
 TYPES OF INCINERATORS
 Incinerators can range from a very basic combustion unit that operates at a
much lower temperature to extremely sophisticated, high temperature operating
plants. It should be carefully chosen based on the available resources, the local
situation, and the risk-benefit consideration.
Three basic kinds of incineration technology are of interest for treating health-
care waste:
a) Double-chamber pyrolytic incinerators, which may be especially designed to
burn infectious health-care waste;
b) Single- chamber furnaces with static grate, which should be used only if
pyrolytic incinerators are not affordable; and
c) Rotary kilns operating at high temperatures, capable of causing
decomposition of genotoxic substance and heat-resistant chemicals.
DETAILS OF DOUBLE
CHAMBERED INCINERATOR
SOME OTHER TYPES OF
INCINERATORS
The following are types of incinerators

•ROTARY KILN
•FLUIDIZED BED
•MOVING GRATE
•LIQUID INJECTION
•MULTIPLE HEARTH
•CATALYTIC COMBUSTION
•WASTE-GAS FLARE
•FIXED GRATE / DIRECT-FLAME
 WET AND DRY THERMAL
TREATMENT
Wet thermal treatment:
Wet thermal treatment or steam disinfection is based on exposure of shredded
infectious waste to high temperature, high-pressure steam, and is similar to the
autoclave sterilization process. The process is inappropriate for the treatment of
anatomical wastes and animal carcasses, and will not efficiently treat chemical and
pharmaceutical wastes.
Screw-feed technology:
Screw feed technology is the basis of a non-burn, dry thermal disinfection process in
which the waste is shredded and heated in a rotating auger. The waste is reduced by 80
percent in volume and by 20-35 percent in weight. This process is suitable for treating
infectious waste and sharps, but it should not be used to process pathological, cytotoxic
or radioactive wastes.
WET AND DRY THERMAL
TREATMENT
INERTIZATION
 The process of “Inertization” involves mixing waste with
cement and other substances before disposal in order to
minimize the risk of toxic substances contained in the wastes
migrating into the surface water or ground water.
 A typical proportion of the mixture is 65 percent
pharmaceutical waste, 15 percent lime, 15 percent cement and
5 percent water. A homogenous mass is formed and cubes or
pellets are produced on site and then transported to suitable
storage sites.
INERTIZATION OF SOLID AND
LIQUID WASTES
OTHER BIOMEDICAL WASTE
TREATMENT OPTIONS
ROLES & RESPONSIBILITY
OF THE NURSE IN
BIOMEDICAL WASTE
MANAGEMENT
1. Nurses are responsible and accountable for professional behaviour. This
involves the application of the nursing process and cooperation with other
concerned authorities within the legislation affecting the practice of nursing.
2. The accountability of a nurse should be in accordance with the profession’s
code of ethics and practice and within the context of the policies of the
employing agency. It should also comply with the customs and values of the
society in which the nursing care is rendered. The following guidelines should
be followed for effective BMW management.
a) The collectors must wear protective gear.
b) The collection of waste should be in coloured bags or coloured covered bins
…
c) The content of the container should not exceed three quarters of its capacity.
d) If the bag is used for waste collection, tie the neck tightly.
e) Avoid throwing, dragging over floor or holding the bottom of the containers.
f) No container should be used if damaged or leaking.
g) All bins should be covered with lid during collection and transportation of
wastes.
h) If there is any spillage of wastes from the container (gently collect the waste into
a bin, soak the area with 2% Lysol solution, wait for 30 mins, and then wash and
wipe.
i) Collection of sharp medical wastes must be under maximum precautions.
 …
j) During collection each container should be replaced with a new one.
k) It is better that the materials should be in domestic origin, so that the
sustainability of supply could be ensured.
l) The materials commonly used are coloured waste containers or bins,
puncture proof container, heavy duty gloves, rubber service gum boots, hand
trays, Balchi, waste carrying trolleys, rubber apron, etc.
m) Appropriate containers should be placed at all important locations where
particular wastes are generated.
n) No container should be transported without labelling. Instructions on waste
identification should be placed over the containers.
…
o) General waste (Black colour bins) could be placed at landing area of the
staircase, in the straight long corridor bin could be placed at 50 meter distance.
p) During the replacement of the bin, same coloured another bin should be placed
at the site.
q) Waste containers should be labelled with some basic information: about its
waste category, weight of the waste materials, due date of collection, and site of
waste production.
r) This information could be written on printed labels with irremovable or water
resistance ink.
s) All the wastes should be labelled and marked with international symbol
especially during transportation.
SECURITY OF MEDICAL WASTES

