Bio-medical Waste Management
Issues and Challenges
Dr Kairavi J Desai
Professor & Head,
Department of Microbiology,
Govt. Medical College,
Bhavnagar.
Environmental Legislation
The Air (Prevention and Control of Pollution) Act, 1981
The Environment (Protection) Act, 1986
The Hazardous Waste (Management & Handling) Rules,
1989
The Biomedical Waste (Management & Handling)Rules,1998
The Municipal Solid Waste (Management & Handling)
Rules, 2000
The Biomedical Waste (Management & Handling) Rules,2011
The Biomedical Waste (Management & Handling) Rules,
2016 and amendment on 16th March 2018
Biomedical Waste Disposal
Indian scenario
Previous Practices
Unsatisfactory
Potentially hazardous
Risks
• Hospital staff
• HCW
• Municipal workers
• Rag pickers
PERSONS AT RISK
CLASSIFICATION OF BMW
NON-HAZARDOUS HAZARDOUS
( 80% ) ( 20% )
INFECTIOUS OTHER HAZARDOUS
( 15% ) ( 5% ) (injurious)
- Non sharp - Radioactive
- Sharp - Broken Glasswares
- Plastic Dispos - Press Containers
- Liquid - Chemical
- Cytotoxic
- Incineration ash
INFECTIOUS WASTE
IT INCLUDES ALL THOSE MEDICAL WASTES,
WHICH HAVE THE POTENTIAL TO TRANSMIT
VIRAL, BACTERIAL OR PARASITIC DISEASES,
GENERATED FROM…
HOSPITALS
NURSING HOMES
CLINICS
LABORATORIES
BLOOD BANKS
VETERNARY PRACTICE
ANIMAL HOUSE
RESEARCH FACILITIES
INFECTIOUS WASTE
Some of the diseases that can be
Transmitted by infectious waste are....
HEPATITIS A, B, C, D & E
GASTROENTRITIS
TYPHOID FEVER
TUBERCULOSIS
POST-OPERATIVE WOUND INFECTION
SKIN & BLOOD INFECTION
AIDS
CYTOTOXIC WASTE
ANTICANCER DRUGS
CONCENTRATED STRONG ACIDS
PHENYL & ALKALIES
RADIO-ACTIVE MATERIAL
They can produce following toxicity
Immunosupression
Anaemia
Ulcers
Cancer
Genetic & foetal abnormalities
ROUTES OF TRANSMISSION
OF BMW
THROUGH RESPIRATION
BY ORAL ROUTE
THROUGH CONTAMINATION OF WOUNDS
ABSORPTION FROM MUCUS MEMBRANES
BY INJURY FOLLWED BY INFECTION
BMW - “ Waste segregation ”
All Waste Mixed together
Infectious
Office
General Collected
Food
Construction
Chemicals Transported
Disposed
Waste leaving hospitals
Chemicals
INFECTIOUS HAZARDOUS
Risk
Basic Principles
Segregation at source – at every level, ward, OT, unit
level, Laboratories etc.
Color coding to support segregation at source
Bio-medical waste shall be segregated into
containers/ bags at the point of generation in
accordance with Schedule II (BMW Rules 2016) prior
to its storage, transportation, treatment and disposal.
Basic Principles
The containers shall be labeled according to
Schedule IV (BMW Rules 2016)
Transport waste safely to pick up site
Identify destination for each type of waste and
ensure safe disposal
Keep track of usage
Biomedical Waste Management - Issues
• Not considered important
Lack of interest from senior management
No ownership of the process
Awareness of problems
Appreciate the need for constant monitoring
Biomedical Waste Management - Issues
Segregation of waste not taken seriously at user level
Non compliance with color coding
Monitoring segregation at source – low budgets
allocated
Quantification of waste generated is not accurately
done
Biomedical Waste Management - Issues
Protection of healthcare workers not given adequate
thought
Clinical waste dumped with non infectious waste so
that Risk for healthcare workers and public
Waste disposal not effective, often dumped in open
landfills
Biomedical Waste Management -
Responsibilities
Central Pollution Control Board/State Pollution
Control Board – Authority
Head of facility
One who generates BMW, one who collect,
transport, storage, final procedure – is responsible
Each healthcare worker – segregation and
appropriate disposal
Medical waste segregation awareness and
Information should be available in all areas of
hospital
Challenges
Establishing the waste management policies
within the organization
Organization wide awareness about the health
hazards
Sufficient financial and human resources
Monitoring and control of waste disposal
Clear responsibility for appropriate handling ..
