BMWM act 2016 and a few innovations made by me and my team

1. by
Dr D.S.Chandel
Ex-Director Health Services
Mail: ds.chandel26@gmail.com
Mobile: 9418105470

2. WHYWE NEED PROPER
BIOMEDICAL WASTE
MANAGEMENT?

4. Safety from occupational hazards
Clean environment; motivates staff
Cleanliness: satisfaction of clients.
Confidence: more utilization of services
Reduces chances of HAI

5.  Health care facility: A place where, diagnosis,
treatment & immunization activities are
performed, irrespective of the type and size of
health treating or research system
 Point of generation: Where the BMW is
generated & accumulated & is under the control
of the generator.
 Storage: Holding BMW for temporary period, at
the end of which, it is treated or disposed.

6.  GOI has notified Bio-Medical Waste (Management
and Handling) Rule 1998, revised in 2016.
 These rules apply to all persons who generate, collect,
receive, store, transport, treat, dispose or handle bio-
medical waste in any form including hospitals, nursing
homes, clinics, dispensaries, veterinary institutions,
animal houses, pathological laboratories, blood
banks, AYUSH hospitals, clinical establishments,
research or educational institutions, health camps,
medical or surgical camps, vaccination camps, blood
donation camps, first aid rooms of schools, forensic
laboratories and research labs. 27.

7. 1998 2016
Occupier for <1000 OPD/month need not to
get authorization.
Every occupier is exempted.
Rules apply only to those who handle BMW
without further definition.
Who generate BMW, including all vet.
institutions, labs, AYUSH hospitals, Blood
donation/vaccination/surgical camps. First
aid room in schools, forensic labs, research
labs, patients in domiciliary care.
Authorization required under BMWM Act
1998 only.
BMWM Act 2016. rule 25 of water Pollution
& control of pollution Act 1974 and 21 of Air
P&C of P Act 1981.
Occupier’s duties not defined in relation to
the operator
Both can report to PCB; if either of them not
following the guidelines. More duties
described now.
Operator’s duties not specified. Operator’s duties specified in more detail.

8. 1998 2016
Reporting period 30th January , for the
calendar year.
Reporting period 30th June for the financial
year.
Duties of BMWM committee not well
defined.
Duties of BMWM committee/person well
defined. Weekly round. Meeting every six
months/SOS.
Accident reporting not well defined. Accident reporting to PCB within 24 hours
along with ATR
Record maintenance manual. Creation of HCF website and to upload the
record & reporting online, within 1 year.
Training schedule not well defined. Training in BMWM at the time of induction
& once in a year.
Guidelines for use of gloves & bags not well
defined.
Chlorinated bags/ gloves not to be used
after 2 years. (May 2018)
No identification of bag, after it is taken out
from the store of HCF.
Bar coding and global positioning system to
be developed for bags.

9. 1998 2016
No instruction for use of Hg equipments. Phase out such equipments.
BMW divided in 10 categories. Only 4 categories.
Surgeon’s gloves segregated into yellow
bag.
Segregation into red bag.
Bags with residual blood segregated into red
bag.
Segregation into yellow bags.
General waste to be segregated into black
bags.
Green bags.
Storage & disposal of sharps not well
defined.
Now it is well defined.
No ETF. ETF in all HCF.
Calcium /sodium hypochlorite solution with
1 % available chlorine.
10 % chlorine. No calcium hypochlorite.

10. 1998 2016
Contact time of hypochlorite sol.30 minutes. 20 minutes.
Bins/bags emptied/removed when full 2/3 3/4
Schedule I,II,III,IV,V,VI. Schedule I,II,III,IV.
Forms I,II,III. Forms I,II,III,IV,V.
No specific storage facility was defined Proper storage facility defined.
Residence time 1 sec. 2 secs.
SPM in incinerator emission 150 ng/ nm3 50 nm/nm3.

11.  Means permission granted by the prescribed
authority for the generation, collection,
reception, storage, transportation, treatment,
disposal and /or other form of handling bio-
medical waste in accordance with these rules
and any guidelines issued by the Central
Government. Form III.
 Authorization is required under BMWM act 2016
co-terminus to operate under rule 25 of water
(prevention & control of pollution) act 1974
and under rule 21 of air (prevention & control of
pollution) act 1981.

12.  Means an occupier or operator authorized by
the prescribed authority to generate, collect,
receive, store, transport, treat, dispose
and/or handle bio-medical waste in
accordance with these rules and any
guidelines issued by the Central Government.

13. Means 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.

14. •Any waste other than BMW, which has
not been in contact with
hazardous/infectious waste, chemical or
biological secretions and ;
•It does not include waste sharps.

15. CBWTF means any facility wherein
treatment/disposal of bio-medical
waste or processes, incidental to
such treatment or disposal is
carried out.

16.  “Occupier” in relation to any institution generating
biomedical waste, which includes a hospital, nursing
home, clinic, dispensary, veterinary institution,
animal house, pathological laboratory, blood bank,
health care facilities, by whatever name called,
means a person who has control over that
institution and/or its premises.
 “Operator of a biomedical waste facility” means a
person, who owns/ controls/ operates a facility for
collection, reception, storage, transport, treatment,
disposal or any other form of handling of bio-
medical waste.