1. Security of medical wastes throughout its lifecycle is significantly a challenge, as because

there is a chance of scavenging in every point of its lifecycle.
2. Scavenging of the medical wastes especially at the generation site and disposal site must
be recognized as threats to the institutional infection control program, quality of patient
care and community health hazard.
3. Reduce the bulk in order to reduce requirement for storage and transportation. Make the
waste unrecognizable for aesthetic reasons.
4. Make recyclable items unusable, for example cutting up syringes and damage the
needles. Recycling infectious plastic wastes can be considered only after adequate
disinfection/sterilization.
5. Disposable items, such as gloves, syringes, and the like should be mutilated after use to
prevent illegal packing and reuse.
6. Tracking of wastes up to the point of disposal.
 HEALTH AND SAFETY

1. To ensure the health and safety of the cleaner in waste management through continuous
monitoring is important.
2. An appropriate health and safety program includes,
a. Training of the worker about the related risk.
b. Timely issue of all protective clothing such as gloves, aprons, masks to all HCW and
waste handlers and encourage wearing PPE.
c. Immunization of the worker under occupational safety program especially against
Hepatitis-B virus and Tetanus.
d. Ensure periodical medical check-up system.
e. Medical surveillance, regular medical check up of all staff associated with BMWM.
HEALTH AND SAFETY
3. 50% of needle stick injuries are because of recapping. Therefore, do not
recap the waste.
4. Chemical disinfectant prior to the disposal is required for sharp disposal of
infectious plastic/rubber and infectious glassware and blood and body fluids by
1% hypochlorite or equivalent disinfectant. Always ensure that the right
concentration of the disinfectant is used.
5. Ensure that all surfaces are exposed to the chemical disinfectant.
6. Use decontaminating units made up of solid plastic, puncture proof material
on the outside and inner perforated container with one-third hypochlorite
solution.
PERSONAL HYGIENE
1. In medical waste management personal hygiene is very important.
2. The working place should be provided with continuous water supply and
soap/ detergent.
3. Hand washing should be ensured on arrival for work, before a meal, before
leaving the working area and whenever it is necessary.
RESPONSE TO INJURY AND
EXPOSURE
This program may include:
1. Service providers should be trained to deal with injury and exposure.
a) In case of accident, immediately reporting to the designated authority.
b) Identify items involved in the accident.
c) Immediate first aid measures.
d) Giving medical attention as soon as possible.
e) Record keeping.
EMERGENCY RESPONSE
A) Should be prepared for accident and or unexpected situation.
B) Should be trained to manage common emergencies, necessary
equipment should be handy and ready at all times.

C) Some common emergencies are,

1) Accidental spillage
2) Equipment failure
3) Accidental tear or breakage of containers.
4) Explosion or fire.
ACCIDENT REPORTING
ACCIDENT REPORTING FORM
IN HOUSE TRANSPORTATION

1) Means, transportation of wastes from the site of origin or collection to

temporary storage area within the institution.
2) Waste should be transported by the designated trolley, through the
designated route according to the time schedule given by the institutional
authority.
3) A consignment note should accompany the waste during transportation.
4) The trolley or handcart should be easy to clean, loading and unloading,
leak proof body, should not be used in any other case than waste
transportation.
RECORD KEEPING
Accurate record keeping is needed for effective medical waste management.
 Record keeping might give some important information which is needed for
assessing the
a. Recurrent expenditure.
b. Quality and quantity of generated waste.
c. Cost directly related with the man and materials.
d. Cost related with waste treatment and disposal method.
e. Risk involved with generated waste, amount and nature of accident, amount
of damage, measures taken against accidents, etc.
f. Failures, problems and obstacles in waste management for better compliance
of the program.
SUMMARY
The basic principle of BMWM is segregation at the source and waste reduction
Good BMW practice is based on the concept of 3Rs, namely, reduce, recycle and
reuse. The best BMWM methods aim at avoiding generation of waste or recovering
as much as possible, rather than disposing.
Only about 10%-25% of BMW is hazardous, and the remaining 75%-95% is non-
hazardous.
The safe and sustainable management of biomedical waste(BMW) is social and
legal responsibility of all people supporting and financing health care activities.
Effective BMWM is mandatory for healthy humans and cleaner environment.
SUMMARY
It is our fundamental right to live in a clean and safe environment.
The pillar of BMWM is segregation of the waste at the source and waste reduction.
Therefore, the various methods of BMW disposal, according to their desirability, are
prevent, reduce, reuse, recycle, recover, treat and lastly dispose.
Hence, the waste should be tackled at the source rather than “end of pipe approach.”
The current BMWM 2016 rules are an improvement over earlier rules in terms of
improved segregation, transportation, and disposal methods, to decrease environmental
pollution and ensure the safety of the staff, patients and public.
All participants in BMWM should pledge to guarantee a cleaner and greener
environment.
CONCLUSION