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Case Report

Biomedical waste management: An overview

Mahendra R. R. Raj
Department of Oral Medicine and Radiology, Maitri College of Dentistry and Research Centre, Anjora, Durg, Chhattisgarh, India

ABSTRACT
The importance of waste disposal management is a very essential and integral part of any health care system. Health care providers
have been ignorant or they did not essentially know the basic aspect of the importance and effective management of hospital waste.
This overview of biomedical waste disposal/management gives a thorough insight into the aspects of the guidelines to be followed
and adopted according to the international WHO approved methodology for a cleaner, disease-free, and healthier medical services
to the populace, i.e., to the hospital employees, patients, and society.

Key words: Bio-medical waste, waste disposal, WHO approved methodology

DOI: 10.4103/0972-1363.58757

INTRODUCTION (b) Storage

(c) Disinfection
One of the main causes for the spread of infections and (d) Disposal.
disease is the improper disposal of waste. It is a health
hazard for hospital employees, patients, and society. TERMINOLOGIES IN BIOMEDICAL WASTE

Hospital employees come in close contact with infected
tissues, biological fluids, and infected materials of
patients. Similarly, doctors, nurses, labor staff, and
technical staffs working in laboratories face the risk of
accidental infection. There is a possibility of nosocomial
infection.
It is a common practice that many hospitals, nursing
homes, and health care centers dump all the waste at
the garbage collection site from where the garbage is
taken away by the vehicles for final disposal. Most of the
sites are prone for ragpickers who may get infected while
handling such infected items. The items picked up are
often sold to the market where the concerned persons tend
to recycle the used needles, syringes, gloves, discarded
drugs,[2] etc. Those who use these items face the risk of
infection.
The Ministry of Environment and Forest has specified the
guidelines for handling and disposing biomedical waste.
These guidelines stress on
(a) Segregation
Address for correspondence: Prof. Mahendra R.R. Raj, Department of Oral
Medicine and Radiology, Maitri College of Dentistry and Research Centre,
Anjora, Durg, Chhattisgarh, India. E-mail: drmahendraraj@yahoo.com
For describing biomedical waste, different terminologies
are used[3]:
(a) Biomedical waste: It indicates waste material which is
generated during diagnosis, treatment, immunizations,
research, slaughtering of animals, and veterinary
practices.
(b) Medical waste: It means any waste which is generated in
diagnosis, treatment of human beings, immunizations,
treatment of animals, research, production of biologicals
and testing of biologicals.
(c) Hospital waste: It is the waste produced or coming out
of the hospitals which may be
• Nonhazardous: 85%
• Infectious: 10%
• Hazardous: 5%.
(d) Critical waste: Waste generated as a result of medical
care in hospitals, nursing homes, diagnostic centers,
laboratories, domiciliary care.
(e) Pathological waste: This includes human tissues,
human organs, and body fluids, containers which
carry above-mentioned items during surgery,
other medical procedures, autopsy, and anatomy
dissection.
(f) Infectious waste: It means any waste which can transmit
bacterial/viral/parasitic infection, even infected animal
waste.