17.  To take all steps to ensure that such waste is
handled without any adverse effect to the human
health and the environment.
 Ensure proper segregation of BMW as prescribed, at
the point of generation etc.
 Make provision for safe, secure ventilated storage
arrangement for BMW.
 Establish ETF & ensure pre-treat lab/microbiological
waste, blood samples, blood bags etc. before
transportation to CBWTF………..by when?

18.  Phase out chlorinated bags, gloves etc. in 2 years.
 Establish proper bar coding & global positioning
system for the bags/containers going out of
premises within 1 year.
 Immunization of the staff against Hepatitis &
Tetanus.
 Develop a system of handling of workplace
accidents & its reporting to PCB within 24 hours and
with annual report (including nil report). Form I.
 Budgetary provision for BMWM.

19.  Training of the staff in BMWM at the time of
induction and at least once in a year.
Documented.
 Provide constant supply of PPE’s for the staff.
 Annual health check up of the staff.
 Renewal of authorization under water (P&C O
P)act 1974 & air (P&C O P) 1981act.
 Ensures that BMW is not stored for >48 hours, if
unavoidable, take measures so that no adverse
effects on human health/ environment.
Permission from SPCB. Not >72 hours

20.  Constitute BMWM committees. Meeting every 6
months/SOS
 Daily maintenance of record/log books.
 Annual online reporting by 30th June. Form IV.
 Create hospital website and put monthly/annual
record in it.
 Inform PCB, if operator doesn’t collect BMW on
alternate day.
 Establish system for monitoring & evaluation of
BMWM in the hospital.

21.  State Pollution control, which works under State
Govt.
 The occupier applies online on Form II to
prescribed authority (Pollution control board)
along with the fee, for grant of authorization
and the prescribed authority shall grant the
provisional authorization in Form III and the
validity of such authorization for bedded health
care facility and operator of a common facility
shall be synchronized with the validity of the
consents.

22.  For non-bedded occupiers the authorization
shall be one time, which shall be deemed to
have been granted, if not objected, within 90
days w.e.f. date of receipt of application.

23.  Can be cancelled/suspended at any
time giving reasons in writing, after
giving opportunity.
 Refusal after giving proper hearing
and reasons in writing.

24.  If aggrieved by
the decision of
the prescribed
authority, the party
can file an appeal
to the Appellate
authority
{Secretary
(environment)
to GOHP} with
in 30 days
on formV.

25.  The HI shall maintain the record of handling
of BMW in the institution, and put it on the
website and shall also be produced to the
inspecting authority from time to time, when
asked for.
 Annual report shall be sent to the PA by 30th
June every year in form no IV.
 Record disposal after 5 years.

26.  In case of any major
accident in the institution
while handling the BMW,
it has to be reported to
the prescribed authority
within 24 hours and with
the annual report along
with action taken report
(including nil report).

27. Major:
 BMW transporting vehicle meets an accident.
 Accidental release of BMW into a water body.
 Accidental fire in the facility.
 Blast.
 Damage of the storage pit, due to flood or
soil erosion.
Minor: needle stick injury, splash, spills.

28. Let it bleed, don’t squeeze.
Wash with soap water
Cover it
Report it

29. Rinse eyes with water/saline several
times or do it by using water jet.
Clean the wound with soap & water
Rinse with water several times, spit it
out

30.  Immediate first aid: cleaning of the wound with
soap and water, no antiseptic use, dressing. Inj.
Tetanus/ATS should be given.
 Immediate reporting to the infection control official/
officer and recorded.
 The patient identified with complete address and
phone no. Follow up of the patient is very essential.
 The patient’s blood test after counselling to ensure
the HIV status and then again after 3 and 6 months,
if the test is negative.
 Immediate post exposure prophylactic treatment
(PEPT) should be started.

31.  If exposure code is 1 (intact skin, few drops,
short duration) and source code is 1 (source is
HIV-tive) then no need of PEP.
 Take consent of the staff on the format.
 Start treatment within 2-72 hours.
 TLE: Tenofovir 300, Lamivudine 300, Effervinz
600 OD X 28 days;2-3 hours after dinner.
Avoid fatty food.
 GI side effects.

32.  Immunization with in 7 days.
 If staff has been immunized for hepatitis, then
booster. Life long immunity reported.
 If not immunized: three doses of hepatitis
(0,1,6).
 If HBsAg titre level <10 i.u., then HBIg: 0.05 to
0.07 ml/kg IM, in deltoid or lateral thigh region,
with in 6-48 hours followed by vaccination.
 If doctor recommends: special medical leave up
to 6 weeks.
 Antibiotics if signs of secondary infection.

33. 28%
25%14%
11%
11%
11%
Injections
Venepunture
Suturing
Manipulating IV inj. Port
Inserting IV catheter
Other medical
procedures

35.  The state High Court:
only court, competent
to
hear the cases
pertaining to BMWM.

36.  Any person is found guilty,
by name & not by designation,
is punishable.
 Imprisonment ranging from
6 months to one year & fine
up to Rs.1 lac.

