Hospital waste management

K.Bhuvana
II MDS
Department of Public health dentistry

1
 Definition

• Bio-medical waste is defined as “any waste which is

generated during the diagnosis, treatment or immunization
of human beings or animals or in research activities
pertaining thereto or in production or testing of
biologicals.

2
Bio-Medical Waste generated by

• Hospitals • Clinical Establishment

• Nursing Homes • Research/Educational Institute/ Research
• Clinics Labs Health Camps
• Dispensaries • Medical or Surgical Camps
• Veterinary Institutes/Animal • Vaccination Camps
Houses • Blood Donation Camps
• Pathological Laboratories • First Aid Rooms of Schools
• Blood Banks/Blood Donation Camps • Forensic Laboratories
• Ayush Hospitals

3
BMW CHARACTERIZATION

Non-Hazardous Waste: 75-85%

Potentially Infectious Waste:10-
15%
Potentially Toxic Waste:5-10%

4
CATEGORIES OF PERSONS EXPOSED TO RISK OF INFECTION

5
 PROBLEM ASSOCIATED WITH BIOMEDICAL WASTE
ORGANISM
VIRUSES
HIV, Hepatitis B, Hepatitis
A,C, Arboviruses,
Enteroviruses,Herpes Virus.
BACTERIA
Salmonella typhi, Vibrio
cholerae, Clostridium Tetani,
Pseudomonas, Streptococcus
PARASITES
Wucheraria Bancrofti,
Plasmodium.
DISEASES CAUSED
AIDS, Infectious Hepatitis,
Dengue, Japanese encephalitis,
Ocular infection,Genital
Infection
Typhoid, Cholera, Tetanus
Wound infections, septicemia,
rheumatic fever, endocarditis,
skin and soft tissue infections.
Cutaneous leishmaniasis,
Filariasis
Kala Azar, Malaria
RELATED WASTE ITEM
Infected needles, body Fluids, Human
excreta, blood. Eye secretions, genital
Secretions.
Human excreta and body fluid in
landfills and hospital wards, Sharps
such as needles, surgical blades in
hospital waste.
Human excreta, blood and body fluids
in poorly managed sewage system.
6
Category Type of Waste Type of Bag or Treatment and
Container to be Disposal options
used
yellow (a) Human Anatomical Waste: Yellow coloured Incineration or Plasma Pyrolysis or
Human tissues, organs, body parts and fetus non-chlorinated deep burial
below the viability period (as per the plastic bags
Medical Termination of Pregnancy Act
1971,amended from time to time).
(b)Animal Anatomical Waste :
Experimental animal carcasses, body parts,
organs, tissues, including the waste
generated from animals used in experiments
or testing in veterinary hospitals or colleges
or animal houses.
(c) Soiled Waste: Items contaminated Incineration or Plasma Pyrolysis or
with blood, body fluids like dressings, deep burial. In absence of above
plaster casts, cotton swabs and bags facilities,autoclaving or
containing residual or discarded blood and microwaving hydroclaving followed
blood components. by shredding or mutilation or
combination of

