Biomedical Waste

Management (BMW)

Let the waste of the sick not contaminate

the lives of healthy
For MBBS IV Semester
26th April 2017

By: Dr Puneet Kumar Gupta

Assistant Professor, Microbiology
 Layout
• Definition
• What’s need of BMW?
• Contribution of different waste type
• Various things required in management
• Rule governing
• Categories, Segregation, Transportation
• Modality of treatment
• Do & Don’t
 Definition
Waste generated during laboratory diagnosis,
treatment or immunization of human being or
animals, or in research activity pertaining thereto, or
in production of biologicals
 What’s Need for BMW?
• Attracts flies, insects, birds and animals
• Filthy and unhygienic conditions
• Injury(NSI) and infection
• Reuse of disposables
• Harmful chemicals and radioactive materials(
contaminate wells and tanks)
• Animals & insects may get inf./ become carriers.
• Survival & mutation of pathogenic microbes→
epidemics, increase in communicable diseases in
the community
 Contribution of different waste type

Waste generation in
Developing countries 0.5-2 Kg/bed/day
Developed 1-5 Kg/bed/day

Hospital Waste

80-85% 15-20%

Non- hazardous Hazardous

5% 15%
Bio degradable Non-bio degradable Potentially Toxic Potentially Infectious

Chemical Radioactive Organic Lab

Pharmaceutical Sharps
 Rule governing
• Biomedical Waste Management & Handling
Rule 1998
• Amended
– 2000
– 2003
– 2011
• Biomedical Waste Management Rule 2016
 Bio-Medical Waste
Management Rules, 2016
Following Waste Not covered under
BMW Management Rule 2016
Waste Covered under

Solid waste Solid Waste Management Rules, 2016

E waste E-Waste (Management) Rules, 2016

Radioactive wastes Atomic Energy Act, 1962(33 of 1962) and the rules
made there under
Hazardous chemicals Manufacture, Storage and Import of Hazardous
Chemicals Rules, 1989 made under the Act
Construction and Construction and Demolition Waste Management
demolition waste Rules, 2016
Lead acid batteries Batteries (Management and Handling) Rules, 2001

Hazardous wastes Hazardous and Other Wastes (Management and

Transboundary Movement) Rules, 2016
Hazardous Manufacture, Use, Import, Export and Storage of
microorganisms, Hazardous Microorganisms, Genetically Engineered
genetically engineered Microorganisms or Cells Rules, 1989 made under the
microorganisms and Act
 Segregation

Biomedical Waste
Management Rule 2016
4 category of waste:

• Yellow

• Red

• Blue

• White (Translucent)
 Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used

Soiled Waste (Items contaminated with Yellow coloured

Yellow blood, body fluids): non-chlorinated
• Dressings, Bandage, Gauze, Linen plastic bags

• Plaster casts,
• Cotton swabs
• Bed Protection pads
common Bio-
• Bags containing residual or discarded medical Waste
blood and blood components including treatment facility
blood set tubing’s

• Diapers, Napkins
• Discarded linen, mattresses, beddings
 Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used

Human Anatomical Waste:Human tissues, Yellow coloured

Yellow organs, body parts and fetus below the non-chlorinated
viability period (as per MTP act) plastic bags

[copy of official MTP certificate from

Obstetrician or the MS of hospital or common Bio-
healthcare establishment must be given] medical Waste
treatment facility
 Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used

Animal Anatomical Waste: Yellow coloured

Yellow Experimental animal carcasses, body parts, non-chlorinated
organs, tissues, including the waste plastic bags
generated from animals used in
experiments or testing in animal houses

common Bio-
Expired or Discarded Medicines (Except medical Waste
cytotoxic drugs) treatment facility
Pharmaceutical waste like antibiotics
 Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used

Cytotoxic drugs including all items Yellow coloured

Yellow contaminated with cytotoxic drugs along non-chlorinated
with glass or plastic ampoules, vials etc plastic bags with
cytotoxic label

common Bio-
medical Waste
treatment facility
 Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used

Chemical Liquid Waste: Separate collection

Yellow • Liquid waste generated due to use of system leading to
chemicals in production of biological and effluent
used or discarded disinfectants, treatment system

• Silver X-ray film developing liquid,

• Discarded Formalin,

• Infected secretions,
• Aspirated body fluids,

• Liquid from laboratories and floor

washings, cleaning, house-keeping and
disinfecting activities etc.
• Lab & highly infectious BMW generated shall be pre-
treated by equipment like autoclave or microwave

• Microbiology waste and all other clinical laboratory waste

shall be pre-treated by sterilisation to Log 6 or
disinfection to Log 4, as per the WHO & NACO
guidelines before packing & sending to CBMWTF