37. SOURCES
OF BMW
INDOOR L.ROOM & OT OUTDOOR
MINOT OT/ PLASTER
ROOM
INJ. / DRESSING
ROOM
MCH LABORATORY
BLOOD BANK

38. Injuries due to sharps to staff
Hospital associated infections
Change in microbial ecology
Antibiotic resistance
Harms due to chemicals

39. Hospital clinical staff
PATIENTS
VISITORSTO HOSPITAL
HOUSEKEEPING STAFF

40. VULTURES
DOGS &WILD ANIMALS
GRAZING ANIMALS

41. RAG PICKERS
GARBAGEWORKERS
ANIMAL GRAZERS
General public

42. OZONE LAYER
FOUL SMELL: A
NUISANCE

43. 1. Human anatomical waste: tissues, organs
& body parts. Nonviable fetus.
2. Animal waste: animal tissue, organs, body
parts, carcasses, bleeding parts, fluids,
blood & experimental animals used in
research, waste generated by veterinary
hospitals/ colleges. Discharge from animal
houses.

44. 3. Microbiological & biotechnology waste: waste from lab
cultures, stocks or specimens of microorganisms, live or
attenuated vaccines, human & animal cultures used in
research, infectious agents from research and industrial labs/
biological tests/ toxins/dishes/devices used for transfer of
culture. Sputum cups, discarded vaccines.
4. Soiled waste: Item contaminated with blood, body fluids,
cotton, dressing, POP casts, residual/discarded blood/its
components.
5. Discarded/expired/contaminated medicines & cytotoxic
drugs.

45. 6. Pathological liquid waste decontaminated & flushed into
drains. E.g. pleural fluid, urine.
7. Chemical liquid waste: generated during production of
biological activities, used/ discarded disinfectants during
washing/ cleaning/housekeeping/ disinfecting activities after
treatment in ETP & then into the drains.
8. Chemical solid waste: according to the nature. Special
incineration. Rare. e.g. DDT.
9. Discarded linen, beddings, sheets, coats, clothings etc.
contaminated with blood or body fluids.

46. Contaminated solid waste: Waste
generated from disposable plastic/rubber
items other than sharps: Ryle’s tube, urine
bags, catheter, micro tips, micro test wells, IV
sets, plastic bottles used for fluids/reagents,
syringe without needle, gloves.

47. Waste generated from infected sharp
material:(WISM): Sharps including metal
needles, syringes with fixed needles,
scalpel, blades, dental accessories
(reamers, files & burs) etc., which may
cause puncture/ cuts.
It includes used and unused items.

48. •Broken glass & contaminated glass wares
like test tubes, syringes, vials, ampoules,
foils of the medicines etc.;
•Needles, syringe with needles, blades,
dental burs & reamers;
•Anything which causes cut.
•Metallic implants.

49. General waste generated in the
hospital/ office. Paper, newspaper,
plastic water bottles, aluminum canes of
soft drinks, food containers, covering of
different material, compostable general
waste.

50.  1%/10% Sodium hypochlorite is used to
decontaminate
BMW.{1/available%)X1000=.....ml/1000 ml
water}.
 BMW should be mutilated/shredded to ensure
that it is not reused.
 Halogenated plastics are not to be incinerated.
 Incineration ash is disposed into secured land
fills.
 No chemical pre-treatment is required before
incineration.

51.  Syringes with fixed needles are disposed into white
translucent container.
 Sharps are stored into puncture proof container and
when full by 3/4, it is decontaminated, sealed and
removed to BMW store for transport.
 The tissue like placenta should be put in the bag after
each delivery, which is tightly closed and shifted to
the store.
 Liquid waste generated from lab, washing,
housekeeping/ disinfecting activities and chemical
waste do not require any container/bag and are
disposed according to discharge standards.
 Effluent treatment facility (ETF) in each HI.

52. •Stored in yellow colored non-chlorinated bags.
•Disposal by incineration.
•Chemical liquid waste (CLW) discharged into drains after
complying with effluent treatment norms.
•Linen etc. by incineration.
•Microbiological (expired/left out vaccines) autoclaving. Final
disposal by incineration/plasma pyrolysis.
•Expired medicines in separate yellow bag with the list & a letter
to the manufacturer/CBMWTF. Incineration (1200°)

53.  Pathological liquid waste (PLW): decontaminated &
then flushed into drains.
Chemical solid waste(CSW): according to nature of
the salt. Special incinerators.
Untreated liquid waste should not be used for
agricultural, aquaculture, drinking or recreational
purpose.
Every hospital should have its Effluent treatment
plant ( ETP)

54. Stored in non-chlorinated red
bags/containers.
Treated with autoclaving/ microwaving/
chemical treatment followed by
mutilation/shredding.
Final disposal by Recycling by registered
agency.

55.  Polyethylene (PE):Water proof sheets, bags, jars,
bottles, gloves, tubing material, caps.
 Polypropylene (PP):Test tubes, beakers, dishes,
bottles.
 Polystyrene (PS): Bottles, Petri dishes, culture tubes.
 Polyvinyl chloride (PVC): Blood products &
transfusion, collection of body fluids, IV therapy/renal
therapy/ respiratory products.

56. Movement of liquid vapors into the condenser
Tapping of liquid fuel (as a product)
COLLECTION & SEGREGATIONOF PLASTICWASTE
SHREDDINGOFWASTE
STORING OF PLASTICWASTE
Tapping of vessel tarry waste
FEEDING INTO HOPPER
Flow of waste into heating vessel in the presence of catalyst

57.  Stored in puncture proof
containers.
 Judicious use of hub cutters.
 Chemical disinfection/ autoclaving
followed by shredding/ mutilation.
 Final disposal to registered
recyclers.