7

(d) Expired or Discarded
Medicines:
Pharmaceutical waste like
antibiotics, cytotoxic drugs
including all items contaminated
with cytotoxic drugs along with
glass or plastic ampoules, vials etc.
sterilization and shredding.
Treated
waste to be sent for energy
recovery.
Yellow coloured
non-chlorinated Expired `cytotoxic drugs and
plastic bags or items contaminated with
containers cytotoxic drugs to be returned
back to the manufacturer or
supplier for incineration at
temperature >1200 0C or to
common bio-medical waste
treatment facility or hazardous
waste treatment, storage and
disposal facility for incineration
at >12000C Or Encapsulation or
Plasma Pyrolysis at >12000C.
All other discarded medicines
shall be either sent back to
manufacturer or disposed by
incineration.
8
(e) Chemical Waste: Yellow coloured Disposed of by incineration or
Chemicals used in production of containers or Plasma Pyrolysis or
biological and used or discarded non-chlorinated Encapsulation in hazardous waste
disinfectants. plastic bags treatment, storage and disposal
facility.
(f) Chemical Liquid Waste : Separate
Liquid waste generated due to use of collection After resource recovery, the
chemicals in production of biological system leading to chemical liquid waste shall be
and used or discarded disinfectants, effluent pre-treated before mixing with
Silver X-ray film developing liquid, treatment system other waste water. The combined
discarded Formalin, infected discharge shall conform to the
secretions, aspirated body fluids, discharge norms given in
liquid from laboratories and floor Schedule-
washings, cleaning, house-keeping III.
and disinfecting activities.
(g) Discarded linen, mattresses,
beddings contaminated with blood or Non-chlorinated
body fluid. yellow plastic Non- chlorinated chemical
bags or suitable disinfection followed by
packing material incineration or Plasma Pyrolysis
or for energy recovery.

9
 In absence of above facilities,
shredding or mutilation or
combination of sterilization and
shredding. Treated waste to be
sent for energy recovery or
incineration or Plasma Pyrolysis

(h) Microbiology, Biotechnology Autoclave safe Pre-treat to sterilize with non-

and plastic bags or chlorinated chemicals on-site as
other clinical laboratory waste: containers per National AIDS Control
Blood bags, Laboratory cultures, Organisation or World Health
stocks or specimens of Organisation guidelines
microorganisms, live or thereafter for Incineration.
attenuated vaccines, human and
animal cell cultures used in research,
industrial .
laboratories, production of biological,
residual toxins, dishes and devices
used for cultures.

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Red Contaminated Waste Red coloured Autoclaving or micro-
(Recyclable) non-chlorinated waving/ hydroclaving
(a) Wastes generated plastic bags or followed by shredding
from disposable items containers or
such as tubing, bottles, mutilation or
intravenous tubes and combination of
sets, catheters, urine sterilization and
bags, syringes (without shredding. Treated waste
needles and fixed needle to be sent to registered
syringes) and or
vaccutainers with their authorized recyclers or
needles cut) and gloves. for energy recovery or
plastics to diesel or fuel
oil or for road making,
whichever is
possible.
Plastic waste should not
be sent to landfill sites.

11
 White Waste sharps
(Translucent) including Metals:
Needles, syringes with fixed
needles, needles from needle tip
cutter or burner, scalpels,
blades, or any other
contaminated sharp object that
may cause puncture and cuts.
This includes both used,
discarded and contaminated
metal sharps
Puncture proof, Autoclaving or Dry Heat
Leak proof, tamper Sterilization followed by
proof shredding
containers orcencapsulation in metal
container or cement
concrete; combination of
shredding cum
autoclaving; and sent for
final disposal to iron
foundries (having
consent to operate from
the State Pollution Control
Boards or Pollution
Control Committees) or
sanitary
landfill or designated
concrete waste sharp pit.
12
Blue
(a) Glassware:
Broken or discarded and
contaminated glass including
medicine vials and ampoules
except those contaminated with
cytotoxic wastes.
(b) Metallic Body Implants
Cardboard boxes with blue
colored marking.
Cardboard boxes Disinfection (by soaking the
with blue washed glass waste after
colored marking cleaning with detergent and
Sodium Hypochlorite
treatment) or through
autoclaving or
microwaving or hydroclaving
and then sent for recycling.
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 KEY FEATURES OF BMW (M) RULES, 2016
• The ambit of the rules has been expanded to include vaccination camps,
blood donation camps, surgical camps or any other healthcare activity.
• Occupier shall take all necessary steps to ensure that bio-medical waste is
handled without any adverse effect to human health and the environment
and in accordance with these rules.
• Make a provision within the premises for a safe, ventilated and secured
location for storage of segregated biomedical waste in colored bags or
containers in the manner as specified.
• Phase-out the use of chlorinated plastic bags, gloves and blood bags within
two years.
• Pretreatment of the laboratory waste, microbiological waste, blood samples
and blood bags through disinfection or sterilization.
• Do not give treated bio-medical waste with municipal solid waste

