Biomedical waste managment as per the revised rules2011 promulgated under Environment protection act 1986

1. BIOMEDICAL WASTEBIOMEDICAL WASTE
MANAGEMENTMANAGEMENT
Dr. SANJAY SINGH NEGI
Assistant Professor, Microbiology
AIIMS, Raipur, Chhattisgarh

2. Points to be discussedPoints to be discussed ……………………
 Overview : Definition
 Extent of Problem , Need, Present practices
 BMW Management Rules, application, duty of
occupier
 Segregation, categories of BMW
 Transport & storage
 Treatment & Disposal
 Authorization, Reporting of Accidents
 BMW Mx Committee

3. What is Biomedical Waste?What is Biomedical Waste?
Bio-medical waste" means any waste, which is generated during the
diagnosis, treatment or immunisation of human beings or animals or in
research activities pertaining thereto or in the production or testing of
biologicals, and including categories mentioned in Schedule I;
Biologicals" means any preparation made from organisms or micro-
organisms or product of metabolism and biochemical reactions intended for
use in the diagnosis, immunisation or the treatment of human beings or
animals or in research activities pertaining thereto;
Specific to hospitals Bio-medical waste is defined as waste that is
generated during the diagnosis, treatment or immunization of human
beings and are contaminated with patient’s body fluids (such as syringes,
needles, ampoules ,organs and body parts, placenta, dressings,
disposables plastics and microbiological wastes).

4. What is Biomedical Waste?
Waste Sharps eg: Needles Discarded medicines
Human anatomical waste Solid waste eg: cotton swabs

5. Who’s at Risk ?
• Doctors and nurses
• Patients
• Hospital support staff
• Waste collection and disposal staff
• General public and
• the Environment

6. NEED FOR BMW MANAGEMENTNEED FOR BMW MANAGEMENT
The hospital waste, in addition to the risk for
patients and personnel who handle these
wastes poses a threat to public health and
environment
Health hazards of BMW
Type of wasteType of waste Health hazardHealth hazard
Human / AnimalHuman / Animal
waste/ Soiledwaste/ Soiled
wastewaste
HIV,HBV,HCV, Hgic fevers, cholera,HIV,HBV,HCV, Hgic fevers, cholera,
salmonellosis, shigellosis, rabies,salmonellosis, shigellosis, rabies,
leptospirosis, anthrax,TB,leptospirosis, anthrax,TB,
pneumonia, septicemiapneumonia, septicemia
SharpsSharps HIV, HBV, HCV, InjuriesHIV, HBV, HCV, Injuries
Cytotoxic/Cytotoxic/
radioactive wasteradioactive waste
Cancer, genetic mutation, birthCancer, genetic mutation, birth
defectdefect
Chemical wasteChemical waste Poisonings, dermatitis, conjunctivitis,Poisonings, dermatitis, conjunctivitis,
bronchitisbronchitis

7. NEED FOR BMW MANAGMENT
 Nosocomial infections to patients from poor infection
control practices and poor waste management.
 Drugs which have been disposed of, being repacked and
sold off to unsuspecting buyers.
 Risk of air, water and soil pollution directly due to waste,
or due to defective incineration emissions and ash.
 Risk of infection outside hospital for waste handlers and
scavengers, other peoples.

8. India :India :Extent of the problemExtent of the problem
CPCB,April,2011 dataCPCB,April,2011 data
>95,000 hospitals and healthcare facilities in India .
4.2 lakh kg of biomedical waste is generated on a daily basis.
Three million tonnes of medical wastes generated every year.
Expected to grow 8% annually.
2,91,983 kg/day BMW is disposed. which means that almost
28% of the wastes is left untreated and not disposed finding its
way in dumps or water bodies and re-enters our system.
Karnataka tops the chart with 62,241 kg/day of BMW.
 Only 179 CTF to treat the BMW in the country.
No. of HCF/CBWTF violated BMW rules 5472
No. of show cause notice/ Directions issued to defaulter
HCE/CBWTF 3585

