Biomedical waste or hospital waste is any kind of waste containing infectious (or potentially infectious) materials.[1] It may also include waste associated with the generation of biomedical waste that visually appears to be of medical or laboratory origin (e.g. packaging, unused bandages, infusion kits etc.), as well research laboratory waste containing biomolecules or organisms that are mainly restricted from environmental release. As detailed below, discarded sharps are considered biomedical waste whether they are contaminated or not, due to the possibility of being contaminated with blood and their propensity to cause injury when not properly contained and disposed. Biomedical waste is a type of biowaste. Biomedical waste may be solid or liquid. Examples of infectious waste include discarded blood, sharps, unwanted microbiological cultures and stocks, identifiable body parts (including those as a result of amputation), other human or animal tissue, used bandages and dressings, discarded gloves, other medical supplies that may have been in contact with blood and body fluids, and laboratory waste that exhibits the characteristics described above. Waste sharps include potentially contaminated used (and unused discarded) needles, scalpels, lancets and other devices capable of penetrating skin. Biomedical waste is generated from biological and medical sources and activities, such as the diagnosis, prevention, or treatment of diseases. Common generators (or producers) of biomedical waste include hospitals, health clinics, nursing homes, emergency medical services, medical research laboratories, offices of physicians, dentists, veterinarians, home health care and morgues or funeral homes. In healthcare facilities (i.e. hospitals, clinics, doctor's offices, veterinary hospitals and clinical laboratories), waste with these characteristics may alternatively be called medical or clinical waste. Biomedical waste is distinct from normal trash or general waste, and differs from other types of hazardous waste, such as chemical, radioactive, universal or industrial waste. Medical facilities generate waste hazardous chemicals and radioactive materials. While such wastes are normally not infectious, they require proper disposal. Some wastes are considered multihazardous, such as tissue samples preserved in formalin.

1. Biomedical Waste and Hospital Wastewater Management during
Covid-19
By
Kamal Pandey
DEPARTMENT OF CIVIL ENGINEERING
NATIONAL INSTITUTE OF TECHNOLOGY KURUKSHETRA

2. Introduction
⚫ Biomedical waste can be defined as the waste (solid or liquid) produced by hospitals, clinics, nursing homes and other health
care units that are potential sources of health hazards and hence these are needed to be treated, managed specially and disposed
of.
⚫ Biomedical waste management has recently turned out as an issue of significant concern not only to hospitals, nursing home
authorities but also to the environmental and law enforcement agencies, media and the general public in India.
⚫ Biomedical waste forms approximately 1-2% of the total municipal solid waste (MSW) stream, although not all hospital wastes
are vulnerable to transmit diseases. Out of 1-2% hospital waste approx. 80-85 % are non-infectious and 10% are infectious and
5% are hazardous.
⚫ Although solid waste management has become one of the major topics of importance, local bodies have failed to develop proper
focus towards some particular sources of waste out of which biomedical waste is one
⚫ Biomedical waste is generated not just during the treatment of the disease but even in the attempts to prevent it. India began
administration of COVID-19 vaccines on January 16, 2021, and as of Dec 21, has administered 1.46 Billion doses.
⚫ While this is good news, it is also concerning as every jab generates a waste syringe, and every 10 or 20 vaccinations, depending
on the vaccine type, generate one waste glass vial. All these are biomedical wastes.

4. LIQUID WASTE
*STANDARDS FOR LIQUID WASTE:
The effluent generated from the hospital should conform to the following limits :
PARAMETERS PERMISSIBLE LIMITS
• pH 6.5-9.0
• Suspended solids 100 mg/l
• BOD 30 mg/l
• COD 250 mg/l
• Bio-assay test 90% survival of fish after 96
hours in 100% effluent

5. Covid-19 PPE disposal
PPE ITEM
• Surgical Masks
• N95 Respirators
• Examination
Gloves
• Surgical Gloves
• Isolation Gowns
• Surgical Gowns
• Heavy duty
Aprons*
*Heavy duty aprons
might be reusable
after disinfection.
COLLECTED IN DISPOSAL
Incineration or Plasma
Pyrolysis or deep burial*
*Disposal by deep burial is
permitted only in rural or remote
areas where there is no access to
CBMWT facility

