Medical Waste

MEDICAL WASTE
An Environmental
Menace
 CONTENTS
•What is medical waste
•Types of medical waste
•Categorization of medical waste
•Quantum of medical waste
•Regulatory frame work in India
a) Bio-Medical Waste (Management and Handling)
Rules 1998
b) Specific guidelines for handling sharps
•Management of medical waste
•Precautions while handling medical waste
•Treatment technologies for medical waste
•Conclusion
•References
 WHAT IS MEDICAL WASTE
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, including but not limited to:

• Blood soaked bandages,

• Culture dishes and other glass wares,
• Discarded surgical gloves (after surgery),
• Discarded surgical instruments (scalpels),
• Needles( used to give shots or draw blood),
• Removed body organs (tonsils, appendices, limbs
etc.),and
• Lancets.
 TYPES OF MEDICAL WASTE

Non infectious Infectious Hazardous

 Paper from offices  Blood and blood products  Formaldehyde

 Corrugated cardboard  Cytotoxic chemicals
 Pathological waste
 Glass  Photographic chemicals
 Sharps
 Metal  Radionuclides
 Cultures and stocks of
 Plastic packaging  Solvents
infectious agents
 Food waste  Toxic chemicals
 Contaminated equipment
 Waste anesthetic gases
 Isolation waste
 Glassware
 CATEGORIZATION OF MEDICAL WASTE

Medical waste is categorized in many ways in different

parts of the world since it comprises a variable mixture
of waste which are very different
• Some can be reused or recycled
• Some safely disposed off as household waste
• Some require special treatment and disposal
techniques to guard against any risk to human
health and environment.
Waste categories are specified by national/local
regulations.
Option Waste category Treatment and disposal

Category no.1 Human Anatomical Incineration; deep burial

Waste

Category no.2 Animal Waste Incineration; deep burial

Category no.3 Microbiology and Local autoclaving/micro-waving

biotechnology waste /incineration
Category no.4 Waste sharps Disinfection and
mutilation/shredding

Category no.5 Discarded medicines Incineration; destruction and drugs

and Cytotoxic drugs disposal in secured landfill
Category no.6 Soiled Waste Incineration; autoclaving/micro-waving
Category no.7 Solid waste Disinfection by chemical treatment;
autoclaving/micro-waving and
mutilation/shredding
Category no.8 Liquid waste Disinfection by chemical treatment and
discharge into drain
Category no.9 Incineration Ash Disposal in municipal landfill
Category no.10 Chemical Waste Chemical treatment; and discharge into
drains for liquids and secured landfill for
Solids.
 QUANTUM OF MEDICAL WASTE
Hospital waste generated in developing countries
( per patient) is much less as compared to the volume
generated in the developed countries.
Volume of waste generated from a medical facility in
developing countries ranges from1-3Kg/day/bed as
compared to 5-8Kg/day/bed in developed countries.
MANAGEMENT OF MEDICAL WASTE
• The management of medical waste is still in its infancy
all over the world.
• Unless carefully managed, medical waste can take
diseases from hospital beds to our homes.
• In most of the developing countries, it is very poorly
managed.
• In medical waste management the hazards and risks
multiply not just to the generators and operators but
also affect the general community.
• Significant cooperation among the concerned parties
and commitment in terms of time and resources.
• Ability and the willingness of the responsible parties to
review their current practices and adopt prevention of
waste generation as a priority.
• Limited access to financial resources as well as to
scientific and technical assistance may also limit the
success of a management programme.
• The best mantra which can be followed in the
management of any type of waste is the three R’s that
are Reduce, Reuse and Recycle.
Waste minimization

1. Segregation
2. Source reduction
3. Resource recovery and recycling
4. Education
5. Purchasing practices
REGULATORY FRAMEWORK IN INDIA

• In India, there was no legislation on medical waste till

the MoEF proposed the first draft rules in 1995.
• The second draft rules were notified in1997.
• The final rules were notified on 20 July 1998 and were
called Bio Medical Waste (Management and Handling)
rules 1998
• These rules were enacted under EPA 1986
The rules have specified a three bin system for the
segregation of wastes:
1) Yellow bin
2) Blue bin
3) Puncture proof containers
 Bio-Medical Waste
(Management & Handling) Rules
1998
Salient features
• The rules apply to all persons who generate, collect,
receive, transport, treat, dispose, store, or handle bio-
medical waste in any form.

• It is the duty of the occupier, where required to set up

requisite bio-medical waste treatment facilities for
treatment of waste, or ensure requisite treatment of
waste at a common waste treatment facility.
• Bio-medical waste is to be treated and disposed in
accordance with Schedule I.

