1. Biomedical waste management
Presenter: Dr.L.Karthiyayini
Moderator: Dr. A.Mehendale

2. Framework Definition Burden of biomedical waste Sources of waste
Types of health care waste & its health hazards
Legislations
Waste generation
Principles of managing waste
Waste minimization
Managing sharps
Chemical disinfectants
Handling of health care waste
Waste segregation & labeling
Waste storage & transport
Waste treatment & disposal
Infection control
BWM at MGIMS
BMWM in national programs
Biomedical waste audit

3. Definition
“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” [Source: Biomedical Waste (Management and Handling) Rules, 1998 of India]

4. MAGNITUDE OF THE PROBLEM
GLOBALLY:
Developed countries generate 1 to 5 kg/bed/day
Developing countries: 1-2kg/pt/day
WHO Report:
85% non hazardous waste
10% infective waste
5% non-infectious but hazardous. (Chemical, pharmaceutical and radioactive)
2002, 22 countries, health care facilities not using proper disposal 18%-64%

5. Hazardous waste generation

6. No national level study Hospitals generate 1-2 kg/bed/day
INDIA:
No national level study
Hospitals generate 1-2 kg/bed/day
BMW generation :
4,05,702 kg/day
2,91,983 kg/day is disposed
28% of the wastes is untreated
53.25% HCE – not authorized

7. Top 5 biomedical waste generating states
Biomedical waste generation & disposal (kg/ day)
Waste
Disposal
Karnataka
62,241
43,971
Uttar Pradesh
44,392
42,237
Maharashtra
40,197
Kerala
32,884
29,438
West Bengal
23,571
12,472
All India
4,05,702
2,91,983

8. Sources of biomedical wastes
Major Sources:
Govt. hospitals/private hospitals/nursing homes/ dispensaries.
Primary health centres.
Medical colleges and research centres/ paramedic services.
Veterinary colleges and animal research centres.
Blood banks/mortuaries/autopsy centres.
Biotechnology institutions.

9. Minor Sources: Physician’s/ dentist’s clinics
Animal houses/slaughter houses.
Blood donation camps.
Vaccination centres.
Acupuncturists/psychiatric clinics/cosmetic piercing.
Funeral services.
Institutions for disabled persons

10. Health hazards of various waste
Waste materials
Potential hazards
Human anatomical waste
Psychological stress
Human anatomical waste, soiled waste, microbial waste, sharps
Infections & disease
Animal wastes
Infectious rabies, Anthrax & other
Sharps, cytotoxic & radioactive drugs, incinerator wastes
Injuries
Chemical, cytotoxic, radioactive, incinerator wastes
Dermatitis, conjunctivitis, bronchitis
Cytotoxic, radioactive drugs & materials, chemical wastes
Cancer, genetic mutation
Cytotoxic & other drugs, liquid & chemical wastes
Poisonings

11. CATEGORIES OF BIO MEDICAL WASTE
OPTION
WASTE CATEGORY
TREATMENT & DISPOSAL
Category No. 1
Human Anatomical Waste
Incineration / deep burial
Category No. 2
Animal Waste
Category No. 3
Microbiology & Biotechnology Waste
Local autoclaving / microwaving / incineration
Category No. 4
Waste Sharps
Disinfection by chemical treatmet / atoclaving / microwaving and mutilation / shredding
Category No. 5
Discarded Medicines and Cytoxic drugs
Incineration / destruction and drugs disposal in secured landfills
Category No. 6
Solid Waste
Incineration / autoclaving / microwaving
Category No. 7
Disinfection by chemical treatment / autoclaving / microwaving and mutilation / shredding
Category No. 8
Liquid Waste
Disinfection by chemical treatment and discharge into drains.
Category No. 9
Incineration Ash
Disposal in municipal landfill
Category No. 10
Chemical Waste
Chemical treatment and discharge into drains for liquids and secured land for solids
Source: Bio-medical Waste Management Rules, 1998, Schedule I.

