biomedical waste management, hospital infection control, infection prevention

1. Biomedical Waste
Management
DR. SSHRUTKIRTI GUPTA
CONSULTANT MICROBIOLOGIST
KEMH MUMBAI

2. Learning objectives
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

3. Biomedical Waste
Definition:
• Wastes that are generated during the laboratory diagnosis, treatment or
immunization of human beings or animals, or in research activities pertaining
thereto, or in the production of biologicals.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

4. Waste Generated in Hospitals
• General waste (80%)
• Pathological and infectious waste (15%)
• Chemical and pharmaceutical waste (3%)
• Sharp waste (1%)
• Less than 1% accounts for special waste such as cytotoxic drug, radioactive
waste, broken thermometers and used batteries.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

5. Situation in India
• According to the Ministry of Environment and Forests gross
generation of biomedical waste in India is about 4,05,702 kg/day
• Of which only 2,91,983 kg/day is properly disposed
• 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 among all the states in generation of
biomedical waste.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

6. Biomedical waste Management Rule, India 2016
Category Type of waste Type of Bag/ container Treatment/ Disposal options
Yellow
infectious
non- plastic
waste
Human anatomical waste Yellow coloured non
chlorinated plastic bags
Incineration/ Plasma
pyrolysis/ deep burial
Animal anatomical waste
Soiled waste Incineration/ Plasma
Pyrolysis/ deep burial/
autoclaving or hydroclaving
+ shredding/mutilation
Expired/ discarded
medicines- pharmaceutical
waste, cytotoxic drugs
Yellow coloured containers/
non chlorinated plastic bags
Incineration (cytotoxic drugs
at temperature > 1200⁰C)
Chemical waste Yellow coloured containers/
non chlorinated plastic bags
Incineration or Plasma
pyrolysis or Encapsulation
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

7. Biomedical waste Management Rule, India 2016
Category Type of waste Type of Bag/ container Treatment/ Disposal options
Yellow
infectious
non- plastic
waste
Chemical liquid waste Separate collection system
leading to effluent treatment
system
Pre-treated before mixing
with other wastewater
Discarded linen
contaminated with blood/
body fluids
Non-chlorinated yellow
plastic bags/ suitable packing
material
Non- chlorinated chemical
disinfection followed by
incineration/ plasma
pyrolysis
Microbiology, other
clinical lab waste, blood
bags, live/ attenuated
vaccines
Autoclave safe plastic bag/
container
Pre-treat to sterilize with
non-chlorinated chemicals
on-site as per NACO/ WHO
guidelines
+ Incineration.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

8. Biomedical waste Management Rule, India 2016
Category Type of waste Type of Bag/ container Treatment/ Disposal options
Red Infectious plastic waste
(Recyclable)
Red coloured non-
chlorinated plastic bags or
containers
 Autoclaving/ micro-
waving/ hydroclaving +
shredding
 Mutilation/ sterilization+
shredding.
Treated waste sent to
registered or authorized
recyclers or for energy
recovery or plastics to diesel
or fuel oil or for road
making,
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

9. Biomedical waste Management Rule, India 2016
Category Type of waste Type of Bag/ container Treatment/ Disposal
options
White
(Translucent)
Waste sharps including
metal sharp
Puncture proof, Leak
proof, tamper proof
containers
 Autoclaving/ dry heat
sterilization+
shredding/ mutilation
 Encapsulation in metal
container or cement
concrete
 Sanitary landfill/
designated concrete
waste sharp pit
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

10. Biomedical waste Management Rule, India 2016
Category Type of waste Type of Bag/ container Treatment/ Disposal options
Blue Glassware
Metallic body implants
Cardboard boxes with blue
colored marking
Disinfection (by soaking the
washed glass waste after
cleaning with detergent and
Sodium Hypochlorite
treatment)/ through
autoclaving/ microwaving/
hydroclaving + recycling
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

11. TREATMENT AND DISPOSAL METHODS-
Incineration
• Method of choice of disposal of biomedical waste.
• High temperature dry oxidation process that reduces organic
and combustible waste into nonorganic incombustible matter,
resulting in a very significant reduction of waste volume and
weight
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

12. Incineration
• Incineration done for:
oThose wastes that cannot be reused, recycled or disposed off in a landfill site, for
example, human and animal anatomical waste, microbiological waste, solid non-plastic
infectious waste
• Incineration should not be done for:
oPressurized gas containers
oReactive chemical waste
oHalogenated plastics such as PVC (polyvinyl chloride)
oWaste with heavy metals such as mercury, silver salts, radiographic waste, broken
thermometers.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