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• Conduct health check up at the time of induction, provide training to all its health
care workers and immunize all health workers at the time of induction and
thereafter at least once every year.
• Report major accidents.
• The details of training programmes conducted, number of personnel
trained and number of personnel not undergone any training shall be
provided in the Annual Report.
• Establish a Bar Code System for bags or containers containing
biomedical waste for disposal.
• Untreated human anatomical waste, animal anatomical waste, soiled
waste and, biotechnology waste shall not be stored beyond a period of
forty – eight hours:
• Existing incinerators to achieve the standards for retention time in secondary
chamber and Dioxin and Furans within two years.

15
• Ensure segregation of liquid chemical waste at source and ensure pre-
treatment or neutralization prior to mixing with other effluent generated
from health care facilities.
• Biomedical waste has been classified in to 4 categories instead 10 to improve
the segregation of waste at source.
• Maintain and update on day to day basis the bio-medical waste management register
and display the monthly record on its website according to the bio-medical waste
generated in terms of category and colour coding as specified.
• Establish a system to review and monitor the activities related to biomedical waste
management by forming a committee & maintain the record.
• Every occupier or operator of common bio-medical waste treatment facility shall
submit an annual report to the prescribed authority in Form-IV, on or before the
30th June of every year.
• Occupier shall make available the annual report on its web-site and all the health
care facilities shall make own website within two years.

16
 Authorities and corresponding duties
S.No Authority Corresponding duties
1 Ministry of Environment, a) Making Policies
Forest and Climate Change, b) Providing financial assistance for the
Government of India. State Pollution Control Boards or
Pollution Control Committees.
c) Undertake or support operational research
and assessment.
d) Constitution of Monitoring Committee for
implementation of the rules.
e) Hearing Appeals and give decision made
in Form- V against order passed by the
prescribed authorities.

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2 Central or State Ministry of
Health and Family Welfare,
Central Ministry for Animal
Husbandry and Veterinary or
State Department of Animal
Husbandry and Veterinary.
a) Grant of license
b) Monitoring, Refusal or Cancellation of
license
c) Publication of list of registered health care
facilities
d) Undertake or support operational research
e) Coordinate with State Pollution Control
Boards for organizing training
programmes
f) Organizing or Sponsoring of trainings for
the regulatory authorities and health care
facilities on bio-medical waste
management related activities.

18
3 Ministry of Defence • Grant and renewal of authorization
• Conduct training courses for authorities
• Publication of biomedical waste
generation from Armed Forces
healthcare facilities or occupiers
• Constitution of Advisory Committee for
implementation of the rules.
• Submission of annual report to Central
Pollution
• Control Board

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4 Central • Prepare Guidelines on bio-medical waste management
Pollution and submit to the Ministry of Environment, Forest and
Control Board Climate Change.
• Lay down standards for new technologies for BMW
treatment and disposal and common biomedical waste
treatment facilities in the Country.
• Review and analysis of data submitted by the State
Pollution Control Boards on bio-medical waste and
submission of compiled information in the form of annual
report along with its observations to Ministry of
Environment, Forest and Climate Change .
• Inspection and monitoring of health care facilities
operated by the Director General, Armed Forces Medical
Services.
• Undertake or support research

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5 State Government • Allocation of adequate funds to Government health
of Health or care facilities for bio-medical waste management.
Union Territory • Procurement and allocation of treatment equipment's
Government and make provision for consumables for bio-medical
orAdministration waste management in Government health care
facilities.
• Constitute State or District Level Advisory
Committees under the District Magistrate or
Additional District Magistrate to oversee the
biomedical waste management in the Districts.
• Advise State Pollution Control Boards or Pollution
Control Committees on implementation of these
Rules.
• Implementation of recommendations of the Advisory
Committee in all the health care facilities.