LABEL FOR BMW
COLOURED BINS BIOHAZARD LABEL CYTOTOXIC WASTE LABEL
Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE
Option Waste Category Treatment & Disposal
Category No. 1 Human Anatomical Waste incineration @@
(human tissues, organs, body parts)
Category No. 2 Animal Waste incineration@@
(animal tissues, organs, body parts carcasses,
bleeding parts, fluid, blood and experimental animals
used in research, waste generated by veterinary
hospitals, colleges, discharge from hospitals, animal
houses)
Category No. 3 Microbiology & Biotechnology Waste & other Disinfection at source by chemical treatment @or by
laboratory waste autoclaving /microwaving followed by mutilation /
(Wastes from clinical samples shredding ## and after treatment final disposal in
,pathology,biochemistry,haematology,blood secured landfill or disposal of recyclable wastes
bank,laboratory cultures,stocks or specimens of micro- (plastics or glass ) through registered or authorized
organisms live or attenuted vaccines,human and recyclers
animal cell culture used in research and infectious
agents from research and industrial laboratories,waste
from the production of biologicals,toxins, dishes and
devices used for transfer of cultures)
Category No. 4 Waste Sharps Disinfection by chemical treatment @or destruction
(needles, glass syringes, syringes with fixed needles by needle and tip cutters, autoclaving or
scalpels, blade, glass, etc. that may cause punture and microwaving followed by mutilation or shredding ## ,
cuts. This includes both used and unused sharps) whichever is applicable and final disposal through
authorized CBWTF or disposal in secured landfill or
designated concrete waste sharp pit.
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Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continued)
Category No. 5 Discarded Medicines and disposal in secured landfills or
Cytotoxic drugs incineration@@
(Waste comprising of outdated,
contaminated and discarded
medicines)
Category No. 6 Soiled Waste incineration@@
(items contaminated with blood,
and body fluids including cotton,
dressings, soiled plaster casts,
lines, bedding, other material
contaminated with blood)
Category No. 7 Infectious Solid Waste Disinfection by chemical
(Waste generated from disposal treatment @or by autoclaving
items other than the waste sharps /microwaving followed by
such a tubings,handgloves , saline mutilation / shredding ## and
,bottles with IV tubes catheters, after treatment final disposal
glass ,intravenous sets etc.) through registered or authorized
recyclers
Category No. 8 Chemical Waste chemical treatment@@ and
(Chemicals used in production of discharge into drains meeting
biologicals, chemicals used the norms notified under these
in disinfection, as insectricides, rules and solids disposal in
etc.) secured landfill.
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Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continue)
Note :
@ Chemical treatment using at least 1% hypochlorite solution or any other
equivalent chemical reagent . It must be ensured that chemical treatment
ensures disinfection
@@ There will be no chemical pretreatment beforeincineration . Chlorinated
plastics /bags shall not be incinerated.
## Multilation/shredding must be such so as to prevent unauthorised reuse.
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Biomedical wastes categories and their segregation and disposal options
RULES 2016
Colour
Type of Waste Type of Container Treatment options
Coding
Human Anatomical Waste
Animal Anatomical Waste Non chlorinated Plastic Bag Incineration or Plasma Pyrolysis or deep burial
Soiled Waste
either sent back to manufacturer or
Expired or Discarded Medicines
Non chlorinated Plastic Bag disposed by incineration.
or container
Disposed of by incineration or Plasma
Chemical Waste
Pyrolysis or Encapsulation
pre-treated before mixing with other
Separate collection
wastewater. The combined discharge shall
Chemical liquid Waste system leading to effluent
conform to the discharge norms given in
treatment system
Schedule-III
Yellow
Discarded linen, mattresses, beddings Non-chlorinated yellow
incineration or Plazma
contaminated with blood or body fluid plastic bags or suitable
Pyrolysis or for energy recovery
routine mask and gown packing material
Pre-treat to sterilize with non-chlorinated
Autoclave safe chemicals on-site as per National AIDS Control
plastic bags or Organisation or World Health Organisation
Containers guidelines thereafter for Incine 23
Microbiology, Biotechnology and other Autoclave or Microwave “as per World Health Organisation
Colour Coding Type of Waste Type of Container Treatment options
Autoclaving or micro-waving/
hydroclaving followed by
shredding or mutilation or
combination of sterilization
Contaminated and shredding.
non-chlorinated plastic bags
Red Waste
or containers **Plastic waste should not be
(Recyclable)
sent to landfill sites
Glassware Cardboard boxes with blue
colored marking Disinfection or through
autoclaving or microwaving or
Blue Puncture proof and leak
hydroclaving and then
Metallic Body proof boxes or containers sent for recycling.
Implants with blue colored marking
Waste sharps
White Puncture proof, Leak proof, Autoclaving or Dry Heat
including Sterilization
(Translucent) tamper proof containers
Metals:
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Do’s anD Don'ts
Universal safety precautions
Segregate waste as soon as it is generated into specified
categories of waste.
Collect the waste in specific color coded covered bins
having bio hazard label.
Destroy needle by using needle cutter or needle burner.
Mutilate plastic waste (solid waste) as soon as it is
generated.
All liquid chemical waste should be drained out in to
drains only after chemical treatment.
Do’s anD Don'ts
Never mix infectious and non- infectious
waste.
Never mix chlorinated wastes with such
wastes those which have designated for
incineration.
Never overfill and store waste beyond 48
hrs.
There should not be any spillage on the
way of transport.
Maintain complete record.
Let the wastes of “the sick” not
contaminate the lives of “the healthy”
Quality Improvement Programme
Thanks
Quality is a Team work &
never achieve by alone
Community Health Center / Primary Health Center
