Unit 6 –Block 2

STRUCTURE

1.0 Objectives
1.1 Introduction
1.2 Biomedical waste management
1.2.1 Classification of Bio-Medical Waste
1.2.2 Sources of Biomedical Waste
1.2.3 Need of Biomedical waste Management in Hospitals
1.2.4 Salient Features

1.3 Biomedical Waste Management Process

1.4 Standards for treatment and disposal of bio-medical wastes

1.4.1 Standards for incineration

1.4.2 Standards for autoclaving of bio-medical waste

1.4.3 Standards of microwaving
1.4.4 Standards for deep burial
1.4.5 Standards for efficacy of chemical disinfection
1.4.6 Standards for plasma pyrolysis
1.4.7 Standards for dry heat sterilization
1.4.8 Standards for liquid waste
1.5 Biomedical Waste Management Rules
1.5.1 Schedule I
1.5.2 Schedule II
1.5.3 Schedule III
1.5.4 Schedule IV
1.5.5 Schedule V
1.5.6 Schedule VI
1.6 Benefits of Biomedical Waste Management
1.7 Recommendations of Biomedical Waste Management
1.0 OBJECTIVES
After going through this unit, you will be able to:
 define biomedical waste management
 classify the Bio-Medical Waste
 explain about the Sources of Biomedical Waste
 enumerate the need of Biomedical waste Management in Hospitals
 list the salient features of biomedical waste management
 explain about the Biomedical Waste Management Process
 describe the standards for treatment and disposal of bio-medical wastes
 explain the Standards for incineration
 enumerate the Standards for autoclaving of bio-medical waste
 describe the Standards of microwaving
 explain the Standards for deep burial
 explain the Standards for efficacy of chemical disinfection
 explain about plasma pyrolysis
 describe the Standards for dry heat sterilization
 enumerate the Standards for liquid waste
 Explain the Biomedical Waste Management Rules
 BIOMEDICAL WASTE MANAGEMENT

Introduction:
Biomedical waste is the leading cause for spreading of nosocomial infections in the hospital.
Improper maintenance of Biomedical Waste may lead to increased risk of blood borne; air
borne and needle prick injuries in the Staff as well as the patients and their attendants. For
Proper treatment and Disposal of Biomedical Waste in the facility following steps should be
ensured.

Definition:

“Any waste which is generated during the diagnosis, treatment or immunization of human beings or
animals or in research activities pertaining there to or in the production or testing of biologicals.”

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories:
General Waste
Pathological
Radioactive
Chemical
Infectious to potentially infectious waste
Sharps
Pharmaceuticals
Pressurized containers
Sources of Biomedical Waste

Hospitals produce waste, which is increasing over the years in its amount and type. The hospital
waste, in addition to the risk for patients and personnel who handle them also poses a threat to
public health and environment.

Major Sources

 Govt. hospitals/private hospitals/nursing homes/ dispensaries.

 Primary health centers.
 Medical colleges and research centers/ paramedic services.
 Veterinary colleges and animal research centers.
 Blood banks/mortuaries/autopsy centers.
 Biotechnology institutions.
 Production units.

Minor Sources

 Physicians/ dentists’ clinics

 Animal houses/slaughter houses.
 Blood donation camps.
 Vaccination centers.
 Acupuncturists/psychiatric clinics/cosmetic piercing.
 Funeral services.
 Institutions for disabled persons

Need of Biomedical waste Management in Hospitals

The reasons due to which there is great need of management of hospitals waste such as:
1. Injuries from sharps leading to infection to all categories of hospital personnel and waste
handler.
2. Nosocomial infections in patients from poor infection control practices and poor waste
management.
3. Risk of infection outside hospital for waste handlers and scavengers and at time general
public living in the vicinity of hospitals.
4. Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels.
5. “Disposable” being repacked and sold by unscrupulous elements without even being
washed.
6. Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers.
7. Risk of air, water and soil pollution directly due to waste, or due to defective incineration
emissions and ash

Salient Features:

The major salient features of BMW Management Rules, 2016 include the following: -

(a) The ambit of the rules has been expanded to include vaccination camps, blood donation
camps, surgical camps or any other healthcare activity;