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6 State Pollution Control • Grant and renewal, suspension or refusal
Boards or Pollution cancellation or oannual report to Central Pollution
Control Committees Control Board
• Action against health care facilities or common
biomedical
• waste treatment facilities for violation of these rules
• Organizing training programmes
• Undertake or support research or operational
research.
• Implementation of recommendations of the
Advisory Committee.
7 Municipalities or • Publish the list of Registered or Authorized
Corporations recyclers.

• Provide or allocate suitable land for development of

common bio-medical waste treatment facilities.

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 BMW 1998
Application:
These camps and such healthcare ‑related
activities not covered under BMW 1998 rules.
Duties of occupier:
• Pretreatment of the laboratory waste, blood •
bags, etc. was not required.
• Use of chlorinated plastic bags, gloves, and
blood bags was mentioned.
• Liquid waste not to be separated at source
and ETP is not mandatory
• Training and immunization not compulsory
• No barcoding system was in place
• Reporting of accidents not specified and
mentioned
BMWM 2016
The realm of the rules have been expanded to
include vaccination camps, blood donation camps,
surgical camps, or any other health care activity
Pretreatment of the laboratory waste,
microbiological waste, blood samples, and blood
bags.
• Phase‑out the use of chlorinated plastic bags,
gloves, and blood bags within 2 years.
• Liquid waste to be separated at source by
pretreatment and ETP is required
• Provide training to all HCWs in BMW rules and
handling and immunize all HCWs against
hepatitis B and tetanus
• Establish a bar code system for bags or
containers containing BMW for disposal
• Report all major accidents
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 BMW 1998
Duties of the operator of a CBMWTF:
• No such recommendation were in place •
• No such records were maintained
• No such records were maintained
CBMWT
• Every HCFs shall set up a requisite
BMW treatment facility or ensure
requisite treatment at a CBMWT
BMWM 2016
To establish barcoding and GPS of BMW
waste carrying vehicle within 1 year.
• Maintain all records of
incinerator/hydroclaving/ autoclaving for a
period of 5 years.
• Maintain a log book of each cycle of treatment
with all details such as time, date, weight,
duration, and hours of treatment.
• No occupier shall establish on their site a
BMW treatment and disposal plant, if, a
CBMWTF is available within 75 km of the
HCF.
• If no CBMWTF not available, the occupier
should establish a BMW treatment and
disposal plant after taking prior permission
from authority
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 BMW 1998 BMWM 2016

Segregation, packaging, transportation,

and storage of BMW
• BMW classified into 10 categories based • BMW classified into 4 categories based on
on treatment options treatment options
• If untreated BMW should be stored • IF untreated human anatomical waste, animal
beyond 48h, authorization needed. anatomical waste, soiled waste, and
biotechnology waste should be stored beyond
48 h, no authorization needed

Authorization

• All HCFs treating 1000 or more • One time authorization for nonbedded HCFs
patients/month need to obtain and for bedded HCFs, the validity of
authorization from SPCB authorization should be coordinated with
consent order

