Bio-medical Waste Management

Issues and Challenges

Dr Kairavi J Desai
Professor & Head,
Department of Microbiology,
Govt. Medical College,
Bhavnagar.
 Environmental Legislation
 The Air (Prevention and Control of Pollution) Act, 1981
 The Environment (Protection) Act, 1986
 The Hazardous Waste (Management & Handling) Rules,
1989
 The Biomedical Waste (Management & Handling)Rules,1998
 The Municipal Solid Waste (Management & Handling)
Rules, 2000
 The Biomedical Waste (Management & Handling) Rules,2011
 The Biomedical Waste (Management & Handling) Rules,
2016 and amendment on 16th March 2018
 Biomedical Waste Disposal
Indian scenario

Previous Practices
Unsatisfactory
Potentially hazardous
Risks
• Hospital staff
• HCW
• Municipal workers
• Rag pickers
PERSONS AT RISK
 CLASSIFICATION OF BMW

NON-HAZARDOUS HAZARDOUS
( 80% ) ( 20% )

INFECTIOUS OTHER HAZARDOUS

( 15% ) ( 5% ) (injurious)
- Non sharp - Radioactive
- Sharp - Broken Glasswares
- Plastic Dispos - Press Containers
- Liquid - Chemical
- Cytotoxic
- Incineration ash
 INFECTIOUS WASTE
IT INCLUDES ALL THOSE MEDICAL WASTES,
WHICH HAVE THE POTENTIAL TO TRANSMIT
VIRAL, BACTERIAL OR PARASITIC DISEASES,
GENERATED FROM…

 HOSPITALS
 NURSING HOMES
 CLINICS
 LABORATORIES
 BLOOD BANKS
 VETERNARY PRACTICE
 ANIMAL HOUSE
RESEARCH FACILITIES
 INFECTIOUS WASTE
Some of the diseases that can be
Transmitted by infectious waste are....

 HEPATITIS A, B, C, D & E
 GASTROENTRITIS
 TYPHOID FEVER
 TUBERCULOSIS
 POST-OPERATIVE WOUND INFECTION
 SKIN & BLOOD INFECTION
 AIDS
CYTOTOXIC WASTE

ANTICANCER DRUGS

CONCENTRATED STRONG ACIDS

PHENYL & ALKALIES

RADIO-ACTIVE MATERIAL

They can produce following toxicity

 Immunosupression
 Anaemia
 Ulcers
 Cancer
 Genetic & foetal abnormalities
 ROUTES OF TRANSMISSION
OF BMW

 THROUGH RESPIRATION

 BY ORAL ROUTE

 THROUGH CONTAMINATION OF WOUNDS

 ABSORPTION FROM MUCUS MEMBRANES

 BY INJURY FOLLWED BY INFECTION

 BMW - “ Waste segregation ”

All Waste Mixed together

Infectious
Office
General Collected
Food
Construction
Chemicals Transported

Disposed

Waste leaving hospitals

Chemicals

INFECTIOUS HAZARDOUS
Risk
 Basic Principles

 Segregation at source – at every level, ward, OT, unit

level, Laboratories etc.

 Color coding to support segregation at source

 Bio-medical waste shall be segregated into

containers/ bags at the point of generation in
accordance with Schedule II (BMW Rules 2016) prior
to its storage, transportation, treatment and disposal.
 Basic Principles

 The containers shall be labeled according to

Schedule IV (BMW Rules 2016)

 Transport waste safely to pick up site

 Identify destination for each type of waste and

ensure safe disposal

 Keep track of usage

 Biomedical Waste Management - Issues
• Not considered important

 Lack of interest from senior management

 No ownership of the process

 Awareness of problems

 Appreciate the need for constant monitoring

 Biomedical Waste Management - Issues

 Segregation of waste not taken seriously at user level

 Non compliance with color coding

 Monitoring segregation at source – low budgets

allocated

 Quantification of waste generated is not accurately

done
 Biomedical Waste Management - Issues
 Protection of healthcare workers not given adequate
thought

 Clinical waste dumped with non infectious waste so

that Risk for healthcare workers and public

 Waste disposal not effective, often dumped in open

landfills
 Biomedical Waste Management -
Responsibilities
Central Pollution Control Board/State Pollution
Control Board – Authority
Head of facility
One who generates BMW, one who collect,
transport, storage, final procedure – is responsible
 Each healthcare worker – segregation and
appropriate disposal
Medical waste segregation awareness and
Information should be available in all areas of
hospital
 Challenges
Establishing the waste management policies
within the organization

 Organization wide awareness about the health

hazards

 Sufficient financial and human resources

 Monitoring and control of waste disposal

 Clear responsibility for appropriate handling ..

