Biomedical waste management

BIOMEDICAL
WASTES
MANAGEMENT
By,
Dr. Priyanka Sharma
II Year MDS
Dept of Public Health Dentistry
Bio-weapons
of Mass
Destruction !!
Lets MakeThis World A
Better Place
to Live in!!

CONTENTS
 Introduction
 History
 Definitions
 Types of wastes
 Classification of healthcare wastes
 Waste management
 Solid waste management
 Biomedical waste management
 Dental waste management
 Conclusion
 References

INTRODUCTIONINTRODUCTION
Medical and dental care is vital in our life.
 Biomedical waste – emerged as an issue of concern.
 Biomedical waste is the real problem for the
MAN,COMMUNITY,ENVIRONMENT
 Safe, scientific, cost-effective method for biomedical
waste management – need of hour.

HISTORY
• In the late 1980’s
– Items such as used syringes washed up on several East Coast
beaches USA
– HIV and HPV virus infection
– Lead to development of Biomedical Waste Management Law in
USA.
• However in India the seriousness about the management
came into lime light only after 1990’s.

WHO has estimated that
• In 2000
• 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);
• 260 000 HIV infections (5% of all new)

Laws of Biomedical Waste Management
On 20th
July 1998
• Ministry of Environment and Forests
(MoEF), Govt. of India, Framed a rule
known as ‘Bio-medical Waste
(Management and Handling) Rules, 1998,’
• Provides uniform guidelines and code of
practice for Bio-medical waste management.

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.

BIOMEDICAL WASTE(MANAGEMENT &
HANDLING) RULES by Govt. of India, 1998
Revised in 2011
Now known as BMW Rules, 2011
2011 1998
Every occupiergenerating BMW,
irrespective of the quantumof wastes
comes under the BMWRules and
requires to obtain authorisation
Occupiers with more than 1000 beds
required to obtain authorisation
Duties of the operatorlisted Operatorduties absent
Treatment and disposal of BMWmade
mandatory forall the HCEs
Rules restricted to HCEs with more
than 1000 beds
A format forannual report appended
with the Rules
No format forAnnual Report
FormVI i.e. the report of the operator
on HCEs not handing overthe BMW
added to the Rules
FormVI absent

Duty of the Occupier

• 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

Duty of the Operator
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.

Setting up BMW treatment facility
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.

Biomedical waste Statistics
• Developed Countries-Developed Countries- 1-5 kg/bed/day, with variations
among countries.
In India-In India-
1-2 kg/bed/day with variation among
Govt. and Private establishments.
Approximately 506.74 tons/ day wastes generated
Out of which only 57% waste undergoes proper
disposal

Health waste Characterization
Hospital waste
Non Hazardous
(≈ 75-90%)
Hazardous waste
(≈ 10-25%)
Infectious
Others
( Radioactive,
Cytotoxic )

DEFINITIONSDEFINITIONS
• Acc to bio medical waste rules ,1998 of India
“ 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.

Hospital waste: refers to all waste, biological
or non biological, that is discarded and is not
intended for further use.
Medical waste: refers to materials generated
as a result of patient diagnoses, treatment,
immunization of human beings or animals.

 Infectious waste: are the portion of medical
waste that could transmit an ‘infectious
disease’.
 Pathological waste : waste removed during
surgery/ autopsy or other medical procedures
including human tissues, organs, body parts,
body fluids and specimens along their
containers.

• Health care Waste: means all the waste generated by
Hospital establishments, research facilities, and
laboratories. 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.)
• [Pruss, A., Giroult, E., and Rushbrook P. et. al; "
Safe Management of Wastes from Health-Care
activities", World Health Organisation, , Geneva,
1999. ]

 Sewage
• Waste water from a community containing
solid and liquid excreta , derived from houses ,
streets and factories.
 Sullage
• Waste water which does not contain human
excreta .

Categories of Bio-Medical Wastes

Classification of health care wastes
Waste categoryWaste category
 Infectious wasteInfectious waste
 Pathological wastePathological waste
Description And ExamplesDescription And Examples
• Lab culturesLab cultures
• Waste from isolation wardsWaste from isolation wards
• Tissues(swabs)Tissues(swabs)
• Materials/equipments of infectedMaterials/equipments of infected
patientspatients
• ExcretaExcreta
• Human tissues/fluidsHuman tissues/fluids
• Body partsBody parts
• Blood or body fluidsBlood or body fluids

Pathological Waste
Blood bags found in the municipal waste
stream in violation of rules for such waste.

