This document provides information on biomedical waste (BMW) management in India. It defines BMW and outlines the types and proper treatment/disposal methods. Some key points include: - BMW consists of potentially infectious waste generated at healthcare facilities that must be properly managed to protect workers and the public. - Approximately 4.2 lakh kg of BMW is generated in India daily but only a portion is treated properly. Improper handling and disposal poses health risks. - The Biomedical Waste Management Rules of 1998 provide guidelines for segregating, storing, transporting, and treating BMW according to the waste category to prevent health and environmental risks.

1. ABHILEKH
Worked on Biomedical Waste Training and Awareness
Campaign
Contact:-
saytoabhi@hotmail.com

2.  Overview : Definition
 Extent of Problem , Need, Present practices
 BMW Management Rules, application, duty of
occupier
 Segregation, categories of BMW
 Transport & storage
 Treatment & Disposal
 Take Home Message

3.  BioMedical Waste, (BMW), consists of solids,
liquids, sharps, and laboratory waste that are
potentially infectious or dangerous and are
considered bio-waste. It must be properly managed
to protect the general public, specifically healthcare
and sanitation workers who are regularly exposed
to biomedical waste as an occupational hazard. In
hospitals, medical waste, otherwise known
as clinical waste, normally refers to waste products
that cannot be considered general waste, produced
from healthcare premises, such as hospitals,
clinics, veterinary hospitals and labs.

4. Hospital waste
Hazardous Non-hazardous
Noninfectious Infectious
Kitchen Recyclables
Non-sharps
Patient contaminated
waste
Anatomical
Equipment
Specimens
Laboratory
waste
Non-plastics
Sharps: needles, scalpel
blades, scalp veins, glass
contaminated with blood
Radioactive
Cytotoxic drugs
Toxic Chemicals
Plastics
PVC, PE PET, PS contaminated cotton
waste, gauze, linen

5. The data below are average values obtained from 10
large hospitals in Bombay,Calcutta, Delhi, and Nagpur
during the period 1993–1996.*
*Source: National Environmental Engineering Research Institute (personal communication, 1997).
Material Percentage (Wet – Weight
Basis)
Paper 15
Plastics 10
Rags 15
Metals (Sharps, etc) 1
Infectious Waste 1.5
Glass 4.00
General Waste (Food, Sweepings from
Hospital premises)
53.5

7. • ONLY 15 -25 PERCENT HOSPITAL WASTES ARE
INFECTIOUS BUT ONLY 5% ARE TREATED AS
PER BMW HANDLING RULES 1998.
• AWARENESS LEVEL ARE VERY POOR IN
BETWEEN HOSPITAL STAFFS AND SOCIETY
RESULTING IN ALL WASTES ARE MIXED WITH
MUNICIPAL AND 100 PERCENT WASTES ARE
INFECTED.
• RAG PICKERS COLLECT THE INFECTIOUS
PLASTICS / MATERIALS AND SELL IT TO MARKET
FOR REPACKING.
• THE THROWN INFECTIOUS WASTE BY THE
HOSPITALS ARE FOOD FOR STREET DOGS
WHICH BECOMES CARRIER OF DISEASES.

8. Examples of infections caused by exposure to health-care wastes,
causative organisms, and transmission vehicles
Type of infection Examples of causative organisms Transmission
vehicles
Gastroenteric infections Enterobacteria, e.g. Salmonella, Shigella spp. Faeces and/or vomit
Vibrio cholerae; helminths
Respiratory infections Mycobacterium tuberculosis; measles virus; Inhaled secretions;
Streptococcus pneumoniae saliva
Ocular infection Herpesvirus Eye secretions
Genital infections Neisseria gonorrhoeae; herpesvirus Genital secretions
Skin infections Streptococcus spp. Pus
Anthrax Bacillus anthracis Skin secretions
Meningitis Neisseria meningitidis Cerebrospinal fluid
Acquired immuno Human immunodeficiency virus (HIV) Blood, sexual
Deficiency Syndrome(AIDS) secretions
Haemorrhagic fevers Junin, Lassa, Ebola, and Marburg viruses All bloody products
and secretions
Septicaemia Staphylococcus spp. Blood
Bacteraemia Coagulase-negative Staphylococcus spp.;
Candidaemia Candida albicans Blood
Viral hepatitis A Hepatitis A virus Faeces
Viral hepatitis B and C Hepatitis B and C viruses Blood and body fluids