9. Extent of the problem-Continued
CHHATTISGARH(Annual report on BMW, 2011, CPCB)
No. of HCE- 740
No. of Bed- 14678
Total quantity of BMW generated(Kg/day) approximately 4492Kg/Day
BMW treated 4492Kg/Day
No. of HCF/CBWTF violated BMW rules 20
No. of show cause notice/ Directions issued to defaulter HCE/CBWTF 20
No. CBWTF 06
No. of HCE using CBWTF/ Private agencies 446
No. of HCE having own treatment facility & Disposal facility 181
No. of HCE applied for authorization 478
No. of HCE granted authorization 425
No. of treatment equipments
INCINERATOR’S 14
AUTOCLAVES 305
OVEN 7
SHREDDERS 358

10. Present practice within many of the HospitalsPresent practice within many of the Hospitals
•Around 40% of the hospitals in the
country are dumping the BMW with
Municipal garbage
•Waste is not segregated at the site
• 3585 hospitals have been served notice
for acting as defaulters of these rules.
•No proper treatment options
•No regulated disposal plan/sites

11. BIOMEDICAL RULES 1998
The Government of India as contemplated under
Section 6,8 and 25 of the Environment (Protection)
Act,1986, has made the Biomedical Wastes
(Management & Handling) Rules, 1998.
The rules are applicable to every institution
generating biomedical waste which includes hospitals,
nursing homes, clinic, dispensary, veterinary
institutions, animal houses, laboratory, blood bank.
The rules are applicable to all persons who generate,
collect, receive, store, transport, treat, dispose, or
handle bio medical waste in any form.

12. BIOMEDICAL WASTE(MANAGEMENT & HANDLING)BIOMEDICAL WASTE(MANAGEMENT & HANDLING)
RULES by Govt. of India, 1998RULES by Govt. of India, 1998
Revised in 2011Revised in 2011
Now known as BMW Rules, 2011Now known as BMW Rules, 2011
2011 1998
Every occupiergenerating BMW,
irrespective of the quantumof wastes
comes under the BMWRules and
requires to obtain authorisation
Occupiers with more than 1000 beds
required to obtain authorisation
Duties of the operatorlisted Operatorduties absent
Treatment and disposal of BMWmade
mandatory forall the HCEs
Rules restricted to HCEs with more
than 1000 beds
A format forannual report appended
with the Rules
No format forAnnual Report
FormVI i.e. the report of the operator
on HCEs not handing overthe BMW
added to the Rules
FormVI absent

13. Duty of the Occupier
It is the duty of every occupier i.e. head of an
institution generating bio-medical waste, to
take all steps to ensure that such waste is
handled without any adverse effect to human
health and the environment.
Provides training to HCW engaged in handling
BMW

14. Duty of the Operator
The operators now have to ensure that the BMWis collected from
all the HCEs and is transported, handled, stored, treated and
disposedin anenvironmentallysoundmanner. Theoperators also
haveto informtheprescribedauthorityin formVIif anyHCEs are
not handing the segregated BMWas per the guidelines prescribed
intherules.

15. Setting up BMW treatment facility
Occupier set up adequate treatment facilities like autoclave /
microwave / incinerator / hydroclave, shredder prior to
commencement of its operation or ensure that the wastes are
treated at a common bio medical waste treatment facility or an
authorized waste treatment facility.
The new Rules have omitted incinerator as one of the pre
requisites for on-site treatment of BMW. The omission is owing to
the various environmental impacts of incineration.
Promotion of new technologies for treatment and disposal of
waste
Deep burial for disposal of BMW has also been removed from the
Rules. The Rules says it can be an option only in rural areas with
no access to CTF with prior approval from the prescribed
authority.

16. Health waste CharacterizationHealth waste Characterization
Hospital waste
Non Hazardous
(≈ 75-90%)
Hazardous waste
(≈ 10-25%)
Infectious
Others
( Radioactive,
Cytotoxic )

17. Liquid wastesLiquid wastes
Approx. Quantity : 4 to 250 liters / bed / day
Sewage from isolation wards, ICU’s
toilets & urinals, Bed-bath, bathrooms
and hospital’s laundry
Wash waters from laboratories,OPD,
Dressing rooms & Operation theaters.