58.  Stored in puncture proof containers.
 Needles not to be cut.
 Chemical disinfection/ autoclaving
followed by shredding/ mutilation.
 Final disposal to registered
recyclers.

59.  Disposal in secured landfill.

60. oDisposal through municipality
by recycling/ decomposition in
secured land fills.

61. Red
White
Blue
Yellow
Soiled plastic waste: catheters, urobags, IV set,
gloves, syringes without needle, rules tube, bottles.
Human /animal anatomical, soiled solid waste, expired
medicine, chemical solid waste, chemical liquid waste,
pathological liquid waste, microbiological.
Metallic sharps like needles & blades, syringe with
fixed needle
Broken/unbroken glass bottles/ ampoules/ vials,
implants.

62.  Fixer to registered vendor-3000-8000 p.p.m.
silver.
 Unused developer to manufacturer/ regd.
vendor---hydroquinone.
 Used developer into drains. Flush with plenty of
water.
 X-ray films (non-MLC) to manufacturer/
registered vendor after a period. Mind the
privacy of information.
 Lead foils/ lead aprons/ lead boxes/ shields/
screen: to the manufacturer/registered vendor.

63. HOSPITAL
WASTE
BIOMEDICAL
WASTE
15-20%
GENERAL
80-85%

65.  The average quantity of the BMW,
produced in India, ranges from 1.5 to 2.2
kg /day/bed (average 2 kg/day /bed)
 We must remember 3 R’s—Reduce,
Reuse & Recycle.
 So segregation at the point of
generation is most important to reduce
the waste.

66. REDUCE
REUSE
RECYCLE

67.  Minimum Injections prescribed. Data indicates that 65%
of the injections, prescribed in India, are unwanted.
 Proper segregation.
 All the colour coded bins placed at the point of
generation, kept out of the reach of the patients and
the attendants.
 Separate green coloured bins general use at one side of
the ward.
 Visitors are not allowed to bring food in plastic packs.
 Sieved containers placed in the toilets of the
maternity/female wards to put the “pads” which should
be transferred to the “BMW-Bins” at regular intervals.

68. More injections-more waste
Injections are given for fever, cough, diarrhea
1 Injection= appx. 40-60gms BMW;(Needles(2)-6gm;
syringe-5gm; ampoule/SD vial/MD vial=3/10/20 gm; gloves-
20gm;cannula=20gm)
2005-Delhi produced 65 tons in 1 year BMW due to injections

69. Nil orally
Unable to retain
orally
Unable to
take orally
Unable to
absorb
No oral
preparation
of drug
Doubtful
compliance
Child/psychiatric
Semi/unconscious-
oral feeding not
possible
Acute severe
pain/high conc. Of
drug required

70.  Repeated use of instruments, linen, caps,
gowns, sheets, etc. after proper
disinfection/sterilization.
 Tooth brushes kept for cleaning the
instruments.
 The sputum slides not re-used.
 Reusable items cost more initially as
compared to disposable, but the long term
effects are clear.

71.  Plastic material after decontamination &
proper shredding.
 General waste like plastic bottles/cans,
paper, cartons, ink cartridges, wooden
boxes, used/waste paper, metallic tins
etc.

72.  All the BMW treated as potentially infectious
and hazardous.
 Mercury should not be touched even with gloved
hands.
 Early and proper segregation of the BMW at the
point of generation.
 Proper colour coded bins used.
 Proper training of the staff to handle the BMW.
 Provision and use of “Personal Protective
Equipments” (P.P.E.’s).

73.  Proper handling of the BMW.
 Proper transportation of the BMW. The
bins/bags should not be filled up to more than
3/4 of its capacity to avoid accidents during
handling/transportation.
 Immediate response to the exposure/accident.
 Immunization of the staff against Hepatitis,
Tetanus.
 Bleaching powder should not be put in the pits
as it will delay the process of decomposition.

74.  Sharps should be handled with utmost care to
avoid any injury. No direct handing over. No
recapping of syringes.
 Sharps stored in puncture proof containers.
 Reusable items disinfected before reuse.
 BMW should not be touched directly.
 Bins/bags should never be dragged during
transportation.

75.  Habit of proper hand washing.
 Never correct errors during segregation.
 If general and hazardous waste are accidently mixed,
the mixture should be treated as hazardous waste.
 Small amounts of chemical and pharmaceutical waste
may be collected together with the infectious waste.
 Large quantities of obsolete and expired drugs should
be transported in yellow bags with detail report.
 Large quantities of chemical waste should be packed
in the chemical resistant containers and sent to the
specialized treatment facility.

76. • Caps,
• Mask,
• Gowns,
• Goggles,
• Gum boots,
• Gloves (surgeons),
 Rubber aprons
• Heavy duty gloves (PVC gloves lined with cloth) for
sweepers.

77.  Gloves,
 Thyroid shield,
 Gonad shield,
 Abdominal shield,
 Lead apron,
 Lead screen,
 Lead lining of the room &
 TLD badges.

78.  Bins: Hard plastic bins with lids/with foot-
operated lids. Colour coded bins: Yellow, blue,
red, green, white translucent puncture proof
containers.

