Biomedical Waste

Management
 Learning objectives

At the end of the session, the students should be able to understand:

 Biomedical Waste Rule

 Waste Segregation in Hospitals

 Treatment and Disposal Methods

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Definition

 Wastes that are generated during the laboratory diagnosis, treatment or

immunization of human beings or animals, or in research activities
pertaining thereto, or in the production of biologicals.

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Waste Generated in Hospitals

 In developing countries, the waste generated falls into two categories:

 General (non-hazardous solid waste, 80%)

 Biomedical waste: includes infectious waste (10%) and

chemical/radioactive waste (5%)

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Hazards Associated with BMW

 Hazards from infectious wastes- Pathogens in infectious waste can infect

HCWs and BBV transmission can occur through sharp waste

 Hazards from chemical wastes- toxic, corrosive and some may cause
physical injuries and chemical burns

 Pharmaceutical waste- exposure may cause several adverse effects

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Hazards Associated with BMW

 Hazards from cytotoxic waste- can be mutagenic, teratogenic or

carcinogenic

 Hazards from radioactive waste- genotoxic, can also cause tissue

destruction

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Situation in India

 According to the Ministry of Environment and Forests, gross generation of

BMW in India is about 484 TPD (only 447 TPD is treated)

 Karnataka tops the chart among all the states in generation of BMW
followed by Maharashtra.

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Waste management Hierarchy

 Largely based on the concept of the “3Rs”, namely:

 Reduce

 Recycle

 Recover

 If none of these methods is available, then the last method opted is

disposal. 8
BIOMEDICAL WASTE RULE,
INDIA
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BIOMEDICAL WASTE RULE, INDIA
 MoEF - formulated BMW rule in 1998, which had classified the waste
into 10 categories - segregated into five color coded containers.

 Considerable overlapping between categories - created ambiguity and

confusion.

 New BMW guideline - published in 2016 - amendment added in 2018

and 2019
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Steps of BMW Management

 Waste segregation (at the point of generation) into color coded containers
 Pre-treatment for laboratory liquid waste
 Transport of waste from generation site to central storage area of the
hospital
 Transport of waste from central storage area to common bio-medical waste
treatment facility (CBMWTF)
 Treatment and/or disposal (within 48 hours of generation).

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Waste Segregation in Hospitals

 According to BMW Rule (2016), segregation should be done by using

containers of four different colors, each is designated for segregation of a
particular waste category.

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Biomedical Waste Management Rule, India, 2016
(including the amendment added in 2018 and 2019)
Category Type of waste Type of Bag/ container Treatment/ Disposal options
Yellow infectious Human anatomical waste Yellow coloured non Incineration/ Plasma pyrolysis/
non- plastic waste Animal anatomical waste chlorinated plastic bags deep burial

Soiled waste Incineration/plasma pyrolysis/

deep burial/autoclaving or
hydroclaving +
shredding/mutilation
Expired/discarded Yellow colored Sent back to manufacturer/
medicines — containers/non- CBMWTF for incineration
pharmaceutical waste, chlorinated plastic bags (cytotoxic drugs at temperature
cytotoxic drugs with cytotoxic label >1200°C)

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Biomedical Waste Management Rule, India, 2016 (including the
amendment added in 2018 and 2019) (Cont..)
Category Type of waste Type of Bag/ container Treatment/ Disposal options
Yellow infectious Chemical solid waste Yellow colored Incineration or plasma pyrolysis
non- plastic waste containers/nonchlorinated or encapsulation
plastic bags
Chemical liquid waste To be discharged into Pre-treated before mixing with
such as discarded separate collection other wastewater
disinfectants, infected system, which leads to
body fluids and effluent treatment system
secretions, liquid from Not to be discarded into
house-keeping related yellow bag
activities

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Biomedical Waste Management Rule, India, 2016 (including the
amendment added in 2018 and 2019) (Cont..)

