 The waste produced in the course of health-care

activities carries a higher potential for infection

and injury than any other types of waste.
 Therefore, it is essential to have safe and reliable
method for its handing. Inadequate and
inappropriate handing of health –care waste may
have serious public health consequences and a
significant impact on the environment.
 Appropriate management of health protection,
and it should become an integral features of
health -care services.
 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 beings or animals or
in research activities pertaining thereto or in
the production or testing of biological
research
 Waste category Description and example

Infectious waste Waste suspected to contain pathogens e.g.

Laboratory cultures; waste from isolation wards; tissues
(swabs) materials or equipment that have been in
contact with infected patients; excreta

Pathological waste Human tissues or fluids e.g. body part; blood and other
body fluids; glass

Sharps Sharp waste e.g. needles infusion sets; scalpels knives

blades; broken glass

Pharmaceutical Waste containing pharmaceuticals e.g. pharmaceuticals

waste that are expired or no longer needed; items
contaminated by or containing pharmaceuticals
(bottles, boxes)
Genotoxic waste Waste containing substances with Genotoxic
properties e.g. waste containing cytostatic drugs
(often used in cancer therapy); genotoxic chemicals

Chemical waste Waste containing chemical substances e.g. laboratory

reagents; film develop; disinfectants that are expired
or no longer needed solvents

Waste with high Batteries; broken thermometers; blood pressure

content of heavy gauges ;etc
metals

Pressurized Gas cylinder; gas cartridges

containers

Radioactive waste Waste containing radioactive substance e.g. unused

liquids from radiotherapy or laboratory research;
contaminated glass ware, packages or absorbent
paper; urine and excreta from patients treated or
tested with unsealed radionuclide sealed sources
The institutions involved in generation of bio-medical waste
are:
 Government hospitals
 Private hospitals
 Nursing homes
 Physician’s office/clinics
 Dentist’s office /clinics
 Dispensaries
 Primary health centers
 Medical research and training establishments
 Mortuaries
 Blood Banks and Collection Centre
 Animals houses
 Slaughter houses
 Laboratories
 Research organizations
 Vaccination centre
 Bio-technology institutions/ Productions Units

All these health –care establishments generates waste and are

therefore covered under Bio-Medical Waste (BMW) Rules.
 Waste generation depends on numerous
factors such as
 established waste management methods,
 type of health –care establishment
 hospital specialization,
 proportion patients treated on a day-care
basis.

In middle and low income countries health –

care waste generated is lower than in high
income countries.
 Exposure to hazardous health –care waste
can result is disease of injury due to one or
more of the following characteristics:

 it contains infectious agents

 it contains toxic or hazardous chemicals or

pharmaceuticals
 it contains sharps
 it is Genotoxic
 it is radioactive.
1. Hazards from infectious waste and sharps
2. Hazards from chemical and pharmaceutical
waste
3. Hazard from Genotoxic waste
4. Hazards from radioactive waste
5. Public sensitivity
 Pathogens in infectious waste may enter the
human body through a puncture, abrasion or
cut in the skin, through mucous membranes by
inhalation or by ingestion.
 There is particular concern about infection with
HIV and hepatitis virus B and C , for which
there is a strong evidence of transmission via
health –care waste.
 Bacteria resistant to antibiotics and chemical
disinfectants, may also contribute to the
hazards created by poorly managed waste.
 Many of the chemicals and pharmaceuticals
used in health-care establishments are toxic,
genotoxic, corrosive, flammable, reactive
explosive or shock –sensitive.
 Although present in small quantity they may
cause intoxication, either by acute or chronic
exposure, and injuries including burns
disinfectants are particularly important
members of this group.
 They are used in large quantities and are
often corrosive, reactive chemicals may form
highly toxic secondary compounds.
 The severity of the hazards for health-care
worker responsible for handling or disposal of
genotoxic waste is governed by a combination
of the substance toxicity itself and the extent
and duration of exposure,
 Exposure may also occur during the preparation
of or treatment with particular drug or
chemical.
 The main pathway of exposure is inhalation of
dust or aerosols, absorption through the skin,
ingestion of food accidentally contaminated
with cytotoxic drugs, chemical or wastes etc,
 The type of disease caused by radioactive waste
is determined by the type and extent of
exposure.
 It can range from headache, dizziness and
vomiting to much more serious problems.
 Because it is genotoxic, it may also affect
genetic material.
 Apart from health hazards, the
general public is very sensitive to
visual impact of health-care
waste particularly anatomical
waste.
 Incineration is a high temperature dry
oxidation process that reduces organic and
combustible waste to inorganic
incombustible matter and results in a very
significant reduction of waste of waste-
volume and weight. The process is usually
selected to treat wastes that cannot be
recycled, reused or disposed off in a land fill
site.
 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, and lead-lined wooden
panels; and
 Sealed ampoules or ampoules containing
heavy metals
 Three basic kinds of incineration technology
are of interest for treating health-care
waste.:
 Double-chamber pyrolytic incinerators
which may be especially designed to burn
infectious health-care waste;
 Single-chamber furnaces with static grate,
which should be used only if pyrolytic
incinerators are not affordable;
 Rotary kilns operating at high temperatures,
capable of causing decomposition of
genotoxic substances and heat-resistant
chemicals.
 Exhaust gas to
atmosphere
ashes