79.  Syringe/hub cutters,
 Digital weighing machine (in case of
incineration),
 SS Bowel for decontaminating instruments,
 Scissors (tailor’s scissors SS with black/blue
handle),
 Phial/serrated knife to cut ampoules,
 Sieved dust bins for toilets to store sanitary pads
in female wards.
 Measuring tumbler.
 Autoclave for blood bank.

80.  Puncture proof, leak resistant, impervious to
moisture.
 Strong enough (55 microns gauge) to prevent
tearing or bursting, and sealed/tied securely.
 The colour of the bag must match the colour of
the container.
 Should bear the logo of BMW/Hazardous waste.
 Non-chromium, non-halogenated.
 Replaced when 2/3 full.
 Stored for<48 hours.

81.  Use upper shelf for keeping injection related
items & trays for used syringes & used swabs
and lower one for BMWM: blue, green, red
bins.
 Used syringes are kept in a tray in one
direction only and are shredded, when the
tray is full by 3/4 or at the end of the injection
round.

82.  Sodium hypochlorite solution (5% or 10%).
 Caustic soda (NaOH/ Sodium bisulphate)
used for deactivate gluteraldehyde.
 Phenyl/ QUAC or QUATS.
 20% Calcium sulphide/ sodium
thiosulphate.(Hg neutralizing agents).
 Glycine.

83. GENERATOR
(HOSPITAL)
IN HOUSE
SEGREGATION IN COLOR
CODED BINS
WASTEWATER TO ETP TRANSPORTATION
(IN APPROVED
VEHILCE)
BMW STORE
RE-USE
DISPOSAL
(RECYCLING/LANDFILL)
UNLOADING &
TEMPORARY STORAGE
IN CBWTF STORE
TREATMENT
AUTOCLAVING, SHREDDING,
INCINERATION

84. Segregation at the
point of generation
Collection & storage of
BMW in Color coded
bins/bags
Pre treatment of lab &
highly infectious waste
Treatment in EFT/
disposal
Transportation from
sections to main
store
Central storage
Transportation &
Final disposal

85.  It is the key.
 Reduces the quantity of BMW
 Proper disposal of BMW.
 Done at the point of generation.
 Colour coded containers kept at the point of
generation.
 The segregation is the responsibility of the
generator.
 Ensure uninterrupted supply of bags etc.

86.  At the point of generation
 Workable height (2 ½ ft.)
 Away from the reach of children.
 Dedicated scissors with black/
blue handle for use in BMWM
only, at the point of generation.
 Responsibility of the generator.
 Needle is removed as such & put into the white
container.
 Hub of the syringe is cut, piston is broken,
followed by disposal into the red bin.

87.  (1%) 10% Sodium hypochlorite solution:
contact time 20 minutes. Stability 3 hours. If
the method of disposal is dumping, then the
tissues/infectious material (yellow) need not to
be disinfected, as it will delay the
decomposition.
 If the method of disposal is incineration,
infectious material should not be disinfected
except in case of microbiological/lab/highly
infectious waste.

88.  Under the BMW act 2016, (1%)10 % solution.
Concentration of >500 ppm. is corrosive to
metals, alloys & thermoplastics.
 Side effects to humans: Eyes: irritation of
eyes/may cause damage; skin: blistering/peeling
of skin; inhalation: irritation of nose, throat,
cough, breathing difficulty; ingestion: burning
throat, abdominal cramps, N &V)
 Store in dry place at room temperature. Do not
keep the container/pack open.

89.  Put on PPE’s. Switch off electric appliances.
 Assemble material required for the spill management.
(SM kit)
 Inspect the area around the spill for any splatter or
splashes.
 Restrict the activity around the spill until the area is
cleaned, disinfected and is completely dry. Place a
sign board “Stop—danger-BMW ahead”
 Confine and contain the spill; wipe up any blood or
body fluid spill immediately, using disposable towel.
 Dispose it into the yellow bin.

90. Disinfect the entire area as per guidelines:
cover the area with absorbent cotton/news
paper and pour 10% hypochlorite solution X
20 minutes remove it & dispose it in yellow
bin.
Wet mop the area with 5% phenyl.
Care must be taken to avoid splash or aerosol
formation during the cleaning process.
Remove gloves, cut them dispose into red
bag.Wash hands.

91.  Can be decontaminated
with 10% hypochlorite
solution for 20 minutes,
followed by wiping it with
paper and disposing it in
yellow bin.

92.  Disinfection of the sputum cups: The
sputum cup is filled with 5 % phenol for 18
hours. Its cover is tightly closed and then it is
put in the container having 10% SHC solution.
Cups are then shredded.

93.  Decontamination of the blankets: by exposure
to formaldehyde vapours or autoclaving. Dry
cleaning of the blankets does not kill HIV.
Damaged items incinerated.
 Decontamination and washing of mattresses:-
-cover all the mattresses with water proof rexin
or plastic. Carbolize with 5% lysol daily. Washing
can be done manually. Damaged mattresses
incinerated.
 Cracked mattress covers replaced and
incinerated.

94.  The pipettes are not in use now as these are
fitted with disposable microtips.
 Disinfection of Hb/WBC/RBC pipettes:
These are disinfected by rinsing with 2.5%
(450 in 1000 ml) SHC solution several times,
followed by 95% alcohol two times, then
acetone two times and then air several times
to dry it up.