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Raj: Biomedical waste management
(g) Hazardous waste: This is hazardous but not
infectious, and includes radioactive substances;
chemicals, liquid, gaseous, vapors; pharmaceutical
waste, cytotoxic drugs, outdated drugs, etc.
DISPOSAL OF BIOMEDICAL WASTE
It follows the following steps:
(a) Segregation
(b) Disinfection
(c) Storage
(d) Transport
(e) Final disposal.
Segregation
Segregation of the waste is very important[4] for the following
reasons:
• General waste does not become infectious
• Segregation reduces chances of infection
• Treatment cost comes down
• Noninfectious waste can be recycled.
Segregation is carried out at the site of waste generation,
e.g., wards, operation theatres, ICUs, stores, pharmacy,
autopsy room, etc.
For an easy identification of different types of waste, a
specific color code is followed:
(a) Yellow: Yellow plastic bags are used for segregating
human anatomical waste; dissected parts; tissue removed
at surgery; aborted fetus; laboratory cultures/specimen;
items contaminated with blood or body fluids, i.e.,
dressing material, cotton, bandages, etc.; animal tissue
and carcasses (used in experimental laboratory).
Method of disposal: Incineration/deep burial.
(b) Red: Red plastic bags or disinfected containers are used
for segregating laboratory waste; culture plates; items
contaminated with blood; nonsharp disposable items
like gloves, catheter tubings, intravenous sets, etc.
Method of disposal: Catheter tubings, etc. are shredded
to prevent reuse. After shredding, they are disinfected by
autoclaving, microwaving, or using chemicals. Finally
they are sent for incineration.
(c) Blue or white translucent plastic bags: Puncture-proof
container-like empty cans or thick cardboard boxes to
store sharp items like needles, syringes, scalpel blades,
broken glass items, etc.
Method of disposal: After shredding these items, either
autoclaving, microwaving, or chemical treatment is
carried out. The waste is then sent for deep burial or
incineration.
(d) Black: Black plastic bags are used to segregate discarded
medicines; cytotoxic drugs; chemicals which have been
used for disinfection; insecticides; incinerated ash.
140 Journal of Indian Academy of Oral Medicine and Radiology / Jul-Sep 2009 / Volume 21 / Issue 3
Method of disposal: Disposal in secured landfills.[1]
(e) Liquid: This waste is disinfected and discarded in
drains.
(f) Radioactive waste: This waste is hazardous. It is
stored in lead containers in the basement of hospital
buildings for a 3- to 6-week period for the radioactivity
to disappear. After this period, it is discharged into
the drains.
DISINFECTION
To render infectious tissues free from pathogenic organisms,
disinfection [5] is carried out before transporting and
disposing them.
Methods of disinfection
• Thermal: Dry/wet autoclaving
• Chemical: Formaldehyde; sodium hypochlorite;
ethylene oxide; bleaching powder
• Irradiation and exposure to ultraviolet rays
• Use of microwave: A small microwave is used for small
quantities of laboratory waste. Larger units are required
for large quantities of waste. Grinding, steam spraying,
microwave irradiation are used.
STORAGE
Until adequate quantity accumulates, the waste needs to
be stored at the site where it is generated. It is necessary to
have security at this place to prevent unauthorized persons
and ragpickers handling the waste material.[6] If the hospital
has its own disposal site (incinerator), the waste can be sent
there by proper garbage trolleys.
Treatment of waste
Treatment of waste is the process which modifies the waste
in some way before it is taken for final resting place, namely,
disinfection; bailing and size reduction; and shredding to
make the recyclable item unusable breaking the tip of
syringe, needles, etc.
TRANSPORT
The transportation of the garbage can be within the hospital
(internal) and from the hospital to the final disposal site
(external).
Internal transport
From different areas of the hospital, segregated waste
bags are sent to the dumping place of the hospital.
Trolleys/carts used for transporting the garbage should
not be used for any other purpose. Persons carrying
garbage should wear disposable plastic gloves. Spillage
must be avoided.
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Raj: Biomedical waste management

External transport Category no. Waste category type Treatment and disposal
From the hospital site, the waste must be carried to an option
appropriate place: 1 Human anatomical Incineration/deep burial
• Incineration waste (human tissues,
organs, body parts)
• Landfill[1] 2 Animal waste (animal Incineration/deep burial
• Vermiculture, etc. tissues, organs, body
parts, fluid, blood and
experimental animals
Note that vehicles carrying hospital waste should not carry used in research, waste
general municipal garbage. generated by veterinary
hospitals, colleges
discharge from hospital,
FINAL DISPOSAL animal houses)
3 Microbiological and Autoclaving/microwaving/
Final disposal of waste depends on its category. Noninfectious biotechnological incineration
waste (waste from
waste like papers can be recycled. Biodegradable waste can lab cultures, stocks,
be used for landfill or vermiculture or can be just buried. or specimens of live
Infectious solid waste is incinerated. Infectious liquid waste microorganisms or
attenuated vaccines,
is disinfected and flushed out in the drains. human and animal
cell culture used in
INCINERATION research and industrial
labs, waste from the
production of biological,
Refuse can be disposed of hygienically by burning or toxins, dishes, and
incineration. It is the method of choice where suitable land is devices used for the
transport of cultures
not available. Incineration is not a proper method in India as 4 Wastes which are sharp Disinfecting chemical
the refuse contains a fair proportion of fine ash which makes (needles, syringes, treatment/autoclaving/
the burning difficult. A preliminary separation of dust or ash scalpels, blades, glass, microwaving, and
etc.) mutilation/shredding
is needed. All this involves heavy outlay and expenditure, 5 Discarded medicines Incineration/destruction
besides manipulative difficulties in the incinerator. and cytotoxic drugs and drugs disposed in
secured landfill
6 Solid waste (items Incineration/autoclaving/
Burning has a limited application in refuse disposal in contaminated with microwaving
India. blood and body fluids
including cotton,
dressing soiled linens,
CATEGORIES OF BIOMEDICAL WASTE[8] beddings, etc.
7 Solid waste such as Disinfection by chemical
tubings, catheters, treatment/autoclaving/
• Chemical treatment is done with 1% hypochlorite intravenous sets, etc. microwaving/mutilation/
solution or equivalent chemical shredding
• Mutilation/shredding must be done to prevent reuse 8 Liquid waste (generated Disinfection by chemical
from labs, washing, treatment and discharge
• No chemical treatment should be done before clearing, housekeeping, into drains
incineration etc.
• Chlorinated plastics shall not be incinerated. 9 Incineration ash from Municipal landfill
biomedical waste
10 Chemical waste Chemical treatment and
LABEL FOR BIOMEDICAL WASTE CONTAINERS/BAGS[9,10] (chemical used in discharge into drains for
the production of liquids and secured landfill
biologicals, chemicals for solids6
Bio hazard symbol cytotoxic hazard symbol used in disinfectant, etc.
Should be marked handle with care
Sender’s name and address
Label for transport of biomedical waste containers/bags Phone no ..............................................................
Fax no ..............................................................
Day ................................. Month ................................. E-mail ID ..............................................................
Year ................................ Contact person ..............................................................
Waste category no .....................................................
Date of generation ...................................................... Receiver’s name and address
Waste class ..................................................... Phone no .......................................................................
Waste description ..................................................... Fax no .......................................................................