18. Solid wastesSolid wastes
Approximate Quantity : 0.3 to 3.5 kg/bed/day
1.Garbage 55%
(Bulk Density :330 kg/m3
,Cal.Value:1000 K.cal / kg, Moisture :40%)
2.Bio-medical waste (sensu stricto) 13%
A. Wasted body remains 05%
(Blood,Cultures,Anotomicals)
B. Pharmaceutical & Chemical Wastes 02%
C. Pathological wastes (may be infectious) 06%
3.Sharp Objects 20%
4.Pressurized Containers & Discarded Instruments 02%
5.Radioactive Wastes 0.3%

19. WASTEWASTE
CATEGORYCATEGORY
WASTE TYPEWASTE TYPE TREATMENT & DISPOSALTREATMENT & DISPOSAL
CategoryCategory
11
Human Anatomical waste (human tissues,Human Anatomical waste (human tissues,
organs, body partsorgans, body parts
Incineration/deep burialIncineration/deep burial
CategoryCategory
22
Animal Waste: Animal tissues, organs, bodyAnimal Waste: Animal tissues, organs, body
parts carcasses, bleeding parts, fluid, blood andparts carcasses, bleeding parts, fluid, blood and
experimental animals used in research, wasteexperimental animals used in research, waste
generated by veterinary hospitals, colleges,generated by veterinary hospitals, colleges,
discharge from hospitals, animal housesdischarge from hospitals, animal houses
Incineration/deep burialIncineration/deep burial
CategoryCategory
33
Microbiology & Biotechnology Wastes: WastesMicrobiology & Biotechnology Wastes: Wastes
from clinical samples, pathology, biochemistry,from clinical samples, pathology, biochemistry,
hematology, blood bank, laboratory cultures,hematology, blood bank, laboratory cultures,
stocks specimens of micro-organisms, live orstocks specimens of micro-organisms, live or
attenuated vaccines human and animal cellattenuated vaccines human and animal cell
culture used in research and infectious agentculture used in research and infectious agent
from research and industrial laboratories,from research and industrial laboratories,
waste from production of biologicals, toxins,waste from production of biologicals, toxins,
dishes and devices used for transfer of culturesdishes and devices used for transfer of cultures
Disinfection at source byDisinfection at source by
chemical treatment or bychemical treatment or by
Autoclaving /Autoclaving /
Microwaving / followed byMicrowaving / followed by
Mutilation / shredding andMutilation / shredding and
after treatment finalafter treatment final
disposal in secured landfillsdisposal in secured landfills
or disposal of recyclableor disposal of recyclable
waste (plastic or glass )waste (plastic or glass )
through registered orthrough registered or
authorized recyclerauthorized recycler
SCHEDULE I: CATEGORIES OF BIO-MEDICAL WASTE

20. WASTEWASTE
CATEGORYCATEGORY
WASTE TYPEWASTE TYPE TREATMENT & DISPOSALTREATMENT & DISPOSAL
CategoryCategory
No. 4No. 4
Waste Sharps (needles, glass syringesWaste Sharps (needles, glass syringes
or syringes with fixed needles,or syringes with fixed needles,
scalpels ,blades, glass etc.) that mayscalpels ,blades, glass etc.) that may
cause puncture and cuts(Includes bothcause puncture and cuts(Includes both
used and unused sharps).used and unused sharps).
Disinfection (chemicalDisinfection (chemical
treatment / destruction bytreatment / destruction by
needle & tip cutter,needle & tip cutter,
autoclaving/microwave andautoclaving/microwave and
mutilation/shredding andmutilation/shredding and
final disposal throughfinal disposal through
CBWTF / landfillsCBWTF / landfills
CategoryCategory
No. 5No. 5
Discarded Medicines & CytotoxicDiscarded Medicines & Cytotoxic
drugs (Wastes comprising of outdated,drugs (Wastes comprising of outdated,
contaminated and discardedcontaminated and discarded
medicines)medicines)
Disposal in secured landfillsDisposal in secured landfills
or Incinerationor Incineration
CategoryCategory
No. 6No. 6
Soiled Waste (Items contaminated withSoiled Waste (Items contaminated with
blood, & body fluids including cotton,blood, & body fluids including cotton,
dressings, soiled plaster casts, linens,dressings, soiled plaster casts, linens,
beddings, other material contaminatedbeddings, other material contaminated
with blood)with blood)
IncinerationIncineration

