BIOMEDICAL WASTE MANAGEMENT

INTRODUCTION
All over the country, unsegregated and untreated biomedical wastes is being indiscriminately
discarded into municipal bins, dump sites, on roadsides, in water bodies or is being incompletely
and improperly burnt in the open. All this is leading to rapid proliferation and spreading of
infectious, dangerous and fatal communicable diseases like hepatitis, AIDS and several types of
cancers. In urban and rural areas alike, incidence and prevalence of several such human diseases
has increased and the per capita medical expenditure has also gone high several folds. Although,
yet to be proven, morbidity or illness amongst both urban and rural dwellers has increased albeit
for different reasons.

DEFINITION:

Bio-medical waste: “Bio-Medical Waste” is any waste, which is generated during the diagnosis,
treatment or immunization of human beings or animals. These wastes are also generated during
research activities or in the production or testing of biological material.

Redefining it scientifically, Biomedical waste is defined as “any solid, fluid or liquid waste,
including its container and any intermediate product, which is generated during its diagnosis,
treatment or immunization of human beings or animals, in research pertaining thereto, or in the
production or testing of biological and the animal wastes from slaughter houses or any other like
establishments.”

TYPES OF WASTE

Infectious wastes are those biomedical wastes which contain sufficient population of infectious
agents that are capable of causing and spreading infections among people, livestock and vectors.
Infectious waste include human tissues, anatomical waste, organs, body parts, placenta, animal
waste (tissue / cell cultures), any pathological / surgical waste, microbiology and biotechnology
waste (cultures, stocks, specimens of micro-organism, live or attenuated vaccines, etc.),
cytological, pathological wastes, solid waste (swabs,bandages, mops, any item contaminated
with blood or body fluids), infectedsyringes, needles, other sharps, glass, rubber, metal, plastic
disposables andother such wastes.

Cytotoxic substances, as the word suggests are toxic to cells and are often anti-neoplastic which
inhibit cell growth and multiplication. These drugs when come in contact with normal cells can
damage them and cause severe disability or even death of those affected. These drugs could be
present in the waste generated from the treatment of cancer patients or from other work related to
testing and control of cancerous cells.
Infected plastics are those biomedical plastics which have been used for administering patient
care or for performing related activities and may contain blood or body fluids or are suspected to
contain infectious agents insufficient number which may lead to infections among other humans
or animals. These generally include IV tubes / bottles, tubings, gloves, aprons, blood bags / urine
bags, disposable drains, disposable plastic containers, endo-tracheal tubes, microbiology and
biotechnology waste and other laboratory waste.

As regards its type and composition, most hospital waste is similar to household waste and can
be disposed of in the same way. In addition to this, however, hospitals generate certain special
types of waste which should not be handled by domestic refuse collection services, because of
the risk of infection, because they are hazardous in other ways, or for ethical reasons. Such waste
must be collected separately at the places where it is generated, and disposed of in specially
approved plants, e.g., incinerators. Hence, types of hospital waste may be classified according to
the disposal methods apropriate for them, as follows:

Type A: Waste which does not require any special treatment.

This is the waste produced by the hospital administration, the cleaning service, the kitchens,
stores and workshops. It can be disposed of in the same way as household waste.

Type B: Waste with which special precautions must be taken to prevent infection in the
hospital.

This is usually taken to include all waste from inpatient and casualty wards and doctors'
practices, e.g. used dressings, disposable linen and packaging materials. It only constitutes a risk
for patients with weakened defences while it is still inside the hospital. Once it has been removed
from the wards it can be handled by the local domestic refuse collection service.

Type C: Waste which must be disposed of in a particular way to prevent infection.

This is waste from isolation wards for patients with infectious diseases; from dialysis wards and
laboratories, in particular those for microbiological investigations, which contains pathogens of
dangerous infectious diseases, e.g. tuberculosis, hepatitis infectious diarrhoeal diseases and
which constitutes a real risk of infection when disposing of this waste. It includes needles and
sharp objects coated with blood, or disposable items contaminated with stool.

Type D: Parts of human bodies: limbs, organs etc.

This waste originates in pathology, surgical, gynecological and obstetric departments. It has to be
disposed of separately, not to prevent infection but for ethical reasons.
Type E: Other waste.