Category Type of waste Type of Bag/ container Treatment/ Disposal options

Yellow infectious Discarded linen waste Non-chlorinated yellow Non-chlorinated chemical
non- plastic waste contaminated with plastic Disinfection followed by
blood/body fluids, mask, bags/suitable packing incineration/plasma pyrolysis
cap, gown and shoe material
cover
Microbiology, other Autoclave safe plastic Pre-treat to sterilize with non
clinical laboratory waste, bag/ chlorinated chemicals2 on-site
blood bags, live/ container as per NACO/ WHO guidelines
attenuated vaccines (Blue book 2014) + incineration

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Biomedical Waste Management Rule, India, 2016 (including the
amendment added in 2018 and 2019) (Cont..)
Category Type of waste Type of Bag/ container Treatment/ Disposal options
Red Infectious plastic waste Red colored non-  Autoclaving/microwaving/
Disposable items such chlorinated plastic bags or hydroclaving + shredding
as tubing, bottles, containers  Mutilation/sterilization+
intravenous tubes and shredding
sets, catheters, urine  Treated waste sent to
bags, syringes (without authorized recyclers or for
needles and fixed needle energy recovery
syringes) and vacutainer
with their needles cut),
gloves, plastic apron and
goggles

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Biomedical Waste Management Rule, India, 2016 (including the
amendment added in 2018 and 2019) (Cont..)

Category Type of waste Type of Bag/ container Treatment/ Disposal options

White Waste sharps including Puncture-proof, leak-proof, Autoclaving/dry heat
(Translucent) metal sharps: tamper-proof containers sterilization followed by:
Needles, syringes with  Shredding or mutilation or
fixed needles, needles encapsulation in metal
from needle tip cutter or container or cement
burner, scalpels, blades, concrete or
or any other  Sanitary landfill or
contaminated sharp  Designated concrete waste
(used or discarded) sharp pit

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 Biomedical waste Management Rule,
India 2016
Category Type of waste Type of Bag/ Treatment/ Disposal
container options
Blue Glassware Cardboard boxes with Disinfection (by
Metallic body blue colored marking soaking the washed
implants glass waste after
cleaning with
detergent and Sodium
Hypochlorite
treatment)/ through
autoclaving/
microwaving/
hydroclaving +
recycling
Logos used for segregation of biomedical waste

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STEPS OF BIOMEDICAL WASTE
MANAGEMENT:
SEGREGATION

COLLECTION AND
STORAGE

TRANSPORTATION

TREATMENT & DISPOSAL

 In House Segregation Common
GENERATOR (collection, segregation, packing Storage
(HOSPITALS) in Point at
Colour coded poly bags)
Hospitals

BIO-MEDICAL WASTE MANAGEMENT

Transportation
CYCLE (Approved Special
Vehicles)

Disposal Treatment Unloading & temp.

(Recycling & (Incineration, Autoclaving and
Landfill) Shredding)
Storage at
CBWTF
Treatment and Disposal Methods

 As per the mandate of the BMWM rules, 2016, the final disposal and
recycling must be performed at common biomedical waste treatment
facility (CBMWTF).

 Only when there is no CBMWTF within 75 km, the hospital can create its
own the disposal facility.

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Incineration

 High temperature (800-1200°C) dry oxidation process that reduces

organic and combustible waste into nonorganic incombustible matter,
resulting in a very significant reduction of waste volume and weight.

 Done for those wastes that cannot be reused, recycled or disposed of in a

landfill site.

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Incineration (Cont..)

 Example - human and animal anatomical waste, microbiological waste,

solid non-plastic infectious waste.

 Halogenated plastics such as PVC should never be incinerated as it

generates furans which are carcinogenic.

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Autoclave

 Thermal process - steam is brought into

direct contact with waste in a controlled
manner and for sufficient duration to
sterilize the wastes.