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 • BMW 1998
Treatment and disposal of waste
• Chemical treatment with 1%
hypochlorite
• Deep burial to be allowed in towns with
population>5 lakhs.
• Cytotoxic drugs disposal in secured
landfills.
• All drugs discarded in black bags.
• All infected metal, plastic, and glass
waste to be put in blue bag and then
sent for autoclaving, microwaving, and
incinerator
• BMWM 2016
• Chemical treatment with at least 10% hypochlorite
having 30% residual chlorine for 20 min or any other
equivalent chemical reagent that should demonstrate
log10 4 reduction efficiency for microorganisms
• Deep burial is only an option in remote rural or remote
areas, where there is other disposal option. The
groundwater table level should be a minimum of 6 m
below the lower level of deep burial pit.
• Cytotoxic waste and items contaminated with cytotoxic
waste should be returned to manufacturer or CBMWTF
for incinerator at 1200° C or encapsulation or plasma
pyrolysis at 1200° C.
• All drugs including expired antibiotics should be sent
back to manufacturer or to incinerator
• The BMW waste to be segregated – plastics in red bag,
sharps in white container (after mutilation), and glass
articles in cardboard box with blue marking; then sent
to authorized recycler.
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 BMW 1998
• This was not included.
Standards for emission from incinerators:
• Permissible limit for SPM‑150 mg/Nm3.
• Residence time in secondary chamber of
incinerator at least 1s.
• Standards for dioxin and furans – not
defined
Monitoring of implementation:
• Not defined
• Not defined
BMWM 2016
• After proper treatment of plastics and glassware,
these recyclables should be given to recyclers
having valid registration
• Permissible limit for SPM‑50 mg/Nm3
• Residence time in secondary chamber of incinerator
2s
• Standards for dioxin and furans ‑ 0.1 ng TEQ/Nm3
• Ministry of environment, forest and climate change
should review the implementation of the rules in
the country once a year.
• SPCB of each state shall constitute district level
monitoring committee under the chairpersonship of
district collector or district magistrate or additional
district magistrate to monitor the compliance of the
above mentioned rules.
• The district level monitoring committee shall
submit its report once every6 months to the SPCB.
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28
 Segregation:

• Segregation refers to the

basic separation of
different categories of
waste generated at
source and thereby
reducing the risks as
well as cost of handling
and disposal.

29
 collectio
n

• The collection of
biomedical waste
involves use of different
types of container .
• The containers/ bins
should be placed in such
a way that 100 %
collection is achieved.

30
 Storage

• Once collection occurs then biomedical waste is stored in a proper place.

• Segregated wastes of different categories need to be collected in identifiable
containers.
• The duration of storage should not exceed for 8-10 hrs in big hospitals (more
than 250 bedded) and 24 hrs in nursing homes.
• Each container may be clearly labelled to show the ward or room where it is
kept.
• The reason for this labelling is that it may be necessary to trace the waste back to
its source.

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 Transport

• Final Transport of
BMW must be to
CBMWTF only in
authorized vehicle
with appropriate
documentation for
further record.

32
LABEL FOR BIO-MEDICAL WASTE CONTAINERS or BAGS

33
Methods of disposal

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 Incinerator

• The first solution for the disposal of BMW was to burn the
waste.
• High temperature dry oxidation process that reduce
organic and combustible waste into inorganic
incombustible matter, resulting in significant reduction in
waste volume and weight.

35
Types if Incinerators:

• Double chambered(for infectious waste)

• Single chambered (if double chamber not affordable)

• Rotatory Kilns(for genotoxic waste)

36
37
New technologies for Biomedical waste disposal are
categorised into four categories:

• Thermal process
• Chemical process
• Irradiative process
• Biological process

38
 Thermal processes are grouped into low and high heat
technologies:

Low heat technologies:

High heat technologies:
Autoclaves • Plasma pyrolysis
• Gravity or downward
• Pyrolysis oxidation
displacement
• Prevacuum or high vacuum
Microwaves

39
 Autoclave

• All infectious waste including cultures, human

waste, laboratory waste, soft waste (gauze,
bandages, and gowns) and sharps, and medical
instruments are sterilized in autoclave.
• Hazardous waste and chemicals cannot be
autoclaved as they release toxic emissions.
• The evacuated air is disinfected before
disposal into the environment by passing
through a high‑efficiency particulate
absolutefilter as it may contain pathogens.

40
 Microwave

• Microwave uses moist heat and steam

generated by microwave energy to disinfect.
• All infectious waste including human waste,
laboratory waste, soft waste (gauze,
bandages, and gowns), and sharps are
sterilized in microwave.
• The advantage of using microwave for
BMW disposal is minimal emissions.

