This document discusses bio-medical waste management. It defines bio-medical waste and outlines the dangers of improper management, which can lead to public health hazards and environmental pollution. It describes the sources and categories of healthcare waste and how waste should be treated and disposed of according to regulations. Methods of treatment discussed include incineration, chemical disinfection, thermal treatment, and land disposal. The document also provides information on bio-medical waste management in India, including generation amounts, treatment facilities, and an example of a common treatment facility called IMAGE in Kerala.

1. BIO MEDICAL
WASTE
MANAGEMENT
Dr.DEEPAK P
JR FAMILY MEDICINE

2. DEFENITION
• As per Bio-Medical Waste(Management and
Handling ) Rules 1998 of India
• “Bio-medical waste” means any waste which
is generated during the diagnosis, treatment
or immunisation of human beings or animals,
or in research activities thereto or in the
production or testing of biologicals, and
including categories as mentioned in table

3. • In addition, it includes the waste originating
from minor or scattered sources such as that
produced in the course of health care
undertaken in the home (dialysis, insulin
injections, etc.).

4. Dangers of improper Management of Bio-Medical
Waste
• Public health hazard-can cause a number of
disease.
• Children and rag pickers are particularly at risk.
• Inappropriate treatment & disposal-
environmental pollution .
• Uncontrolled incineration-air pollution.
• Dumping in drains, tanks ,along the river bed-
water pollution.
• Unscientific land filling-soil pollution.

5. Dangers of improper Management of Bio-
Medical Waste
• Mixed with general waste - whole of waste turn
to infectious waste.
• Sharps --needle stick injuries, cuts, and
infections.
• Needles and syringes which are not mutilated
or destroyed -circulated back through traders
and destitute.

6. Dangers of improper Management of
Bio-Medical Waste
• The dumping of untreated bio-medical waste -
epidemics & increased incidence of
communicable diseases.
• Vector population like cats, rats, mosquitoes,
flies and stray dogs increases.

7. SOURCES
• Govt & private hospitals
• Nursing home
• Physicians clinics
• Dentists clinics
• Dispensaries
• PHCs
• Medical research & training establishments
• Mortuaries
• Blood banks
• Labs etc

8. HEALTH CARE WASTE
GENERATION
• 80% general health care waste –dealt as
normal domestic & urban waste management
system
• 15%-pathological & infectious waste
• 3%-chemical & pharmacological waste
• 1%-sharps waste
• <1%-special waste radioactive ,cytotoxic
waste, broken thermometers, used batteries
etc

9. • WHO classified medical waste into eight
categories:
1. General waste
2. Pathological waste
3. Radioactive waste
4. Chemical waste
5. Infectious waste and potentially infectious waste
6. Sharps
7. Pharmaceutical waste
8. Pressurised containers

10. HEALTH HAZARDS OF HEALTH
CARE WASTE
Exposure to health care waste results in disease
or injury due to:
1. Contain infectious agents
2. Contain toxic or hazardous agents
3. Contain sharps
4. Is genotoxic
5. Is radioactive

11. Main group at risk include:
• Med doctors, nurses,
health care auxillaries &
hospital maintenance
personnel
• Patients in heath care
establishments
• Visitors to health care
establishments
• Workers in support service
allied to health care
• Workers in waste disposal

12. WHO (in 2000) estimated that, injections with
contaminated syringes caused:
• 21 million hepatitis B virus (HBV) infections
(32% of all new infections);
• Two million hepatitis C virus (HCV) infections
(40% of all new infections);
• 2,60 ,000 HIV infections (5% of all new
infections).

13. Epidemiological studies indicate that
• a person who experiences one needle-stick
injury from a needle used on an infected source
patient has risks of
30%, 1.8%, and 0.3% respectively to become
infected with HBV, HCV and HIV.