95.  All infected blood bags, in the blood bank,
should be autoclaved first & then disposed of.
 Temperature 121º Celsius – Pressure 15
Ibs./sq. inch for 60 minutes.
 Temperature 135º Celsius – Pressure 31
Ibs./sq. inch for 45 minutes.
 Temperature 149º Celsius – Pressure 52
Ibs/sq. inch for 30 minutes.

96.  Cytotoxic, hazardous and
radioactive waste, animal carcasses
and body parts and large metal
items should not be disinfected by
this method.

97.  Sterilables are used to ensure
complete and efficient sterilization.
 Bacillus stearothermophilus
capsules.

98.  Some do’s & don’ts:
 Mercury in all forms (organic or inorganic forms) is
hazardous.
 Compounds unstable at 600º C.
 It should never be touched, even with gloved
hands, as its vapours can penetrate the gloves.
 Methyl mercury-very hazardous--Can enter into
the body in 15 secs. even with gloved
hands…..death.
 One thermometer contains 300 to 5000 mg of
mercury.

100. One LED lamp contains 3.5 to 6 mg. (5mg=tip
of ball point pen).
Never heat the clogged amalgam carriers or
any other instrument with amalgam debris
with an open flame as the mercury would
evaporate.
Replace mercury thermometers/BP
apparatus by non-mercury items.
More dangerous, when its vapours are
inhaled.

101.  Small/simple spill <10 gms.
 Large/complex spill >10 gms,
 When spilled, electric devices like fans and
heaters are switched off immediately.
 Close all interior doors & windows and open all
exterior doors & windows.
 Do not broom/ vacuum clean the area.
 Remove all types of jewellery/watch and put
on PPE’s (latex/ HD), mask, goggles,
disposable shoe covers.

102.  Mark & restrict the area by placing “danger sign”.
 Locate the small beads with the help of a flashlight
thrown at low angle on the floor in darkened room
or spray Zinc or sulphur powder.
 Start collecting the spill from the outer perimeter.
 Collect the beads and glass pieces with the help of
two pieces of card boards & confine in a small area.
 Remove broken glass pieces with the help of forceps
to avoid any injury and put into blue container.
 Remove the mercury beads by sucking with a
syringe. Store in an unbreakable bottle with screw
cap under water seal.

103.  Hand it over to registered agency.
 Put the used gloves/syringe/cardboards
/towel/contaminated items in a sealed leak proof
plastic bag/container and hand over to the waste
collector.
 Do not burn/wash them.
 Wash the area with mercury neutralizing agents
like 20% calcium sulphide or sodium
thiosulphate solution (if the chemicals are
available).
 Keep the room ventilated for a minimum of 48
hours.

104.  Disposal of DDT: Stored in air tight
containers which should then be dumped
deep into the soil. Or incinerated in special
incinerators made for this purpose only.
 Handling of extracted tooth with amalgam
filling: Generally, it is a fixed compound and
mercury can be released/will evaporate, only
if it is heated for more than 600° C.

105.  Used as a disinfectant in hospitals, as 1% or 2%
aqueous solution, to disinfect endoscopes,
bronchoscopes, dental and other instruments by
immersing them in closed containers.
 Used as 2.4% aqueous solution after activating it
with an activator (Potassium nitrite). Sodium
bicarbonate can also be used.
 Solution once activated can be used up to 2 weeks.
 Available as 2.45% (Cidex 14 days)solution and 5
liter packing for use in hospitals.110 ml of activator
is added to 5 liters of gluteraldehyde (11ml in 500
ml).
 Also available as 3.4%. (Cidex 28 days)

106.  The solution turns green and is ready for use.
 Instruments should be dry and free from any
organic matter, before these are immersed in
it.
 Contact time: 20 minutes for disinfection
and 10 hours for HLD.
 After taking the instrument from the
solution, it should be rinsed with sterile
water/saline.
 Stored below 30°C.

107.  It is used in developer of the X-Ray
films, to shorten the drying cycle.
 Used as fixative in histology and
microscopy in 1.5 to 6% aq.
Solution.
 It is used to treat common or plantar
warts as 10% w/w solution.

108.  Inflammable and evaporates readily the vapors
are harmful for the human health. It evaporates
into the atmosphere and is hydrophilic and thus
dissolves in the rain water. So keep it covered.
 Biodegradability is 80% in 15 hours.
 Health hazards: Irritant to skin, eyes and
respiratory system causing skin sensitization,
contact dermatitis, allergic reactions and
occupational asthma. Carcinogenic.

109.  Keep away from food area, children and eyes.
 Wear appropriate gloves (Nit rile/Butyl rubber
gloves for handling high concentration and
polyethylene or latex gloves for low
concentration. PVC gloves are not
recommended). Do not handle without using
PPE’s.
 Instruments with carbon contents and low grade
plating should not be immersed in it.
 The container is kept covered.
 Do not mix with other chemicals.
 The room should be well ventilated.

110. Sodium bisulfite/ sodium hydroxide (caustic
soda) are used as deactivating/reducing
agents.
 ½ oz or 15 gms. of “Glute out” is added to 4
liters of gluteraldehyde.
 Wait for 5 minutes, when the solution turns
into red orange.
 Discard into the drains and run cold water
freely after disposal.

