Bio medical waste management

1. BIO-MEDICAL
WASTE
MANAGEMENT

2. DEFINITION :
• “ Bio-medical waste” means any waste which is generated during the diagnosis, treatment
or immunization of human beings or animals or in research activities pertaining there to or in
the production or testing of bio medicals.
• Any unwanted residual material which cannot be discharged directly, or after suitable
treatment can be discharged in the atmosphere or to a receiving water source, or used for
landfill is waste.
NEED FOR BMW MANAGEMENT:
• If BMW is not segregated at source & allowed to be mixed with MSW, it may cause
dreadful and infectious diseases like HIV, hepatitis B & C, tuberculosis and other skin and
respiratory ailments.

3. SOURCES OF HEALTH CARE WASTE
 GOVERNMENT/PRIVATE HOSPITALS
 NURSING HOMES
 PHYSICIAN/DENTIST OFFICE OR CLINIC
 DISPENSARIES
 PRIMARY HEALTH CARE CENTERS
 MEDICAL RESEARCH AND TRAINING CENTERS
 ANIMAL./SLAUGHTER HOUSES
 LABS/RESEARCH ORGANIZATIONS
 VACCINATING CENTERS
 BIO TECH INSTITUTIONS/PRODUCTION UNITS

4. WHAT CAUSES DUE TO BIO-MEDICAL WASTES
PREMISES HAZARDOUS?
1. Waste chemical-medications, solutions, or
2. Infectious microbes,
3. Chemicals such as formaldehyde, waste anesthetic gases, etc.,
4. Used disposables, wasted equipments and chemotherapeutic agents,
5. Laser smoke and aerosolized medications

5. MAGNITUDE OF THE PROBLEM
 GLOBALLY- DEVELOPED COUNTRIES GENERATE 1 TO 5 KG/BED/DAY
 DEVELOPING COUNTRIES: MEAGER DATA, BUT FIGURES ARE LOWER.
• 1-2KG/PT./DAY
 WHO REPORT: 85% NON HAZARDOUS WASTE
• : 10% INFECTIVE WASTE
• : 5% NON-INFECTIOUS BUT HAZARDOUS.
• (CHEMICAL, PHARMACEUTICAL AND RADIOACTIVE)
 INDIA:-NO NATIONAL LEVEL STUDY
- LOCAL OR REGIONAL LEVEL STUDY SHOWS HOSPITALS
• GENERATE ROUGHLY 1-2 KG/BED/DAY

6. CLASSIFICATION OF HEALTH CARE WASTE
INFECTIOUS WASTE
 LAB CULTURES
 WASTE FROM ISOLATION WARDS
 TISSUES(SWABS)
 MATERIALS/EQUIPMENTS OF INFECTED PATIENTS
PATHOLOGICAL WASTE
 Excreta
 Human tissues/fluids
 Body parts
 Blood or body fluids

7. SHARP WASTE
 Needles
 Infusion Sets
 Scalpels
 Knives Blades
 Broken Glass
PHARMACEUTICAL WASTE
 Expired Pharmaceuticals
 Contaminated Pharmaceuticals
 Banned Pharmaceuticals

8. GENOTOXIC WASTE
 Waste Containing Cytotoxic Drugs(often Used In Cancer Theraphy)
 Genotoxic Chemicals
CHEMICAL WASTE
 Lab reagents
 Film developer
 Expired disinfectants
 Expired solvents
WASTE WITH HIGH CONTENT OF HEAVY_METALS
 Waste with high content of heavy metals
 Batteries
 Broken thermometers
 Blood pressure guages etc

9. PRESSURIZED CONTAINERS
 Gas cylinders
 Gas catridges
 Aerosol cans
RADIOACTIVE WASTE
 Radiotherapy/lab research liquids
 Contaminated glass wares, packages,
absorbent papers

10. HOSPITAL WASTE DISPOSAL
 Hospital waste management is a part of
hospital hygiene and maintenance activities.
In fact only 15% of hospital waste i.e.
"Biomedical waste" is hazardous, not the
complete.
 But when hazardous waste is not segregated
at the source of generation and mixed with
nonhazardous waste, then 100% waste
becomes hazardous