 Sharp wasteSharp waste
 Pharmaceutical wastePharmaceutical waste
 Genotoxic wasteGenotoxic waste
• NeedlesNeedles
• Infusion SetsInfusion Sets
• ScalpelsScalpels
• Knives BladesKnives Blades
• Broken GlassBroken Glass
• Expired PharmaceuticalsExpired Pharmaceuticals
• Contaminated PharmaceuticalsContaminated Pharmaceuticals
• Banned PharmaceuticalsBanned Pharmaceuticals
• Waste Containing CytotoxicWaste Containing Cytotoxic
Drugs(often Used In Cancer Theraphy)Drugs(often Used In Cancer Theraphy)
• Genotoxic ChemicalsGenotoxic Chemicals

Pharmaceutical
Waste
Sharp
Waste

 Chemical wasteChemical waste
 Waste with highWaste with high
content of heavycontent of heavy
metalsmetals
 PressurizedPressurized
containerscontainers
 Radioactive wasteRadioactive waste
• Lab reagentsLab reagents
• Film developerFilm developer
• Expired disinfectantsExpired disinfectants
• Expired solventsExpired solvents
• BatteriesBatteries
• Broken thermometersBroken thermometers
• Blood pressure guages etcBlood pressure guages etc
• Gas cylinders, Gas catridgesGas cylinders, Gas catridges
• Aerosol cansAerosol cans
• Radiotherapy/lab research liquidsRadiotherapy/lab research liquids
• Contaminated glass wares, packages, absorbent papersContaminated glass wares, packages, absorbent papers

Cytotoxic drugs
Lab reagents
Genotoxic waste
Chemical
waste

Waste with high content of
heavy metals
Worn out batteries
Blood pressure guages

Gas cartridges
Aerosol cans
PRESSURISED
CONTAINERS

WASTE MANAGEMENT
Let the waste of the “sick” not
contaminate the lives of “The
Healthy”

• Waste management is the collection ,transport,
processing ,recycling or disposal of waste materials.
• Term usually relates to materials produced by human
activity and is generally undertaken to reduce effect
on health, the environment and aesthetics.

The Waste Management Hierarchy

The 5 R’s of Waste Management
Refuse – Do not use non bio-degradable materials is the process
in the first place
Eg. No Plastic bags as packaging for consumer products.
Reduce – don’t manufacture goods that will be discarded in the
first place.
Eg. Reduced packaging for consumer products.
Re-use – use materials over again for the original intended
purpose or for a new purpose.
Eg. Plastic grocery bags can be reused for groceries or
you can use them as a lunch bag or something else.

Recycle – break down materials and reform them into
new products. Requires much less energy than
manufacturing products from raw materials.
Eg. Pop cans. Aluminum is melted down and
made into new pop cans, storm doors,etc.
Recover – recover as much energy as possible before a
material is discarded.
Eg. Some places will burn garbage, then use the
heat to generate electricity before disposing of the
ash.

Dumping
• Easy method of disposal of “dry refuse”
• Dumped in low lying areas
• Decomposes: bacterial action, decreased in
volume & converted to humus.

Dumping
Disadvantages
 Refuse exposed to flies & rodents
 Source of nuisance (smell & unsightly appearance)
 Loose refuse dispersed by the action of wind
 Pollution of surface & ground water.

Controlled tipping (or) Sanitary land fill
• Method:
• Material placed in trench
• Adequately compacted
• Covered with earth at the end of the day
• “Modified sanitary land fill”
- Compaction & covering once or twice a week

Controlled tipping
• Three methods used:
1. Trench method: 2-3 meter deep trench dug out 4 -12 meter
wide. Refuse upto a depth of 2meters - 1 acre of land /yr for
10000 popln
2. The ramp method: used in sloping terrain
3. The area method: used for filling land depressions, disused
quarries & clay pits

Controlled tipping
• Changes in the buried refuse:
Physical, chemical & bacteriological changes
During decomposition temp rises to 60 deg
In 7 days. Kills all the pathogens
2 – 3 weeks to cool down
4-6 months for decomposition

Incineration
• Burning the refuse
• More hygienic
• Hospital refuse
• Disadv: production of harmful gases &
chemicals (carcinogenic)
• Used: where suitable land is not available
• Not suitable in India

Composting
Composting is a method of combined disposal of
refuse and nightsoil or sludge.
Process of nature whereby organic matter breaks
down under bacterial action resulting in the relatively
stable humus like material called compost.