14. Approximately 3 million HCWs experience
percutaneous exposure to blood borne viruses
(BBVs) each year.
This results in an estimated 16,000 HCV, 66,000
HBV and 200-5000 HIV infections annually.
( Source: Needle stick injuries in a tertiary care hospital by S T
Jayanth et al , Indian Journal of Medical Microbiology, year 2009
, Vol. 27, Issue 1, page 44-47)

15. • WHO assessment (2002 ) conducted in 22
developing countries :- showed that
The proportion of healthcare facilities that do
not use proper waste disposal methods
ranges from 18% to 64%.
(WHO-Health-care waste management,To reduce the burden of disease,
health-care waste needs sound management, including alternatives to
incineration,Fact sheet N°281,October 2011 )

16. Regulations on Bio-medical Waste
Management
• Biomedical Waste (Handling and Management)
Rules—
• In 1998, by the MoEF
• Based on the principle of segregation of
communal waste from BMW, followed by
containment, treatment, and disposal of BMWs
in different categories.
• The rules were amended twice in 2000, primarily
to address administrative matters.

17. State Strategies and Activities Related
to Health Care Waste Management
• The responsibility was delegated to individual
states and territories, with
• State Pollution Control Boards (SPCBs) in states .
• Pollution Control Committees in territories
designated as the authorities.

18. Schedules..
• Schedule 1- category wise treatment and disposal
methodology .
• Schedule II-color coding &type of container for
disposal.
• Schedule III- Label for Bio-Medical Waste
Containers/ Bags.
• Schedule IV- Describes the type of waste where it is
generated and to where it is being transferred.
• Schedule V - Standards for incinerators, autoclave,
liquid waste, microwave and deep burial.
• Schedule VI- Schedule For Waste Treatment Facilities.

19. Forms
• Form I:-Application For Authorisation /Renewal Of
Authorisation
• Form II:-Annual report (To be submitted to the
prescribed authority by 31 January every year)
• Form III:- Accident Reporting
• Form IV:-Authorisation for operating a facility for
collection, reception, treatment, storage transport
and disposal of biomedical wastes.
• Form V:- Application for filing appeal against order
passed by the prescribed authority at district level or
regional office of the PCB acting as prescribed
authority or the State/Union Territory level authority

20. TREATMENT & DISPOSAL
TECHNOLOGIES
• Incineration
• Chemical disinfection
• Wet & dry thermal treatment
• Microwave irradiation
• Land disposal
• Inertization

21. INCINERATION
• High temp dry oxidation process
which reduces org & combustible
waste to inorganic incombustible
matter.
• Significant reduction in waste
volume and weight.
• Selected for wastes that cannot be recycled,
reused or disposed off

22. Characteristics of suitable waste:
1. Low heating volume-
• >2000kcal/kg – single chamber
• >3500kcal/kg –pyrolytic double chamber
2. Combustible matter > 60%
3. Non combustible solids < 5%
4. Non comustible fines <20 %
5. Moisture content <30%

23. Not to be incinerated:
1. Pressurised gas containers
2. Large amount of reactive chemical waste
3.Silver salts and photographic or radiographic
waste
4.Halogeated plastics such as PVC
5.High Hg or Cadmium containing-broken
thermometers, used batteries
6. Sealed ampules or ampules containing heavy
metals

24. TYPES OF INCINERATORS
a) Double chamber pyrolytic incinerators-to
burn infectious waste
b) Single chamber furnaces-used only if
pyrolytic incinerators are unaffordable
c) Rotary kilns operating at high temperature-
causes decomposition of genotoxic
substances & heat resistant chemicals

25. CHEMICAL DISINFECTION
• Disinfection rather than sterilisation
• Treating liquid waste-blood, urine, stools or
hospital sewage
• Solid waste with certain limitation

26. WET & DRY THERMAL TREATMENT
WET THERMAL TREATMENT/STEAM DISINFECTION:
• Exposure of waste to high temperature, high
pressure steam similar to autoclaving
• Inappropriate for anatomical waste, animal
carcass, chem & pharm waste