21. WASTEWASTE
CATEGORYCATEGORY
WASTE TYPEWASTE TYPE TREATMENT & DISPOSALTREATMENT & DISPOSAL
CategoryCategory
No.7No.7
Infectious Solid Waste (wasteInfectious Solid Waste (waste
generated from disposablegenerated from disposable
items other than the wasteitems other than the waste
sharps such as tubing's, handsharps such as tubing's, hand
gloves, saline bottles with IVgloves, saline bottles with IV
tubes, catheters, glass,tubes, catheters, glass,
intravenous sets etc.intravenous sets etc.
Disinfection by chemicalDisinfection by chemical
Treatment /Treatment /
autoclavingautoclaving
/Microwaving followed/Microwaving followed
by mutilation /by mutilation /
shredding & finalshredding & final
disposal throughdisposal through
registered recyclerregistered recycler
CategoryCategory
No.8No.8
Chemical Waste ( ChemicalsChemical Waste ( Chemicals
used in production ofused in production of
biologicals, chemicals used inbiologicals, chemicals used in
disinfection as insecticides etc.)disinfection as insecticides etc.)
Chemical treatment andChemical treatment and
discharge into drains fordischarge into drains for
liquids and securedliquids and secured
landfill for solidslandfill for solids

22. NOTE
1.Chemicals treatment using at least 1% hypochlorite solution or
any other equivalent chemical reagent.
2. Mutilation/shredding must be such so as to prevent unauthorized
reuse.
3. There will be no chemical pretreatment before incineration.
Chlorinated plastics should not be incinerated.

23. Schedule-IISchedule-II
Colour coding and Type of Containers forColour coding and Type of Containers for
Different Biomedical WastesDifferent Biomedical Wastes
ColourColour
codingcoding
Type ofType of
containercontainer
WasteWaste
categorycategory
Treatment /Treatment /
DisposalDisposal
Non chlorinatedNon chlorinated
Plastic BagsPlastic Bags
Incineration/Incineration/
Deep BurrialDeep Burrial
Non chlorinatedNon chlorinated
plastic bag /plastic bag /
puncture proofpuncture proof
Container forContainer for
sharpssharps
Chemical Treatment /Chemical Treatment /
Autoclaving /Autoclaving /
Microwaving and followedMicrowaving and followed
by Mutilation & shreddingby Mutilation & shredding
and disposal in landfills orand disposal in landfills or
disposal of recyclabledisposal of recyclable
wastewaste
Non chlorinatedNon chlorinated
Plastic Bags /Plastic Bags /
ContainersContainers
Chemical TreatmentChemical Treatment
and discharge into drainsand discharge into drains
for liquids and securedfor liquids and secured
landfill for solidslandfill for solids
Non chlorinatedNon chlorinated
Plastic BagsPlastic Bags
MunicipalMunicipal
wastewaste
Disposed as per the
Municipal Solid Waste

24. BIOHAZARD
SYMBOL
CYTOTOXIC
HAZARD SYMBOL
BIOHAZARD CYTOTOXIC
HANDLE WITH CARE
Note : Lable shall be non-washable and
Schedule-III
LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

26. Segregation, Packing,Segregation, Packing,
Bio-medical waste shall not be
mixed with other wastes
Bio-medical waste shall be
segregated into containers/bags at
the point of generation in
accordance with Schedule II
The containers shall be labeled
according to Schedule III.

