This document discusses bio-medical waste management. It defines bio-medical waste and lists typical waste compositions from healthcare facilities. It categorizes waste as infectious, pathological, pharmaceuticals, chemicals, sharps and radioactive. It discusses the objectives, practices and strategies for safe waste management including collection, segregation, transportation, storage, treatment and disposal methods like incineration, autoclaving, chemical disinfection and sanitary landfilling. The Bio-Medical Waste Management Rules 2016 in India are also summarized.

1. BIO-MEDICAL WASTE
MANAGEMENT
Dr. Arkadeb Kar

2. Any waste, which is generated during the diagnosis, treatment or
immunization of human beings or animals or research activities
pertaining thereto or in the production or testing of biological or in
health camps.

3. Typical waste compositions in health-care facilities

4. Sources of bio-medical waste
• Hospitals
• Nursing homes
• Laboratories
• Clinics
• Slaughter houses
• Mortuaries
• Research institutes
• Blood banks
• Immunization centres

6. Categories of bio-medical waste
• Infectious waste - Waste suspected to contain pathogens and that poses a
risk of disease transmission.
 waste contaminated with blood and other body fluids;
 laboratory cultures and microbiological stocks;
 waste from infected patients in isolation wards.
• Pathological waste - Human tissues, organs or fluids; body parts; fetuses;
unused blood products.

7. Categories of bio-medical waste
• Pharmaceuticals waste - that are expired or no longer needed; items contaminated
by or containing pharmaceuticals.
• Cytotoxic waste –
contaminated materials from drug preparation and administration, such as syringes,
needles, gauzes, vials, packaging.
outdated drugs, excess (leftover) solutions, drugs returned from the wards
urine, feces and vomit from patients, which may contain potentially hazardous
amounts of the administered cytostatic drugs or of their metabolites, and which
should be considered genotoxic for at least 48 hours and sometimes up to 1 week after
drug administration.

8. • Chemicals - Chemical waste from health care is considered to be hazardous if it
has at least one of the following properties
toxic (harmful)
corrosive (e.g. acids of pH <2 and bases of pH >12)
flammable
reactive (explosive, water reactive, shock sensitive)
oxidizing.

9. • Sharps - hypodermic, intravenous or other needles; syringes with attached
needles; infusion sets; scalpels etc.
• Radioactive waste.

10. Types of hazards
1. Infection – can enter through punctures, abrasions, mucous membrane,
inhalation or ingestion.
Potential infections caused by exposure to health-care wastes & causative organisms
Gastro-intestinal Salmonella, Shigella spp., Vibrio cholerae, Clostridium difficile, helminths
Respiratory
infections
Mycobacterium tuberculosis, measles virus, Streptococcus pneumoniae,
severe acute respiratory syndrome (SARS)
Acquired
immunodeficiency
syndrome (AIDS)
Human immunodeficiency virus (HIV)
Viral hepatitis B and
C
Hepatitis B and C virus
Genital infections Neisseria gonorrhoea, herpes virus
Ocular infection Herpesvirus

11. 2. Chemical toxicity –
many of the chemicals used are hazardous e.g. toxic, corrosive, explosive,
flammable or chemically reactive.
Cause intoxication, either by acute or chronic exposure, or physical injuries –
the most common being chemical burns.
Intoxication can result from absorption of a chemical or pharmaceutical
through the skin or the mucous membranes, or from inhalation or ingestion.
 Injuries to the skin, the eyes or the mucous membranes of the airways can
occur by contact with flammable, corrosive or reactive chemicals (e.g.
formaldehyde and other volatile substances)

12. 3. Cytotoxicity –
 Many cytotoxic drugs are extreme irritants and have harmful local effects after direct
contact with skin or eye .
also cause dizziness, nausea, headache or dermatitis.
Severity of the toxicity depends on the substance toxicity and the duration of
exposure .
4. Radioactivity hazards
Exposure to radioactive waste may cause headache, dizziness, vomiting, genotoxicity
and tissue damage.

13. 5. Physical injuries:
may result from sharps, chemicals and explosive agents
6. Public sensitivity :
the visual impact of anatomical waste, recognizable body parts including
foetuses.

14. OBJECTIVES OF THE WASTE MANAGEMENT SYSTEM
• To reduce the infectious/hazardous nature of the waste
• To reduce the volume of the waste
• To prevent misuse or abuse of the waste
• To ensure occupational safety and health
• To reuse the items that can be of repeat utility
• To recycle the waste so that it can serve as another utility item.

15. SAFE WASTE MANAGEMENT PRACTICES
• It helps to –
• To maintain order and cleanliness in the hospital
• To maintain a healthy environment for patients, staff and public
• To prevent spread of infectious diseases
• To project good impression of the management.

16. STRATEGIES ADOPTED FOR HOSPITAL WASTE
MANAGEMENT
1. Waste reduction strategy
2. Waste assessment strategy
3. Waste recycling strategy
4. Hospital waste disposal –
Collection of wastes
Source segregation
Transportation
Storage
Treatment

17. Categories of bio-medical waste

18. Collection of waste
• The wastes should be collected and stored in a thick, noncorrosive,
disposable plastic bags kept in a hard plastic container of suitable size
covered with a lid.
• All containers having specified colored plastic bags should be located at the
point of waste generation.
• The containers need to be cleaned with hot water frequently.
• Containers for recyclable wastes should be kept away from those for
infectious wastes, to avoid mixing.

19. Source segregation
• The hospital wastes of different categories are best segregated at source by
personnel who generate the waste.
• Mistakes done in segregation can result in serious health risks as some
infectious wastes may be taken for recycling.
• Plastic bags should be allowed to fill to a maximum of three quarters of
their capacity.
• Wastes which need pre-treatment should be removed from the generation
site only after treatment.