6. PPE ITEMS
Protective Goggles*
Face shield
*Goggles might be
reusable after
disinfection.
COLLECTED IN DISPOSAL
Autoclaving or
microwaving/
Hydroclaving Followed
by shredding

7. OBJECTIVES OF THE STUDY
● Characterization of liquid waste from the common biomedical waste management treatment and disposal facility.
● To find out shortcomings and gaps in the system.
● To optimize BMW management and adopt stop-gap solutions during COVID-19. And will give the idea of increment
in the waste generation in the pandemic period.
● COVID-19 will increase the consumption of personal care and single-use products, especially in countries with
overwhelmed or few healthcare facilities. The study will suggest how to safely dispose of the used medical equipment.
● The basic aim is to protect the public and the environment from potentially infectious diseases caused due to lack of
management of medical waste.
● To find out the types of wastes produced by the hospital and how much it is affecting the living animals i.e. humans or
animals.

8. NEED OF THE STUDY
● India is ranked 120 among 165 nations with respect to sustainable development and critically suffers from insufficient
waste treatment provisions and amenities. And the abrupt occurrence of the COVID-19 virus has aggravated the issue of
managing medical waste in India, manifolds. As a result, the safe disposal of a huge volume of hazardous medical waste
has become a top priority.
● This conceptual study evaluates India's management of medical waste during the COVID-19 pandemic. Additionally,
this article aims to highlight the inadequacies in India's implementation of the BMW 2016 standards by a synthesis of
multiple agency reports (government and non-government) and data obtained directly from the Central Pollution Control
Board (CPCB).
● The findings indicate that India is well behind in terms of COVID-19 waste management and requires comprehensive
monitoring and implementation systems to enable the achievement of SDGs related to environmental health.
● Amidst the coronavirus disease 2019 (COVID-19) pandemic, the scenario might worsen, as evidenced by some initial
experiences, with piles of personal protective equipment (PPE) accumulating in the hospitals. Despite the guidelines by
the World Health Organization and Ministry of Health and Family Welfare, GoI regarding the rational use of PPE for
COVID-19, health care settings are experiencing high demand for PPE from all strata of health care workers owing to
the fear of infection.

9. Bio-Medical Waste Management Rules 2016 (amd.
2018)
• Bio-medical waste has been classified into 4 categories instead of 10 categories
• Phase-out the use of chlorinated plastic bags, gloves and blood bags within two years (by 2019)
• Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags
• Provide training to all its health care workers and immunize all health workers regularly.
• Establish a Bar-Code System for bags or containers containing bio-medical waste for disposal
• Report major accidents like needle stick injuries, broken mercury thermometer, accidents caused by
fire, blasts during handling of bio-medical waste and the remedial action taken.
• Stringent standards for incinerator to reduce the emission of pollutants in environment
• No hospital/ healthcare facility shall establish on-site treatment and disposal facility, if a service of
CBMWTF is available at 75Km. Operator of a CBMWTF to ensure the timely collection of bio-medical
waste and assist the healthcare facility in conducting training.

10. COVID-19 Waste Management Scenario
in India
Hon’ble Tribunal acknowledged the guideline issued by CPCB for management of COVID-19 waste, heard details
of actions initiated by CPCB, and passed the Order dated 24.04.2020, with action points given below:
(i) Need for further revision of the guidelines to cover all aspects including individual households and for dealing
with situations where scientific disposal facilities like incinerators are not available or not adequate.
(ii) Need to develop an electronic /digital manifest system to track and log COVID-19 waste from all sources.
(iii) Creating awareness about precautions to be taken by all COVID19 waste handlers, including healthcare
workers, workers involved in the disposal of waste, and the citizens.
(iv) Create a model plan for COVID-19 waste management at Village/Panchayat Level.
(v) Chief Secretary of States/UTs by coordinating the activities of State’s concerned departments like Urban
Development, Health, Irrigation & Public Health to closely monitor the scientific storage, transport, handling,
management and disposal of COVID-19 waste.
(vi) At the national level, a high-level task team of the Ministry of MoEF&CC, Health UD, Jal Shakti, Defense and
CPCB to supervise the handling and scientific disposal of COVID-19 waste by the guidelines.
vii)Ensure compliance to Biomedical Waste Management Rules, 2016 by State Environment Department and
State Pollution Control Boards/Pollution Control Committees.