27. Black Dustbin & Bags
Paper waste, food waste
and other non infectious
wastes generated from the
hospitals should be stored
in black coloured bags /
containers & Disposed as
per MSW management
rules, 2000
MANAGEMENT OF HOSPITAL WASTE

28. KITCHEN WASTE/FOOD
PAPER/
plastic
WASTE DISPOSAL
WRAPPERS
Outer packing/
Cardboard
General/Kitchen
waste
BLACK BIN
For Noninfectious
Solid waste

29. Bandages
Humananatomical
waste-placenta
Swab stick-
decontaminated
WASTE DISPOSAL
SWABS
Dressing
soiled linen,
contaminated
gowns,
drapes
Animal waste
Discarded
medicine/cytotoxic
drugs
YELLOW BIN
Category 1,2, 5,6

30. Human/Animal tissue organs or body partsHuman/Animal tissue organs or body parts
Animal carcassesAnimal carcasses
Any non plastic soiled waste( contaminated withAny non plastic soiled waste( contaminated with
blood/ body fluids )blood/ body fluids )
Cotton dressings, bandagesCotton dressings, bandages
Linen beddingsLinen beddings
Soiled plaster casts, Soiled paperSoiled plaster casts, Soiled paper
Used/ removed suturesUsed/ removed sutures

31. Red Dustbin & BagsRed Dustbin & Bags
Cotton pads, Swabs, Gauge
Pieces, Dressings,Bandages,
Cloths, Bedsheets and
Plaster castes Soiled with
blood, Pus, Vomits, Sputum
and other Body Fluids.
MANAGEMENT OF HOSPITAL WASTE

32. RED BINDrains
Plastic culture
plates & tubes
I/V sets
Urine bag
WASTE DISPOSAL
All infectious waste
sharp, non
sharp & sharps
plastic waste
Category 3, 4, 7
Pathology waste

33. Microbiology & laboratory waste , Waste sharps,
infectious solid waste(Category3,4,7)
 Wastes from clinical samples, pathology, biochemistry,Wastes from clinical samples, pathology, biochemistry,
hematology, blood bank, laboratory cultures, stockshematology, blood bank, laboratory cultures, stocks
specimens of micro-organisms, live or attenuated vaccinesspecimens of micro-organisms, live or attenuated vaccines
human and animal cell culture used in research andhuman and animal cell culture used in research and
infectious agent from research and industrial laboratories,infectious agent from research and industrial laboratories,
waste from production of biologicals, toxins, dishes andwaste from production of biologicals, toxins, dishes and
devices used for transfer of culturesdevices used for transfer of cultures
 Waste Sharps (needles, glass syringes or syringes with fixedWaste Sharps (needles, glass syringes or syringes with fixed
needles, scalpels ,blades, glass etc.) that may cause punctureneedles, scalpels ,blades, glass etc.) that may cause puncture
and cuts(Includes both used and unused sharps).and cuts(Includes both used and unused sharps).

34. Microbiology & laboratory waste , Waste sharps,
infectious solid waste(Category3,4,7)--- Continued
Infectious Solid Waste (waste generated fromInfectious Solid Waste (waste generated from
disposable items other than the waste sharps such asdisposable items other than the waste sharps such as
Gloves,tubing, saline bottles with i. v tubes, I. V sets
,Catheters, Urine bags, Blood bags, Syringes,
Suction tips, Infected plastic containers, Rubber
base materials, Retraction cords

35. In Blue Nonchlorinated bags
Chemical waste
Chemical TreatmentChemical Treatment and dischargeand discharge
into drains for liquids and securedinto drains for liquids and secured
landfill for solidslandfill for solids

36. Segregated incinerable wastes kept in Yellow bagSegregated incinerable wastes kept in Yellow bag

37. Segregated Autoclavable waste in red bagSegregated Autoclavable waste in red bag

38. General wastes of health care unit in Black bagGeneral wastes of health care unit in Black bag

39. Sharps in sharp containerSharps in sharp container

40. Personnel safety devicesPersonnel safety devices
The use of protective gears should be made mandatory forThe use of protective gears should be made mandatory for
all the personnel handling waste.all the personnel handling waste.