(b) Phase-out the use of chlorinated plastic bags, gloves and blood bags within two years;
(c) Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags
through disinfection or sterilization on-site in the manner as prescribed by WHO or NACO;

(d) Provide training to all its health care workers and immunize all health workers regularly;

(e) Establish a Bar-Code System for bags or containers containing bio-medical waste for
disposal;

(f) Report major accidents;

(g) The new rules prescribe more stringent standards for incinerator to reduce the emission of
pollutants in environment;

(h) Existing incinerators to achieve the standards for retention time in secondary chamber and
Dioxin and Furans within two years;

(i) Bio-medical waste has been classified in to 4 categories instead of 10 to improve the
segregation of waste at source;

(j) Procedure to get authorization simplified. Automatic authorization for bedded hospitals. The
validity of authorization synchronized with validity of consent orders for Bedded HCFs. One
time Authorization for Non-bedded HCFs;

(k) No occupier shall establish on-site treatment and disposal facility, if a service of common
bio-medical waste treatment facility is available at distance of seventy-five kilometers.

(l) Operator of a common bio-medical waste treatment and disposal facility to ensure the
timely collection of bio-medical waste from the HCFs and assist the HCFs in conduct of training.

Biomedical Waste Management Process

The hospital waste like body parts, organs, tissues, blood and body fluids along with soiled
linen, cotton, bandage and plaster casts from infected and contaminated areas are very
essential to be properly collected, segregated, stored, transported, treated and disposed of in
safe manner to prevent nosocomial or hospital acquired infection.
1. Waste collection
2. Segregation
3. Transportation and storage
4. Treatment & Disposal
5. Transport to final disposal site
6. Final disposal

STANDARDS FOR TREATMENT AND DISPOSAL OF BIO-MEDICALWASTES

Health care waste is a heterogeneous mixture, which is very difficult to manage as such. But the
problem can be simplified and its dimension reduced considerably if a proper management
system is planned.

Incineration Technology

This is a high temperature thermal process employing combustion of the waste under
controlled condition for converting them into inert material and gases. Incinerators can be oil
fired or electrically powered or a combination thereof.
Broadly, three types of incinerators are used for hospital waste: multiple hearth type, rotary
kiln and controlled air types.
Autoclaving
The autoclave operates on the principle of the standard pressure cooker.
The process involves using steam at high temperatures.
The steam generated at high temperature penetrates waste material and kills all the micro
organism.
These are also of three types: Gravity type, Pre-vacuum type and Retort type.
Autoclave treatment has been recommended for microbiology and biotechnology waste, waste
sharps, soiled and solid wastes
Microwave Irradiation

 The microwave is based on the principle of generation of high frequency waves.

 These waves cause the particles within the waste material to vibrate, generating heat.
 This heat generated from within kills all pathogens.
Deep Burial
(1) A pit or trench should be dug about two meters deep. It should be half filled with waste,
then covered with lime within 50 cm of the surface, before filling the rest of the pit with soil.
(2) It must be ensured that animals do not have any access to burial sites. Covers of galvanised
iron or wire meshes may be used.
(3) On each occasion, when wastes are added to the pit, a layer of 10 cm of soil shall be added
to cover the wastes.
(4) Burial must be performed under close and dedicated supervision.
(5) The deep burial site should be relatively impermeable and no shallow well should be close
to the site.
(6) The pits should be distant from habitation, and located so as to ensure that no
contamination occurs to surface water or ground water. The area should not be prone to
flooding or erosion.
(7) The location of the deep burial site shall be authorised by the prescribed authority.
(8) The institution shall maintain a record of all pits used for deep burial.
(9) The ground water table level should be a minimum of six meters below the lower level of
deep burial pit.
Chemical Methods
1 % hypochlorite solution can be used for chemical disinfection

Plasma Pyrolysis
 Plasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste. It is
an environment-friendly technology, which converts organic waste into commercially useful
byproducts.
 The intense heat generated by the plasma enables it to dispose all types of waste
including municipal solid waste, biomedical waste and hazardous waste in a safe and reliable
manner.
 Medical waste is pyrolysed into CO, H2, and hydrocarbons when it comes in contact
with the plasma-arc.
 These gases are burned and produce a high temperature (around 1200oC).
DRY HEAT STERILIZATION
Waste sharps can be treated by dry heat sterilization at a temperature not less than 185C, at
least for a residence period of 150 minutes in each cycle, which sterilization period of 90
minutes. There should be automatic recording system to monitor operating parameters.