Composting
• Principle by products are:
 Carbon dioxide, water & heat.
 Heat produced is 60 deg
Destroys eggs & larvae of flies, weed seeds &
pathogenic agents.
 The end product - compost - contains few or no
disease producing micro organisms, contains plant
nutrients - nitrates & phosphates

Composting
• Principle methods:
1.Bangalore method
(Anaerobic method / Hot fermentation process)
2. Mechanical composting (Aerobic method)

Composting
1. Bangalore method:
Indian council of Agricultural research at Indian
institute of Science, Bangalore.
Anaerobic compositing
Trenches are:
• 3 feet deep, 5-8 feet broad, 15-30 feet long
• Located ½ mile away from the city limits

Composting
Bangalore method:
• Method:
• First a layer of refuse about 6 inches thick
• Over this night soil is added 2 inch thick
• Alternate layers of night soil & refuse added
• Till the heap rises to 1 feet above the ground level.
• Top layer - refuse at least 9 inches thickness.
• Heap covered with excavated earth.

Composting
Bangalore method:
• Within 7 days heat generated
• Heat persists for 2 or 3 weeks
• Destroy all pathogenic & parasitic organisms
• End of 4-6 months decomposition is complete
• Manure: well decomposed, odourless, innocuous
material, high manurial value, ready for application
to the land.

Composting
2. Mechanical composting:
• Aerobic method
 Method:
• Refuse first cleared of salvable material
• Then pulverized in the pulverizing equipment
• Reduce the particle size to 2 inches
• Mixed with sewage, sludge or night soil in rotating
machine & incubated
• 4-6 weeks composting completed.

Manure pits
• Rural areas
• Garbage, cattle dung, straw & leaves
• Covered with earth after each days dumping
• 2 pits required
• 5-6 months time refuse converted to manure
• Effective and simple.

Burial
• Suitable for small camps
• Trench:
• 1.5m wide , 2 meters deep
• At the end of the day refuse is covered with 20-30cms
of earth
• 40cms from ground level, new trench is dug out.
• Contents removed after 4 -6 months

Sanitation barrier
Concept found wide acceptance.
Diseases due to insanitary conditions can be
prevented by blocking the channels/modes of
transmission namely the 5 F’s.
Segregate the faeces & arrange for its proper
disposal
water
Fingers
Flies
Soil
Food
Protected
host
Faeces
Sanitationbarrier
water
Fingers
Flies
Soil
Food
Protected
host
Faeces
Sanitationbarrier

Sanitation barrier
 Simple terms:
• Sanitary latrine & a Disposal pit
 More elaborate schemes: Installation of a
sewerage system & Sewage treatment plans

Water Carriage System
Duct system
Excrements are safely disposed off by carrying those
along with water.
Sewage = 99.9% water & only 0.1% solids
Sanitary sewage : waste water from residences and
industries and is also called DRY WEATHER FLOW
(D.W.F).
Combined system of sewerages allows rainwater
during monsoons.

Water Carriage System
 These are all carried through underground
sewerages.
 The amount of sewage produced per person is
directly related to the water supplied per capita
and ranges from 1.15 litres per day in small
towns to 180 litres per day in large cities.

WARNING!!!
 Sewage gas is a mixture of gases in sewers
and manholes comprising of CO2,methane,
hydrogen sulphide and a little oxygen.
 This is generated by putrefying bacteria and is
combustible.
 This is an important information should be
kept in mind before anybody attempts to go
into a manhole or a septic tank for repair
works.

Sea outfall
• Sea coast town and cities
• Nearly two-third of sewage of greater mumbai
• Purification by dilution and oxidation
• Drawback: offensive solid waste back to coast.
• Sewage outfall designed to discharge it deep into the
sea at many points.