Hospitals provide a service, and hence have infrastructures which can also generate hazardous
waste products. Chemical residues from laboratories, as well as inflammable, exposable, toxic or
radioactive waste, which must be disposed of in accordance with statutory provisions.

SHARPS HANDLING AND DISPOSAL:

Sharps consist of needles, syringes, scalpels, blades, glass etc., which have the capability to
injure by piercing the skin. As these sharps are used in patient care, there is every chance that
infection can spread through this type of injury. Nurses can get a sharp injury before and after
using a sharp on a patient. Further, sharps discarded without any special containment or
segregation can injure and transmit disease to those who collect waste (including safai
karamcharis, municipal sweepers and rag pickers). There have been reports that waste collected
from the hospitals are resold, this creates an additional occupational and community health
hazard.

PLASCTICS IN HELTHCARE

Hospitals use plastics because they fear a spread of infection through the use of reusable medical
equipment. Thus, plastic use has grown with increasing concern for infection control. However,
there have been cases where even with the use of plastics there has been a spread of infection in
wards. Nurses complained of nosocomial infections in wards even though disposable equipment
was used — they related it to improper waste disposal of disposable equipment within the wards.
PVC is a thermoplastic, with approximately 40 percent of its content being additives.
Plasticisers are added to make PVC flexible and transparent.

Medical equipment made from PVC:

 Blood bags
 Breathing tubes
 Feeding tubes
 Pressure monitor tubes
 Catheters
 Drip chamber
 IV Containers
 Parts of a syringe
 IV Components
 Labware
 Inhalation masks
 Dialysis tubes
MEDICAL WASTE INCINERATION

Incineration is a complex technology that is used to burn waste. The problem of medical waste is
one of disinfecting the waste and not of destroying it. With the increased use of disposables in
medicine, the amount of plastic going for incineration has increased manifold. The burning of
plastics, especially in unregulated incinerators, creates a new set of chemical toxins, some of
which, are super toxins even in extremely small quantities. Incineration thus converts a
biological problem into a chemical one.

MERCURY : A HEALTH HAZARD

Sources of Mercury in hospitals:

 Thermometers

 Blood pressure cuffs

 Feeding tube

 Dilators and batteries

 Dental amalgam

 Used in laboratory chemicals like Zenkers solution and histological fixatives.

GLUTARALDEHYDE/ CIDEX

Glutaraldehyde is a colourless, oily liquid, which is also commonly availableas a clear,

colourless, aqueous solution. It is a powerful, cold disinfectant, used widely in the health services
for high-level disinfection of medical instruments and supplies and available with trade names
such as: Cidex, Totacide, and aseptic. Glutaraldehyde is a widely used disinfectant and a
sterilizing agent (commonly available in 1 percent and 2 percent solutions) in medical and dental
settings. It is used in embalming (25% solution), as an intermediate and fixative for tissue-fixing
in electron microscopy (20 percent, 50 percent and 99 percent solutions) and in X-ray films.

RADIOACTIVE WASTE

Radiations are used for wide variety applications in research, industry, medicine, manufacturing,
agriculture, consumer goods and services. The common concern is that in all these uses, care
must be taken to ensure that everyone is protected from the potential hazards of radiation.
EFFECTS OF BIO-MEDICAL WASTE:
SHARPS HANDLING AND DISPOSAL

Sharps consist of needles, syringes, scalpels, blades, glass etc., which have the capability to
injure by piercing the skin. As these sharps are used in patient care, there is every chance that
infection can spread through this type of injury. Nurses can get a sharp injury before and after
using a sharp on a patient. Further, sharps discarded without any special containment or
segregation can injure and transmit disease to those who collect waste (including safai
karamcharis, municipal sweepers and ragpickers). There have been reports that waste collected
from the hospitals are resold, this creates an additional occupational and community health
hazard.