11. WHO’S AT RISK ?
• Doctors and nurses
• Patients
• Hospital support staff
• Waste collection and disposal staff
• General public and the Environment

12. HEALTH HAZARDS
Risk of HIV &
HBV
Nosociomial
infections
Others..

13. Inhalation of
dust
particles
containing
germs
Intact or
non intact
skin,
mucous
membranes
By ingestion
(contaminated
unwashed hands,
contaminated food
stuffs, water etc)
ROUTES OF TRANSMISSION

14. WHY BIO MEDICAL WASTE REGULATED ?
WASTE MANAGEMENT SUDDENLY HAS BECOME BIGGEST CONCERN
 To minimize the potential for spread of disease from a medical settings to the
general public;
 To reduce the overall amount of infectious medical waste produced.
 Infectious agents may become toys of terrorists,
 As bioweapons of mass destruction

15. PROSPECTIVE BIO WEAPONS
BIOLOGICAL AGENTS
 ANTHRAX
 SMALLPOX
 BOTULISM
 PLAGUE
 TULAREMIA
 HEMORRHAGIC FEVERS
 Q Fever
 Glanders
 Cholera
 E.Coli O157:H7
 Chemical Agents
 Nerve Agents
 Vesicants or Blister Agents

16. BASIC CONCEPTS OF HOSPITAL WASTE MANAGEMENT
• Never mix infectious bio waste into the municipal wastes ( The entire waste lot shall become
infectious)
• Segregation and safe containment(packing) of waste at health facility level.
• Process and storage for terminal disposal.

17. HOSPITAL WASTES ARE DANGEROUS AND REQUIRE
MORE CAREFUL ATTENTION
•These are heterogeneous waste, both solid &
liquid, primarily from health care facilities.
•The available techno-economic options for
the disposal are largely determined by
nature of activity of HCF and volume of the
various waste components

18. State Pollution
control Board
Grant
authorization in
FormIII
Occupier or
Operator shall make
an application in
FormII
KEYFEATURESOFBIOMEDICALWASTE

19. KEY TO PROPER BIO - MEDICAL WASTE
MANAGEMENT IS THE SEGREGATION
1. Out rightly send domestic effluents to the municipal sewers.
2. Isolate & collect the infectious liquid wastes(streams 2 & 3), disinfect completely and
then send to municipal sewers.
3. Pack the segregated solid waste according to prescribed mode.
4. The BMW shall be treated using standard methods such as incineration, autoclaving,
micro- waving, and chemical & mechanical techniques and the treated waste residue
shall be finally disposed off in a secured landfill.

20. PROCESSFLOWOFBMW GENERATIONANDDISPSOAL
Generation
by HCF
Segregation
as per the
colourcode
On sit safe
Storagefacility
Collectionby
CBMWTF
Transportation
by CBMWTF
Treatment
& Disposal at
common facility

21. COLOUR CODING AND TYPE OF CONTAINERS FOR
DIFFERENT BIO MEDICAL WASTES
Colour coding Type of container Waste category Treatment/ Disposal
Yellow P l a s t i c Bags 1,2,3,6 Incineration/ deep
burial
Red Disinfected
Container / Plastic
Bags
3,6,7 Autoclaving,
microwaving and
chemical treatment
Blue whit (translucent) P lastic Bags
/Puncture
4 & 7 Autoclaving,
microwaving
Black Proof
Containers
5,9,10 Chemical treatment
destruction/ shredding

22. WHAT GOES INYELLOWBAG
 Humananatomical wastes
 Bodyparts / tissuesetc
 Cotton dressings,plaster castsGauze
pieces
 Antibiotics andother drugs
 Microbiology waste
 Culturedevices,stocks or specimenof
microorganisms
 Discarded linens, mattresses, dressings soiled with blood
or body fluids, routine masksandgown.

23. WHATGOESINRED BAG
 Disposable contaminated waste which can be recyclable
–will be disposed by autoclaving treatment followed by
shredding
 Tubing,bottles,
 Intravenous tubes and sets,catheters,
and fixed
urine bags,
 Syringes (without needles
needle syringes) and
 Vaccutainers with their needles cut
andgloves.