 It is mainly used for the treatment of

infectious plastic and sharp waste.
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Chemical Disinfection

 A chemical such as hypochlorite 1-2% is mixed to waste which results in

disinfection.

 More suitable for liquid waste such as discarded blood and body fluid and
also for hospital sewage.

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Effluent Treatment Plant

 The liquid waste (effluent) generated in the hospital if mixes directly with
groundwater it can create significant health risks.

 Therefore, it is first subjected to chemical treatment and then is drained in

to effluent treatment plant (ETP).

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Effluent Treatment Plant (Cont..)

 ETP removes the suspended solids and organic matter in wastewater and
then disinfects the wastewater (with hypochlorite) and finally drain the
water to municipal drainage.

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Microwaving

 Microwaves are radio-frequency waves,

used at a frequency of 2450 MHz.

 They produce friction of water molecules

which generates heat.

 Large size microwaves are used for

disposal of BMW
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Hydroclaving

 Low-temperature steam sterilizer,

involving steam treatment with
fragmentation and drying of waste.

 It breaks up the waste into small pieces

of fragmented material; thus obviates
postcycle shredding (unlike autoclave).
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Shredder

 Process by which wastes are de-shaped

or cut into smaller pieces so as to make
the wastes unrecognizable.

 It helps in prevention of reuse of BMW

and also helps to reduce the waste
volume.
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Deep Burial

 Deep burial is a pit dug about two meters deep.

 It needs to be half filled with waste, and then covered with lime within 50
cm of the surface, before filling the rest of the pit with soil.

 The ground water level should be a minimum of six meters below the
lower level of deep burial pit.

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Sharp Pit

 Constructed within the hospital premises.

 Provides an alternative method for

disposal of the sharp waste generated
from the facility.

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Encapsulation

 Involves filling the containers with waste, adding immobilizing material

and sealing the containers, to prevent the access to unscrupulous activities.

 Cubic boxes (metallic drums) which are three quarters filled with sharps or
chemicals or pharmaceutical wastes  then filled with plastic foam,
cement mortar or clay material.

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Inertization

 Involves mixing waste with cement before disposal

 It is especially suitable for pharmaceuticals and for incinerated ashes with a

high metal content.

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Plasma Pyrolysis

 Uses ionized gas in the plasma state to convert electrical energy to

temperatures of several thousand degrees using plasma arc torches or
electrodes.

 The system provides high temperatures combined with high UV radiation

flux which destroys pathogens completely.

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Disposal of Cytotoxic Drug Waste

 Expired cytotoxic drugs to be returned back to the manufacturer or

supplier or CBMWTF for incineration at >1,200°C or encapsulation or
plasma pyrolysis at >1,200°C.

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Disposal of General Waste (Solid Waste)

 Constitute the large component of hospital waste (80%).

 They are not biomedical waste - their disposal can be carried out by several
strategies.

 Composting: It is the decomposition of organic matter by microorganism in

warm moist environment.

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Disposal of General Waste (Solid Waste)
(Cont..)
 Waste-to-energy - by various methods such as incineration, pelletisation,
biomethanation etc.

 Recycling of the waste

 Landfilling in dump yard (least preferred method)

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MONITORING OF BMW MANAGEMENT

 Monitoring is an essential component of managing biomedical waste in the

hospital.

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MONITORING OF BMW MANAGEMENT
(Cont..)
 BMW management committee should be formed, which serves several
functions—

 (1) to oversee the implementation of BMW practices,

 (2) to educate HCWs about BMWM practices, and

 (3) to monitor BMW management in a hospital.

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MONITORING OF BMW MANAGEMENT
(Cont..)
 Monitoring of BMW management practices can be carried out through
following ways:
 Biomedical waste segregation audit by direct observation
 Biomedical waste segregation audit by CCTV camera
 Onsite inspection of BMW segregation at common storage area
 Conducting surveys through structured questionnaires
 Barcoding-based tracking of BMW, starting from segregation to
disposal.
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