27. SCREW-FEED TECHNOLOGY:
• Non burn dry thermal
disinfection
• Heated in a rotating auger
• Waste volume reduced by
80% volume & 20-35 % wt
• Suitable for inf waste
and sharps
• Cannot be used for pathological
, cytotoxic or radioactive waste

28. MICROWAVE IRRADIATION
• Works at frequency of about 2450 MHz &
wave length of 12.24nm
• Water contained is rapidly heated & inf
content destroyed

29. LAND DISPOSAL
MUNICIPAL DISPOSAL SITES:
• If there is genuine lack of means to treat
waste before disposal
• Two types-
1. Open dumps
2. Sanitary land fills
• Health care wastes should not be disposed
on or around open dumps

30. SANITARY LAND FILLS:
ADVANTAGES:
• Geological isolation
• Appropriate engineering
preparations
• Staff present on site
to control operations
• Organised deposits
• Daily coverage of waste

31. INERTIZATION
• Mixing waste with cement & other substances
before disposal to minimise the risk of toxic
substance in the waste migrating into surface
waster or ground water

32. • Typical proportion is:
• 65 %- pharmaceutical waste
• 15 % - lime
• 15 % - cement
• 5 % - water
• Homogenous mass is produced on site and
cubes or pellets are transported to suitable
storage site

33. • The final choice of treatment should be made
on the basis of factors, many of which depend
on local conditions.

34. BIO-MEDICAL WASTE
MANAGEMENT IN INDIA
• Bio-Medical Waste (Management & handling)
Rule 1998, by Ministry Of Environment and
Forests, Govt of India came in force on 28th July
1998
• Rule applies to those who generate, collect,
receive, store, dispose, treat or handle
biomedical waste in any manner
• Waste should be segregated into containers or
bags at the point of generation of waste.

35. Schedule 1: Categories of Bio-Medical Waste
Waste
Category
Waste Category Type Treatment and
Disposal
Option+
Category No. 1 Human Anatomical Waste (body parts, organs,
human tissues etc.).
Incineration /
deep burial
Category No. 2 Animal Waste (animal tissues, organs, body
parts, carcasses, bleeding parts, fluid, blood
and experimental animals used in research,
waste generated by veterinary hospitals,
colleges, discharge from hospitals, animal
houses).
Incineration /
deep burial
Category No. 3 Microbiology & Biotechnology Waste (Wastes
from laboratory cultures, stocks or micro-
organisms live or vaccines, human and animal
cell culture used in research and infectious
agents from research and industrial
laboratories, wastes from production of
biologicals, toxins, dishes and devices used for
transfer of cultures).
Local
autoclaving/
micro waving /
incineration

36. Category No. 4 Waste Sharps (needles,
syringes, scalpels, blade,
glass, etc. that may cause
puncture and cuts. This
includes both used and
unused sharps).
Disinfection
(chemical treatment
/ autoclaving /
micro waving and
mutilation /
shredding
Category No. 5 Discarded Medicines and
Cytotoxic drugs (Waste
comprising of outdated,
contaminated and discarded
medicines).
Incineration /
destruction and
drugs disposal in
secured landfills
Category No. 6 Soiled Waste (items
contaminated with blood,
and body fluids including
cotton, dressings, soiled
plaster casts, lines, bedding,
other material contaminated
with blood).
Local autoclaving /
micro waving /
incineration
Category No. 7 Solid Waste (Waste
generated from disposal
items other than the sharps
such a tubings, catheters,
intravenous sets etc.).
Disinfection by chemical
treatment /autoclaving /
micro waving and
mutilation/
shredding

37. Category No. 8 Liquid Waste (Waste
generated from
laboratory and
washing, cleaning,
housekeeping and
disinfecting activities).
Disinfection by
chemical treatment
and discharge
into drains
Category No. 9 Incineration Ash (Ash
from incineration of
any bio-medical
waste).
Disposal in
municipal landfill
CategoryNo.10 Chemical Waste
(Chemicals used in
production of
biologicals, chemicals
used in disinfection, as
insecticides, etc.).
Disinfection by
chemical treatment
and discharge into
drains for
liquids and secured
land fill for solids

41. BIOMEDICAL WASTE MANAGEMENT BY IMAGE
• Indian Medical Association Kerala State Branch
established a Common Biomedical Waste
Treatment and Disposal Facility at Palakkad.
• Established on 14thDecember 2003.