24. WHATGOES IN BLUEBAG
Glassware– broken,Contaminated glass
Medicine Vials,ampoulesetc.,

25. WHATGOESIN WHITEPUNCTUREPROOFCONTAINEROR
LEAKPROOFCONTRAINER
 White (Translucent) – Waste sharps including metals –
packedinpuncture proof containers
 Needles,syringeswithfixedneedles
 Scalpels,Blades,lancet
causing
 Sutureneedle,aluminumfoil
 Anycontaminatedsharpobject puncture/
cuts

26. DIFFERENT BIO MEDICAL WASTE TREATMENT
TECHNOLOGIES
• Bio medical liquid wastes disinfection by sodium hypochlorite.
• Bio medical liquid wastes treatment by an effluent treatment plant
• Sharp encapsulation : sharp pit
• Waste sharp & syringe destruction
• Autoclave and Hydro clave test
• Bio medical wastes destruction by double chambered incinerator
• Incinerator ash disposal
• Deep burial pit for Bio Medical Waste
• D - standard for deep burial
• Plasma pyrolysis

27. STORAGE OF BMW
 Immediate treatment and disposal are ideal procedures to be followed for disposal of bio medical
waste.
 Untreated bio medical waste however, can be stored for not more than 48 hrs.
 If for some reason it becomes necessary to store the waste beyond such period, permission from the
local state authority must be taken and it must be ensured that it does not adversely affect human
health and the environment.

29. EMISSION STANDARDS FOR INCINERATION
Standards & Requirements for Incineration
 Minimum height of the stack should be 30 meters above the ground.
 Above emission limits should be achieved.
 Waste to be incinerated not to be disinfected with chlorine substance.
 Chlorinated plastics should not be incineratedToxic metals in incineration ash should be limited
to within regulatory quantities.
 Only low sulphur fuels like LDO/LSHS to be used as fuel.
Parameters Conc (mg/N m3 at 12% CO2
correction )
Particulate matter 150
Nitrogen oxides 450
HCL 50

30. Chemical Disinfection
 High level disinfectants like chlorine releasing compounds are used for
disinfecting materials contaminated with blood and blood products. The
recommended dilutions for these compounds are given as follows:
Name ofDisinfectant Available
chlorine
Required
chlorine
Required
chlorine
Contactperiod
Amount of
disinfectant to be
dissolved in 1ltrof
water
Sodium hypochlorite 5% 0.5% 30 min 100 ml
Calcium hypochlorite 70% 0.5% 30 min 7.0 g
NaOCl powder - 0.5% 30 min 8.5 g
Chloramine 25% 0.5% 30 min 20 g

33. MICROWAVE IRRADIATION
• The microwave is based on the principle of generation of high frequency waves.
• These waves cause the particles within the waste material to vibrate, generating heat.
• This heat generated from within kills allpa thogens.
Plasma Pyrolysis
• It is a state-of-the-art technology for safe disposal of medical waste.
• It is an environment-friendly technology, which converts organic waste into commercially
useful byproducts.
• The intense heat generated by the plasma enables it to dispose all types of waste
including municipal solid waste, biomedical waste and hazardous waste in a safe and
reliable manner.
• Medical waste is pyrolysed into CO, H2, and hydrocarbons when it comes in contact
with the plasma-arc.
• These gases are burned and produce a high temperature (around 1200oC).

34. Transportation of BMW
 Properly designed carts, trolleys and other wheeled containers should be used for the
transportation of waste inside the facilities both within the health facility and from the
facility to the final disposal location.
 Wheeled containers should be so designed that they have no sharp edges.
 Waste handlers must be provided with uniform, apron, boots, gloves and masks, and
these should be worn when transporting the waste.