9. SHARPS
Sharps may not only cause cuts and punctures but also infect
these wounds if they are contaminated with pathogens.
Hypodermic needles constitute an important part of the sharps
waste category and are particularly hazardous because they are
often contaminated with patients blood.
 Sero-conversion following exposure:
According to a WHO report, HBV can survive in a syringe, in dry
conditions for 7-8 days.
Blood borne occupational diseases of healthcare workers, PRIA, ACILS, Dec 1999
Pathogen Sero Conversion
Rate
Time of
Conversion
HIV 0.3% 6 months
HBV 30% 2 – 6 months
HCV 10% 7 weeks

10. Staff prone to NSI Relative percentage of
injury
Staff nurses 34.6
Interns 15.7
Residents 11.7
Practical Nurses 8.5
Technical Staff 6
Environmental Workers 19
Others 4.5
Epidemiology of needlestick and sharps injury, Khuri-Bulos et al. AJIC, Vol.25, No.4

11. Type of Incident %
Blood Drawing 22.60
Garbage Collection 12.50
Placing Intravenous Lines 11.30
Recapping 11.00
Needle Disposal Box 10.50
Administering Medication 8.50
Neglected Needle 4.80
Cleaning Surgical
Equipment
2.80
Others 16.00
The cost of needle stick injury, Armstrong E Sarah et al, Nursing Economics, Vol. 9, No.6

13. >95,000 hospitals and healthcare facilities in India .
4.2 lakh kg of biomedical waste is generated on a daily basis.
Three million tonnes of medical wastes generated every year.
Expected to grow 8% annually.
2,91,983 kg/day BMW is disposed. which means that almost 28% of the wastes is
left untreated and not disposed finding its way in dumps or water bodies and re-enters
our system.
Karnataka tops the chart with 62,241 kg/day of BMW.
 Only 179 CTF to treat the BMW in the country.
No. of HCF/CBWTF violated BMW rules 5472
No. of show cause notice/ Directions issued to defaulter HCE/CBWTF 3585

14. Snap shot- Patna

15.  Mush-rooming growth and hence inappropriate increase in the
generating units of bio-medical-waste in the form of private
Medical Clinic, Private Nursing Home, Private Medical Research
Institute and the like in between Residential Area.
 Staff members, are either not made
adequately knowledgeable or responsible about waste
management.
 There is no system of formal and dedicated training on this
subject for the staff members of the Hospitals.
 The safety precautions adopted by the staff engaged in Waste
Management are not adequate.
 Sharps and Plastics which used in hospitals are not properly
disinfected and after repacking it is available in market for resale.
 Low awareness in Society.
 Spread through scavengers.
 Not all waste generators are registered with CBWTF.

17. BIOMEDICAL RULES 1998
The Government of India as contemplated under Section 6,8
and 25 of the Environment (Protection) Act,1986, has made
the Biomedical Wastes (Management & Handling) Rules,
1998.
The rules are applicable to every institution generating
biomedical waste which includes hospitals, nursing homes,
clinic, dispensary, veterinary institutions, animal houses,
laboratory, blood bank.
The rules are applicable to all persons who generate,
collect, receive, store, transport, treat, dispose, or
handle bio medical waste in any form.

18. 2011 1998
Every occupier generating BMW,
irrespective of the quantum of wastes
comes under the BMW Rules and
requires to obtain authorisation
Occupiers with more than 1000 beds
required to obtain authorisation
Duties of the operator listed Operator duties absent
Treatment and disposal of BMW made
mandatory for all the HCEs
Rules restricted to HCEs with more
than 1000 beds
A format for annual report appended
with the Rules
No format for Annual Report
Form VI i.e. the report of the operator
on HCEs not handing over the BMW
added to the Rules
Form VI absent

19. It is the duty of every occupier i.e. head 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.
Provides training to HCW engaged in handling
BMW

20. The operators now have to ensure that the
BMW is collected from all the HCEs and is
transported, handled, stored, treated and
disposed in an environmentally sound manner.
The operators also have to inform the
prescribed authority in form VI if any HCEs
are not handing the segregated BMW as per
the guidelines prescribed in the rules.

21.  Occupier set up adequate treatment facilities like autoclave /
microwave / incinerator / hydroclave, shredder prior to
commencement of its operation or ensure that the wastes are
treated at a common bio medical waste treatment facility or an
authorized waste treatment facility.
 The new Rules have omitted incinerator as one of the pre
requisites for on-site treatment of BMW. The omission is owing
to the various environmental impacts of incineration.
 Promotion of new technologies for treatment and disposal of
waste
 Deep burial for disposal of BMW has also been removed from
the Rules. The Rules says it can be an option only in rural areas
with no access to CTF with prior approval from the prescribed
authority.

