BIO-MEDICAL WASTE MANAGEMENT

ISSUES AND CHALLENGES

Presented by – Dr.DharmendraGahwai
(PG Student)

Guided by-
Dr. Y.D. Badgaiyan
Prof. and Head
Deptt. of Community Medicine
CIMS, Bilaspur (C.G.)
Let the waste of the “sick”
not contaminate the lives
of “The Healthy”
 Medical care is vital for our life, health
and well being.

 But the waste generated from medical

activities can be hazardous, toxic and
even lethal.
 Indiscriminate disposal of waste has
resulted in a rise in deadly infections
such as –
- HIV
- Hepatitis B.
 Its ability to contaminate other
nonhazardous municipal waste
jeopardise the efforts undertaken for
overall municipal waste management.
 At the same time, illegal and unethical
reuse can be extremely dangerous and
even fatal.
 Unfortunately, in the absence of reliable
and extensive data, it is difficult to
quantify the dimension of the problem.

 With a judicious planning and

management, however, the risk can be
considerably reduced.
DEFINITION
According to Bio-medical Waste(Management and
Handling ) Rules, 1998 of India, Bio-medical Waste
means –
“Any waste, which is generated
during the diagnosis , treatment or
immunization of human being or animal, or
in research activity pertaining thereto or in
the production or testing of biologicals, and
including categories as mentioned in
schedule I.”
Sources of health care waste
 Government/private hospitals
 Nursing homes
 Physician/dentist office or clinic
 Dispensaries
 Primary health care centers
 Medical research and training centers
 animal./slaughter houses
 labs/research organizations
 Vaccinating centers
 Bio tech institutions/production units
 According to a WHO report-
- 85% of the hospital wastes are non-
hazardous.
- 10% are infective (hence, hazardous), and
- 5% are non-infectious but hazardous
(chemical, pharmaceutical and radioactive).
• 1. To minimize the potential for spread of disease
from a medical settings to the general public.

 2. To reduce the overall amount of infectious medical

waste produced.

 3. Prevention of Environment pollution.

 4. Infectious agents may become toys of terrorists, as

Bio-weapons of Mass Destruction
MAGNITUDE OF PROBLEM
GLOBALY
 The quantity of Bio-Medical Waste
generated will vary depending on the
hospital policies and practices and the type
of care being provided.
 The data available from developed countries
indicate a range from 1-5 Kg/bed/day,
with substantial inter country and inter
speciallity differences.
 Meager data from developing countries
but the figures are lower.

 i.e. 1-2 Kg/bed/day.

INDIA

- No national level study.

- Local or regional level study shows

hospitals generate roughly 1-2
kg/bed/day.
 A survey done in Banglore revealed that the quantity of
BMW generated in hospitals are –

 1. Govt. Hospitals – ½ to 4 kg/ bed / day.

 2. Private Hospitals – ½ to 2 kg / bed / day.

 3.Nursing Homes – ½ to 4 kg / bed / day.

CLASSIFICATION OF BIO-MEDICAL WASTE
 1. Infectious waste-  Lab cultures, tissues, swabs,
equipments and excreta.

 2. Pathological waste-  Human tissue or fluids e.g. body

parts, blood, other body fluids.

 3. Pharmaceutical waste  Expired and contaminated

medicines.
 4.Genotoxic waste-  Cytotoxic drugs, genotoxic
chemicals.

 5.Chemical waste-  Expired Lab reagents, film

developer, disinfectants.

 6.Waste with high

content of heavy  Batteries, broken thermometers.
metals-
 8. Pressurized containers-  Gas cylinders, gas cartridges.

 9. Radioactive waste-  Unused liquid in radiotherapy

or lab research.
Pathological waste
Pharmaceutical waste
Genotoxic waste
Waste containing heavy metals
Pressurized containers
Radioactive waste
HAZARDS OF BIOMEDICAL WASTE
Hazards of BMW
• 1. Infectious wastes and sharps cause
transmission of infections like HIV
Hepatitis B and C.

 2. Chemical and Pharma waste toxic,

corrosive, flammable, reactive and
shock sensitive.
• 3. Genotoxic and Radioactive wastes
are responsible for toxicity ranges from
the headache , nausea and vomiting to
the skin reactions and malignancies.