41
 Pyrolysis oxidation and plasma pyrolysis
Pyrolysis oxidation:
The organic solid and liquid waste
vaporize at high temperature
(approximately 594°C) leaving
behind inert ash and glass and
metal fragments, followed by
combustion of the vapors at a
temperature of 982°C –1093°C and
clean exhaust steam is later
released.
Plasma pyrolysis:
• Plasma pyrolysis uses plasma
torches to generate plasma energy.
• Infectious waste, sharps, plastics,
dialysis waste, hazardous waste,
chemotherapeutic waste,
chemotherapy waste, and
low‑level radioactive waste.
• The residue generated include
carbon black, vitrified glass
aggregates, and metallic residues
42
Chemical disinfection

• Commonly Used for treatment of liquid infectious

waste eg. blood, urine, stool.
• Chemicals are added to waste to kill or inactivate
the pathogen it contains.
• Most commonly used solution is sodium
hypochlorite solution.

43
Biological processes

• Biological methods for disposal of BMW include

an emerging system called “Bio‑converter” 9
Biomedical Disposal, Inc.).
• It uses a solution of enzyme to decontaminate
medical waste, and the resulting sludge is put
through an extruder used to remove water for
sewage disposal and the solid waste is sent to
landfill.

44
 Land Disposal:

Municipal disposal sites:

A. Open Dumps: risk for public health
B. Sanitary landfills: designed and constructed to prevent
contamination of soil, surface, ground water and direct
contact with public.

45
 Studies showing scenario of BMW management in Indian hospitals

• Anitha pandey et..al conducted a cross sectional

study among health care personnels to assess
knowledge related to biomedical waste management.
Though awareness (knowledge) about segregation of
BMW was seen in 90% of the HCP, 30%-35% did
not practice
• Out of the total waste generated (57912 kg.), 8686.8
kg. (15%) was infectious waste. Average infectious
waste generated was 0.341 Kg per bed per day.
46
• K V Radha et..al conducted a study o assess the quantities and proportions of
different constituents of wastes, their handling, treatment and disposal
methods in different health-care settings in south Chennai.
• Solid waste of health care units are constituting 26.5% of infectious waste and
1.65% of hazardous waste.
• The segregation of waste in almost all hospitals is not satisfactory and there is
a need for strict enforcement of legal provisions and a better environmental
management system for the disposal of biomedical waste in hospitals.

47
• India is likely to generate about 775.5 tons of medical waste
per day by 2022 from the current level of 550.9 tons per
day growing at compound annual growth rate (CAGR) of
about 7%.
The monitoring bodies SPCBs and CPCB, should make a
strict timeline and visit the healthcare facilities and CBWTFs
regularly and update their date on time.

• https://timesofindia.indiatimes.com/business/india-business/
indias-medical-waste-growing-at-7-annually-assocham/
articleshow/63415511.cms
48
 • Total BMW generated in the country is 484 TPD
(tonnes per day) from 1,68,869 HCFs.
Unfortunately, only 447 TPD is treated, and 37
TPD is left untreated.
• There are 198 CBMWTF in operation and 28 under
construction. The number of HCFs using
CBMWTFs are 1, 31,837, and approximately
Datta P, Mohi GK, Chander J. Biomedical waste management in India: Critical appraisal. J Lab Physicians
21,870 HCFs have their own treatment facilities
2018;10:6-14.

on‑site
49
 Central pollution control board annual report

• As on annual report of central pollution board for 2015-2016,

there are 1,88,098 health care facilities (HCF”S) having
17,61,316 beds and generating bio-medical waste at about
501 tonnes per day.
• 99, 945 HCF’S have obtained authorization under the BMW
rules. There are 203 number of CMWTFs in operation and
21,462 HCF’s having captive biomedical waste treatment and
disposal facilities, which are involved in treatment and
disposal of 486 out of 501 tonnes per day bio-medical waste.
And 6,074 HCF’s observed to be violating the provision of
BMW rules.
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 BIOMEDICAL WASTE TREATMENT PROCESS 5
1
COLLECT AND
GENERATION
SEGGREGATION TRANSPORT TO
Hospitals/Hcf’s CBWMTF