42. IMAGE..
• The affiliation fee is Rs. 1000/- per bed.
• The minimum affiliation fee for clinics,
laboratory, and diagnosis centre, dental clinics
with two chairs -Rs. 5000/-
• Government hospitals have been exempted
from paying affiliation fee.

43. IMAGE…
• Charge of BMW management:-
Govt. hospitals  Rs.2.75/bed/day
Private hospitals Rs.3.50/bed/day
• IMAGE serves in all the 14 districts of the state.
• More than 2500 health care establishments are
affiliated to IMAGE.
• Total bed strength of about 65000.

44. IMAGE…
• IMAGE handles more than half of the biomedical
waste generated in Kerala.
• IMAGE consists of a common treatment and
disposal facility.
• The treatment facilities consist of 3 incinerators,
2 autoclaves, 1 shredder, sharp pits, facility for
storage of incineration ash, waste water
treatment plant, etc.

45. IMAGE…
• KEIL (Kerala Environmental Infrastructure
Limited) ,Ernakulum :- collects and transports
all incineration ash and waste water treatment
plant sludge from IMAGE.
• This model is unique to Kerala and has
propelled the state ahead of other states.

46. Services by the IMAGE
• Training the staff of the institutions for scientific
segregation of biomedical waste.
• Provision to make available colour coded bags
and containers with emblem.
• Daily collection of segregated and contained
biomedical waste from institutions.

47. Services(IMAGE)
• Safe disposal of the biomedical waste in the
plant as per the rules.
• To make available monthly statement regarding
the quantity of biomedical waste collected and
disposed on behalf of the institutions.
• Facilitate to obtain Authorization from the State
Pollution Control Board.

48. India
• Generation of waste: 0.33 million tons/year
• 1 to 2 kg of waste / bed/day

49. India
• In South region, 35 Common Biomedical
Waste Treatment Facilities (CBWTF) mainly by
private agencies
• Andhra Pradesh -14 nos
• Tamilnadu -11 nos
• Karnataka -9 nos
• Kerala -1no.

50. Kerala
• {Source-Central Pollution Control Board:-Annual Report
Information on Bio-medical Waste Management for the year
2010 (as submitted by SPCBs)}
• Kerala has the highest number (about 27%) of
health care institutions in India.
• Total no. of HCF-3168
• Total bed strength of hospitals in Kerala-1,13,530
• 43,273 are in the Government sector
• 2,740 in the co-operative sector and
• 67,517 in the private sector.

51. Kerala
• No of CBWTF-1
• No of HCF utilising CBWTF-1175
• No of HCF having treatment and disposal
facilities- 352
• No. of HCF applied for Authorisation-1384
• No. of HCF granted authorisation-694

52. Kerala..
• Total Quantity of BMW generated (kg/day) (Approx)-
34679
• Total Quantity of BMW treated (kg/day) (Approx)-30565
• Waste water generated 450L/bed/days
• No. of Healthcare Facilities violated BMW Rules-644
• Total No. of Show cause notices/Directions issued to
defaulter HCFs-281

53. Medical College Hospital, Kozhikode
• Only one incinerator in MCH
• One incinerator in MCH –not working
• IMCH- all infectious waste are taken by IMAGE
• IMAGE charges Rs.4.50/bed/day
• No other waste treatment facility.
MCH
• All waste including human anatomical waste,
plastics including packing materials, tubings etc
are incinerated.
• No proper segregation of waste.

54. MCH
• Pollution control devices are fitted to the
incinerator-but damaged &poorly maintained.
• Incinerator releasing black fumes directly to
operation theaters.
• Needles, broken ampoules etc. are buried in
pit.
• Personal protective measures are inadequate.

55. THANK YOU