2. LEARNING OBJECTIVES
• Types of BMW
• Sources of health care waste
• Health care waste management plan
• Biomedical waste treatment techniques
• Maintenance of records
• DIFFERENCES between BIOMEDICAL WASTE MANAGEMENT RULES of
2016 and 1998
3. WASTE : “Something that is not put into proper usage at
a given time”.
What comprises Biomedical Waste?
Bio-medical waste is defined as any solid, liquid or
fluid waste including its container and any intermediate
product which is generated during the diagnosis,
treatment and immunization of humans and animals or
while carrying out research activities.
- Biomedical Waste (Management and Handling) Rules of India, 1998.
4. In the late 1980’s
Items such as used syringes washed up on several East coast beaches of USA
Consequent cases of HIV and HPV virus infection
Led to development of BMWM laws in USA
• In India, the seriousness about this management came into
lime light only after 1990s.
5. Where are we looking at?
GLOBALLY-
Developed countries generate 1 to 5 kg/bed/day
Developing countries:
meager data, but figures are lower, 1-2kg/bed/day
INDIA:
No national level study yet.
-local or regional level study shows hospitals generate roughly
1-2 kg/bed/day
6. MAGNITUDE OF PROBLEM: Indian scenario
• Per capita waste generation increasing by 1.3% per annum
• With urban population increasing between 3 – 3.5% per annum
• Yearly increase in waste generation is around 5% annually
• India produces more than 42.0 million tons of municipal solid waste annually.
• Per capita generation of waste varies from 200 gm to 600 gm per capita / day.
Average generation rate at 0.4 kg per capita per day in 0.1 million plus towns.
7. Types of waste
• Infectious waste: waste contaminated with blood and other bodily fluids (e.g.
from discarded diagnostic samples),cultures and stocks of infectious agents from
laboratory work (e.g. waste from autopsies and infected animals from
laboratories), or waste from patients with infections (e.g. swabs, bandages and
disposable medical devices);
• Pathological waste: human tissues, organs or fluids, body parts and
contaminated animal carcasses;
• Sharps waste: syringes, needles, disposable scalpels and blades, etc.;
• Chemical waste: for example solvents and reagents used for laboratory
preparations, disinfectants, sterilants and heavy metals contained in medical
devices (e.g. mercury in broken thermometers) and batteries;
8. • Pharmaceutical waste: expired, unused and contaminated drugs and
vaccines;
• Cyctotoxic waste: waste containing substances with genotoxic properties
(i.e. highly hazardous substances that are, mutagenic, teratogenic or
carcinogenic), such as cytotoxic drugs used in cancer treatment and their
metabolites;
• Radioactive waste: such as products contaminated by radionuclides
including radioactive diagnostic material or radiotherapeutic materials; and
• Non-hazardous or general waste: waste that does not pose any particular
biological, chemical, radioactive or physical hazard.
9. ENVIRONMENTAL HAZARD
• Inappropriate treatment and disposal of biomedical waste leads to
environmental pollution.
• Uncontrolled incineration cause air pollution,
• Dumping in nallas, tanks and along the river beds causes water pollution,
• Unscientific land filling causes soil pollution.
10. GENERAL CLASSIFICATION OF HOSPITAL
WASTE
HOSPITAL WASTE
NON-HAZARDOUS(80%) HAZARDOUS(20%)
BIO DEGRADABLE
NON BIODEGRADABLE INFECTIOUS(15%) TOXIC WASTE(5%)
-NON-SHARPS -RADIOACTIVE WASTE
-SHARPS -DISCARDED GLASS WASTE
-PLASTIC DISPOSABLES -CYTOTOXIC WASTE
-LIQUIDS - INCINERATION WASTE
11. Biomedical waste management (BMWM )rules
According to the Ministry of Environment and Forests (MoEF)
gross generation of BMW in India is 4,05,702 kg/day of which
only 2,91,983 kg/day 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.