STANDARDS FOR LIQUID WASTE

 The effluent generated or treated from the premises of occupier or operator of a common
bio medical waste treatment and disposal facility, before discharge into the sewer should
conform to the following limits

PARAMETERS PERMISSIBLE LIMITS

pH 6.5-9.0
Suspended solids 100 mg/l
Oil and grease 10 mg/l
BOD 30mg/l
COD 250 mg/l
Bio-assay test 90% survival of fish after 96 hours in 100%
effluent.

(2) Sludge from Effluent Treatment Plant shall be given to common bio-medical waste
treatment facility for incineration or to hazardous waste treatment, storage and disposal facility
for disposal.

Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India. The Biomedical Waste
Management & Handling) Rules, 1998 came into force on 1998.
Schedule I
Schedule II
Schedule III
Schedule IV
Schedule V
Schedule VI
Schedule I
Waste Waste Category [Type] Treatment and Disposal
Category
No.
Category Human Anatomical Waste Incineration/deep burial
No.1 (human tissues, organs, body parts )
Category Animal Waste Incineration/deep burial
No.2 (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 Microbiology & Biotechnology Wastes local
No.3 (Wastes from laboratory cultures, stocks or specimens of autoclaving/microwaving/inci
micro-organisms live or attenuated vaccines, human and neration
animal cell culture used in research and infectious agents
from research and industrial laboratories, wastes from
production of bio-logicals, toxins, dishses and devices used
for transfer of cultures)
Category Waste sharps disinfection (chemical
No.4 (needles, syringes, scalpels, blades, glass etc. that may treatment/auto claving/
cause puncture and cuts. This includes both used and microwaving and multilation
unused sharps) /shredding
Category Discarded Medicines and Cytotoxic drugs incineration /destruction and
No.5 (wastes comprising of outdated, contaminated and drugs disposal in secured
discarded medicines) landfills
Category Soiled Waste incineration
No.6 (Items contaminated with blood, and body fluids including autoclaving/microwaving
cotton, dressings, soiled plaster casts, lines beddings,
other material contaminated with blood)
Category Solid Waste disinfection by chemical
No.7 (wastes generated from disposable items other than the treatment autoclaving/
waste 5 [sharps] such as tubing’s, catheters, intravenous microwaving and
sets etc.) mutilation/shredding
Category Liquid Waste disinfection by chemical
No.8 (waste generated from laboratory and washing, cleaning, treatment and discharge into
house-keeping and disinfecting activities) drains.
Category Incineration Ash disposal in municipal landfill
No.9 (ash from incineration of any biomedical waste)
Category Chemical Waste Chemical treatment and
discharge into drains for
No.10 (Chemicals used in production of biologicals, chemicals
liquids and secured landfill
 used in disinfection, as insecticides etc.) for solids

Schedule II
Color code Waste description

Yellow Human Anatomical waste, soiled waste(include all

waste which is contaminated with blood and body
fluids)

Red Glass, Plastic (Waste generated from disposable items

other than the waste sharps such as tubing’s catheters
& gloves)

Green Paper, disposable cups, plates and other general waste

including food waste

Blue Glass wear, Metallic body implants

White(PPC) Needles, Scalpels, blades & all other metal sharps

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
Phone No …..........…... Phone No .......……………
Telex No …...................Telex No ……..........………
Fax No ……………....... Fax No ………...........……..
Contact Person ……................................................... Contact Person ………
In case of emergency please contact Name & Address:
Phone No.
Note: Label shall be non-washable and prominently visible.
Schedule-V

Standards for Treatment and Disposal Of Bio-Medical Wastes Standards For Incinerators

Schedule-VI

Schedule for Waste Treatment Facilities like Incinerator/ Autoclave/ Microwave System.