 LABEL FOR BMW

COLOURED BINS BIOHAZARD LABEL CYTOTOXIC WASTE LABEL

 Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE
Option Waste Category Treatment & Disposal
Category No. 1 Human Anatomical Waste incineration @@
(human tissues, organs, body parts)

Category No. 2 Animal Waste incineration@@

(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)
Category No. 3 Microbiology & Biotechnology Waste & other Disinfection at source by chemical treatment @or by
laboratory waste autoclaving /microwaving followed by mutilation /
(Wastes from clinical samples shredding ## and after treatment final disposal in
,pathology,biochemistry,haematology,blood secured landfill or disposal of recyclable wastes
bank,laboratory cultures,stocks or specimens of micro- (plastics or glass ) through registered or authorized
organisms live or attenuted vaccines,human and recyclers
animal cell culture used in research and infectious
agents from research and industrial laboratories,waste
from the production of biologicals,toxins, dishes and
devices used for transfer of cultures)
Category No. 4 Waste Sharps Disinfection by chemical treatment @or destruction
(needles, glass syringes, syringes with fixed needles by needle and tip cutters, autoclaving or
scalpels, blade, glass, etc. that may cause punture and microwaving followed by mutilation or shredding ## ,
cuts. This includes both used and unused sharps) whichever is applicable and final disposal through
authorized CBWTF or disposal in secured landfill or
designated concrete waste sharp pit.

19
 Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continued)
Category No. 5 Discarded Medicines and
Cytotoxic drugs
(Waste comprising of outdated,
contaminated and discarded
medicines)
Category No. 6 Soiled Waste
(items contaminated with blood,
and body fluids including cotton,
dressings, soiled plaster casts,
lines, bedding, other material
contaminated with blood)
Category No. 7 Infectious Solid Waste
(Waste generated from disposal
items other than the waste sharps
such a tubings,handgloves , saline
,bottles with IV tubes catheters,
glass ,intravenous sets etc.)
Category No. 8 Chemical Waste
(Chemicals used in production of
biologicals, chemicals used
in disinfection, as insectricides,
etc.)
disposal in secured landfills or
incineration@@
incineration@@
Disinfection by chemical
treatment @or by autoclaving
/microwaving followed by
mutilation / shredding ## and
after treatment final disposal
through registered or authorized
recyclers
chemical treatment@@ and
discharge into drains meeting
the norms notified under these
rules and solids disposal in
secured landfill.
20
 Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continue)

Note :

@ Chemical treatment using at least 1% hypochlorite solution or any other

equivalent chemical reagent . It must be ensured that chemical treatment
ensures disinfection
@@ There will be no chemical pretreatment beforeincineration . Chlorinated
plastics /bags shall not be incinerated.

## Multilation/shredding must be such so as to prevent unauthorised reuse.

21
22
 Biomedical wastes categories and their segregation and disposal options
RULES 2016
Colour
Type of Waste Type of Container Treatment options
Coding

Human Anatomical Waste

Animal Anatomical Waste Non chlorinated Plastic Bag Incineration or Plasma Pyrolysis or deep burial

Soiled Waste

either sent back to manufacturer or

Expired or Discarded Medicines
Non chlorinated Plastic Bag disposed by incineration.
or container
Disposed of by incineration or Plasma
Chemical Waste
Pyrolysis or Encapsulation

pre-treated before mixing with other

Separate collection
wastewater. The combined discharge shall
Chemical liquid Waste system leading to effluent
conform to the discharge norms given in
treatment system
Schedule-III
Yellow

Discarded linen, mattresses, beddings Non-chlorinated yellow

incineration or Plazma
contaminated with blood or body fluid plastic bags or suitable
Pyrolysis or for energy recovery
routine mask and gown packing material

Pre-treat to sterilize with non-chlorinated

Autoclave safe chemicals on-site as per National AIDS Control
plastic bags or Organisation or World Health Organisation
Containers guidelines thereafter for Incine 23
Microbiology, Biotechnology and other Autoclave or Microwave “as per World Health Organisation
Colour Coding Type of Waste Type of Container Treatment options

Autoclaving or micro-waving/
hydroclaving followed by
shredding or mutilation or
combination of sterilization
Contaminated and shredding.
non-chlorinated plastic bags
Red Waste
or containers **Plastic waste should not be
(Recyclable)
sent to landfill sites

Glassware Cardboard boxes with blue

colored marking Disinfection or through
autoclaving or microwaving or
Blue Puncture proof and leak
hydroclaving and then
Metallic Body proof boxes or containers sent for recycling.
Implants with blue colored marking

Waste sharps
White Puncture proof, Leak proof, Autoclaving or Dry Heat
including Sterilization
(Translucent) tamper proof containers
Metals:
24
 Do’s anD Don'ts
Universal safety precautions

 Segregate waste as soon as it is generated into specified

categories of waste.
 Collect the waste in specific color coded covered bins
having bio hazard label.
 Destroy needle by using needle cutter or needle burner.
 Mutilate plastic waste (solid waste) as soon as it is
generated.
 All liquid chemical waste should be drained out in to
drains only after chemical treatment.
 Do’s anD Don'ts
 Never mix infectious and non- infectious
waste.
 Never mix chlorinated wastes with such
wastes those which have designated for
incineration.
 Never overfill and store waste beyond 48
hrs.
 There should not be any spillage on the
way of transport.
 Maintain complete record.
Let the wastes of “the sick” not
contaminate the lives of “the healthy”
 Quality Improvement Programme

Thanks
Quality is a Team work &
never achieve by alone

Community Health Center / Primary Health Center