• Use of Non-chlorinated chemicals

• No chemical pretreatment before incineration, except for

microbiological, lab & highly infectious waste
 Autoclave conditions for BMW
handling
• Should not be less than
– 1210C x 15psi x 60 minutes
– 1350C x 31psi x 45 minutes
– 1490C x 52psi x 30 minutes

• Biological Indicator: (Maintain record)

– First Validate with 4 biological indicator
– Then Daily testing with chemical indicator (>1 strips per bag of
discard at different locations
– Once a Week biological indicator testing
 Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used

Microbiology, Biotechnology and other clinical Autoclave safe

Yellow laboratory waste: plastic bags or
• Blood bags, containers
• Vacutainers containing blood

• Dishes and devices used for cultures

• Laboratory cultures, stocks or specimens of Autoclave/
microorganisms, Microwave
• Live or attenuated vaccines,

• human and animal cell cultures used in research,

production of biological, common Bio-
• Residual toxins medical Waste
treatment facility
Category Type of waste Container to be used

Contaminated Waste (Recyclable) Wastes Red coloured non-

Red generated from disposable items such as chlorinated plastic bags
or containers
• All plastic tubings (Ryle’s, ICD, ET, drains)

• Intravenous tubes and sets,

common Bio-medical
• Catheters (Foley’s, suction etc) Waste treatment facility

• Cardiac cannulas

• Plastic iv Bottles

• Uro bags,

• syringes (without needles and fixed needle

syringes)

• vacutainers with their needles cut

Category Type of waste Container to be used

• Gloves Red coloured non-

Red chlorinated plastic
• Nebulization masks bags or containers

• Surgical disposable face mask, caps, gown,

Shoe cover
common Bio-medical
• Needle caps (If infected) Waste treatment
facility
• Plastic Test tubes

• Pipettes

• Disposable tips

• Plastic Trough
Category Type of waste Container to be used

Waste sharps including Metals: Puncture proof, Leak

White • Needles (including Hypodermic proof, tamper proof
(Translucent) needles, I/v set needles, suture containers
needles, LP needles etc.)

• Stylets of IV cannula
common Bio-medical
• syringes with fixed needles, Waste treatment facility
• Needles from needle tip cutter or
burner,

• scalpels,
• blades,
• Lancets
• Saws

• Any other contaminated sharp object

that may cause puncture and cuts
includes used, discarded and
contaminated metal sharps
Alternative

• Heavy duty plastic containers

• But, they should be
• leak resistant,
• Remain upright during use without sharp able to come out
• Tight fitting, puncture resistant lid
• Translucent which has to be marked
• Examples
• Plastic laundry detergent container,
• Plastic bottles
• Empty detergent metal cans
• Disinfectants empty plastic container
• Empty dry media containers

• A tin or a plastic box with a small opening at top with a lid for closure of the
Box
Alternative

• Clearly labelled “Sharp Metallic waste” with “biohazard symbol”

• A line should be drawn on the box to mark ¾ of the volume

• Needles should be filled only till this line

Locally made Sharp Waste
containers
• Syringes should be either mutilated or needles should be
cut and or stored in tamper proof, leak proof and
puncture proof containers for sharps storage
Category Type of waste
Glassware:
Blue • Broken or discarded and
contaminated glass including
medicine vials and ampoules except
those contaminated with cytotoxic
wastes
Glassware:
• Broken petri dishes,
• Slides and cover slips,
• Broken pipettes and other glass
material
Metallic Body Implants
Container to be used
Cardboard boxes with blue
colored marking
(If soiled with infectious
waste: treat by disinfectants
or autoclaving)
common Bio-medical Waste
treatment facility
 Methods of disposal of microbiological
samples & cultures
Disposal of sputum container with specimen
and LJ culture:

The phenol
solution poured
of in to drain
The container is and the
autoclaved container is sent
to the final
disposal site in
red bag/blue
Sputum, LJ bag
media, container
soaked in 5%
phenol
overnight
 Disposal of blood samples

Clotted blood samples along with the

Blood samples and container
container

10%sodium hypochlorite Autoclave

Container sent to disposal site and the Container sent to the common disposal site in
disinfectant to the drain appropriate bag
 Other infectious samples

Urine pus

5% phenol

Stool Sputum
Disposal of Microbiological cultures

cultures

10%sodium
hypochlorite Autoclavable bags
overnight

Petri dishes
Autoclave and reuse
1.Autoclave if the petri dishes and
Discharge into the reusable or the culture medias
drain
2. Disposal site for can be disposed off
recycling into the drain
 Transportation
• Always collect waste in a covered bin/bags

