1. Dr. SUMI NANDWANI
Associate Professor, Microbiology,
E.S.I.C.-PGIMSR& Hospital, Basaidarapur, New Delhi

2. Points 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, Appeal, Reporting of
Accidents
 BMW Mx Committee
 Take Home Message

3. What is Biomedical Waste
Bio-medical waste is defined as waste that is
generated during the diagnosis, treatment or
immunization of human beings and are
contaminated with patients’ body fluids (such
as syringes, needles, ampoules ,organs and
body parts, placenta, dressings, disposables
plastics and microbiological wastes).

4. NEED 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 waste Health hazard
Human / Animal HIV,HBV,HCV, Hgic fevers, cholera,
waste/ Soiled salmonellosis, shigellosis, rabies,
waste leptospirosis, anthrax,TB,
pneumonia, septicemia
Sharps HIV, HBV, HCV, Injuries
Cytotoxic/ Cancer, genetic mutation, birth
radioactive waste defect
Chemical waste Poisonings, dermatitis, conjunctivitis,
bronchitis

5. Extent of the problem
Most countries of the world, especially the developing nations, are facing the grim
situation arising out of environmental pollution due to pathological waste
In India :three million tonnes of medical wastes generated every year and the
amount is expected to grow at eight per cent annually.
 4.2 lakh kg of biomedical waste is generated on a daily basis,( CPCB April2011)
 Only 157 facilities to treat the same.
 84,809 hospitals and healthcare facilities in India
 only 48,183 are using either common biomedical waste treatment facilities or
have commissioned private parties to take care of the same.
Quantum of BMW Generation & Treatment in Delhi- DPCC:
 No. of Health Care Establishments in Delhi : About 1900 , 10.125 Tons
BMW/day (based on the annual report for the year 2010).
There are 10 Incinerators (including 3 CBWTFs), 21 autoclaves(including
3CBWTFs) and 3 microwaves operating in Delhi.

6. Present practice within
Hospitals
• Around 50% of the hospitals in the country are
dumping the BMW with Municipal garbage
• Waste is not segregated at the site
• 15000 hospitals have been served notice for acting
as defaulters of these rules.
• No proper treatment options
• No regulated disposal sites

7. Present practices within
hospitals
1- Mostly dumped in the open space
- Rag pickers can collect
contaminated syringes, cotton,
plastics, etc.
2- Burnt at dumpsites in an open
environment
- Incomplete
- Small quantities of many organic
and chlorinated organic compounds
as well as pathogens survives -
dispersal of dangerous diseases.
3- Landfills - Designed poorly and can
pollute ground-water.

8. BIOMEDICAL WASTE(MANAGEMENT & HANDLING)
RULES by Govt. of India , 1998
Amended on 2000
• Authoritative order to all the hospitals
to stop the indiscriminate disposal of
waste and ensure that it is treated in
such a manner that it does not hamper
the environment and human health.
• All the BMW to be segregated at the
point of generation

9. Application
 These rules apply to all persons who generate,
collect, receive, store, transport, treat, dispose,
or handle bio-medical waste in any form
 includes a hospital, nursing home, clinic,
dispensary, veterinary institutions, and
animal house, pathological laboratory,
blood bank e.t.c.

10. Duty of Occupier
 It shall be the duty of every occupier 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.

11. . Segregation, Packing,
 a. Bio-medical waste shall
not be mixed with other
wastes
 b. 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.

12. Health waste
Characterization
Hospital waste
Hazardous waste
Non Hazardous
(≈ 10-25%)
(≈ 75-90%)
Others
Infectious (sharps, radioactive,
Cytotoxic )

13. CATEGORIES OF BIO-MEDICAL WASTE
S.N WASTE WASTE TYPE TREATMENT
CATEGORY & DISPOSAL
1 Category No.1 Human Anatomical waste (human tissues, Incineration/deep
organs, body parts burial
2 Category No.2 Animal Waste: Animal tissues, organs, body Incineration/deep
parts carcasses, bleeding parts, fluid, blood burial
and experimental animals used in research,
waste generated by veterinary hospitals,
colleges, discharge from hospitals, animal
houses
3 Category No.3 Microbiology & Biotechnology Wastes: Autoclave/
Wastes from laboratory cultures, stocks of Microwave/
specimens of micro-organisms live or Incineration
attenuated vaccines etc.
4 Category No.4 Waste Sharps (needles, syringes, scalpels Disinfection
,blades, glass etc.) that may cause (chemical
puncture and cuts. treatment/autoclavE/
microwavE and
mutilation/shredding

