Biomedical waste management

CHAPTER-1
INTRODUCTION
1.1 General
Today the problem is intensified because of liability issues, land-fill laws, public concern
and a tremendous increase in the cost of handling, transport, and disposal of medical waste. All
activities of living thing on earth produce waste in some form or other. The fast decade witness a
significant increase in public concern regarding medical waste disposal. The concern regarding
medical waste is mainly due to the preparation of pathogenic organism and organic substances in
hospital solid waste is significantly high concentration. Poor waste management practices may
lead to a negative risk on the health of the public.
One of the main causes for the spread of infections and disease is the improper disposal of
waste. It is a health hazard for hospital employees, patients, and society.
The treatment and disposal of medical waste from hospitals has been of growing concern
in recent times. This is due to the hazardous nature of these wastes and the potential threat to
spread deadly diseases to humans and other living organisms. To characterize and quantify these
wastes, a study was carried out to ascertain the generation of biomedical wastes from hospitals.
Medical care is very important for our life, health and wellbeing. But the waste extracted from
medical practice can be harmful, poisonous and even deadly because of their high potential for
diseases transmission. The concern for hospital waste management was increase in infectious
diseases and indiscriminate disposal of waste in worldwide.

1.2 WHAT IS BIO MEDICAL WASTE?

“Bio Medical waste” is any waste, which is generated during the diagnosis, treatment or
immunization of human beings or animals or in research activities pertaining to or in the
production or testing of biological.

1.3 SOURCE OF BIO MEDICAL WASTE

Biomedical waste is generated in hospitals, nursing homes, clinics, medical laboratories,
blood banks, animal houses etc. Such a waste can also be generated at home if health care is
being provided there to a patient (e.g. injection, dressing material etc.)
Following are the 2 biomedical sources

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Fig-1: The major sources of Biomedical waste

Fig-2: The Minor sources of Biomedical waste

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CHAPTER-2
LITERATURE REVIEW
2.1 V.N. Kalpana, D. Sathya Prabhu, S. Vinodhini and Devirajeswari V., 2016: “Biomedical
waste and its management”.
The Biomedical and Health Care waste management is very different from other house
Waste or industries waste management. Biomedical waste management is one of the biggest
challenges of the present day times because it has a direct impact on the health of human beings.
Since it is hazardous in nature its safe and proper disposal is extremely important. For proper
disposal management of biomedical waste the Ministry of Environment and Forests has
published the Bio-Medical Waste Rules, 1998. This review explains the hospital waste
management and the environmental problem in India. This study also focused on the problems
associated with Biomedical waste. In the past, medical waste was often mixed with municipal
solid waste and disposed in nearby landfills. In recent years, many efforts have been made by
environmental regulatory agencies to better manage the biomedical waste.

2.2 Mahendra R. R. Raj, 2017: “Biomedical waste management”

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.

2.3 Sutha Irin A, 2018: “An analytical study on medical waste management in selected
hospitals located in Chennai city”
Hospital medical waste was collected by cleaning personnel who picked up the medical
waste from completely different departments and transported it manually to a temporary storage
area where the hospital waste was kept before being taken to the final disposal place as most of
time general waste will be mixed with medical waste, and this area was poorly sanitized and not
secure. They Stated steps for safe management of bio medical waste are handling, segregation,

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mutilation, disinfection, storage, transportation and final disposal. Author says that incineration,
autoclave hydroclave are the technologies to reduce the harm of bio medical waste and
segregation process helps to separate the infectious waste and non infectious waste, lack of
separating technique increase the chance of mixing the infectious and non infectious waste,
additionally found lack of training among waste handler and auxiliary staffs lead to mixing the
collected infectious and non infectious waste together and the result of segregation is ultimately
failed.

2.4 Dhasarathi Kumar, 2019: “A Study to Access the Knowledge Level on Bio-Medical
Waste Management among the Nurses in Tamilnadu”
Today the problem is intensified because of liability issues, land-fill laws, public concern and
a tremendous increase in the cost of handling, transport, and disposal of medical waste. All
activities of living thing on earth produce waste in some form or other. The fast decade witness a
significant increase in public concern regarding medical waste disposal. The concern regarding
medical waste is mainly due to the preparation of pathogenic organism and organic substances in
hospital solid waste is significantly high concentration. Poor waste management practices may
lead to a negative risk on the health of the public.