• Dispose bags every day or whenever ¾ filled

• Handover waste to dedicated waste collection team

• Collection team should tie properly labelled bag, weight,

record particular in waste collection register

• Then collection team should keep the waste

bag/container in transportation trolley/container

• Transportation should be done safely without spillage &

leakage
 Transportation
• Collection container should then be cleaned with
soap and water/disinfectant by housekeeping staff
and new suitable bag/ container will be applied and
to be checked by staff nurse or technician (OT,
Laboratory) of respective area

• No waste to be stored >24 hours at point of segregation

• Collection team then transport waste in closed container

to storage area in a pre-defined path of least crowding

• Waste in common storage area will be delivered to the

authorised person from common biomedical treatment
facility
Every Biomedical waste bags/container must
have biohazard sign and label with details
 What's differences b/w
1998/2011/2016 BMW Rules?
BMW (Management BMW Management Rules, 2016
and Handling) Rules,
1998, 2000, 2003,
2011
Word Handling Handling word omitted Management’ includes Handling

Not cover these Cover healthcare activity undertaken outside the healthcare facility:
vaccination camps, blood donation camps, surgical camps or any other

----- Additional Duties of occupier Added:

• Provision of safe, ventilated and secured location for storage of
segregated BMW

• Pre-treat the laboratory waste, microbiological waste, blood

samples and blood bags through disinfection or sterilisation on-site
as per WHO or NACO guidelines & then sent to CBMWFs

• Phase out use of chlorinated plastic bags, gloves and blood bags
within two years of notification of rule
BMW (Management BMW Management Rules, 2016
and Handling) Rules,
1998, 2011

------ Additional Duties of occupier Added:

• Immunise all its HCP and others involved in handling of BMW for
protection against diseases including Hepatitis B & Tetanus

• Establish a Bar- Code System for bags or containers

• Report major accidents including accidents caused by fire hazards,

blasts during handling of BMW

-------- Operator of CBMWFs

• Ensure timely collection of BMW from HCFs, assist the HCFs in conduct
of training

------- Not to establish on-site treatment & disposal facility if a service of

CBMWFs available at a distance of 75Km
BMW (Management BMW Management Rules, 2016
and Handling) Rules,
2011

8 category (10 in 1998 4 category

Rule)
No storage beyond 48 • Untreated human anatomical waste, animal anatomical waste,
hrs soiled waste and, biotechnology waste shall not be stored beyond a
Permission required to period of 48 hrs
be taken • In case for any reason it becomes necessary to store such waste
beyond such a period, the occupier shall take appropriate measures
to ensure that the waste does not adversely affect human health &
environment
• Inform the SPCB along with reasons
Hospitals treating ≥ • One time Authorisation for Non-bedded HCFs.
1000 patients/month • Validity of authorization shall be synchronised with validity of
to obtain consent orders for Bedded HCFs
authorization from
SPCBs/PCCs
BMW (Management BMW Management Rules, 2016
and Handling) Rules,
2011

To strengthen advisory committee of Government of every State/Union

Territory- Additional members added
Emission standards Incineration
• 150 mg/nm3 • SPM in Incinerator’s Emission 50 mg/nm3

• 1 sec • Residence Time in Secondary chamber of incinerators =2 Sec

• ...Nil.. • Standards for Dioxin and furans

Chemical Treatment
• 1% • 10% sodium Hypochlorite
• Black color • Cytotoxic waste in Yellow

• Blue/ white bags • Sharp 2 types

• High Temperature Processes
– Incineration
– Pyrolysis
– Plasma Technology
– Gasification
• Non-Burn/Low-Temperature Treatments
– Autoclave
– Hydroclave
– Microwave
– Dry heat
– Steam auger (waste is shredded prior to t/t)
• Incineration is a high heat
system process of burning
combustible solids at very
high temperature in a furnace.

• Burning of waste material in 10

Chamber stages (850±500C)

• Followed by combustion of
gases in 20Chamber
(1050±500C)

•- Cleaning of flue gas through a

number of pollution control
devices
• End product is devoid of
infectious organisms

• Not to be done: Burning of

Plastic waste & Sharp
 Operates at
Not<121°C at 15psi for not < 60
minutes

• Vacuum pumps are utilized to evacuate

air in the chamber of autoclave

• Steam under pressure is pushed

• Operates at

Not<121°C at 15psi for not < 45 minutes

Not<135°C at 31psi for not < 30 minutes

• Not Recommended for pathological Waste

• Expansions of
Autoclave

• Steam sterilization
technology

• Steam Introduced into

hollow walls of
hydroclave

• Steam does not come

in contact with waste

• Volume & Weight

Reduction much more
than autoclave

• Cycle time 1 hr
• Use electromagnetic
waves 300-300,000 MHz

• Radiation produced by
microwave break
molecular chemical
bonds

• Heat up waste material

from inside, unlike the
external heat given in
autoclave & hydro
clave

• Work at temp 97-100 0C

• Cycle time 40-45 min

• Not to be used with

Body parts & tissue
 Deep Burial Pit
• A pit or trench 2m deep

• 1/
2 with
waste, then covered with lime within 50 cm of
surface, before filling the rest of pit with soil