12. LEGISLATIONS ENVIRONMENTAL REGULATIONS FROM MoEF:
Environment protection act,1986:
Bio-medical waste management rules,1998(RENEWED 2011)
Municipal solid waste rules,2000
Hazardous waste rules,1989
EIA Notification, July 2004

13. Bio-Medical Waste Rules 2011
Elaborate, stringent and several new provisions have been added
Not applicable:
Radioactive waste,
Hazardous waste,
Municipal solid waste
Battery waste

14. Accident reporting must HCE- BMWM unit & meetings
Mandatory treatment & disposal
Adequate treatment facilities
Promote new technologies
Omitted- Incinerator & deep burial
District level monitoring committee
Allocation : Funds & Equipments
Lacking: guidelines for linen & mattress, blood bags & pressurized containers

15. Schedules Schedule I : Categories of Biomedical waste
Schedule II : Color coding
Schedule III : Labels for Hazardous waste
Schedule IV : Label for transport of BMW container/bags
Schedule V : Standards for – incineration , autoclaving, sewerage, deep burial
Schedule VI : Deadlines for implementation

16. SCHEDULE III LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS BAGS

17. SCHEDULE-IV LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE CONTAINERS BAGS
Day Month ….……. Year…………Date of generation
Waste category No ... Waste Class ………
Waste description ………………………………………………….
Sender's Name & Address
Receiver's Name & Address .
In case of emergency please contact……….

18. Forms FORM-I : Application for authorization/ renewal of authorization
FORM II : Annual report(To be submitted to the prescribed authority by 31 January every year
FORM III :- Accident reporting
FORM IV: Authorization granting format
FORM V : Application for filing appeal against order passed by the prescribed authority
FORM VI: Operator of CBMWTF filing against HCE- if no proper segregation

19. ANNEXURE-I

20. ANNEXURE-II
GUIDELINES FOR DESIGN AND CONSTRUCTION OF BIO-MEDICAL WASTE INCINERATOR
Air Pollution Control Device (APCD)
Emission limit mg/Nm3 (corrected to 12% CO2) for Particulate Matter

21. BMW Rules 2011 vs. 1998
2011
1998
Every occupier irrespective of the quantum of wastes requires to obtain authorisation
Occupiers with more than 1000 beds required authorisation
Duties of the operator listed
Operator duties absent
Categories of BMW eight
Ten categories
Treatment and disposal of BMW mandatory for all the HCEs
Restricted to HCEs with more than 1000 beds
A format for annual report
No format
Form VI present
Form VI absent

22. COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTES
WASTE CATEGORY
TREATMENT OPTIONS
Yellow
Plastic Bag
Cat.. 1, 2, 3 and 6
Incineration / deep burial
Red
Disinfected container / Plastic Bag
Cat. 3, 6, and 7
Autoclaving / Microwaving / Chemical Treatment
Blue / White Translucent
Plastic Bag / puncture proof container
Cat. 4, Cat. 7
Autoclaving / Microwaving / Chemical treatment and destruction shredding
Black
Cat. 5, 9 and 10 (Solid)
Disposal in secured landfill
Source: Bio-medical Waste Management Rules, 1998,

23. Colour Coding and Type of Container for Disposal of BMW
Type of container to be used
Waste Category Number
Yellow
Non Chlorinated plastic bags
Category 1,2,5,6
Red
Non Chlorinated plastic bags/puncture proof container for sharps
Category 3,4,7
Blue
Non Chlorinated plastic bags container
Category 8
Black
Municipal Waste

24. Number of CTF against HCEs in major states
Health Care Establishments
Common Treatment Facility
Maharashtra
12,753 38
Gujarat
21,779 13
Karnataka
11,248 14
Delhi
1900 3
West Bengal
2747 6

25. PRINCIPLES OF MANAGING HEALTH CARE WASTE
Waste minimization
Safe reuse & recycling
Managing sharps

26. Waste minimization Source reduction
Management and control measures at hospital level
Stock management of chemical and pharmaceutical products

27. SAFE REUSE & RECYCLING
Sterilization methods for reusable items:
Thermal sterilization
• Dry sterilization - Exposure to 160 °C for 120 minutes or 170 °C for 60 minutes in a “Poupinel” oven.
• Wet sterilization - Exposure to saturated steam at 121°C for 30 minutes in an autoclave.
Chemical sterilization
• Ethylene oxide - Exposure to an atmosphere saturated with ethylene oxide for 3–8 hours, at 50–60°C, in a reactor tank
Glutaraldehyde - Exposure to a glutaraldehyde solution for 30 minutes