Benefits of Biomedical Waste Management

 Cleaner and healthier surroundings.
 Reduction in the incidence of hospital acquired and general infections.
 Reduction in the cost of infection control within the hospital.
 Reduction in the possibility of disease and death due to reuse and repackaging of
infectious disposables.
 Low incidence of community and occupational health hazards.
 Reduction in the cost of waste management and generation of revenue through
appropriate treatment and disposal of waste.
 Improved image of the healthcare establishment and increase the quality of life.

Recommendations

1. For the use of incinerator Training should be given to some number of persons from staff.
2. Specific fund should be allocated for the use of incinerator.
3. Every hospital should have special boxes to use as dustbin for bio-medical waste.
4. Bio-medical waste should not be mixed with other waste of Municipal Corporation.
5. Private hospitals should also be allowed to use incinerator, which is installed, in govt.
hospital. For this purpose a specific fee can be charged from private hospitals.
6. Special vehicle i.e. bio-medical waste vehicle should be started to collect waste from private
hospitals and private medical clinics and carry it up to the main incinerator.
7. As provided by bio-medical waste rules, the whole of the waste should be fragmented into
colours due to their hazardous nature.
8. Bio-medical waste Management Board can be established in each District.
9. Either judicial powers should be given to the management board or special court should be
established in the matters of environment pollution for imposing fines and awarding damages etc.
10. Housekeeping staff wear protective devices such as gloves, face masks, gowned, while handling
the waste.
11. There is biomedical waste label on waste carry bags and waste carry trolley and also poster has
put on the wall adjacent to the bins (waste) giving details about the type of waste that has to
dispose in the baggage as per biomedical waste management rule. Carry bags also have the
biohazard symbol on them.

Do’s and Don’ts in Bio Medical Waste Management

Do’s
1. Segregate waste as soon as it is generated into different categories of waste.
2. Collect the waste in properly labeled specific color coded covered bins.
3. Keep same color bags in the bins.
4. Clean regularly with soap and water and disinfect the bins (weekly).
5. Collect the domestic waste (eatables, wrappers, fruit peels, papers etc., in green bin).
6. Use dedicated waste collection bins/trolleys for transporting waste.
7. Transport waste through a pre- defined route and time within the hospital.
8. Mutilate and disinfect the needle soon after administration of injection.
9. Dispose body parts in yellow bin.
10. Always use PPE while handling the waste.
Don’ts
1. Never mix infectious and non- infectious waste
2. Never mix plastic wastes with the waste which goes for incineration.
3. Never overfill the bins.
4. There should not be any spillage of waste on the way of transport.
5. Avoid transport of waste through crowded areas.
6. Do not put infectious waste into general waste.
 7. Don’t dispose waste sharps with other wastes.
8. Over loading of the Bags and the bins should be avoided. Color coded bags to be
replaced when ¾th full.
9. Never drag filled waste bags.

LET US SUM UP
In this unit you have learnt about the biomedical waste management, segregation and the
waste disposal and the treatment. The standards of waste disposal and treatment are
elaborated.

KEY WORDS
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.
Incineration: The destruction of something, especially waste material, by burning.
Sterilization: Process that eliminates, removes, kills, or deactivates all forms of life and
other biological agents.
(such as fungi, bacteria, viruses, spore forms, prions, unicellular eukaryotic organisms such
as Plasmodium, etc.) present in a specified region
Autoclaving: means a sterilization method that uses high-pressure steam.

SELF ASSESSMENT
Define biomedical waste management
List down the various types of waste treatment

Enumerate the colour code with waste description

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Bibliography
1. Mandal S. K. and Dutta J. , Integrated Bio-Medical Waste Management Plan for Patna City,
Institute of Town Planners, India Journal 6-2: 01-25 (2009).
2. Singh V. P., Biswas G., and Sharma, J. J., Biomedical Waste Management - An Emerging
Concern in Indian Hospitals Indian, Journal of Forensic Medicine & Toxicology, Vol. 1, No. 1.
(2007-12).
3. Hem Chandra, Hospital Waste an Environmental Hazard and Its Management, (1999).
4. Govt. of India, Ministry of Environment and Forests Gazette notification No 460 dated July
27, New Delhi: 1998: 10-20