S.N
O
WASTE
CATEGORY
WASTE TYPE TREATMENT
& DISPOSAL
1 Category No.1 Human Anatomical waste (human tissues,
organs, body parts
Incineration/deep
burial
2 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
3 Category No.3 Microbiology & Biotechnology Wastes:
Wastes from laboratory cultures, stocks of
specimens of micro-organisms live or
attenuated vaccines etc.
Autoclave/
Microwave/
Incineration
4 Category No.4 Waste Sharps (needles, syringes, scalpels
,blades, glass etc.) that may cause puncture
and cuts.
Disinfection
(chemical
treatment/autoclavE/
microwavE and
mutilation/shredding
CATEGORIES OF BIO-MEDICAL WASTE

S.No WASTE
CATEGORY
WASTE TYPE TREATMENT
AND DISPOSAL
5 Category No.5 Discarded Medicines and Cytotoxic
drugs Wastes comprising of outdated,
contaminated and discarded medicines
Incineration/destruction
and drugs disposal in
secured landfills
6 Category No.6 Soiled Waste (Items contaminated with
blood, and body fluids including cotton,
dressings, soiled plaster casts, linens,
beddings, other material contaminated
with blood)
Incineration
autoclaving/
microwaving
7 Category No.7 Solid Waste (waste generated from
disposable items other than the waste
(sharps) such as tubing's, catheters,
intravenous sets etc.
Disinfection by chemical
treatment/autoclaving/
Microwaving &
mutilation/shredding
8 Category No.8 Liquid Waste generated from laboratory
and washing, cleaning, house keeping and
disinfecting activities
Disinfection by chemical
treatment and
discharge into drains

S.No WASTE
CATEGORY
WASTE TYPE TREATMENT AND
DISPOSAL
9 Category No.9 Incineration Ash: Ash from
incineration of any bio-medical
waste
Disposal in municipal landfill
10 Category No.10 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
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.
4. Deep burial shall be an option available only in towns with population less than five lakhs and in rural
area.

COLOUR CODING AND TYPE OF CONTAINER FOR
DISPOSAL OF BIOMEDICAL WASTE
ColorColor
CodingCoding
Type ofType of
ContainerContainer
WasteWaste
CategoryCategory
TreatmentTreatment
options as peroptions as per
Schedule ISchedule I
YellowYellow Plastic bagPlastic bag Cat.1, 2,3,6Cat.1, 2,3,6 Incineration/deepIncineration/deep
burialburial
RedRed DisinfectedDisinfected
container/Plasticontainer/Plasti
c bagc bag
Cat 3,6,7Cat 3,6,7 Autoclave/Microwave/Autoclave/Microwave/
Chemical TreatmentChemical Treatment
Blue/WhiteBlue/White
translucenttranslucent
Puncture proofPuncture proof
containercontainer
Cat.4,7Cat.4,7 Autoclave/Microwave/Autoclave/Microwave/
Chemical Treatment &Chemical Treatment &
destruction/shreddingdestruction/shredding
BlackBlack Plastic bagPlastic bag Cat 5,9,10Cat 5,9,10 Disposal in securedDisposal in secured
landfilllandfill

 Segregation and Collection
 Safe transportation and Storage
 Treatment & Disposal of BMW
To ensure clean & healthy environment:

 Use of plastic bags makes the transportation easier, it prevents the spillage and the
waste remains outside the view of others. This also keeps the original containers
clean. The plastic bags are not to be reused.
 When bag or container, as the case may be, is three fourth full, it should be sealed
by tying it. The disposable sharps container should be sealed by tape. All bags or
containers must be labeled which shall be non washable/prominently visible

TRANSPORT TO THE CENTRAL STORAGE AREA
 While transporting the waste to the central storage area certain rules
must be followed:
1. Check that waste bags/containers are properly and effectively sealed.
2. Waste bag is properly labeled.
3. Bags should be picked up by the neck and placed, so that bags can be
picked up by the neck again for further handling. Hand should not be put
under the bag. At a time only one bag should be lifted.

4. Manual handling of waste bags should be minimized to reduce the risk of
needle prick injury and infection. Avoid close contact between body and bag
container.
5. Waste bag or container should not be thrown or dropped.
6.After removal of the bag, clean the container including lid with an appropriate
disinfectant.
7.Bags or containers containing the waste should be transported in covered
wheeled containers or large bins in covered trolleys dedicated for this purpose.
The bags and containers should be replaced by fresh bag/container .
Bio- medical waste storage areas must be separate from general waste storage
sites and should have clear signs indicating "For Biomedical Waste only".