MEDICAL WASTE INCINERATION

Acid gases include nitrogen oxide, which has been shown to cause acid rain formation
and affect the respiratory and cardiovascular system. As large amounts of plastic are incinerated
hydrochloric acid is produced. This acid attacks the respiratory system, skin, eyes and lungs with
side effects such as coughing, nausea and vomiting. Heavy metals are released during
incineration of medical waste. Mercury, when incinerated, vaporizes and spreads easily in the
environment. Lead and cadmium present in the plastics also accumulates in the ash. Acute and
chronic exposure to lead can cause metabolic, neurological and neuro-psychological disorders. It
has been associated with decreased intelligence and impaired neurobehavioral development in
children. Cadmium has been identified as a carcinogen and is linked to toxic effects on
reproduction, development, liver and nervous system.

PLASCTICS IN HELTHCARE

Disposal of PVC via incineration leads to the formation of dioxin and furans. Dioxin and furans
are nwanted by-products of incineration with carcinogenic and endocrine-disrupting properties.
They are toxic at levels as low as 0.006 picograms per Kg of body weight.

MERCURY HEALTH HAZARD:

When products containing mercury are incinerated, the mercury becomes airborne and
eventually settles in waterbodies from, where via bio-magnification in the food chain and
bioaccumulation, it reaches humans. If it is flushed, it enters waterbodies directly, and if it is
thrown in bins it could enter the body of animals via skin or inhalation, or permeate into the
ground causing soil and groundwater poisoning. This metal accumulates in the muscle tissues.

Three major types of mercury are found in the environment – methyl mercury, mercury (zero),
mercury (two). Out of these, methyl mercury is the most toxic; it bio accumulates and has the
capability to interfere with cell division and cross the placental barrier. It also binds to DNA and
interferes with the copying of chromosomes and production of proteins. Pregnant women and
children are most vulnerable to the effects of mercury. The Minamata disaster in Japan is an
example of mercury-poisoning via bio- magnification and bioaccumulation. Mercury exposure
can lead to pneumonitis, bronchitis, muscle tremors, irritability, personality changes, gingivitis
and forms of nerve damage.

GLUTARALDEHYDE/ CIDEX
Aqueous solution is not flammable. However, after the water evaporates the remaining material
will burn. During a fire, toxic decomposition products such as carbon monoxide and carbon
dioxide can be generated.

RADIOACTIVE WASTE

Accidents due to improper disposal of nuclear therapeutic material from unsafe operation of x-
ray apparatus, improper handling of radio- isotopic solutions like spills and left over doses, or
inadequate control of radiotherapy have been reported world over with a large number of persons
suffering from the results of exposure. In Brazil while moving, a radiotherapy institute a left over
sealed radiotherapy source resulted in an exposure to 249 people of whom several either died or
suffered severe health problems International atomic Energy Agency, 1988). In a similar
incidence four people died from acute radiation syndrome and 28 suffered serious radiation
burns.

COLLECTION AND TREATMENT:

The fight against hospital infection demands the cooperation of all those employed in the
hospital: doctors, technicians, nursing and cleaning staff. This is why one of the most urgent
tasks is to convince, train and monitor the personnel responsible for refuse disposal. Unless they
are convinced of the need, trained and monitored, all efforts to improve the situation will be
doomed to failure.

Hospital waste should always be collected in disposable containers which satisfy the following
requirements: they must be moisture-resistant and non-transparent; sellable in such a way as to
prevent egress of micro-organisms;safe to transport; and colour-coded to distinguish them from
household refuse bags. The waste must be collected in such containers at the point where it is
generated, and removed from the wards daily without being sorted or transferred to other
containers. The containers must be carefully sealed. Generally, plastic bags are used for Type B
and C waste, and plastic buckets for Type D waste. The material these disposable containers are
made of must be appropriate for the next treatment stage.
If the waste is subsequently incinerated, for example, combustible materials with a low level of
toxicity must be used; if it is heat-disinfected the materials must be steam-permeable. This
requirement also applies, incidentalIy, to all disposable items purchased by hospitals. The waste
must be transported to a central incineration plant outside the hospital in specially designed
vehicles which do not compress it. The interior of the vehicle body must be easy to clean and it
must be adequately ventilated. Generally speaking, hospital waste should be burnt in appropriate
incinerators: this is a recognized, proven method for disposing of all hospital waste. There are
many different incineration systems available on the market today. Basically, an incineration
plant should satisfy the following requirements:

• it should burn dry, wet and organic waste completely.