111.  Available in 0.55% concentration.
 No activation is required. Less time required for
disinfection. Less harmful.
 HLDTime 12 minutes at 20ºC.
 Once the container is opened: shelf life 75 days.
Mark the date of opening.
 If put in secondary container: shelf life 14 days.
 Deactivate with 25 gms of glycine per gallon
(4.5 liters) of OPA for 1hour.
 Pour it into drains & flush with plenty of water.

112.  The bags/bins when filled up to 3/4 of the
capacity should immediately be tied up,
removed and replaced with the new same colour
bag. Use PPE’s.
 Fixed timings of removal of bags, preferably
after the visiting hours.
 Containers for sharp should be removed when ¾
full, after decontamination.
 Bar code labelling of the bags should be done.
 The label should be non-washable and
prominently displayed.
 Bag should bear the “logo” of BMW.

113.  If there is no bar coding facility: then paste a
sticker:
Date of generation.
Type of waste.
Quantity in kg.
Name & address of HI.
Name & phone no. of contact person
Contacts & details in case of emergency.
Receiver’s contact details, address & phone
no.

114.  The bins/bags should never be dragged to
avoid damage and thus any injury.
 The bags, once closed, should not be opened.
 Loading and unloading done, one by one only
 Transportation should not be through the
patient area/high traffic area/ high risk areas.
 Ensure no spillage/scattering of waste during
transportation.

115.  Properly designed.
 Stable and should not produce noise,
while being used.
 It should not have sharp edges and
should be easy to disinfect and drain,
and easy to handle.
 Covered.

119.  In-house store for the BMW.
 Just away from the indoor/outdoor/ diagnostic
sections/ secluded place in the building (e.g.
basement) and near the parking point.
 The floor elevated, non-slippery and
impermeable (tiled) with proper slope.
 Facility of hand washing with elbow operated
taps.
 24 x7 water supply.
 Room washing facility with proper drainage
system (drainage pipes of not less than 6"
diameter).

120.  Proper power supply and one exhaust fan,
proper cross ventilation system.
 Windows having four parts—each part having
two sets of pans- one glass and one meshed.
 The doors and windows tightly closed with
facility of locking of the doors to prevent the
entry of any unauthorized person, animals,
reptiles and rodents.
 A ceiling hook to hang the weighing machine.
 Away from the kitchen and canteen.
 Separate area to keep the PPE’s.
 A sign board with BMW logo. Restricted entry.

123.  The vehicle should be a closed van,
having a logo of BMW covered under
MVA, 1988.
 The occupier shall ensure that there is
no secondary handling of the waste.
 The occupier shall ensure that the waste
is not kept in the store >48 hours.

124.  It should be deep. Bleaching powder should
not be put inside the pit. BMW should be
covered with a 10 cm layer of soil, every time
the waste is put into, to avoid flies and
emission of obnoxious gases.
 Water level should be at least 6 meters below
the floor of the pit.

127. SN Parameters Permissible limits
1 pH 6.5-9
2 Suspended solids 100 mg/l
3 Oil & grease 10mg/l
4 Biochemical O2 demand (BOD) 30 mg/l
5 Chemical O2 Demand (COD) 250mg/l
6 Bioassay test 90% survival of fish after 96 hours is 100%

128.  Incineration is a high temperature dry oxidation
process that reduces organic, combustible waste
to inorganic, non-combustible matter and
results in a very significant reduction of the
volume and weight.
 Used to treat waste that can not be recycled/
reused/ disposed in the landfill site.
 Produces mainly gaseous emissions e.g., steam,
carbon di-oxide, nitrogen oxides and certain
toxic substances (metals, halogenic acids) and
particulate matter.

129.  Two chambers with the temperature going up to
800+_50º C and 1050+_50º C respectively.
 Less temperature will cause incomplete
combustion.
 Incomplete incineration will produce harmful
compounds—carbon mono-oxide, dioxins, furans
and co-planar, which affect our immune system and
cause developmental defects of nervous, endocrinal
(Hypothyroidism, Thymus atrophy) and
reproductive systems and may cause acne, skin
lesions, sarcomas.

130.  Dioxins can be inhaled or ingested orally
through food & water chain.
 The stack height of the chimney; not less
than 30 meters from the ground.
 The health department should avoid
installing its own incinerators.
 Bags with Chromium, if incinerated cause
ulcers in the nasal mucosa, irritation of lungs,
kidney damage, and skin rashes.

132.  In-house incinerator is not allowed. In case
there is no facility within 75 km, permission
from PCB has to be taken before installation.
 If the Common biomedical waste treatment
facility (CBMTF) is available within 75 Km.
(two districts in hilly areas) then the HCF shall
outsource the disposal of BMW.

133.  Leaching of DEHP (Di-2 ethyl hexyl phthalate) in
human body from I.V. cannula/ Ryle’s tubes can cause
low fertility, low birth weight, abnormality of skeleton
and kidney functions, if kept in situ >24 hrs.
 The final disposal of the BMW should be outsourced
to the operator, empanelled by the PCB.
 The rates may be decided by calling open
tenders/negotiations.
 The incineration ash is also hazardous as it may
contain heavy metals, so it should be disposed by
deep burial.

134.  Pressurized containers
 Large amount of reactive chemical waste
 Silver salts and photographic or radiographic
waste
 Halogenated plastics –PVC.
 Waste with high mercury, cadmium
contents—thermometers,
 Used batteries, lead lined wooden panels.
 Sealed ampoules, vials.