• Bio-medical waste has to be segregated at the point

of generation before its storage, transportation,
treatment and disposal.

• No untreated bio-medical waste can be kept beyond

a period of 48 hours.
• Prescribed Authority

• Authorization

• Advisory committee

• Annual report

• Maintenance of records

• Accident reporting

• Appeal
 Specific guidelines for handling sharps
Definition of sharps: The rules categorize sharps in
Category No 4.Sharps are defined as comprising of
needles, syringes, scalpels, blades, glass, i.e. anything
that may cause puncture and cuts. These include both
used and unused sharps.
Segregation and storage: The types of containers
prescribed for waste sharps have to be puncture-proof
and can be blue, white or translucent in color.
Treatment: Chemical treatment /autoclaving/
rotoclaves/ microwaving.
Mutilation prior to disposal is mandatory to prevent any
unauthorized re-use.

Final disposal: After disinfection and mutilation of

sharps they should be disposed in secured landfills as
per the rules. As secured landfills are not available
everywhere alternate systems recommended include:
a) Sharps pit:

Pit can be dug and lined

with brick, masonry or
concrete rings. The pit
should be
covered with a heavy
concrete slab.
 a)Encapsulation:

Sharps are collected in puncture-proof and leak proof

Containers.
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.
After the medium has
dried, the containers are
sealed and disposed of in
landfill sites.
 PRECAUTIONS FOR HANDLING MEDICAL WASTE

Never overload bins Do not inhale chemicals

Never transfer sharps used for storing Bio directly. Use always
directly from person to Medical Waste mask.
person

Never transfer sharp directly

Never recap the needles Keep away sharps medicines from children
 TREATMENT TECHNOLOGIES FOR
MEDICAL WASTE
1)Incineration

• Most common method.

• Temperature:1600° F - 2500° F or 871°C - 1371° C

• Over 90% of infectious waste is often burned in

incinerators.

• Incinerators are either located onsite or offsite.

Advantages:

1) Reduce landfill cost.

2) Reduces overall energy cost.

Disadvantages:
1)Emit toxic air pollutants.

2) Incineration ash is potentially

hazardous.

3)Health impacts of incineration

2)Steam sanitation

• Carried out in device called Autoclave

• Process takes 30-90 minutes

• Temperature: 30-190°C

• Volume reduced by 75%

• Residue can be landfilled

• Used for low radioactive, chemical, pathological waste

 3) Dry heat disinfection
 Fragmentation of waste and preheating in a rotating
auger

 Temperature varies from 110-140° C

 Process takes 20 min.

 Volume reduced by 80%

 Recommended for the treatment of infectious waste

and sharps
4)Chemical disinfection
 This technology is used for :
a) Infected body fluids
b) Microbiological waste
c) Reusable objects
d) Hospital sewer systems

 Chemicals used are:

a) Aldehydes
b) Chlorine compounds
c) Ammonium salts
d) Phenol compounds
5) Microwave sanitation

• Microorganisms destroyed by waves of frequency

2450MHz.

• Waste are shredded before the process.

• Volume reduced by 80%.

6) Hydroclave
• Based on hydrolysis of organic material.
• Dry, sterilized waste are shredded and their volume
reduced by 80%.
• Total process takes one hour.
• Used for infectious and anatomical waste.
 7) Rotoclave

 Process is fully automated.

 Modernized version of autoclave.

 Sterilizing agent is water vapour in a rotating

pressure chamber.

 Used for laboratory waste, bedding material & animal

waste.
7) Vermiculture-deep burrowing earthworms

• The only alternative that holds promise for waste

disposal seems to be ingoing back to mother earth.

• Earthworms have succeeded in reducing even the

toughest of pathogens to compost dust.

• This bioreactor work silently without making its presence

felt-there is no smell, it does not attract flies and the result
is rich manure.
 CONCLUSION

With newer diseases attacking human kind, it is

incumbent on the part of the medical fraternity to ensure
that hospitals don’t become breeding grounds for
infections.

Awareness and sensitization at all levels through

education, training and internal communication are must.
 REFERENCES

Books
• Environmental treatment technologies for Hazardous
and Medical waste by Subijoy Dutta
• Environmental chemistry by A.K.Dae
• Environmental law by P.S Jaswal

Internet
• www.noharm.org
• www.medical-advisor.org
• www.toxicslink.org
• www.medicalwaste.com
• www.cpcb.nic.in
• www.medind.nic.in