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CHAPTER-3

OBJECTIVES
 To assess the knowledge on biomedical waste management among the staff nurses.
 To associate the level of knowledge on waste management among staff nurses with
selected demographic variables.
 To prevent transmission to disease from patient to patient, from patint to health worker
and vice versa.
 To prevent injury to the health care worker and workers and workers in support services,
while handling biomedical waste.
 To prevent general exposure to the harmful effects of to toxic and chemical biomedical
waste.

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CHAPTER-4
CASE STUDY
Approximately 75-90% of the biomedical waste is non-hazardous and as harmless as any
other municipal waste. The remaining 10-25% is hazardous and can be injurious to humans or
animals and deleterious to environment. It is important to realise that if both these types are
mixed together then the whole waste becomes harmful.

Fig-3: Classification of Bio-Medical Waste.

4.1 METHODOLOGY
4.1.1 BIO MEDICAL WASTE MANAGEMENT PROCESS
It follows the following steps:
1. Waste collection and Segregation.
2. Disinfection.
3. Storage.
4. Transport.
5. Final disposal.

1. WASTE COLLECTION AND SEGREGATION

Waste should be collected and segregated at the site generation itself. Its aim is to keep
the harmful waste separate from the harmless and noncontagious waste. The key to minimization
and effective management of biomedical waste is segregation and identification of the waste.
The most appropriate way of identifying the categories of biomedical waste is by sorting the
waste in to color coded plastic bags or containers in accordance with Table (2) of Bio Medical
Waste (Management and Handling) Rules as given in Table (1) and Table (2).

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Table-1: Categories of biomedical wastes and methods of their disposal

CATEGORY TYPE
1 Human waste
2 Animal waste
3 Microbiology and bio
technology waste
4 Waste sharps
5 Discarded medicine
and cytotoxic drugs
6 Contaminated
solid waste
7 Solid waste
8 Liquid waste
9 Incineration ash
10 Chemical waste
TREATMENT AND DISPOSAL METHOD
Incineration
Incineration
Autoclave/microwave/incineration
Disinfection (chemical treatment) +
microwaving/autoclaving & mutilation shredding
Incineration/ destruction and drugs disposal in secured
landfills
Incineration/autoclaving / microwaving
Disinfection by chemical treatment+
microwaving/autoclaving & mutilation shredding
Disinfection by chemical treatment+ and discharge into
the drains
Disposal in municipal landfill
Chemical Treatment + and discharge in to drain for
liquids and secured landfill for solids

Deep burial shall be an option available only in towns with population less than 5 lakhs
and in rural areas.

Table-2: Colour coding of bags for segregation of bio medical waste

Colour Types of Category Waste treatment
container of waste
Incineration/deep
Yellow Plastic bag 1,2,3,6
burial
Plastic bag
Autoclaving/microwaving/chemical
Red or disinfected 3,6,7
treatment
container
Plastic bag/
Blue/white 4,7 Autoclaving/ microwaving
puncture
Chemical treatment
Proof
Translucent and destruction/
container
shredding
5,9,10
Black Plastic bag Land filling
(solid)

NOTES
1. Color coding of waste management with multiple treatment options shall be selected
depending on the treatment option chosen.

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2. Waste collection bags for waste types needing incineration shall not be made of
chlorinated plastics.
3. Categories 8 & 10 (liquid) do not require container/bags.
4. Category 3 if disinfected locally need not be put in containers/bags.

 PROCEDURE FOR WASTE COLLECTION

1. Specifically colored plastic bag should be kept in its container. Bins and bags should bear
the biohazard symbol.
2. As soon as three fourth of the bag is full of waste it should be removed from the
container, tied tight with a plastic string and properly labeled.
3. Under no circumstances, an infectious waste should be mixed with the non-infectious
waste.
4. Collection of disposable items (syringes, I/V bottles, catheters, rubber gloves etc) should
be undertaken when they have been mutilated (cut) chemically disinfected (by dipping in
1% hypochlorite solution for 30min.)
5. Syringe barrel should always be separated from the plunger before disinfection. Needles
should be destroyed with needle destroyer. Manual mutilation of sharps should never be
tried as it may cause injury. All other sharps must be strongly disinfected (chemically)
before they are shredded or finally disposed. Sharps should be kept in puncture proof
containers and properly labeled.
6. Biomedical waste handlers should be trained in handling the waste and made aware of
proper way of handling waste to avoid injury and accidents.