28. Managing sharps
Auto disable syringes

29. Disposables syringes

30. Glass syringes

31. In 2000, WHO estimation-injections with contaminated syringes caused:
21 million hepatitis B virus (HBV) infections (32% of all new infections)
two million hepatitis C virus (HCV) infections (40% of all new infections)
HIV infections (5% of all new infections).
One needle stick injury risks:
30% -HBV
1.8% -HCV
0.3% -HIV. 

32. Handling of health care waste

33. Waste generation globally
COUNTRIES
TOTAL WASTE
% OF INFECTED WASTE
USA
7-10
10-15
Western Europe
3-6
India
0.5-2
30-60
Source: International healthcare workers network,
Patil & Shekdar 2001

34. Quantity of waste generation in a 30 bedded CHC
Waste type
Quantity
Percentage 1.
Infectious waste
Pathological & anatomical
1.5 6
Sharps including syringes 1 4
Non-sharp wastes
7.5 30
Total 10 40 2.
General waste 15 60 25

35. Average composition of hospital waste in India
Material
Percentage(wet-weight basis)
Paper 15
Plastics 10
Rags
Metals 1
Infectious waste
1.5
Glass 4
General waste
53.5
SOURCE: National engineering research institute

36. Steps of waste management

37. Segregation

38. Collection

39. Storage

40. Transport

46. DEEP BURIAL PIT

48. Name of the disinfectant Available chlorine Required Chlorine
Disinfectants commonly used for disinfection of materials contaminated with blood & body fluids
Name of the disinfectant
Available chlorine
Required Chlorine
Required contact period
Amount of disinfectant to be dissolved in 1 L of H2O
Sodium Hypochlorite 5%
0.5%
30 min
100 ml
Calcium Hypochlorite
70%
7.0 gm
NaOCl powder -
8.5 gm
Na dichloro Isocyanate (Na DCC) tablets
60%
4 tabs
Chloramine
25%
20 gm

49. Infection control Hand washing Personnel protective equipment
Safe handling of waste
Prevention of needle stick injuries
Environmental cleaning & spillage management
Proper training to health care workers
Immunization of health care workers

50. Hospital waste management structure

51. BMW committee – MGIMS, Sevagram
Occupier - Secretary, KHS
Dean, MGIMS
Medical superintend
Officer in charge - HOD, Community Medicine
HOD, Microbiology
Faculty member, community medicine
Faculty Member, Microbiology
CAO KHS & KH
Matron
Engineering Section-In-charge & civil section
Sanitary Inspector
Infection control Nurse

52. At MGIMS

53. GOPD

54. BOILER & NEEDLE CUTTER - GOPD

55. AUTOCLAVE

56. DOUBLE DOOR AUTOCLAVE

57. SHREDDER

58. DOUBLE CHAMBERED DIESEL FIRE INCINERATOR

59. 200 kg/day

61. BMWM – NATIONAL PROGRAMS
NVBDCP
RNTCP
NACO-ICWM plan
BIOMEDICAL WASTE AUDIT

62. References
Pruss A, Giroult E and Rushbrook P. (1999) Safe Management of Wastes from Health Care Activities, World Health Organization, Geneva
Kishore J and Ingle G.K. (2004) Biomedical Waste Management in India, Century Publications, New Delhi
Srishti - Managing Hospital Waste, A Guide for Healthcare Facilities, September 2000
Agarwal, A.G. and Singh, R. (2005) Understanding and Simplifying Bio-Medical Waste Management, Toxics Link, New Delhi
Mandal S. K & Dutta J , Integrated Bio-Medical Waste Management Plan for Patna City, Institute of Town Planners, India Journal 6-2:01-25 (2009)
The Bio Medical Waste(Management & Handling) Rules, (1998)& (2011)
WHO - Healthcare Waste Management –
NRHM-Infection management & environment plan. Policy framework march Ministry of Health & Family Welfare , Government of India.
-Biomedical waste rules made stringent

63. Thank you