12. Literature review
● Anurag v. Tiwari and Prashant A. Kadub et al(December 2013) in this paper he has described various methods
of Biomedical waste management in various countries and how in India population is the main role in the increase
of biomedical waste , out of total waste 1-1.5% waste is biomedical waste and how this waste creates a serious
problem in society.
● Praveen Mathur, Sangeeta Patan et al(2017) in this paper they discuss mainly on handling and transportation
and disposal of biomedical waste and the role of hospitals in managing to do in a better way by just separating
things at initial level. Praveen mathur, Sangeeta Patel and Anand S. Shobhawa has discussed in this paper about
how biomedical waste causes serious health issues in the society and why disposal of waste should be done in a
better way.
● Pandit NB et al(2009) cross sectional study was conducted in a Pramukhswami medical college Gujarat in
involving 30 hospital with more than 30 beds were be randomly selected from Sabarkantha District the doctors and
auxiliary staff of those 30 hospitals were the study population the result showed that Doctor’s were aware of risk of
HIV and Hepatitis B and C where as Auxiliary staff (ward boys, Ayabens, sweepers) had very poor knowledge.

13. ● Usha Prabakar and Neelam Makhija et al(2008) conducted a study to assess the knowledge on Biomedical waste
management among 30 nursing personnel in Delhi. The study finding revealed that 66% will be having knowledge on
Biomedical waste generation 77.7% will be having knowledge on Biomedical waste category and segregation 92.22%
will be having knowledge regarding Biomedical waste transportation 70% had knowledge on needle disposal 70% had
knowledge on universal precaution.
● Escaf M. Shurteff et al (2007) suggested a program for reducing Bio medical waste. The Wellesley hospital. That a
programme included redefining bio medical waste reviewing waste practices throughout the hospital educating staff &
Monitoring outcome. Resulted in bio medical waste within month. Saving realized will be approximately 67,000. This
program is easily reproducible.
● Rsheed S et al (2005 ) conducted a cross sectional study of 8 teaching hospitals to evaluate the current practices of
sectional study of 8 teaching hospitals to evaluate the current practices of segregation approaches, storage arrangement
collection and disposal system in the teaching hospital of Karachi using a Questionnaire method and checklist. The
study reported that sharp, pathological waste, chemical infectious waste pharmaceuticals and pressurized containers,
25% provided protection years, 12.5% arranged training section 62.5% hospital disposed of their hazard waste by
nursing incinerator. 25% disposed of by municipal landfill. 12.5% will burn waste in open air without any specific
treatment.
● Bellour A et al 2003. Conducted a case study to assess waste management and recycling practices of the urban poor.
The findings of the study showed that the urban poor and low income communities have environmentally friendly solid
waste management. The study suggests that policies should be formulated to focus on promoting knowledge, education
and the skills of the urban poor. Pandit.

14. ● Gupta S. Boojh et al(2008) conducted a study in Babrampus hospital Lucknow .The study was conducted in
Lucknow at the infectious and non infectious waste are dumped together with in the hospital premises resulting
in a mixing of the two which are then disposed of with municipal waste at the dumping sites in the city. All
types of waste are collected in common bins placed outside the patients wards for disposal of this waste; the
hospital depends on the generosity of the Lucknow municipal corporation. Whose employees generally collect
it every 2 or 3 days. The hospital does not have any Treatment facility for infectious waste.
● Natraj. G. Baveja. S. et al (2003) this study will be conducted to assess the level of practices. 100 samples
will be taken. The results revealed a statistically significant improvement in waste suggestion practices
occurred in all areas. Thus a large hospital with a medical college can identify students or a similar group for
monitoring waste of biomedical waste management.
● Oanchaivijit etal (2005) this study will be conducted to identify the problem in management of medical waste
in Thailand. The sample size is 39. hospitals Questionnaire method will be used. This study Result shows
improper management of medical waste will present in all hospitals. Risk exposure and indication of infection
selected to the management will be at concerned level.