41. StorageStorage
In an area away from general traffic and accessible
only to authorized personnel
DO NOT store for more than 48 hours
If for any reason it becomes necessary to store the
waste beyond such period take measures to ensure
that the waste does not adversely affect human
health and environment

42. TransportTransport
 Transport by wheeled
trolleys/containers /carts only in
vehicles authorized for the
purpose
 They should be
 Easy to load and unload
 No sharp edges
 Easy to clean
 Disinfect daily
 Trolleys ,Wheelbarrows:
covered

43. Transportation and StorageTransportation and Storage
 If a container is transported
from the premises where bio-
medical waste is generated to
any waste treatment facility
outside the premises, the
container shall, apart from
the label prescribed in
Schedule III, also carry
information prescribed in
Schedule IV.

44. Schedule-IVSchedule-IV
Label for Transportation of Bio-Medical Waste Containers /Label for Transportation of Bio-Medical Waste Containers /
BagsBags
 Waste category No. Day -------- Month --------
 Waste class Year --------
 Waste description Date of generation-----------
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.

45. Treatment and DisposalTreatment and Disposal
SCHEDULE V
STANDARD FOR TREATMENT AND DISPOSAL OF
BMW
STANDRAD for Incinerator
STANDARD for Autoclave
STANDARD for Microwave


46. IncinerationIncineration
 Combustion efficiency (CE) shall be at least
99.00%.
 The Combustion efficiency is computed as
follows:
 %C02
 C.E. = ------------ X 100
 %C02 + % CO
 The temperature of the primary chamber
shall be 800 +/-500
C
 The secondary chamber gas residence time
shall be at least 1 (one) second at 1050 +/-
500
C
DrawbackDrawback
toxic products like furanes and dioxins - can cause air pollution

47. Bio Medical Wastes Destruction byBio Medical Wastes Destruction by
Double Chambered IncineratorDouble Chambered Incinerator

48. Details of Double Chambered IncineratorDetails of Double Chambered Incinerator

49. Incinerator Ash DisposalIncinerator Ash Disposal

50. Emission Standards
Parameters Concentration mg/Nm3
at
(12%CO2 correction)
Particulate matters 150
Nitrogen Oxide 450
HCl 50
Minimum stack height shall be 30 metres above ground
Volatile organic compounds in ash shall not be more
than 0.01%

51. AutoclaveAutoclave
A temperature of not less
than 121 0
C and pressure
of 15 pounds per square
inch (psi)for an autoclave
residence time of not less
than 60 minutes
Validation test :
Spot testing by Bacillus
stearo-thermophilus
spores on a spores strip
with at least 1 x 104
Spores/ml.
Routine test :
Chemical indicator strip/tape

52. STANDARD FOR MICROWAVING
SHOULD KILL BACTERIA AND OTHER PATHOGENIC
ORGANISM
BIOLOGICAL INDICATOR Bacillus Subtilis
CHEMICAL PROCESSES
Dissolved chlorine dioxide, bleach (sodium hypochlorite),
peracetic acid, or dry inorganic chemicals.
To enhance exposure of the waste to the chemical agent,
chemical processes often involve shredding, grinding, or
mixing.

54. Common waste treatment facility( CWTF)

56. AuthorizationAuthorization
Every occupier of an institution generating,
collecting, receiving, storing, transporting, treating
and /or handling Biomedical Waste shall apply on
Form 1 for Authorization to the Board.
 The State Pollution Control Board are declared as
prescribed Authority for grant of Authorization. The
Board grants authorizations after satisfying itself.