20. Transportation
• There should be a designated waste route
• Separate time for transportation of bio-medical waste
• Designated wheeled carts or containers should be used
• Equipment used for transport should be frequently cleaned using
disinfectants.

21. Storage
• No untreated bio-medical waste shall be kept untreated for more than
48 hours
• If it is stored for more than 48 hours, the authorized person should
inform higher authority.
• The authorized person should take measures that it does not affect
human health and environment.

22. Treatment & disposal
• The objectives of treatment are –
Decontamination of the waste to render it non-infectious
Reduction of bulk volume by incineration.
To give the waste an aesthetic look, e.g. for body parts, etc.
To destroy reusable infected materials like needles and blades.

23. Selection of treatment methods depends on -
Waste characteristics
Quantity of waste for treatment and disposal
Infrastructure and availability of equipment
Environmental and safety factors
Public acceptability
Cost consideration

24. Incineration
• Waste that cannot be recycled, reused or disposed off in a landfill site.
• Burning the waste in a simple kiln or incinerator to a very high temperature
of about 1000°C.
• Volume reduction of 85-95 percent.
• Reduction of organic and combustible solid waste to inorganic,
incombustible matter
• The ash may be collected in thick puncture proof bags and stored for
periodic dumping into community landfill

25. • There are basically three types of incinerators:
I. Double chamber pyrolytic incinerators
II. Single chamber furnaces
III. Rotary kilns

26. Double chamber pyrolytic
incinerators
Single chamber furnaces Rotary kilns
This is designed to burn the
infectious health care waste, at
temperatures between 800 to
900°C
Infectious waste (including
sharps), pathological waste and
general health care waste (similar
to domestic refuse)
The temperature is 300 to 400°C.
Used to burn the chemical waste
such as infectious waste (including
sharps) and pathological waste at
1200 to 1600°C
Gasses produced in the primary
chamber are then burnt in the
second, post-combustion chamber
at 900-1200°C
Emissions are volatile organic
chemicals and acid gases such as
sulphur dioxide, hydrogen chloride
and hydrogen fluoride, black
smoke, carbon monoxide, nitrogen
oxide, etc.
Gases produced in the kiln are
heated to high temperatures to burn
off gaseous organic compounds in
the post-combustion chamber and
have a residence time of 2 seconds.
Very high disinfection property
Drastic reduction in weight and
volume.
Low cost.
Adequate for all infectious waste
Incomplete destruction of
cytotoxic wastes .
Emission of atmospheric
pollutants.
Need to remove slag and soot.
High investment and operating cost

27. Chemical Disinfection
• Chemical disinfectants such as bleaching powder, glutaraldehyde, alcohols or
quaternary ammonium compounds are used.
• Most suitable for treating liquid waste such as blood, urine, stools or hospital
sewage.
• Solid wastes such as sharps and microbiological cultures may also be disinfected.
• Highly efficient, inexpensive
• Hazardous – requires safety measures.

28. Wet thermal treatment (Autoclaving)
• Wastes are exposed to steam at a particular temperature (121 ℃ - 149℃) and
pressure (15 – 51psi) over a specified period of time ( 30 – 60 minute).
• There is no change in the volume or appearance of the waste.
• A shredder or grinder can used after treatment
• Odours can be a problem around autoclaves
• Regular validation tests using biological indicators ( Bacillus stearothermophilus
spore) should be performed at periodic intervals.
• Low investment and operating costs.
• Requires qualified technicians

29. Dry thermal treatment
The waste is heated in a rotating auger
Reduced 80% in volume and 20 – 35% in weight
Suited for treating infectious wastes and sharps
Should not be used for pathological, cytotoxic and radioactive waste

30. Microwave irradiation
• Microorganisms are destroyed by microwave of 2450 MHz and 12.24 nm.
• Cultures, sharps, materials contaminated with blood and body fluids,
isolation and surgery waste, laboratory waste (excluding chemical waste)
and soft waste from patient care can be treated by microwave.
• Good disinfection efficiency
• Reduction in waste volume
• Costly.

31. Sanitary landfill:
for non-biodegradable waste.
Simple and cost - effective.
It has an impermeable base
All waste bags are completely pushed into it.
Daily covered with earth and hay.
Should have a leachate collection system.
Inertization:
Minimizes the risk of toxic substances getting mixed with surface water or ground water.
65% waste + 15% lime + 15% cement + 5%water.

32. Bio-medical Waste Management Rules 2016
• Prescribed by ministry of environment and forest, came into force on 28th July 1998 –
revised in 2011.
• Biomedical waste management rule 2016 came into force from 28th March 2016.
• Failure to comply with the provisions of the Rules - will attract penal action which
includes imprisonment for a period of 5 years or a fine of Rs.1 lakh or both.
• Bio-Medical Waste rules 2016 doesn’t apply to –
radioactive wastes, hazardous chemicals, municipal solid wastes, lead acid batteries,
e-wastes, hazardous micro organisms, genetically engineered micro organisms and cells

33. Salient features
Bio-medical waste divided in four categories rather than 10.
Every health care facility generating BMW should get authorisation including vaccination
camps, blood donation camps, surgical camps or any other healthcare activity
A format for annual report has been prepared.
Phase-out the use of chlorinated plastic bags, gloves and blood bags
Establish a Bar-Code System for bags or containers containing bio-medical waste for disposal.
No healthcare facility shall setup onsite BMW treatment facilities if a CBMWTF exists within 75
kms.
Disposal by deep burial is permitted only in rural or remote areas where there is no access to
common bio-medical waste treatment facility.