15. ● The apprehension often results in the misuse of PPE on many occasions, aggravating the problem by generating vast
quantities of BMWs that are difficult to store and transport with limited resources and workforce available at the time
of crisis.
● Added to the menace is the indiscriminate use and disposal of single-use surgical masks (at times N95 respirators)
even in the community. Their disposal is often being carried on along with the noninfectious kitchen/general waste
from the household and residential areas where color-coded BMW bins are difficult to be found.

16. Treatment Process for Hospital Wastewater
Conventional sewage treatment has preliminary, primary and secondary treatment processes, while some treatment plants also consist
of tertiary treatment. Other than screening and grit chamber, all sewage treatment units can destroy viruses including SARS-Cov,
although no unit can completely remove any viruses in wastewater. For controlling the transmission of COVID-19, treatment of
wastewater containing virus is important for hospitals. Following are the various COVID specific treatment procedures to destroy the
virus from wastewater.
1. Ultraviolet radiation
The wavelength of 260 nm is usually the most effective for ultraviolet disinfection. Its is cost effective when compare to chlorine
treatment. Presence of oxidising agents react with intractable chemicals in sewage. Advanced oxidation techniques, such as ultrasonic
processes, Fenton photocatalysis, ozone coupled hydrogen peroxide, have been successfully used to treat wastewater.
1. Chlorine based disinfectants
The use of disinfectants that release free chlorine, such as hypochlorous acid and hypochlorite ion, is the most effective way to treat
viral infection. Although concentrated sodium hypochlorite is the preferred anti - mycobacterial treatment, hypochlorite, a potent
oxidising agent, is effective at oxidising organic pollutants. According to research, bleach is effective against viruses; yet, viruses are
much more resistive to chlorinated disinfection than bacteria, which may be because viruses lack a metabolic enzyme system. Chlorine
is frequently added to the effluent after primary and secondary sewage treatment at rates of 30-55 mg/l and 15-30 mg/l, respectively.

17. 3. Ozone
Although ozone treatment has shown effectiveness in disinfecting SARS-CoV and is effective against viruses, there are no reports of
ozone treatment for wastewater against covid. Viruses have more ozone tolerance mechanisms than bacteria. Ozone is a strong
disinfectant that can enhance the biological water quality more quickly and with greater effectiveness.
4. Hydrogen peroxide
When bio treatment is not possible or when pretreatment of wastewater is necessary, hydrogen peroxide is utilized as a source of
oxygen in the water. It is also used to predigest wastewaters that include various amounts of dangerous compounds. The liquid
disinfectant may also be preferable due to its simplicity of use and quick start-up, although hydrogen peroxide is insufficient for the
full-scale treatment of wastewater.

18. Conclusion
The need of the hour is for the healthcare system's BMW to be managed safely and sustainably while adhering to
present legal requirements. As a result, by managing BMW sustainably, the incinerator is essential for preserving
both human lives and the environment. For the straightforward processing of Y-BMW, which makes up a sizable
fraction of the entire BMW, incineration is an appropriate alternative for disposal. Many biotech firms and
healthcare organizations lack the equipment and knowledge required to appropriately sort waste before burning. All
medical establishments must have on-site biological waste incineration units. The government must take action to
fight the risks of open disposal and improper dumping of hazardous biomedical waste through regular monitoring
and aggressive regulatory bodies. Strict laws, procedures, and regulations must be implemented in order to penalize
and control the threat of unsafe BMW disposal in public areas. BMW source segregation based on color-coded
disposal must be supported by regular awareness, education, and training programmes.It must make sure that
biological waste is handled appropriately during this infectious pandemic since it can harm the environment and
seriously endanger the health of medical staff, patients, and the general public. The entire BMW management
system needs to be properly streamlined in order to effectively combat the corona epidemic, and disposal practices
need to be optimized in a sustainable way in order to protect human health and promote a clean, green environment.

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21. THANK YOU