12. Applicable to Whom ???
To all persons who generate, collect, receive, store, transport, treat, dispose
or handle BMW in any form including:
- Ayush hospitals
- Clinical establishments
- Health camps
- Medical or surgical camps
- Vaccination camps
- Blood donation camps
- First aid rooms of schools
Hospitals
Nursing homes
Clinics Research or
Educational Institutions
Dispensaries
Veterinary institutions
Animal houses
Pathological laboratories,
Blood banks
Forensic laboratories and research labs
13. Salient Features of BMW Rules,2016
• 12 Chapters; 4 Schedules & 5 Forms
Schedules
Schedule I – Bio-medical Wastes categories and theirsegregation, collection, treatment, processing
and disposal
Schedule II – Standards for treatment and disposal of bio-medicalwastes
Schedule III – List of Prescribed Authorities and Correspondingduties
Schedule IV – Label for Bio-medical Waste Containers orBags
Forms
Form I – Accident Reporting
Form II – Application for Authorisation or Renewal ofAuthorisation
Form III – Authorisation
Form IV – Annual Report
Form V – Application for filing appeal against order passed by the Prescribed Authority
19. APPLICATION
Rules apply to those who-
GENERATE
COLLECT
RECEIVE
STORE
TRANSPORT
TREAT
DISPOSE
HANDLE biomedical waste in any form.
20. EPA – ENVIRONMENTAL PROTECTION ACT
Infectious or potentially infectious biomedical waste is a contaminant
and must be managed as a hazardous waste.
The objective of guidelines are:
• To provide uniform standards for the segregation, management
and disposal of infectious or potentially infectious biomedical waste.
• To reduce the incidence of health care worker and the public
from contacting a disease or injury from biomedical waste.
• To waste minimization and the reduction of air contamination
from incineration of biomedical waste.
21. INFECTIOUS WASTE MANAGEMENT PLAN
1. Designation of the waste that should be managed as infectious
2. Segregation of infectious waste from the noninfectious waste
3. Packaging
4. Storage
5. Treatment
6. Disposal
7. Contingency measures for emergency situations
8. Staff training
22. 1. Segregation of wastes
• Key to successful Biomedical waste management.
• Done at point of Generation of waste and put in separate coloured bags.
• The responsibility lies mainly with the generator, i.e., doctors, nurses and the
technicians.
• BMW should not be mixed with any other kind of waste. Mixing of waste
will make entire waste potentially hazardous.
• If coloured bag is not available, then a clearly visible label of
appropriate colour is acceptable
23. How to segregate waste .... in Non
Chlorinated Bags
WASTE
PLASTIC
NON
PLASTIC
BMW
SHARP
GENERAL
PUNCTURE
PROOF
Infectious plastic waste
Infectious non plastic waste
Glassware and metal waste
Sharp waste
25. BMW
Category
BMW categories &
Type of waste
Treatment Options
Treatment Options
Yellow
In bags /
containers
Human anatomical; animal
anatomical waste; soiled waste;
Expired or discarded medicines;and
Chemical waste
Incineration Plasma Pyrolysis
Expired cytotoxic drugs to be returned back to
manufacturer
Chemical Liquid waste Chemical liquid waste shall be pretreated and then
conform to Schedule III
Discarded linen, mattresses,
beddings contaminated with blood
or body fluid
Non-chlorinated chemical disinfection followed by
incineration or plasma pyrolysis or for energy recovery
Microbiology, biotechnology and
other clinical lab waste
Pre-treat to sterilize with non-chlorinated chemicals
on-site thereafter for incineration
Red
In bags Contaminated Waste(Recyclable)
Autoclaving or microwaving/hydroclaving
followed by shredding
or mutilation or combination of sterilization and
shredding
Treated waste to be sent to recyclers for energy recovery
Plastic waste should not be sent to landfill
26. BMW categories & Treatment Options
BMW
Category
Type of waste Treatment Options
White
In container
/ bags
Waste sharps including metals Autoclaving
Dry Heat Sterilisation followed by shredding
or mutilation or encapsulation in metal
container or cement concrete
Combination of shredding cum autoclaving
and sent for final disposal to iron foundaries or
sanitary landfill
Blue
Boxes
Glassware and Metallic body
implants
Disinfection -
by soaking the washed glass watse after cleaning
with detergent and Sodium Hypochlorite
treatment/
Autoclaving/microwaving/hydroclaving and then
sent for recycling
27. CHEMICAL/LIQUID WASTE
liquid waste: To be
treated with 1 to 2 %
Hypochlorite or to have
an ETP.