136.  Two types of pits, which should be well covered.
 For sharps: A “pucca”/concrete pit, of the size of
2 X 2 meters with concrete roof with an
outlet/manhole of 2´x 2´ diameter, which is kept
covered with a metal/concrete cover.
 For decomposable material: A “kuchcha”/non-
concrete pit of the same size covered with a
steel structure of the size of 2.75 X 2.75 meters,
so that there is no access to wild animals, flies,
birds and rain water.

137.  Four angle irons at the corners—appx.ht. 4 to 5 feet.
 Angle irons are welded/joined with each other at its
upper end and appx. one foot above the lower end
which is kept free to fix it in the soil.
 Sides are closed with the iron mesh-size 16 mesh
wires per sq.cm. A door, with a bolt, is kept on one
side, for putting the BMW inside the pit.
 The roof is well-covered with the tin sheets. When the
pit gets filled up to 2/3 of its capacity, then it should be
closed by putting 35 cm. of lime and rest soil.

139.  A written agreement has to be signed by the in-
charge of the institution (MS/SMO/BMO) with the
operator before outsourcing.
 Any HI which falls within 75 km range of CBWTF,
shall have sent the BMW to this facility.
 At present, there is the practice of finalizing the
rates after negotiations by the in-charge of the
institution with the operator, who has been
empanelled by the state PCB.

140.  The operator will lift the BMW on the alternate
day, from the facility. BMW can not be stored for
more than 48 hrs.
 If >48 hrs: permission form PCB, only up to 72
hours; steps have to be taken by the occupier so
that there is no harmful effect to the humans
environment.

141.  For HI with >30 beds capacity:BWM
committee is constituted. Meeting every 6
months /SOS. Documentation of the minutes
of the meeting.
 For HI with <30 beds capacity: only one
person is designated to take care of BMWM.
 Ensure that all the BMW is handled as per
guidelines from PCB and it is the duty of the
generator to segregate or shred the BMW.

142.  Team work: In addition to the MS/SMO/members of
BMW Committee., doctors and paramedical in-
charges of various departments should also supervise
BMWM on day to day basis and any shortcoming in
the system is pointed out to the staff, there and then,
along with the suggestions to correct it.
 The BMW committee should take weekly round of the
hospital and it should be recorded in the round
register.

143.  In-charge of the medical camp responsible for
safe handling and disposal of BMW as per
guidelines from the PCB either by onsite deep
burial or handing over to the operator.

144.  P. P. E.’s: should be provided to the staff.
 Proper handling: develop habit.
 Immunization: against Hepatitis,Tetanus and ?Typhoid.
 All BMW is potentially hazardous. Do not touched directly.
 Behaviour change: A habit of proper hand washing after
handling the patient. Proper handling of the syringes by
staff. Hazardous and general waste should not be mixed.
 Management practices: Proper segregation, shredding,
treatment, transportation and disposal of BMW. A fool-proof
system of reporting of accidents.

145.  All the categories of
staff members including
sanitation worker in
BMWM-technical &
behavioural change to
handle the patient and
the BMW.
 Followed by daily supervision, which is the
most essential key & most often lacking.

146.  Staff training is a never ending process.
 It is a Continuous Education.

147.  To develop awareness:
regarding provision of PPE’S to sanitation
staff by the contractor.
about health, safety and environment issues.
of the staff regarding safety at the work
place.
 To make them understand the roles and
responsibility of all the categories of the staff
members in BMW.

148.  To prevent exposure of scavengers/handlers or
accidents in hospitals.
 To create awareness among the hospital
patients and the visitors, regarding hygiene and
BMWM.
 To educate the people about the risks of BMW,
focusing on the people living or working in close
proximity to, or visiting hospitals/families of the
patients being treated at home, or scavengers
on the waste dumps.

149.  A system at the level of the institution, which
evaluates and shows that there is an improvement
in the BMWM.
 BMWM committees at HI level should record any
shortcoming on a register and should take
corrective action and follow it up, so that it is not
repeated.
 There should be decrease in the number of
workplace accidents.
 The premises and the campus around the hospital
building should look clean and without any BMW
lying, here and there.

150.  You are not only protecting yourself, but also
those around you.

151.  Scissors three- black/blue for BMW, orange
–miscellaneous work, steel large-for
cotton/gauze.
 Extra bowel of chlorine solution in
LR/OT/MOT for instruments.
 Availability of deactivators.
 Measuring tumblers.
 Pressure pumps.

152.  Brush. Unlocking of instruments before
cleaning
 Jars for sharps.
 Black only in radiology and Chief Pharmacist
(medicine store).
 Serrated knife.
 Spill management.
 Decontamination of Hb pippets. REPLACE
WITH MICROTIPS.
 Non mercury thermometer/BP apparatuses.

153.  Form I: Accident reporting
 Form II: Application for registration.
 Form III: Authorization by PA.
 Form IV: Annual report by occupier.
 FormV: Application for filing appeal.

154.  Schedule I: Color coding.
 Schedule II: Standards for CTF.
 Schedule III: List of authorities and their
duties.
 Schedule IV: Logo.

157.  last river has been poisoned;
 last tree has been cut down;
 last fish has been caught;
only then, you will find that;
 money cannot be eaten.