Flue gas cleaning Waste water

Flue gas Heat recovery

steam

air
furnace
waste

Water discharge
ashes

Waste water
Waste water
treatment sludges
 Chemical are added to waste kill or inactivate the
pathogens it contains, this treatment usually
results in disinfection rather than sterilization.
Chemical disinfection is most suitable for treating
liquid waste such as blood, urine, stools or
hospital sewage. However, solid wastes including
microbiological cultures, sharps etc, may also be
disinfected chemically with certain limitations.
 Wet thermal treatment: Wet thermal treatment
or steam disinfection is based on exposure of
shredded infectious waste to high temperature,
high pressure steam, and is similar to the
autoclave sterilization process. The process is
inappropriate for the treatment of anatomical
waste and animal carcassess, and will not
efficiently treat chemical and pharmaceutical
waste.
Screw-feed technology:
 Screw –feed technology is the basis of a non-
burn, dry thermal disinfection process in which
waste is shredded and heated in a rotating
auger. The waste is reduced by 80 % in volume
and by 20-35 % in weight. This process is
suitable for treating infectious waste and
sharps, but it should not be used to process
pathological, cytotoxic or radioactive waste.
 Most microorganisms are destroyed by the action
of microwave of a frequency of about 2450 MHZ
and a wave length of 12.24 cm. The water
contained within the waste is rapidly heated by
the microwaves and the infectious components
are destroyed by heat conduction. The efficiency
of the microwave disinfection should be checked
routinely through bacteriological and virological
tests.
Municipal disposal sites:
 There are two types of disposal land open

dumps and sanitary landfills. Health-care

waste should not be deposited on or around
open dumps. The risk of either people or
animals coming into contact with infectious
pathogens is obvious.
 Sanitary landfills are designed to have at least four
advantages over pen dumps:
 geological isolation of waste from the environment,
 appropriate engineering preparation before the site

is ready to accept waste,

 staff present on site to control operations,
 organized deposit and daily coverage of waste.
The process of “Inertization” involves mixing waste
with cement and other substances before disposal,
in order to minimize the risk of toxic substances
contained in the wastes migrating into the surfaces
water or ground water.
 A typical proportion of the mixture is 65%

pharmaceutical waste. 15 %lime, 15% cement and 5

% water. A homogeneous mass is formed an cubes
or pellets are produced on site and then
transported to suitable storage sites.
Treatment disposal Advantages Disadvantages
method

Rotary kiln Adequate for all infectious waste, most High investment and operating costs
chemical waste and pharmaceutical
waste

Pyrolytic Very high disinfection efficient. Adequate Significant emissions at of atmospheric pollutants
Incineration for all infectious waste and most need for periodic removal of slag and soot.
pharmaceutical and chemical waste Inefficiency in destroying thermally resistant
chemicals and drugs such as cytotoxics

Drum or brick Drastic reduction of weight and volume of Destroys only 99% of microorganisms no destruction
incinerator the waste. Very low investment and of many chemicals and pharmaceuticals.
operating costs Massive emission of black smoke, fly ash, toxic
flue gas, an odours

Chemical Highly efficient disinfection under good Requires highly qualified technicians for operation of
disinfection operating conditions the process
Some chemical disinfectants are relatively Uses hazardous substances that require
comprehensive safety measures
Inadequate for pharmaceutical, chemical and some
types of infectious waste