22. WASTE
CATEGORY
WASTE TYPE TREATMENT & DISPOSAL
Category
1
Human Anatomical waste (human
tissues, organs, body parts
Incineration/deep burial
Category 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 3 Microbiology & Biotechnology Wastes:
Wastes from clinical samples,
pathology, biochemistry, hematology,
blood bank, laboratory cultures, stocks
specimens of micro-organisms, live or
attenuated vaccines human and animal
cell culture used in research and
infectious agent from research and
industrial laboratories, waste from
production of biologicals, toxins, dishes
and devices used for transfer of
cultures
Disinfection at source by
chemical treatment or by
Autoclaving /
Microwaving / followed
by Mutilation / shredding
and after treatment final
disposal in secured
landfills or disposal of
recyclable waste (plastic
or glass ) through
registered or authorized
recycler

23. WASTE
CATEGORY
WASTE TYPE TREATMENT &
DISPOSAL
Category
No. 4
Waste Sharps (needles, glass
syringes or syringes with fixed
needles, scalpels ,blades, glass
etc.) that may cause puncture and
cuts(Includes both used and
unused sharps).
Disinfection (chemical
treatment / destruction
by needle & tip cutter,
autoclaving/microwave
and
mutilation/shredding
and final disposal
through CBWTF /
landfills
Category
No. 5
Discarded Medicines & Cytotoxic drugs
(Wastes comprising of outdated,
contaminated and discarded medicines)
Disposal in secured
landfills or Incineration
Category
No. 6
Soiled Waste (Items contaminated with
blood, & body fluids including cotton,
dressings, soiled plaster casts, linens,
beddings, other material contaminated
with blood)
Incineration

24. WASTE
CATEGORY
WASTE TYPE TREATMENT &
DISPOSAL
Category
No.7
Infectious Solid Waste (waste
generated from disposable items
other than the waste sharps
such as tubing's, hand gloves,
saline bottles with IV tubes,
catheters, glass, intravenous
sets etc.
Disinfection by
chemical Treatment /
autoclaving
/Microwaving
followed by
mutilation /
shredding & final
disposal through
registered recycler
Category
No.8
Chemical Waste ( Chemicals
used in production of
biologicals, chemicals used in
disinfection as insecticides etc.)
Chemical treatment
and discharge into
drains for liquids
and secured landfill
for solids

25. 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.

26. Colour
coding
Type of
container
Waste
category
Treatment /
Disposal
Non chlorinated
Plastic Bags
Incineration/
Deep Burrial
Non chlorinated
plastic bag /
puncture proof
Container for
sharps
Chemical Treatment /
Autoclaving /
Microwaving and followed
by Mutilation &
shredding and disposal in
landfills or disposal of
recyclable waste
Non chlorinated
Plastic Bags /
Containers
Chemical Treatment
and discharge into drains
for liquids and secured
landfill for solids
Non chlorinated
Plastic Bags
Municipal
waste
Disposed as per the
Municipal Solid Waste

27. BIOHAZARD
SYMBOL
CYTOTOXIC
HAZARD SYMBOL
BIOHAZARD CYTOTOXIC
HANDLE WITH CARE
Note : Lable shall be non-washable and
prominently visible.

28. Bio-medical waste shall not be
mixed with other wastes
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.

29.  The Prevalence rate of blood born disease
Hepatitis B 38/1000, HIV 7/1000. (NACO 1993)
 Difficult to test each patient.
 Infections are spread through Scavengers.
 NSI and other sharp injuries are the key
Canadian health issue, affecting 70000 people
per year and costing around dollar 140 million.
 A safety program at Toronto Hospital achieved
80% reduction in injuries within an year.

30.  Prevent and minimize waste production.
 Reuse or recycle the waste to the extent
possible.
 Treat waste by safe and environmentally
sound methods.
 Dispose of the final residues by landfill in
confined and carefully designed sites.

31.  Bio-medical Waste (Management & Handling) Rules, 1998
were notified by the Ministry of Environment & Forests
(MoEF) under the Environment (Protection) Act, 1986.
 The ‘prescribed authority’ for enforcement of the provisions
of these rules in respect of all the health care facilities
located in any State/Union Territory is the respective State
Pollution Control Board (SPCB)/ Pollution Control
Committee (PCC) and in case of health care
establishments of the Armed Forces under the Ministry of
Defence shall be the Director General, Armed Forces
Medical Services (DGAFMS).
 Bio-medical Waste (Management & Handling) Amendment
Rules, 2003.

33.  Run awareness program in public.
 Create model hospitals for example.
 Training for Health Care Workers and follow
up on regular basis for Implementation
whenever it turns habit.

34.  After these programs Biomedical Waste
Management System will be working
effectively.
 People will be aware and they will be
cautious about biomedical waste.
 Health Care Workers can avoid hazards of
Biomedical Waste.