8. In case, a lift is to be used during transportation of biomedical
waste it should be designed and reserved for this purpose only.

To reduce the impact on the community
To reduce the chances of infection and accidental injury to
the workers
To support conservation of natural resources and preservation
of environmental quality.
To reduce the cost and handling time

CENTRAL STORAGE
 The central storage area should be ideally situated on the ground floor and
near the rear entrance. This will make the transportation of waste to the site of
final disposal easier.
 The central storage area should be big enough to store the required number of
waste bags at a time. There should be sufficient storage capacity to store at least
two day's waste.
 It should have a good flooring, light, ventilation and water supply. There
should be special drain to discharge the washing, which should go to the sewer.
 A full time storekeeper should be responsible to receive and dispatch the
waste and maintain proper records.

 Unauthorized people should not be
able to enter the storage area.
 An accidental spillage should be
properly attended.
 As per rules, biomedical waste cannot
be stored for more than 24 to 48 hours.
 Refrigerated storage room (cold
rooms) can be considered where wastes
have to be stored in bulk for over 48
hours.

TRANSPORT TO THE FINAL DISPOSAL SITE
 Transportation from the health care establishment to the site of final disposal
should preferably be done in a motor vehicle, as these sites are likely to be
situated at a distance from the hospital.
 Closed transportation in these motor vehicles (truck, tractor, trolley, etc) is
desirable as it prevents the spillage on the way.
 All these vehicle must have the biohazard symbol and they should not be used
for any other purpose.
 Proper servicing is a must regular basis.

 Temporary storage of biomedical waste may also be needed at the site of final
disposal. It should have all characteristics similar to that described for the central
storage area of the hospital.

 Treatment is a term used for those processes that modify the waste in some
way before it is finally disposed off.
 According to the draft Biomedical (Management and Handling) R 1995…..
 Treatment means: "a method, technique, or process designed to change the
physical, chemical or biological characteristics or composition of any biomedical
waste so as to render such waste non-hazardous to health and environment".
 The primary aim of treatment is to disinfect or decontaminate the waste to
eliminate the pathogens before it reaches the site of its final disposal.


Five technology options for treatment
Incineration
Chemical disinfection
Wet and dry thermal treatment
1. Wet thermal treatment
2. Screw-feed technology
Micro wave irradiation
Land disposal
1. Municipal disposal sites
2. Sanitary landfills
Inertization

INCINERATION
 Incineration is the complete destruction of materials to their inert
constituents by a process of combustion.
 Safe way of disposal
 There is reduction of volume and weight by approximately--- 95%

Types of incinerators:
•Double-chamber pyrolytic incinerators: designed to burn infectious
health-care waste.
•Single-chamber furnaces with static grate, used only if pyrolytic
incinerators are not affordable.
•Rotary kilns operating at high temperatures, capable of causing
decomposition of genotoxic substances and heat-resistant chemicals.

Characteristics of the waste suitable for incineration are:
a) Low heating volume-above 2000 Kcal/kg for single-chamber
incinerators, and above 3500 Kcal/kg for pyrolytic double-chamber
incinerators
b) Content of combustible matter above 60%
c) Content of non-combustible solids below 5 %
d) Content of non-combustible fines below 20 %
e) Moisture content below 30%

Chemical treatment
 Plastic, rubber and metallic items (like IV sets, blood bags, gloves, catheters,
syringes and needles must be chemically disinfected before they are sent for final
disposal (landfill).
 Chemical disinfection can be done in following steps:
1. Mutilate the syringes and needles with a needle destroyer.
Cut all other plastic/rubber item with the help of scissors (so that they cannot be
reused),
2. Make 1 per cent hypochlorite solution (fresh everyday) by dissolving 10 gms of
this powder (approx 2 spoonfuls) in 1 litre of water in a plastic bucket.