57. APPLICATION FOR AUTHORISATION
(To be submitted in duplicate.)
To
The Prescribed Authority
(Name of the State Govt/UT Administration)
Address.
1. Particulars of Applicant
(i) Name of the Applicant
(In block letters & in full)
(ii) Name of the Institution:
Address:
Tele No., Fax No. Telex No.
2. Activity for which authorisation is sought:
(i) Generation
(ii) Collection
(iii) Reception
(iv) Storage
(v) Transportation
(vi) Treatment
(vii) Disposal
(viii) Any other form of handling
3. Please state whether applying for resh authorisation or for renewal:
(In case of renewal previous authorisation-number and date)

58. Form 1- Continued
4.
(i) Address of the institution handling bio-medical wastes:
(ii) Address of the place of the treatment facility:
(iii) Address of the place of disposal of the waste:
5.
(i) Mode of transportation (in any) of bio-medical waste:
(ii) Mode(s) of treatment:
6. Brief description of method of treatment and disposal (attach details):
7.
(i) Category (see Schedule 1) of waste to be handled
(ii) Quantity of waste (category-wise) to be handled per month
8. Declaration
I do hereby declare that the statements made and information given above are true to
the best of my knowledge and belief and that I have not concealed any information.
I do also hereby undertake to provide any further information sought by the prescribed
authority in relation to these rules and to fulfill any conditions stipulated by the
prescribed authority.
Date : Signature of the Applicant
Place : Designation of the Applicant

59. Annual ReportAnnual Report
Every occupier/operator submit an annual report to
the prescribed authority in Form II by 31 January
every year, to include information about the
categories and quantities of bio-medical wastes
handled during the preceding year. The prescribed
authority shall send this information in a compiled
form to the Central Pollution Control Board by 31
March every year.

60. Maintenance of Records & Accident ReportingMaintenance of Records & Accident Reporting
a. Every authorized person shall maintain records
related to BMW.
b. All records shall be subjected to inspection and
verification by the prescribed authority at any time.
c. In any accidents, the authorized person shall report
the accident in Form III along with the remedial
action taken to the prescribed authority forth with

61. Setting up a CELL or UNIT for BMW management.
The BMW 2011, Rules have also made mandatory for all the
HCEs with 30 or more beds to set up a cell or unit to deal
with the BMW management. The cell has to meet every six
months and minutes of the meeting have to be submitted
along with the Annual Report to the prescribed authority

62. Dos and DonDos and Don’ts’ts
Do’s
 The used product should be segregated
 The used product should be mutilated.
The used product is treated prior to disposal.
 Use protective gear when handling waste
 Collect waste when the bin is 3/4 the full
 Clean spills with disinfectant
 Use trolleys & do not drag waste bags
Do not
 Reuse plastic equipment.
 Mix plastic equipment with other wastes.
 Burn plastic waste.
 Avoid needle stick injuries
 Avoid using common lift to move waste
 Avoid spillage

63. BMW management committeeBMW management committee
 Head of the hospital : chairman
 Waste Mx officer (dev. and implementation plan)
Members:
 HOD’s of all department
 Nursing superintendent,
 Head nurse,
 Sanitary inspector
 Chief pharmacist,
 Radiation officer
 Supply officer,
 financial officer

64. Responsibility of WMCResponsibility of WMC
 Day to day control of segregation, transport & disposal of BMW
 Co-ordinate with the store officer for continuous supply of basic
items for BMWM
 Prepare guidelines for BMWM & distribute to all department
 Prepare BMW posters to raise awareness
 Arrange training programmes on BMWM & safety measures for all
categories of HCW
 Co-ordinate with HOD/In-charge of Deptt. where deficiencies are
pointed out
 Co-ordinate with Chhattisgarh Environment Conservation Board )

65. BMW Spills & Surface DisinfectionBMW Spills & Surface Disinfection
 Proper spill handling:
–Notify people in the area
–Don appropriate PPE
–Place absorbent material on spill
–Apply appropriate disinfectant – allow sufficient contact time (30
min)
–Pick up material (watch for glass – use tongs or dust pan); dispose
of material into biomedical waste
–Reapply disinfectant and wipe
–For large/high hazard spills use 10% hypochlorite
 For routine disinfection of surfaces where BMW is handled, use
a 1:10 solution of freshly diluted bleach or 1% hypochlorite
(ethanol evaporates too quickly!)