Floor washing etc should
be pre-treated onsite
using 1 - 2% Sodium
Hypochlorite or
connected to ETP
28. Handling of Wastes
• Disposable items like gloves, syringes, IV bottles,
catheters etc. have to be shredded, cut or mutilated.
• For instance, the fingers of the gloves should be cut,
IV bottles can be punctured and the same can be done
for other disposable items.
• Extreme care has to be taken while handling the
SHARPS (needles and syringes) & blood bags with
proper protection.
31. SHARPS
All the health workers employed in/outside the hospital must be
vaccinated against Hepatitis B, tetanus and typhoid.
32. Policy for Handling Sharps
• User responsible for disposal of sharps
• Must dispose of sharps after each test
• Must place sharps in sharps boxes
• Do not drop sharps on the floor or in the office waste bin
• Place sharps container near your workspace
• Seal and remove when box is ¾ full
• Incinerate all waste
33. Sharp container
All sharp containers should have:
• A lid
• Puncture-proof or thick walls
• A large enough hole for lancets and needles
• Leakproof sides and bottom
• A label or color code indicating bio-hazard material
• Sufficient quantity available at each testing site
• Not all sharps containers need be purchased commercially. An empty bleach
container will sufficient. This type container meets all previously mentioned
specification.
39. 3. Collection of waste:
- Sanitation staff should collect waste under the supervision of nursing
staff and sanitation supervisor;
- Documentation
40. -Polythene bags to be
changed with each shift or
when they are 3/4th full
and they have to be sealed
whenever the waste is
being transported within or
outside the hospital.
- Bins with lids.
41. 4. Storage of Waste:
• Not to be stored for longer than 4-6 hours.
• Presence of an impermeable, hard-standing floor with good drainage
which should be easy to clean and disinfect.
• Good lightning and at least passive ventilation.
• Availability of water supply for cleaning purposes.
• Easy access for staff and collection services.
• Inaccessible for animals, insects, and birds.
• Away from fresh food stores or food preparation areas.
42. 5. Transportation
• The bio-medical waste collected
in designated coloured containers
shall be transported to the
CBWTF in a fully covered
vehicle.
• Such vehicle shall be dedicated
for transportation of bio-medical
waste only.
46. 6. Treatment & Disposal:
• General waste should be dumped at municipal dumping site.
• Sanitation officer should be responsible for proper coordination
between municipal and hospital.
OUT HOUSE MANAGEMENT
Role of Common Facilitator:
*To collect Bio Medical Waste from Individual Hospital every
day.
47. Treatment & Disposal Technologies
1. Chemical Disinfection
2. Wet and dry thermal treatment
3. Microwave irradiation
4. Incineration
5. Land disposal
6. Inertization
7. Newer methods
48. i) Chemical disinfection
• Chemicals are added to waste to kill or inactivate the
pathogen it contains.
Disinfection prior to disposal is required for the
following categories of waste-:
1. Sharp waste
2. Disposable infectious plastics
3. Infectious glassware
4. Blood and body fluids
49. HYPOCHLORITE — Most economical and effective
disinfectant.
• Sodium Hypochlorite available as 4% solution
• Floor washing etc should be pre-treated onsite using 1 - 2% Sodium
Hypochlorite
• Available as Sodium hypochlorite sol. and calcium
hypochlorite sol.
• Should be allowed to act for 30 mins.
• Changed frequently: atleast once a day.
• There will be no chemical pre-treatment before incineration.