Human Anatomical Waste Contaminated Waste

Animal Anatomical Waste
(Recyclable):
Soiled Waste
Tubing, bottles, Glassware
Expired or Discarded medicines Waste sharps
intravenous tubes, sets, Metallic Body
Chemical Waste Including metals
Chemical Liquid Waste catheters, urine bags, Implants
Microbiology, Biotechnology and syringes, gloves and
other clinical laboratory waste Vacutainers.

STORAGE
TREATMENT AND DISPOSAL AT
CBWMTF

Autoclaving, microwaving, Autoclaving (or) dry heat Disinfection or

Incineration (or) plasma
pyrolysis (or)deep burial.
Pre treatment with non-
chlorinated chemical
sterilization followed by
hydroclaving followed by microwaving
shredding and sent to encapsulation in metal
and sent to
registered recycler concrete or cement
recycling
concrete
 52
Dental health care waste management

Department wise dental waste categorization :

Oral surgery:
Oral medicine
1.Extracted
and radiology: Conservative
tooth 2.Cotton Periodontics:
fixer, and Prosthodontics:
filled with Excised tissue Orthodontics:
developer, endodontics: Impression
blood parts Stainless steel
lead foil, Excess materials
3.Excised Blood filled wires and
exposed x- mercury Plaster of paris,
tissue parts with cotton brackets
rays, x-ray Amalgam dental stone
4.Sharps,
covers
implants,
screws

DISPOSAL

Fixer with a recovery

Cat 1,2&3 are unit can be mixed Scrap amalgam 1.Gypsum recycling
segregated into with water and Amalgam container. Segregated into Collected into
2.Acrylic, rpd,
yellow bag and cat 4 developer and Under vacuum line yellow bag and sent blue bag and sent
bridges are sent for
into white bag and disposed down the amalgam separator to CBMWTF for recycling
incineration
sent to CBMWTF septic system after should be there
desilvering.
 Conclusion

• It is just not the law abide compliance but the

social responsibility of every health care
establishment to say “no to hazard of biomedical
waste”. The pillar of BMWM is segregation of
waste at source and disposal. All participants in
BMWM should pledge to guarantee a cleaner
and greener environment.

53
References
• K. Park, Text book of preventive and social medicine -24th
edition, Jabalpur: Banarsidas Bhanot 2017 pg no:826-831.
• Datta P, Mohi GK, Chander J. Biomedical waste
management in India: Critical appraisal. J Lab Physicians
2018;10:6-14.
• Bio‑Medical Waste Management Rules, 2016. Published in
the Gazette of India, Extraordinary, Part II, Section 3,
Sub‑Section (i), Government of India Ministry of
Environment, Forest and Climate Change. Notification;
New Delhi, the 28th March, 2016.
54
• Pandey A, Ahuja S, Madan M, Asthana AK. Bio-Medical Waste Managment
in a Tertiary Care Hospital: An Overview. J Clin Diagn Res.
2016;10(11):DC01-DC03.
• V. Radha, K & K, Kalaivani & R, Lavanya. A Case Study of Biomedical
Waste Management in Hospitals. Global Journal of Health Science.
2009;1(1).
• Central pollution control board annual report
http://cpcb.nic.in/displaypdf.php?id=aHdtZC9BUl9CTVdNXzIwMTUucGR
m
(accessed on 25-12-2018).
• https://timesofindia.indiatimes.com/business/india-business/indias-medical-
waste-growing-at-7-annually-assocham/articleshow/63415511.cms
(accessed on 25 2018).
• www.google.com for images

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