3. Keep another, smaller bucket with perforations inside the main
bucket (having the solution). Put all the items that are to be
disinfected inside the perforated bucket and keep well- dipped for
about 30-60 minutes.
4. After 30 to 60 minutes take out the disinfected items and put
them in a proper waste bag. Sharps should be first kept in a tough
cardboard box then only put in the plastic bag so as to avoid
damage to the bags.
5. Change the solution every 12 hours.
Commonly used – Sodium hypochlorite solution, Cresol, Savlon,
Bleaching powder

Wet and dry thermal treatment
Wet thermal treatment:
•Based on exposure of shredded infectious waste to high temperature, high pressure steam.
•Similar to the autoclave sterilization process.
•Inappropriate for the treatment of anatomical waste and animal carcasses.
•Will not efficiently treat chemical and pharmaceutical waste.
Screw-feed technology
•Screw-feed technology is the basis of a non-burn, dry, thermal disinfection process in which
waste is shredded and heated in a rotating auger.
•The waste is reduced by 80 % in volume and by 20-35 % in weight.
•Suitable for treating infectious waste and sharps.
•Should not be used to process pathological, cytotoxic or radioactive waste.

Microwave irradiation
•Most microorganisms are destroyed by the action of microwave of a frequency of
about 2450 MHZ and a wavelength of 12.24 cm.
•The water contained within the waste is rapidly heated by the microwave and the
infectious components are destroyed by heat conduction.
• The efficiency should be checked routinely through bacteriological and virological
tests
STANDARDS OF MICROWAVE
•Not be used for cytotoxic, hazardous,/radioactive wastes, contaminated animal
carcasses, body parts, & large metal items.

Disposal means placing the biomedical waste in its final resting
place
According to the draft Biomedical Waste (Management and
Handling) Rules, 1995.
Disposal means : "burial, discharge, deposit, dumping, land filling or
placing on land of any biomedical waste".

Two types of disposal:- 1) Land open dumps.
2) Sanitary landfills.
Health-care waste should not be deposited on or around open dumps.
Advantages of sanitary landfill over open dumps:
Geological isolation
Appropriate engineering preparation of the site.
Staff present on site to control operations,
Organized deposit and daily coverage of waste.

Sanitary landfills
 It is another choice for final disposal of biomedical waste and it can be quite
effective if practiced appropriately.
 While open dumping of biomedical waste cannot be recommended for the reasons of
acute pollution problems, fires, higher risk of disease transmission and open access to
scavengers and animals.
Some essential elements for design and operation of a sanitary landfill are given below:
1. A specifically designated place should only be used for the landfill.

2. The site should preferably be away from the residential areas.
3. Location should be such that vehicles carrying waste can easily
approach it in all weathers.
4. The area should be under constant supervision and security control.
Unauthorized entry must be strictly prohibited.
5. It should not be in the vicinity of a drinking water source as pollution
may result.
6. The site should be divided into various manageable phases and all of
them should be adequately prepared before the actual and fill starts.

7. The site should be so organized that the waste can be spread, compacted and covered
daily.
8. A final cover should be constructed to prevent the rain water infiltration when each
phase of landfill is completed. A temporary cover should be provided if rains are
expected in between and before the site is completed.
9. Waste should be buried as rapidly as possible so as to minimize the exposure to
humans or animals.

Inertization
•The process of “Inertization” involves mixing waste with cement and
other substances before disposal.
proportion of the mixture :
•65% pharmaceutical waste, 15 % lime, 15% cement and 5 % water.

The purpose of treatment of biomedical waste
To reduce or eliminate pathogens so that they no longer pose a hazard to
persons exposed to it
It changes the physical appearance of waste to make it unrecognizable so
that it is not aesthetically offensive or frightening.
It also reduces the bulk volume of waste to reduce requirements for
storage and transport.
It makes recyclable items unusable so that unauthorized reuse is
prevented.
To reduce the cost and handling time

Statewise status of common Biomedical waste
management facilities
(As per the informationprovided by the
SPCBs/PCCs for the year 2008)

• There are a number of wastes typically generated by a dental office which,
if improperly handled may pose a risk to human health and the
environment. These are:
 Mercury and silver residues from amalgam
 Lead found in lead-foil packets and lead shields
 Silver found in X-ray fixer solutions
 Chromium, used in many X-ray cleaners
 Chemical wastes, such as formaldehyde, acetones, and ketones