36. COMPARISON OF TREATMENT TECHNOLOGIES

37. IMPROPER BIOMEDICAL WASTE DISPOSAL POSES RISK
• Walk past any GVMC garbage dump at ramnagar, maharanipeta or the areas around
king george hospital (KGH) and you can be sure to spot used syringes, saline bottles or
bandages strewn around dustbins.
• Rag-pickers and GVMC staff rummage through these bins and stray animals litter the
hazardous bio medical waste on the roads an open invitation to HIV, hepatitis and other
infections.
• Though biomedical waste should be properly segregated and then incinerated in a
separate plant at kappulupada on the city’s outskirts, in reality the norms are often
flouted blatantly and hazardous waste is dumped in regular garbage bins, jeopardising
the health of denizens.
Source: https://timesofindia.indiatimes.com/city/visakhapatnam/Improper-biomedical-waste-
disposal-poses-risk/articleshow/46590493.cms

38. BIO-MEDICAL WASTE: NGT ISSUES NOTICE TO FOUR
STATES
• The National Green Tribunal on wednesday issued notices to uttar pradesh,
uttarakhand, haryana and punjab governments over improper disposal and burning of
bio-medical waste in the states.
• Putting an immediate ban on the burning of bio-medical waste, the green tribunal
directed the four states to file their replies within one week. The case will now come up
for hearing in the first week of december.
• The green panel headed by Justice Swatanter Kumar also said action would be taken
against officials of the district concerned, in case bio-medical is found being burnt,
thrown in the open or sold to scrap dealers.
The four states will also have to provide information about hospitals inspected for
violation of the bio-medical waste management rules, 2016.
Source: https://economictimes.indiatimes.com/news/environment/pollution/bio-medical-waste-
ngt-issues-notice-to-four-states/articleshow/61668299.cms

39. BIOMEDICAL WASTE MANAGEMENT - ISSUES
 Lack of interest from senior management
 No ownership of the process
 Awareness of problems
 Appreciate the need for constant monitoring
 Segregation of waste not taken seriously at user level
 Non compliance with colour coding
 Monitoring segregation at source
 Low budgets allocated
 Cost of colour coding, staff, transport and disposal is a major determent
 Qualification of waste generated is not accurately done
 Protection of health care workers not given adequate thought
 Clinical waste dumped with non infectious waste

40. Personal hygiene
Elementary personal hygiene is important for reducing risks of
infections and breaking the infection chain when medical waste
are being handled. Ideally, wash basins with hot water and soap
should be installed wherever wastes are handled (storage and
treatment
areas).
Washing one’s hands meticulously with a sufficient
amount of water and soap eliminates over 90 % of
the micro-organisms present.
Surgical mask
 Protects against aerosols exhaled by the wearer
 Effectiveness rated for exhalation
FFP1, FFP2 or FFP3 respirator
 Protects the wearer against the risk of inhaling particles (dust)
Source: International Committee of the Red Cross

41. When should one wash one’s hands?
• when going on and off duty;
• after any contact with wastes;
• after removing gloves;
• after removing a mask or respirator;
• before/after certain routine actions (eating, using the toilet, blowing one’s
nose);
How should one wash one’s hands? (Norm NF
EN 1500)
• wet the hands and wrists;
• apply a dose of liquid soap;
• lather the soap by rubbing the hands, paying particular attention to the parts
between the fingers and around the nails and to the thumbs (40-60 seconds);
• rinse;
• dab dry;
• do not use a brush (which promotes the penetration of micro-organisms).

42. CASE STUDY OF BIO-MEDICAL WASTE OF A
RURAL HOSPITAL IN CHHATTISGARH
• The survey of a medical hospital with 550 beds, 42 wards and 20 opds, attached to a
medical college was carried
• The data collected is tabulated as follows: (all units are in kg/day)
TABLE 1: SEGREGATION OF BIO-MEDICAL WASTE OF GROUND FLOOR

43. TABLE 2 : Segregation of bio-medical waste of ground floor
TABLE 3: Segregation of bio-medical waste of ground floor

44. TABLE 4: Segregation of bio-medical waste of first floor
TABLE 5: segregation of bio-medical waste of second floor

45. TABLE 6: Incineration ash generated
TABLE 7: Incineration ash generated
Source: Motilal Nehru National Institute of Technology Allahabad