2. DISINFECTION
To render infectious tissues free from pathogenic organisms, disinfection is carried out
before transporting and disposing them.

i. Chemical disinfection
Chemical disinfection is the preferred treatment for liquid infectious wastes. Consider the
following: Type of microorganism, Degree of contamination, Amount of proteinaceous material
present, Type of disinfectant, Contact time, Other relevant factors such as temperature, pH,

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mixing requirements, and the biology of the microorganism. Ultimate disposal of chemically
treated waste should be in accordance with State and local requirements.

3. 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 Bag
pickers handling the waste material. If the hospital has its own disposal site (incinerator), the
waste can be sent there by proper garbage trolleys.

i. CENTRAL STORAGE
 The central storage area in a hospital should be ideally situated on the ground floor near
the rear entrance. This makes the transportation of waste to the site of final disposal
easier.
 The central storage area should have sufficient storage capacity to store the required
number of waste bags, depending upon the quantum of waste generated in the hospital. It
should have the storage capacity of at least 2 days waste.
 It should have good flooring, light, ventilation, water supply and drainage system.
 A full time storekeeper should be there to receive and dispatch the waste and to maintain
proper record.
 As per rules BMW cannot be stored for more than 24 to 48 hrs. (Refrigerated storage
room should be available where wastes have to be stored in bulk for over 48 hrs).

4. TRANSPORT
The transportation of the garbage can be within the hospital (internal) and from the hospital
to the final disposal site (external).
i. 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.
ii. External transport
From the hospital site, the waste must be carried to an appropriate place:

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• Incineration.
• Landfill.
• Vermiculture, etc.

Note that vehicles carrying hospital waste should not carry general municipal garbage.

The waste may be temporarily stored at the central storage area of the hospital and from
there it may be sent in bulk to the site of final disposal once or twice a day depending upon the
quantum of waste during transportation following points should be taken care of:
1. Ensure that waste bags/containers are properly sealed and labeled.
2. Bags are picked up from the neck and placed so that bags can be picked up by the neck
again for further handling. Hand should not be put under the bag. At a time only one bag
should be lifted.
3. Manual handling of waste bags should be minimized to reduce the risk of needle prick
injury and infection.
4. BMW should be kept only in a specified storage area.
5. After removal of the bag, clean the container including the lid with an appropriate
disinfectant.
6. Waste bags and containers should be removed daily from wards / OPDs or even more
frequently if needed (as in Operation Theatres, ICUs, and labour rooms) Waste
bags/containers should be transported in a covered wheeled containers or large bins in
covered trolleys.
7. BMW storage area should be separate from the general waste storage area.

5. FINAL DISPOSAL
Final disposal of waste depends on its category. Noninfectious waste like papers can be
recycled. Biodegradable waste can be used for landfill or Vermiculture or can be just buried.
Infectious solid waste is incinerated. Infectious liquid waste is disinfected and flushed out in the
drains.
 Disposal of bio medical waste pretreatment
The infected waste that cannot be incinerated (e.g. Plastic and rubber items, sharps) has to
be disinfected first, before it is sent for final disposal.

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5.1 Incineration
Incineration is a high temperature dry oxidation process, which reduces organic and
combustible waste to inorganic incombustible matter. This method is usually used for the waste
that cannot be reused, recycled or disposed of in landfill site.

 Characteristics of waste suitable for incineration are:

 Low heating volume – above 2000 Kcal/Kg for single chamber incinerators and above
3500 Kcal/Kg for pyrolytic double chamber incinerators.
 Content of combustible matter above 60%.
 Content of non combustible matter below 50%.
 Content of non combustible fines below 20%.
 Moisture content below 30%.

 Waste types not to be incinerated are:

 Pressurized gas containers.
 Large amount of reactive chemical wastes.
 Silver salts and photographic or radiographic wastes.
 Halogenated plastics such as PVC.
 Waste with high mercury or cadmium content such as broken thermometers, used
batteries.
 Sealed ampoules or ampoules containing heavy metals.

5.1.1 TYPES OF INCINERATORS

1. Single chamber furnaces with static grate: These should be used only if pyrolytic
incinerators are not affordable.
2. Double Chamber Pyrolytic Incinerator: These are the most commonly used
incinerators. In the first (pyrolytic) chamber, waste is destroyed through an oxygen
deficient, medium temperature combustion process (800° C).This produces solid ashes
and gases. In the second chamber gases are burnt at a high temp. (900-1200° C) using an
excess of air to minimize smoke and odour. This type of incinerator is somewhat
expensive and requires trained personnel to handle it.

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3. Rotary Kilns: It comprises of rotating oven and a post combustion chamber. They are
used to burn chemical wastes (chemicals, pharmaceuticals including cytotoxic drugs).