 4. Public sensitivity for visual impact

of anatomical wastes.
 Who’s at Risk ?
• Doctors and nurses

• Patients

• Hospital support staff

• Waste collection and disposal staff

• General public and

• the Environment
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 Principles of Waste Management
1. Identification of points of generation of waste.
2.Waste minimization & recycling of waste.
3.Waste segregation at source.
4.Waste treatment (disinfection etc.) at the site.
5. Waste collection and transportation, on-site and
off-site.

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1
6. Waste treatment , on-site & off the site
7. Final disposal of waste
8. Occupational safety
9. Continuous monitoring of the system
10.Training of the staff.
PROCESS OF BMW MANAGEMENT
Biomedical Waste Management Process

 1. Source Identification.
 2. Segregation.
 3. Collection and storage.
 4. Transport.
 5. Treatment and Disposal.
1. Source Identification
 Identification of source required both at
- the macro level.
(Institutes that generates wastes)

- the micro level.

(Points and activities within the
institution).
2. SEGREGATION
 “Separation of different types of
waste as per treatment and disposal
options.”

 It is the key to the active process of

scientific waste management.
3. COLLECTION AND STORAGE
 Storage of waste refers to storage within
wards or collection points within the
departments.
 Collection centers are planned between 2-3
wards.
 Central collection.
 Common Treatment Facility (CTF)
 No untreated biomedical waste shall
be kept stored beyond period of 48
hours.

 If any reason it is necessary then

permission of the prescribed
authority is essential.
4. TRANSPORT

 Transportation system should be secured

with special containers and well defined
route with minimum patient influx.
 The containers should have non-washable
and prominently visible label showing the
type of waste it contains – Cytotoxic or
Biohazrds.
5. TREATMENT AND DISPOSAL

 The main objectives of treatment are

- disinfecting and decontaminating the waste
and
- volume reduction.
 Broadly two categories –

 1. BURN TECHNOLOGY.

 2. NON-BURN TECHNOLOGY.
BURN TECHNOLOGY
1. Open Burning.
2. Small Scale incinerators.
3. Single Chamber Incinerators.
4. Double Chamber Incinerator.
5. Pyrolyltic incinerators and Ratary
Kiln.
NON-BURN TECHNOLOGY
1.Chemical Disinfection.
2. Microwave Irradiation.
3. Dry and Wet thermal
techniques.(AUTOCLAVING)
4. Sanitary landfill
5. Deep Burial
6. Inertization and Encapsulation.
INCINERATION
 Method of choice for most hazardous
health care waste.
 High temp dry oxidation process.
 Reduces organic and combustible waste to
inorganic and incombustible material.
 Significant reduction in waste volume
and weight.
 INCINERATORS

SINGLE CHAMBER INCINERATOR DRUM/BRICK INCINERATION

 INCINERATORS

ROTARY KILN PYROLYTIC INCINERATOR

AUTOCLAVING
 Autoclaving is efficient thermal disinfection process.

 Commonly used for reusable medical equipments.

 Effective inactivation of all the micro-organism and

bacterial spores at 121 degree C temperature and
30 psi pressure for 3 minutes holding time.
TEMPERATURE PRESSURE HOLDING TIME

134 C 30 psi 03 minutes

126 C 20 psi 10 minutes

121 C 15 psi 15 minutes

CHEMICAL DISINFECTION
 Most suitable for treating liquid waste
such as infected blood, urine,
stools, or hospital sewage.

 Chemicals are added to waste to kill

the pathogens.
MICROWAVE IRRADIATION
 Microorganisms are
destroyed by the action
of microwave at -
- a frequency of about
2450 MHz and
- a wavelength of 12.24
nm.
LAND DISPOSAL
 Whatever may the modality of waste
treatment, final product has to be taken to
the land.