• PVC shall not be incinerated.
52. STANDARDS FOR AUTOCLAVING OF BIO-
MEDICAL WASTE (Pre-treatment..at source)
Chemical indicator strip….is to
be used with each batch of
waste and note change in color
as an indication of temperature
and pressure achieved.
Frequency: To use more than
one strip with every batch and
bag,record the same.
Spore testing at least once in
every week
PROCEDURE : The autoclave should
be dedicated for the purposes of
disinfecting and treating bio-medical
waste.
When operating a gravity flow
autoclave, medical waste shall be
subjected to: A temperature of not
less than 121° C and pressure of 15
pounds per square inch (psi) for an
autoclave residence time of at least 20
minutes.
54. Screw feed technology:
• It is a Dry thermal treatment in which waste is shredded and heated
in rotating auger.
• There is a decrease in 80% by volume and 20-35% by weight.
Hydroclaving
- Newer method
• Indirect heating without any direct contact with the waste. Steam is
introduced into the outer jacket while the waste is kept inside
another chamber .
55. Turned mechanically with the help of a series of large
rotating rods which spin continuously, rupturing the
waste bags & ensuring complete exposure to heat.
Moisture content in the waste turns to steam & builds
pressure inside the vessel which sterilizes the waste:
80-85% reduction in volume &
65-70% reduction in weight.
Waste is shredded followed by recycling or disposed by
secured land filling .
57. iii)Microwave irradiation
• Treatment of most infectious wastes except body parts and
large metal cytotoxic wastes.
• Microwaves of frequency 2450MHz and wave length
12.24nm is used to destroy the microorganisms.
Water contained in the waste is rapidly heated by
microwave and infectious components are destroyed by
heat conduction.
Hazardous wastes cannot be treated by microwaving.
59. Innovation in microwaving techniques:
Sanitec Microwave
• Waste is processed at relatively low (95-100°C) temperatures. There
are no chemicals used in any part of the process, and there are no
liquid discharges of any kind.
Ecosteryl ( two stage microwave decontamination)
• Waste is first reduced in a shredder into particles smaller than 20mm.
These are brought to temperatures close to 100°C for one hour so as to
destroy all micro-organisms.
• The end result is an unrecognisable decontaminated pulp which can
join the household waste chain.
60. iv) Incineration:
• It is a High temperature dry oxidation process that reduces organic and combustible waste
into inorganic and incombustible matter, resulting in significant reduction in waste volume
and weight.
• waste that
*cannot be recycled , reused or can be disposed in land.
* have a low heating value, and containing -
combustible matter above 60%.
non-combustible solids below 5%.
non-combustible fines below 20%.
moisture content below 30%.
65. WASTES NOT TO BE INCINERATED
• Pressurized gas containers.
• Reactive chemical wastes.
• Silver salts and photographic and radiographic wastes.
• Halogenated plastics such as polyvinyl chloride (PVC).
• Waste with high mercury or cadmium content, such as broken thermometers,
used batteries, and lead-lined wooden panels. Sealed ampoules or ampoules
containing heavy metals.
• Red bags must not be incinerated as red colour contains cadmium which
causes toxic emissions.
66. Advantages
• Good disinfection efficiency.
• Drastic reduction of waste volume and weight.
• No requirement for highly qualified operators.
• Relatively low investment and operation costs.
Disadvantages
• Generation of significant emissions containing atmospheric pollutants ,
including gases and ash;
• May produce odours (which can be limited by not incinerating
halogenated plastics).
• Periodic removal of slag and soot necessary.
68. v)Land Disposal:
-Open Dumps:
risk for public health
-Sanitary landfills:
designed and constructed to prevent contamination
of soil,surface,ground water and direct contact
with public.
69. Sanitary Landfills
They have atleast four advantages over open dumps
1. Geological isolation of waste from the environment.
2. Appropriate engineering preparations before the site is
ready to accept wastes.