66. Hand WashingHand Washing
 Handwashing is the single most
effective way to stop the spread of
disease.
 Make certain that jewelry is limited to
wedding rings, certain areas such as
OR< C-section,Cath Lab and NBN allow
no jewelry. Nails should be kept short
and clean.
 Gloves do not replace handwashing.
Hand sanitizer may be used if no visible
soiling is present and the sinks cannot
be readily accessed. This is in every
patient room. It can also be used when
the water is out of service.
 Inspect your hands each time they are
washed. Only use hospital approved
soaps and lotions, do not bring in any
from home
 Alcohol based hand rubs at point of care
 Sinks and clean running water
 Training

67. Steps to Effective HandwashingSteps to Effective Handwashing
 Thorough hand washing
after any procedure
involving nursing care or
close contact with the
patient is essential.
 Alchol based hand
antiseptics gaining
importance where washing
with water and soap are
not practicable.

68. Biomedical Waste Management - IssuesBiomedical Waste Management - Issues
• Not considered importantNot considered important
– Lack of interest from senior managementLack of interest from senior management
– No ownership of the processNo ownership of the process
– Awareness of problemsAwareness of problems
– Appreciate the need for constant monitoringAppreciate the need for constant monitoring
– Segregation of waste not taken seriously at user levelSegregation of waste not taken seriously at user level
– Non compliance with color codingNon compliance with color coding
– Monitoring segregation at source – low budgets allocatedMonitoring segregation at source – low budgets allocated
– costs are not always known/nor worked out properly– costs are not always known/nor worked out properly
– Cost of color coding, staff, transport and disposal is aCost of color coding, staff, transport and disposal is a
majormajor deterrentdeterrent
– Quantification of waste generated is not accurately doneQuantification of waste generated is not accurately done

69. 69
ChallengesChallenges
Establishing robust waste management policies within theEstablishing robust waste management policies within the
Health Care Facility/organizationHealth Care Facility/organization
 Organization wide awareness about the health hazardsOrganization wide awareness about the health hazards
 Sufficient financial and Trained human resources neededSufficient financial and Trained human resources needed
 Monitoring and control of waste disposalMonitoring and control of waste disposal
 Clear responsibility and tracebility for appropriate handling andClear responsibility and tracebility for appropriate handling and
disposal of waste.disposal of waste.

70. 7070
ADRESSING THE ISSUES
1. Need to build-up of a comprehensive system, address
responsibilities, resource allocation, handling and
disposal
2. This is a long-term process, sustained by gradual
improvements.
3. Specific personnel need to be assigned to monitor the
bio-medical waste management in the hospital.
4. Man power needs and other resources for the BMWM of
hospital to be addressed.
5. Quality assessment of bio-medical waste management
should be done from time to time.

71. 71
ADRESSING THE ISSUES- continued
6. Segregated collection and transportation – need for Non-
ambiguous color coding and labeling of wastes.
7. Clear directives in the form of a posters and notice to be
displayed in all concerned areas in English and local
languages.
8. Safety of handlers is a big concern that is still not addressed
adequately.
9. Raising Awareness about risks related to health-care waste;
training staff & Waste handlers on safe practices.
10.Selection of safer & environmentally friendly management
options, to protect people from hazards when collecting,
handling, storing, transporting, treating or disposing waste.

72. 7272
ADRESSING THE ISSUES
11.Issue of all protective clothing such as, gloves,
aprons, masks etc. to all HCW & Waste handlers.
12.Regular medical check-up (half-yearly) of staff
associated with BMWM.
13.Maintenance of Record registers for this purpose.
14.Containers should be robust and leak proof
15.Tracking of Bio Medical Waste up to point of Disposal.
16.Proper treatment and final disposal.

73. ConclusionConclusion
Bio-medical waste programme cannot be
successfully implemented without the
willingness, self-motivation, and co-operation
from all sections of employees of any health
care setting.
If we want to protect our environment and
health of community we must sensitize our
selves to this important issue not only in the
interest of health managers but also in the
interest of community.

74. Dr. SANJAY SINGH NEGI
Assistant Professor, Microbiology,
AIIMS, Raipur, Chhattisgarh