• glass, plastics and metals contained in the waste should not impair the
function of the plant in any way.

The combustion process should be fully automated, and exhaust gases should be within the
statutory limits even if there are considerable differences in the calorific values of the waste.
Plants which satisfy these requirements are now available in all sizes.

Alternatively, Type C waste can be disinfected and subsequently disposed of as household

refuse, or, in special cases, removed to guarded sanitary landfills and immediately covered. Type
D waste can be interred in an appropriate manner in cemeteries.
A variety of methods, chemical and physical, can be used for disinfection. To disinfect waste,
however, only thermal systems in which the waste is steam- treated at temperatures above 105°C
have so far proved successful.
Disinfection in pressure-resistant installations involves approximately the same amount of work
as incineration, but has the disadvantage that it is not possible to check visually whether the
treatment has been a complete success. With incineration this is of course possible. For this
reason incineration is to be preferred in countries which have no trained inspection personnel.
There are also devices on the market which shred waste and then disinfect it with liquid
chemicals. These devices are only suitable for small quantities, mostly prone to breakdowns,
and there is no guarantee that the disinfectant fluid will reach all the waste. They are not suitable
for handling all the waste generated by a hospital.

CATEGORIES OF BIO-MEDICAL WASTE MANAGEMENT

OPTION TREATMENT AND WASTE CATEGORY

DISPOSAL
 Cat. No. 1 Incineration /deep burial Human Anatomical Waste (human tissues, organs,
body parts)

Cat. No. 2 Incineration /deep burial Animal Waste 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)
Cat. No. 3 Local autoclaving/ micro Microbiology & Biotechnology waste (wastes from
waving/ incineration laboratory cultures, stocks or specimens of micro-
organisms live or attenuated vaccines, human and
animal cell   culture used in research and infectious
agents from research andindustrial laboratories,
wastes from productionof biological, toxins, dishes

Cat. No. 4 Disinfections (chemical Waste Sharps (needles, syringes, scalpels blades, glass
treatment etc. that may cause puncture and cuts. This includes
/autoclaving/micro both used & unused sharps)
waving and mutilation
shredding
Cat. No. 5 Incineration / destructionDiscarded Medicines and Cytotoxic drugs (wastes
& drugs disposal in comprising of outdated, contaminated and discarded
secured landfills   medicines)
Cat. No. 6 Incineration, Solid Waste (Items contaminated with blood and body
autoclaving/micro waving fluids including cotton, dressings, soiled plaster casts,
line beddings, other material contaminated
withblood)
Cat. No. 7 Disinfections by chemical Solid Waste (waste generated from disposable items
treatment other than the waste sharps such as tubing, catheters,
autoclaving/micro intravenous sets etc.)
waving& mutilation
shredding.
Cat. No. 8 Disinfections by chemical Liquid Waste (waste generated from laboratory &
treatment and washing, cleaning , house-keeping and disinfecting
discharge into drain activities)
Cat. No. 9 Disposal in municipal Incineration Ash (ash from incineration of any bio-
landfill medical waste)
Cat. No. Chemical treatment Chemical Waste (chemicals used in production of
10 & discharge into drain for biological, chemicals, used in disinfect ion, as
liquid & secured landfill insecticides, etc)
for solids 
COLOR CODING & TYPE OF CONTAINER FOR DISPOSAL OF BIO-MEDICAL
WASTE

COLOUR TYPE OF WASTE TREATMENT OPTION AS

CODING CONTAINER CATEGORY PER SCHEDULE

Yellow Plastic bag 1,2,3,6 Incineration/deep burial

Red Disinfected 3,6,7 Autoclaving/Micro waving/

Container/ Chemical Treatment
Plastic bag

Blue/ White Plastic 4,7 Autoclaving/Micro waving/

translucent bag/puncture chemical treatment and
proof container destruction/shredding

Black Plastic bag 5,9,10 (Solid) Disposal in secured landfill

SHARPS HANDLING AND DISPOSAL:

-Make needle reuse impossible: Auto disable syringes, like Solo Shot device, cannot be used
more than once and therefore cannot carry infection from one patient to another.
-Take the sharp out of sharps waste: Needle removers “de-fang” syringes, immediately
removing the needles after injection and isolating them in secure containers. The syringe cannot
be reused, and there’s no risk of accidental needle sticks.
-Keep needles away from vulnerable hands: Special stick proof containers capture used needles
and other medical waste until they can be destroyed. PATH is working to increase access to
these “safety boxes,”
identifying low-cost options and making them available for all types of injections.
Using a needle cutter/destroyer:

1. Place used needle in the cutter/destroyer.

2. Cut/destroy the needle and the nozzle of syringe in the destroyer/cutter.
3. Separate syringe’s barrel and plunger and put in liquid disinfectant.
4. After every shift empty the contents of needle container/destroyer into liquid disinfectant,
remove through pouring out contents through a sieve.

MEDICAL WASTE INCINERATION

Due to poor operation and maintenance, these incinerators do not destroy the waste, need a lot of
fuel to run, and are often out of order. There is a lot of difference between the theory and practice
of incinerator operation. This is true around the world. The problem of medical waste needs a
systematic approach, with investments in training of staff, segregation, waste minimisation and
safe technologies, as also centralised facilities. Merely investing in unsafe incinerators cannot
solve it.

PLASCTICS IN HELTH CARE

Do’s and Don’ts:

1. That the used product is mutilated.

2. That the used product is treated prior to disposal.
3. Segregation

Do not

1. Reuse plastic equipment.

2. Mix plastic equipment with other waste.
3. Burn plastic waste.

GLUTARALDEHYDE/ CIDEX

Identify All Usage Locations: All departments that use glutaraldehyde must be identified and
included in the safety program. Eliminate as many usage locations as possible and centralize
usage to minimize the number of employees involved with the handling of glutaraldehyde.

Monitor Exposure Levels: Measurement of glutaraldehyde exposure levels must be conducted in

all usage locations.

Training: An in-depth education and training program should be conducted for all employees
who work with hazardous chemicals.

Use Personal Protective Equipment: All employees who work with glutaraldehyde must be
provided appropriate personal protective equipment. This equipment includes proper eye/face
protection, chemical protective gloves, and protective clothing.

Engineering controls: Rooms in which glutaraldehyde is used should have a minimum of 10 air
exchange rates per hour.
General room ventilation: A neutralizing agent will, over time, chemically inactivate the
glutaraldehyde.
  LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS
 

CONCLUSION:

Hospital is a place of almighty, a place to serve the patient. Since beginning, the hospitals are
known for the treatment of sick persons but we are unaware about the adverse effects of the
garbage and generated by them on human body and environment. Now it is a well established
fact that there are many adverse and harmful effects to the environment including human beings
which are caused by the "Hospital waste" generated during the patient care.. This problem has
now become a serious threat for the public health and, ultimately, the Central Government had to
intervene for enforcing proper handling and disposal of hospital waste and an act was passed in
July 1996 and a bio-medical waste (handling and management) rule was introduced in 1998.

REFERENCES:

1. The Royal Australian College of General Practitioners. "RACGP Infection Control

Standards for Office-based Practices (4th Edition)".
http://www.racgp.org.au/infectioncontrol.
2. Dix, Kathy. "Airborne Pathogens in Healthcare Facilities".
http://www.infectioncontroltoday.com/articles/581clinical.html. Retrieved 11 December
2008.
3. Nicas, Mark et al.; Nazaroff, WW; Hubbard, A (2005). "Toward Understanding the Risk
of Secondary Airborne Infection: Emission of Respirable Pathogens". Journal of
Occupational and Environmental Hygiene 2 (3): 143–15.
4. http://www.osha.gov/pls/oshaweb/owadisp.show_document?
p_table=STANDARDS&p_id=10051
5. Maine Department of Environmental Protection. "Biomedical Waste Management
Rules". http://maine.gov/dep/rwm/rules/pdf/chapter900effectiveaugust_4_2008.pdf.
Retrieved 2008-12-21.
6. MIT EHS. "Biomedical Waste". http://web.mit.edu/environment/ehs/biomed.html.
Retrieved 2008-12-21.
7. Florida Division of Environmental Health.