46. • Average ash generation is normally between 4-5% of the weight of the waste; as against that we
have the ash generation as 13% which is on higher side.
• For Preliminary Planning for waste management estimation is done on following
• 80%- General health care waste.
• 15%-Pathological & infectious waste.
• 1%-sharp waste.
• 3%-Chemical & Pharmacological waste.
• 1%-special waste (Cardio active, cytotoxic, Pressurized container)
TABLE 8 :Actual waste generated at the hospital
Sr.
No.
Typeof waste Actual waste from study
in %
Wastein
Kg
1. General 77.48 687
2. Pathological & Infectious 12.06 107
3. Sharp 2.02 18
4. Chemical pharmacological 5.63 50
5. Special Waste 2.81 25
Total 100 887

47. DISPOSAL SYSTEM PRACTICED BY THE RURAL
MEDICAL HOSPITAL
• The waste from color-coded containers is transported to the appropriate disposal points.
• No Infectious waste is stored beyond 24 hours.
• Properly designed carts, trolleys and other wheeled containers are used for the transportation
of waste inside the facilities.
• Treatment of sharps is done, i.e. by treating with 1% hypochlorite solution or any
other equivalent chemical reagent. Shredder is used for disposal of sharp content.
• “Incinex incinerator” (Double chamber pyrolytic incinerator established in 1981) with capacity
of 35 Kg/hr is used by rural health care institution.
• Fuel: LDO(Diesel) is used whose consumption is around 25 to 27 liters per day.
• Sanitary Land Filling is done at their own land fill site.

48. A CASE STUDY OF BHOPAL CITY
• The survey of a 245 medical hospital with 7913 beds was carried
• The data collected is tabulated as follows: (all units are in kg/month)
Source: Nature Environment and Pollution Technology, An International Quarterly Scientific Journal

50. SCENARIO OF BIO-MEDICAL WASTE
GENERATED IN BHOPAL CITY
The finding of the present case study are as follows.
Number of hospitals: Out of total approximately 245 hospitals in Bhopal city, 32
hospitals are governed by the State Govt., 4 by Central Govt., while the rest 209 are
private hospitals.
Number of beds: Capacity under State Govt. is 2559 beds, whereas in Central
Govt. there are 580 beds, and in private hospitals the number is 4804 beds .
Waste generated: Bio-medical waste generated in kg/month in various categories
in State Govt. hospitals is 7937, in Central Govt. hospitals it is 556, and in private
hospitals it is 12224.
Waste per bed per month: According to Table 2, bio-medical waste generated per
bed per month in State Govt. hospitals is calculated as 3.101, in Central Govt. as
0.958, and in private hospitals as 2.544 kg/bed/month.

51. DISCUSSION
Safe and effective management of waste is not only a legal necessity but also a social
responsibility. Lack of concern, motivation, awareness and cost factors are some of the
problems faced in the proper hospital waste management. Proper surveys of waste
management procedures are needed. Clearly, there is a need for education as to the hazards
associated with improper waste disposal. Lack of apathy to the concept of waste management
is a major stymie to the practice of waste disposal. An effective communication strategy is
imperative.

52. SUGGESTIONS FORADVANCEMENT
• In case of failure of current instruments and infrastructure of waste disposal, the
hospital must have alternate plan for safe transportation of infectious waste to
disposal.
• Instead of Incineration, it is suggested to use “Plasma Pyrolysis” which is
new & widely used economical and environment friendly method.
• Plasma Pyrolysis is smoke free technology for safe disposal of chlorinated waste.
• It is so compact that it can be installed in a small premises.
• Neither chimney nor foul odour removal system is required in it.
• Also, it has no dependency on air & moisture unlike incineration process because
it uses plasma torch for heating.

53. CONCLUSION
• It is just not the law abide compliance but the SOCIAL RESPONSIBILITY of
every
 Health Care Establishment to say…
 NO TO HAZARD OF BIOMEDICAL WASTE
• Thus refuse disposal cannot be solved without public education.
• Individual participation is required.
• Municipality and government should pay importance to disposal of waste
economically.
• Thus educating and motivating oneself first is important and then preach others
about it.
• PPE does not replace proper procedures and techniques, consider all as hazard.