• On each occasion, when wastes are added to pit, layer

of 10 cms of soil shall be added to cover the wastes

• Ensure that animals do not have any access to burial

site
• Covers of galvanized iron / wire meshes
• Should be distant from habitation
• Should be relatively impermeable & no shallow well
should be close to the site.
• Burial must be performed under close & dedicated
supervision
 Sharp Pit
• Dug according to the requirement of hospital

• All sides of the pit should be plastered with cement

• A cylindrical metal pipe of 4 inches diameter or more is fixed at

the ceiling of the pit

• The opening of the metal pipe should have locking facility

• The sharps are deposited in this pit through the pipe from the
puncture proof translucent container after mutilating.
Building a protected sharp Barrel
 Do’s FOR WASTE M/M
• Generate waste when essential

• Segregate waste at source into specified categories of waste

with biohazard logo

• Mutilate waste at source if possible to prevent unauthorized

reuse

• Destroy needle by using needle cutter or needle burner

• Keep the needles in puncture proof, translucent container

• Clean the bins regularly with soap & water and disinfect the
bins regularly.

• All liquid chemical waste should be drained out in to ETP

 Don’ts
• Do not generate waste unnecessary (e.g. avoid injection by
prescribing oral medicines)

• Never mix infectious & non- infectious waste

• Never mix chlorinated wastes with such wastes those which

have designated for incineration.

• Never overfill the bins.

• Never store waste beyond 48 hrs.

• There should not be any spillage on the way of transport.

 Don’ts
• Avoid transport of waste through crowded areas

• Do not throw infectious waste into general waste without any

pre- treatment and mutilation

• Don’t dispose the solid waste (plastic) and sharp waste without
mutilation
 Q1: How much percentage of waste will come
under biomedical waste?

A. 5%
B. 15-20%
C. 25-30%
D. 85%
Q2: Nursing sister finds expired chemotherapeutic drugs stored in
glass ampoules in RCC ward. She tells the sister in charge to
dispose those expired drugs . The sister in-charge is confused
regarding the disposal . Suggest the appropriate BMW
management

A. Chemotherapeutic drugs has to be disposed into red bag

B. Chemotherapeutic drugs being in a glass ampoule dispose in a puncture
proof box
C. Chemotherapeutic drugs has to be disposed in black bag
D. Chemotherapeutic drugs has to be disposed in yellow bag
 Q 3: There was a blood sample from a HIV pateint. The lab
personnel wanted to discard the blood in a safe manner. Tell the
appropriate BMW management

A. Blood sample has to be discarded in yellow bag

B. Blood sample has to be pretreated with 10% sodium hypochlorite and
then disposed
C. Blood samples should be autoclaved and then disposed.
D. Both b and c are correct methods of disposal
 Q4: A TB patient coming to mycobacteriology lab gives a
sputum sample for drug susceptibility testing. The lab
personnel after processing the sputum sample discards the
sample into 10 % sodium hypochlorite. Is this the appropriate
method of disposal?
A. Yes , as the right chemical pretreatment is 10% sodium hypochlorite
B. No, 5% lyzol should be used.
C. No, 5% phenol should be used.
D. No pretreatment required as it has to be disposed in the sewage effluent
plant .
 Q5: According to rules 2016, the BMW management should be
done

A. Inside the hospital campus

B. Outsource it if the disposal site is within 125km radius from the hospital

C. Outsource it if the disposal site is within 75km radius from the hospital

D. Can be stored and disposed after a month to the outsourcing unit

Q6: Which among these waste is not included under biomedical
waste?

a. expired medicines
b. Laboratory cultures
c. Lead acid batteries
d. e- waste
e. Both c and d
 Q7:Bags used for the BMW management should be

A. Plastic/ chlorinated
B. Plastic/ nonchlorinated
C. Plastic/ flurinated
D. Nonplastic/ nonchlorinated
 References
• Biomedical Waste Management Rule 2016
• Safe management of wastes from health-care activities. WHO 2nd
Edition
• 1st Edition of Essential of Medical Microbiology by Apruba Shankar
Sastry & Santhiya Bhat K.
• 5th Edition of Texbook of Microbiology by Dr CP Bhaveja
• NACO Manuals