5.1.2 SAFE PIT FOR SHARPS

Sharps (needles and blades etc) are being used in a day to day practice in all health care
establishments. To avoid recycling of sharps, their burial in safe pit is an effective and
economical disposal method. It can be constructed by 5 feet deep circular concrete ring of 3’
diameter. A slab is used on top in which GIC pipe with 5” or 6” diameter is used which is fitted
lock and key arrangements. Size of the pit may vary as per the quantum of sharp waste to be
disposed of. The pit is plastered inside at bottom and around. When it is filled up, cement slurry
can be used to close it and second pit is constructed.

5.1.3 LANDFILL DISPOSAL

It is another method of final disposal of BMW. If a municipality or medical authority
genuinely lacks the means to treat the waste before disposal, sanitary landfill observing certain
standards can be as an acceptable choice especially in developing countries.
 Standards for deep burial
1. A pit or trench should be dug about 2 meters deep. It should be half filled with waste, and
then covered with lime within 50 cm of the surface, before filling the rest of the soil with
soil.
2. It must be ensured that animals do not have any access to burial site.
3. On each occasion, when wastes are added to the pit, a layer of 10 cm of soil shall be
added to cover the wastes.
4. Deep burial site should be relatively impermeable and no shallow well should be close to
the site. The site should be away from the residential area and the vicinity of drinking
water so as to avoid the risk of pollution.
5. The location of deep burial site will be authorized by the prescribed authority.
6. The institution shall maintain a record of all pits for deep burial.

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CHAPTER-6
ADVANTAGES AND DISADVANTAGES
 Cleaner and healthy surroundings.
 Reduction in the incidence of hospital acquired and general infections.
 Reduction in the cost of infection control within the hospitals.
 Reduction in the possibility of disease and death due to reuse and repackaging of
infectious disposables.
 Low incidence of community and occupational health hazards.
 Reduction in the cost of waste management and generation of revenue through
appropriate treatment and disposal of waste.
 Improved image of the healthcare establishment and increase the quality of life.
 Improper practices such as dumping of biomedical waste in municipal dustbins, open
spaces water bodies etc. leads to the spread of diseases.
 The improper management of bio-medical waste causes serious environmental problems
in terms of air, water and land pollution.
 Air Pollution can be caused in both indoors and outdoors. Bio-Medical Waste that
generates air pollution is of three types - Biological, Chemical and Radioactive.

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CHAPTER-7
FUTURE SCOPE
The Global Medical Waste Management Market is projected to grow at a healthy growth
rate from 2018 to 2025 according to new research. The study focuses on market trends, leading
players, supply chain trends, technological innovations, key developments, and future strategies.

The Global Medical Waste Management Market is growing continuously and expected to
grow healthy by Forecast year 2025. Rising demand for hospital waste management is due to the
strict rules imposed for emission, disposal and recycling of hospital waste. Moreover, there has
been a lot of technological innovations and advancements that has helped in reducing and
recycling of the waste to a large extent. Many governmental and non-governmental firms are
working towards spreading awareness among masses, educating them about disposal of medical
waste and taking care of their safety from harmful medical waste and its ill-effects.

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CHAPTER-8
CONCUSION
Hospital Management must understand the gravity of the issue and they must be able to
differentiate between hospital waste and general waste. They must ensure proper identification,
segregation at the source of generation, collection in prescribed colored containers, safe
transportation, appropriate treatment and environmentally sound disposal of Bio-Medical Waste.
They should also provide health education and training of everyone involved in the management
and handling of Bio-Medical Waste.

Last but not the least is effective implementation of rules by surprise visits and inspection
by appropriate authorities and fixing the accountability of each and every person involved in
management of Bio-Medical Waste. If Hospital Management wants to protect our environment
and health of community Hospital Management must sense ourselves to this important issue not
only in the interest of health managers but also in the interest of community.

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REFERENCES
 V.N. KALPANA, D. SATHYA PRABHU, S. VINODHINI AND DEVIRAJESWARI
V., (2016): “Biomedical waste and its management”.
 MAHENDRA R. R. RAJ, (2017): “Biomedical waste management”.

 SUTHA IRIN A, (2018): “An analytical study on medical waste management in selected
hospitals located in Chennai city”.
 DHASARATHI KUMAR, (2019): “A Study to Access the Knowledge Level on Bio-

Medical Waste Management among the Nurses in Tamilnadu”.

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