14. S.N WASTE WASTE TYPE TREATMENT
CATEGORY AND DISPOSAL
5 Category No.5 Discarded Medicines and Cytotoxic Incineration/destruction
drugs Wastes comprising of outdated, and drugs disposal in
contaminated and discarded medicines secured landfills
6 Category No.6 Soiled Waste (Items contaminated with Incineration
blood, and body fluids including cotton, autoclaving/
dressings, soiled plaster casts, linens, microwaving
beddings, other material contaminated
with blood)
7 Category No.7 Solid Waste (waste generated from Disinfection by chemical
disposable items other than the waste treatment/autoclaving/
(sharps) such as tubing's, catheters, Microwaving &
intravenous sets etc. mutilation/shredding
8 Category No.8 Liquid Waste generated from laboratory Disinfection by chemical
and washing, cleaning, house keeping and treatment and
disinfecting activities discharge into drains

15. S.N WASTE WASTE TYPE TREATMENT AND
CATEGORY DISPOSAL
9 Category No.9 Incineration Ash: Ash from Disposal in municipal landfill
incineration of any bio-medical
waste
10 Category No.10 Chemical Waste Chemical treatment and
Chemicals used in production of discharge
biologicals, chemicals used in into drains for liquids and
disinfection as insecticides etc. secured landfill for solids
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.
4. Deep burial shall be an option available only in towns with population less than
five lakhs and in rural area.

16. COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL
OF BIOMEDICAL
WASTE
Color Type of Waste Treatment
Coding Container Category options as per
Schedule I
Yellow Plastic bag Cat.1, 2,3,6 Incineration/deep burial
Red Disinfected Cat 3,6,7 Autoclave/Microwave/
container/Plastic Chemical Treatment
bag
Blue/White Puncture proof Cat.4,7 Autoclave/Microwave/
translucent container Chemical Treatment &
destruction/shredding
Black Plastic bag Cat 5,9,10 Disposal in secured
landfill

17. Proper labeling of bins
 The bins and bags should carry
the biohazard symbol indicating
the nature of waste to the
patients and public.
 Schedule III (Rule 6) of Bio-
medical Waste (Management and
Handling) Rules, 1998 specifies
the Label for Bio-Medical Waste
Containers / Bags as:
 Label shall be non-washable and
prominently visible

19. WASTE DISPOSAL
PAPER
WRAPPERS
KITCHEN WASTE/FOOD BLACK BIN

20.  General waste
 Paper, plastics
 Wrappers
 Cardboards
 Outer packaging
 Kitchen waste
 Unsoiled plaster cast

21. WASTE DISPOSAL Pathology waste
soiled linen,
contaminated
W ABS gowns,
S
drapes
Swab stick-
centa ical
decontaminated
wast n anatom
e-pla
a
Hum
Dressing
Bandages
YELLOW BIN

22.  Human/Animal tissue organs or body parts
 Animal carcasses
 Any non plastic soiled waste( contaminated with
blood/ body fluids )
 Cotton dressings, bandages
 Linen beddings
 Soiled plaster casts, Soiled paper
 Used/ removed sutures

23. WASTE DISPOSAL
All infectious, non
sharp plastic waste Urine bag
Plastic culture
plates & tubes
I/V sets
Drains RED BIN

24. Infectious Plastic and rubber waste such as
 Gloves
 i. v tubings and I. V sets
 Catheters
 Urine bags, Blood bags
 Syringes
 Suction tips
 Infected plastic containers
 Rubber base materials
 Retraction cords

25. DISPOSAL OF SHARPS
Destroy
needle
Cut syringe
tip
Decontaminate in twin
bucket having 1% bleach
SHARPS including
catheter guide wires

26.  Sharp edged or pointed metallic sharps
 Needles
 Scalpel blades
 Suture needle
 Intracath
 LP needle
 Bone screws ( sharps), Arch bars, Burs
 Lancets
 Glass sharps such as broken ampoules,injection vials
 Glass slides, coverslip
 Injection vials
 Broken test tubes/ Broken pippettes