3. Staff present on site to control operations.
4. Organized deposit and daily coverage of waste.
70. • Deep burial site should be relatively
impermeable and distant from
habitats.
• There should be no well, lake, river
etc. close to the site to avoid
contamination of surface water or
ground water.
DEEP BURIAL PIT for BMW
71. Encapsulation
• It is a method involving filling container with waste, adding immobilizing
material and sealing the containers, to prevent the access to unscrupulous
activities.
• The process uses cubic boxes made up of metallic drum which are three
quarters filled with sharps or chemicals or pharmaceutical waste and then
filled with a medium such as plastic foam, cement mortar or clay materials
72. vi) Inertization
• Process of mixing waste with cement and other substances before disposal in
order to minimize the risk of toxic substance migrating into surface water or
ground water and to prevent scavenging.
• The proportion of the materials used in inertization are as follows
65% pharmaceutical waste
15% lime
15% cement
5% water
73. vii) Newer methods
Plasma pyrolysis
• Utilises rapid heating – 5000 deg Celsius that can be achieved in
milliseconds.
• It consumes small quantity of gas.
• generation of heat is independent of chemistry of material used.
• The high ultraviolet radiation flux destroys pathogens and waste to be
treated.
• Advantage : No segregation of waste is needed.
75. Sharps Blaster
Sharps Blaster consists of a computerised sterilisation unit and disposable, four litre
metal canisters for sharps or clinical waste. The unit treats the waste canister for up
to two and a half hours at temperatures reaching 185°C, sterilising the infectious
waste and sealing the canister for safe disposal.
Bio-Oxidizer Model #100
The principle of operation is the electro-pyrolysis of organics followed by two
phases of electro-oxidation. The Bio-Oxidizer® system electrically heats the organic
solids and liquids, turning them into vapor, and then oxidizes the vapors in two
oxidizers. The remaining residue, which is typically less than 5% of the original
weight and volume, is sterile, inert, and may be discarded as municipal waste in most
instances or possibly recycled .
76. Ecolotec
• The patented Ecolotec system consists basically of a jacketed
pressure/vacuum vessel into which infectious waste is loaded.
• The vessel is fitted with internal knife hammers which rotate at up to
3500 revolutions per minute to break up and shred the waste while
live steam is being injected to raise the temperature to about 132°C.
• The violent knife action brings every waste particle in immediate
contact with the steam atmosphere and eliminates cold spots, while
drastically shortening the time needed for reliable sterilization.
78. • Handle waste as per norms
• Arrange safe storage of waste
• Follow onsite pre-treatment of infective waste
• Replace chlorinated plastic bags,gloves and bood bags
with non chlorinated
• Dispose of solid waste separate from bio medical waste
other than bio-medical waste in accordance.
DUTIES OF OCCUPIER-
Healthcare facility
79. DUTIES OF OCCUPIER-
Healthcare facility
• Handle waste as per norms
• Arrange safe storage of waste
• Follow onsite pre-treatment of infective waste
• Replace chlorinated plastic bags,gloves and bood bags with non chlorinated
• Dispose of solid waste separate from bio medical waste other than bio-
medical waste in accordance.
80. • Provide training to all its health care workers at the time of induction and
thereafter atleast once every year and the details of training programmes
conducted, number of personneltrained and number of personnel not
undergone any training shall be provided in the Annual Report
• Immunise all its health care workers against Hepatitis B and Tetanus as per
protocol
• Establish a Bar- Code System for bags or containers containing bio-medical
waste
• Ensure segregation of liquid chemical waste at source and ensure pre-
treatment or neutralisation
81. • Provide PPE to healthcare workers
• Report major accidents
• Make available the annual report on its web-site
• Inform the prescribed authority immediately if waste is not picked or retained for more
than 48 hrs
• Establish a committee to review and meet once in every six months and the record of the
minutes of the meetings of this committee and incorporate in annual report
• Maintain all records for a period of 05 yrs
• Conduct health check up at the time of induction and at least once in a year for all its health
care workers
• Maintain daily register and upload monthly records on website