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Raj: Biomedical waste management

E-mail ID .............................................................. • Waste to be incinerated shall not be chemically treated

Contact person ..............................................................
In case of emergency please contact .................................
Name and address: .........................................................
Phone no. .........................................................
Note: Label shall be non-washable and prominently visible
with any chlorinated disinfectants
• Chlorinated plastics shall not be incinerated
• Toxic metals in incineration ash shall be limited within
the regulatory quantities as defined under.
The hazardous waste (Management and handling rules)
1989.

STANDARDS FOR TREATMENT AND DISPOSAL OF Only low sulphur fuel like L.D.O/L.S.H.S/Diesel shall be
BIOMEDICAL WASTE[9] used as fuel in the incinerator.

Standards for incinerators REFERENCES

All incinerators should meet the following operating and
emission standards: 1. Agamuthu P Post-closure of landfill: Issues and policy. Waste Manag
• Combustion efficiency (CE) shall be at least 99%[7] Res 2006;24:503-4.
2. Meyers GD, McLeod G, Anbarci MA. An international waste
• The combustion efficiency is computed as follows:
convention: Mmeasures for achieving sustainable development.
%CO 2 ×100 Waste Manag Res 2006;24:505-13.
CE = 3. Poonam Khanijo Ahluwalia and Arvind K Neema. Multi-objective
%CO 2 +%CO reverse logistics model for integrated computer waste management.
Waste Manag Res 2006;24:514-26.
• The temperature of the primary chamber shall be 800 ⫾ 4. Gupta S, Boojh R. Biomedical waste management practices
50⬚C in Balrampur Hospital, Lucknow, India. Waste Manag Res
• The secondary chamber gas residence time shall be at 2006;24:584-91.
least 1 s at 1050 ⫾50⬚C, with minimum 3% oxygen in 5. Block SS. Disinfection, sterilization and preservation. 5th ed. Lippincott
Williams and Wilkins publication; 2001.
the stack gas. 6. Hörsted-Bindslev P. Amalgam toxicity - environmental and
occupational hazards. J Dent 2004;32:359-65.
EMISSION STANDARDS 7. Chitnis V, Chitnis S, Patil S, Chitnis D. Solar disinfection of infectious
biomedical waste: A new approach for developing countries. Lancet
2003;362:1285-6.
Parameters Concentration (mg/Nm3) 8. Environmental protection agency 1991-Medical Waste Management
and disposal. Noyes Data corporation. Biomedical Waste
(Management and Handling) Rules 1998: Gazette of India
• Particulate matter 150 extraordinary, Part II, Sector-3, Subsections II), 1998. [last dated on
• Nitrogen oxides 450 1998 Jul 28].
• HCI 50 9. Mehta G. Draft Guidelines for Hospital waste management; GOI/
• Minimum stack height shall be 30 m above the ground WHO Project; MOHFW, New Delhi: 1999.
• Volatile organic compounds in ash shall not be more
Source of Support: Nil, Conflict of Interest: Nil
than 0.01%

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