27. Segregated incinerable wastes kept in Yellow
bag

28. Segregated Autoclavable waste in
Blue/ red bag

29. General wastes of health care unit in Black
bag

30. Sharps in sharp container

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

32. Storage
 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

33. Transport
 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
and open, Chutes:

34. Transportation and Storage
 c. 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.

35. Treatment and Disposal
 a. Bio-medical waste shall be treated and
disposal of in accordance with Schedule 1, and in
compliance with the standards prescribed in
Schedule V
 b. Every occupier, where required, shall set up
requisite bio-medical waste treatment facilities
like incinerator, autoclave, microwave system for
the treatment of waste, or, ensure requisite
treatment of waste at a common waste
treatment facility or any other waste treatment
facility.

36. Incineration
 Burning of waste material
in the presence of
oxygen.
 Waste volume reduction,
destroying some harmful
constituents.
 Works at temperature (~
400–700°C).
Drawback
toxic products like furanes and dioxins - can cause air pollution

37. Non-incineration methods
1 - THERMAL PROCESSES
A - Low-Heat Thermal Processes (93°C-177°C) Wet heat
(steam) disinfection - autoclave ,Dry heat (hot air) disinfection
- infrared heaters.
B - Medium-Heat Thermal Processes (177°C-370°C)
Chemical breakdown of organic material. Reverse
polymerization using high-intensity microwave
C - High-Heat Thermal Processes (540°C-8,300°C) or
higher Electrical resistance, induction, natural gas, and/or
plasma energy provide the intense heat ,total destruction of
the waste Significant change in the mass and volume

38. Non-incineration methods
2 - 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.
3 - IRRADIATIVE PROCESSES
 Electron beams,Cobalt-60, or UV irradiation.

40. Common waste treatment facility( CWTF)
Operators auth. by Delhi Pollution Cont. Commit.
 Biotic Waste Solutions Pvt. Ltd.,
46, SSI Industrial Area, G.T. Karnal Road, Delhi 33
Phone (O) : 011 -47528106, 47528107
 Metro Bio Care Technological Services (P). Ltd.,
55, Railway Road, Samaipur Industrial Area, Delhi-42
Phone No. 27898011, 27898033, 278661422.
 Synergy Waste Management (P) Ltd.,
Near Compost Plant, Okhla Tank
Mathura Road New Delhi - 110020,
Phone No. 26933371, 26933372

41. Waste Generation
survey
•Return outdated
Waste Segregation
drugs/ chemicals
•Recycling/ reuse
Waste Storage
Waste transport
Waste
Waste treatment Cycle
Waste disposal
Municipal ,sanitary lan
drain in sewer

42. Authorization
 Every occupier of an institution
generating, handling BM W should make
an application in Form 1 to the prescribed
authority for grant of authorization.
 Every operator of a bio-medical waste
facility shall make an application in Form 1
to the prescribed authority for grant of
authorization.

43. Annual 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.

44. Maintenance 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. When any accidents the authorized person
shall report the accident in Form III to the
prescribed authority forth with

45. Dos and Don’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

47. BMW 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

48. Responsibility of WMO
 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

49. Responsibility of WMO (Contd…..)
 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 CPWD Deptt. (Civil &
Electrical)
 Send monthly & annual report to DPCC

50. • Check Segregation • Check segregation
• Monitoring disinfection of waste • Check labeling
on site • Weigh the waste
• Availability of basic items for • Monitor final disposal of the
BMWM waste
• Monitoring compliance of usage • Ensure the working of
of facilities by HCW incinerator
• Monitor level of awareness • Provide monthly data of
• Prepare waste audit waste generated by both
• Liason between HOD’s, CNO’s Hospitals
& WMO
Feedback to WMO
Assist in training programme

51. BMW 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!)

52. Hand 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
 Compliance

53. Steps to Effective
Handwashing
Use soap & warm
water. Scrub 10-15 Rinse well with fingers
seconds pointed downward.
After drying hands,
turn off water using a
paper towel. Discard towel in trash.

54. It is TIME to ACT, to
prevent an epidemic waiting
to happen.
 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.

55. Conclusion
 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.

56. THANK YOU
 Presented By
Dr Sumi Nandwani
MD,DNB, PGCHM,MNAMS
Associate Professor
Department of Microbiology