Wet thermal Environmentally sound Shredders are subject to frequent breakdowns and
treatment Relatively low investment and operating poor functioning
costs Operation requires qualified techniques.
Inadequate for anatomical, pharmaceutical chemical
waste and waste that is no readily steam -
permeable
Micro Good disinfection Relatively high investment and
wave efficiency under operating costs
irradiation appropriate operating Potential operation and
condition maintenance problems
Drastic reduction in waste
volume, Environmentally
sound
Encapsulat Simple low-cost and safe. Not recommended for non-
ion May also be applied to sharp infectious waste
pharmaceuticals

Safe Low costs. Safe only if access to site is

burying Relatively safe if access to limited and certain precautions
site is restricted and where are taken
natural infiltration is
limited

Inertization Relatively inexpensive Not applicable to infectious

waste
 Bio-Medical Waste (Management and Handling)
Rule 1998, prescribed by the Ministry of
Environment and Forests, Government of India,
came into force on 28th July 1998.

 This rule applies to those who generate, collect,

receive, store, dispose, treat or handle bio-Medical
Waste in any manner.
Option Waste category Treatment and
disposal
Category No-1 Human Anatomical Waste (human tissues organs, body Incineration2 /deep
parts) burial
Category No 2 Animal Waste Incineration2 / deep
(animal tissues, organs, body parts carcasses, bleeding burial
parts, fluids, blood and experimental animals used in
research, Waste generated by veterinary hospitals
colleges discharges from hospital animal house./

Category No-3 Microbiology and Biotechnology Waste Local autoclaving /

(Waste from laboratory cultures, stocks or specimens of microwaving /
micro-organism. Live or attenuated vaccines, human incineration2
and animals cell culture used in research and
infectious agent from research and industrial
laboratories waste from production of biological
toxins dishes and devices and for transfer of cultures
Category No-4 Waste sharps Disinfection
(needle, syringes, scalpels, blades, glass etc that may (chemical
cause puncture and cuts, this includes both used and treatment/@
unused sharps. autoclaving
/microwaving and
mutilation/
shredding
Category No-5 Discarded medicines and Cytotoxic drugs (Waste Incineration @
comprising of outdated contaminated and discarded destruction and
medicines) drugs disposal in
secured landfills

Category No-6 Solid waste Incineration @

(items contaminated with blood, and fluids including cotton autoclaving
dressings solid plaster casts, linen, bedding other material microwaving
contaminated with blood)

Category No-7 Solid waste Disinfection by

(waste generated from disposal items other then the waste chemical treatment @
sharps such as tubing’s catheters intravenous sets etc autoclaving
/microwaving and
mutilation/ shedding
##
Category No-8 Liquid waste Disinfection by the
(waste generated from laboratory and was chemical treatment
@@ and discharge
into drains

Category No-9 Incineration ash Disposal in municipal

(ash from incineration of any bio medical waste) landfill

CategoryNo10 Chemicals used in production of biological chemicals used Chemical treatment

disinfection a insecticides, etc. @@ and discharge
into drains for liquids
and secured landfill
for solids
Color coding and type of container for disposal of bio-medical
wastes
The bio-medical waste should be segregated into containers/bags at the
point of generation of the waste

Colour Types of Waste category Treatment options as

coding container per Schedule 1
Yellow Plastic bag Cat. 1, Cat. 2, and Incineration/ deep
Cat. 3, Cat. 6 burial
Red Disinfected Cat.3, Cat. 6, Cat.7 Autoclaving/
container microwaving /
/ plastic chemical treatment
bag
Blue/White Plastic bag/ Cat. 4, Cat. 7, Autoclaving /
translu puncture microwaving /
cent chemical treatment
and Destruction /
Shredding
Black Plastic bag Cat.5 and Cat. 9 Disposal in secured
and Cat.10 (solid landfill
 Park K. Park’s Textbook of Preventive and
social medicine. 17th ed., Jabbalpur, M/s
Banarsidas Bhanot, 2002
 Park K. Park’s Textbook of Preventive and
social medicine. 18th ed., Jabbalpur, M/s
Banarsidas Bhanot, 2002
 B.K. Mahajan, M.C. Gupta. Textbook of
preventive and social medicine. Jaypee
Brothers Medical Publishers Pvt. Ltd., New
Delhi, 3rd ed., 2003