ADA Best Management Practices
for Amalgam Waste
• Do’s :
1. Do use precapsulated alloys and stock a variety of capsule sizes
2. Do recycle used disposable amalgam capsules
3. Do salvage, store and recycle non-contact amalgam (scrap amalgam)
4.Do salvage (contact) amalgam pieces from restorations after removal and recycle the
amalgam waste
5. Do use chair-side traps, vacuum pump filters and amalgam separators to retain amalgam and
recycle their contents.
6. Do recycle teeth that contain amalgam restorations.
7. Do manage amalgam waste through recycling as much as possible
(Note: Ask your recycler whether or not extracted teeth with amalgam restorations require
disinfection.)

ADA Best Management Practices
for Amalgam Waste
• Don’ts
1. Don’t use bulk mercury
2. Don’t put used disposable amalgam capsules in biohazard containers, infectious waste
containers (red bags) or regular garbage.
3. Don’t put non-contact amalgam waste in biohazard containers, infectious waste containers (red
bags) or regular garbage
4. Don’t put contact amalgam waste in biohazard containers, infectious waste containers (red
bags) or regular garbage
5. Don’t rinse devices containing amalgam over drains or sinks
6. Don’t dispose of extracted teeth that contain amalgam restorations in biohazard containers,
infectious waste containers (red bags), sharps container or regular garbage
7. Don’t flush amalgam waste down the drain or toilet

Never dispose of scrap amalgam in the sharps
container, red biohazard bag or the trash.

SHARPS
• Sharps waste is in the form of medical waste in
the form of devices or objects used to puncture
or lacerate the skin.
• Sharps waste is designated as biohazard and is
to be carefully handled.

SHARPS
 Contaminated sharps are capable of transmitting the disease
from injection needles, orthodontic bands,burs, scalpel blades,
sutures, instruments and broken glass.
Sterilization of sharp containers
• Use labeled and specified container
• Spore test the sterilizer.
• Label the disposable containers as to local regulations.
• Keep containers in upright position.
• Process containers for 40- 60 minutes.
• Leave containers vent open.

Handling of Sharps
• Needles should not be bend, break, or
manipulated for the avoidance of accidents in
clinic
• Protective cap holdings devices capping sheath
by scoop technique
• Size of sharp container also influence overall
efficacy of sterilization

X-RAY FIXER AND DEVELOPER
• Separate fixer and developer solutions in the
container provided by the approved waste
carrier and supplier.
• Label the container.
• Once the container is full contact appropriate
waste carrier for disposal.

CONTAMINATED LAUNDRY
• Contaminated laundry is to be placed and transported
in bags containers that are color coded or labeled with
a biohazard symbol.
• If the contaminated laundry is sent off site for
cleaning, it must be placed in bags or containers that
are color coded or labeled with a biohazard symbol,
unless the laundry uses universal precautions in
handling all soiled laundry.

• Safe and effective management of bio-
medical waste is not only a legal
necessity but also a Social
Responsibility.

• Bio-Medical Waste Management cannot
successfully be implemented without the
willingness, devotion, self-motivation,
cooperation and participation of all
sections of employees of any health care
establishment.

• If we want to protect our environment
and health of the community we must see
ourselves to this important issue not only
in the interest of health managers but also
in the interest of community.

REFERENCES
• Textbook of preventive and social medicines –
Park- Ed 21
• Text of essential of preventive and community
dentistry – Soben Peter – Ed 5
• “Infection Control & Management of
Hazardous Materials for Dental Team” Chris
H.Miller,Charles John Palenik.

REFERENCES
• http://www.moef.nic.in/downloads/public-
information/salient-features-draft-bmwmh.pdf
• http://www.mercvt.org/PDF/nwfdentalguide.p
df
• http://www.cpcb.nic.in/wast/bioimedicalwast/
CBWTF_Status_2008.pdf
• International journal of environmental science
and development, Vol 1.No3,August 2010
ISSN:2010-0264

• http://dpcc.delhigovt.nic.in/bio-medical-
waste.html
• An introduction of essentials of biomedical
waste management : Sing et al: MJAFI,Vol
57.No.2 : 2001.
• Biomedical Waste Disposal - Singh
Anantpreet, Kaur Sukhjit : Ed 1 : 2010

Biomedical waste management

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