 Two types of methods –

 1. Open dump.
 2. Sanitary landfill.
Land Disposal Facility for Cities & Towns
INERTIZATION
 Mixing of waste with cement and other
substances .
 Commonly used for the pharmaceutical waste.
 A typical proportion of mixture is –
- 65 % of Pharmaceutical waste.
- 15 % lime
- 15 % cement and
- 5 % water.
Bio-medical Waste (Management
and Handling) Rule 1998 of India
Bio-Medical Waste Management and
Handling Rule 1998, of India.
 Govt. of India, by sections 6, 8 and 25 of
Environment (Protection ) Act 1986,
notified rules to improve the environment
by prescribing norms and rules for health
care waste management under the
notification called Bio-Medical Waste
(Management and Handling ) Rules
1998.
Bio-Medical Waste Management and
Handling Rule 1998, of India.

 This rule is prescribed by the Ministry

of Environment and Forests,
Government of India.

 Came in to force on 28 July 1998.

Bio-Medical Waste Management and
Handling Rule 1998 of India.
This rule applies to those who
generate, collect, receive,
store, dispose, treat or
handle bio-medical waste in
any manner.
Any violation of these rules is
punishable up to 5 years rigorous
imprisonment or fine of
rupees one lakh or both.
Bio-medical Waste (Management and
Handling) Rule 1998

Schedule- 1.
Categories of bio-medical waste in India.
Schedule- 2.
Color coding and type of container for disposal
of bio-medical waste.
Schedule- 3.
Label for bio-medical waste container/bags.
 Categories of Bio-medical Waste
Schedule-I
Category Waste Type Treatment and Disposal Method
Human Anatomical
Category 1 Wastes (Tissues, organs, Incineration / deep burial
body parts )
Category 2 Animal Waste Incineration / deep burial
Microbiology and
Category 3 Autoclave/microwave/incineration
Biotechnology waste
Disinfection (chemical
Category 4 Sharps treatment)+/autoclaving/microwaving
and mutilation shredding

Discarded Medicines Incineration/ destruction and drugs

Category 5
and Cytotoxic Drugs disposal in secured landfills
 Schedule-I. contd…

Category Waste Type Treatment and Disposal Method

Category 6 Contaminated solid waste Incineration/autoclaving / microwaving

Disinfection by chemical treatment+

Solid waste (disposable
Category 7 microwaving/autoclaving & mutilation
items other than sharps)
shredding

Liquid waste (generated

from laboratory washing, Disinfection by chemical treatment+ and
Category 8
cleaning, housekeeping discharge into the drains
and disinfecting activity)

Category 9 Incineration ash Disposal in municipal landfill

Chemical Treatment + and discharge in

Category10 Chemical Wastes to drain for liquids and secured landfill
for solids
ISSUES AND CHALANGES
ISSUES. . . .

 1.Lack of Priority in policy on Bio-Medical Waste

Management and funds on the issue.
 2. Lack of Managerial skill and Training of Bio-
Medical Waste Management.
 3. Lack of Appropriate technologies for treatment
and disposal of Bio-Medical Waste.
 4. Lack of Strict implementation of infection
control measures like sterilization and
disinfection techniques.

• 5. Lack of Awareness among medical personal,

patients, attendants and people at large.
 6. Lack of coordination between municipality,
Pollution Control Board and hospital authorities.

 7. Lack of Accountability of persons involved in

the management of Bio-Medical Waste.
Challenges

1. Establishing robust waste management

policies within the Health Care Facility.

2. Organization wide awareness about the

health hazards.

3. Sufficient financial and Trained human

resources needed.
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4. Monitoring and control of waste
disposal .

5. Clear responsibility and traceability

for appropriate handling and disposal of
waste.
 Environmental Legislations in India

 The Air (Prevention and Control of Pollution) Act, 1981.

 The Environment (Protection) Act, 1986.
 The Hazardous Waste (Management & Handling) Rules,
1989.
 The National Environmental Tribunal Act, 1995.
 The Biomedical Waste (Management & Handling) Rules,
1998.
 The Municipal Solid Waste (Management & Handling) Rules,
2000.

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CONCLUSION
Safe and effective management
of bio-medical waste is not only
a legal necessity but also a
Social Responsibility.
 Bio-Medical Waste Management
cannot successfully be implemented
without the willingness, devotion, self-
motivation, cooperation and
participation of all sections of
employees of any health care
establishment.
 If we want to protect our environment
and health of the community we must
see ourselves to this important issue
not only in the interest of health
managers but also in the interest of
community.
THANK YOU