13. Autoclave
• For ease and safety in operation, the system should be
horizontal type and exclusively designed for the treatment of
biomedical waste.
• For optimum results, pre-vacuum-based system is preferred
against the gravity type system.
• Tamper-proof control panel with efficient display and recording
devices for critical parameters such as time, temperature,
pressure, date and batch number, etc.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

14. Chemical Disinfection
• Chemicals such as sodium hypochlorite (1–2%) are added to waste to kill or
inactivate the pathogens within it.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

15. Effluent Treatment Plant
• Liquid effluent generated during the process of washing containers, vehicles,
floors, etc. is first subjected to chemical treatment and then disposed in
effluent treatment plant.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

16. Microwaving
• In microwaving, microbial inactivation occurs as a result of the
thermal effect of electromagnetic radiation.
• Intermolecular heating process
• Heating occurs inside the waste material in the presence of
steam
• Efficacy should be monitored regularly.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

17. Shredder
• Waste are deshaped or cut into smaller pieces so as to make
the wastes unrecognizable.
• Helps in prevention of reuse of biomedical waste
• Acts as identifier that the waste has been disinfected and is
safe to dispose off.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

18. Sanitary Landfill
• Small deep burial pit of 2 meters depth.
• 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.
• Designed for disposal of hospital waste.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

19. Encapsulation
• Involves filling containers with waste, adding immobilizing material and
sealing the containers
• To prevent the access to unscrupulous activities.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

20. Inertization
• Involves mixing waste with cement and other substances before disposal
• To minimize the risk of toxic substances contained in the waste migrating into
surface or ground water.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

21. Plasma Pyrolysis
• Makes use of an ionized gas in the plasma state to convert electrical energy to
temperatures of several thousand degrees using plasma arc torches or
electrodes.
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

22. Differences between Biomedical Waste Rule
1998 and 2016 BMW Rule 1998 BMW Rule 2016
Categories Ten Four
Overlapping of category Yes No
Incinerator May have only one
chamber
Upgrade to have secondary
chamber
Chlorinated Bags Using it Phase out in two years
Cytotoxic drugs Black colour bag Yellow bag
Majority of idea Discarding the BMWs For recycling
Essentials of Medical Microbiology by Apurba S Sastry © 2018,
Jaypee Brothers Medical Publishers

24. HOW TO SEGREGATE WASTE
WASTE
PLASTIC
Nonplastic
BMW
SHARP
GENERAL
PUNCTURE
PROOF

25. Waste
categorisation
Waste
Non
infectious
infectious Hazardous

26. SCHEDULE I
(See Rule 5)
CATEGORIES OF BIO-MEDICALWASTE
Waste
Category No.
Waste Category [Type] Treatment ad Disposal
[Option+]
Category No. I HumanAnatomical Waste (human
tissues, organs, body parts)
Incineration@/deep burial*
Category No. 2 Animal Waste
(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)
Incineration@/deep burial*
Category No 3 Microbiology & Biotechnology Waste Local autoclaving/micro-
waving/incineration
Category No 4 Waste sharps
(needles, syringes, scalpels, blades, glass,
etc. that may cause puncture and cuts.
This includes both used and unused
sharps)
Disinfection (chemical treat-
ment@01/auto calving/micro-waving
and mutilation/ shredding"
Category No 5 Discarded Medicines and Cytotoxic
drugs
(wastes comprising of outdated,
Contaminated and discarded medicines)
Incineration @/destruct ion and drugs
disposal in secured landfills

27. Cont.........
Category No 6 Solid Waste
(Items contaminated with blood, and
body fluids including cotton, dressings,
soiled plaster casts, lines, beddings, other
material
contaminated with blood)
incineration@ autoclaving/microwaving
Category No. 7 Solid Waste
(wastes generated from
disposable items other than the waste
[sharps] such as tubing's, catheters,
intravenous sets etc).
Disinfection by chemical treatment
autoclaving/microwaving and
mutilation/ shredding
Category No. 8 Liquid Waste
(waste generated from laboratory and
washing, cleaning, house- keeping and
disinfecting
activities)
Disinfection by chemical
treatment@@and discharge
Category No. 9 IncinerationAsh
(ash from incineration of any bio-medical
waste)
Disposal in municipal landfill
Category No. 10 Chemical Waste
(chemicals used in production of
biological, chemicals used in
disinfection, as insecticides, etc.)
Chemical treatment and discharge into
drains for liquids and secured landfill
for solids.

28. PROCESS OF FLOW OF BMW
GENERA
TION SEGREGA
TION STORAGE
COLLECTION
TRANSPORTATION
TREATMENT N
DISPOSAL