A very important topic: we have done some innovations also. Just a sharing of experience.

1. BIOMEDICAL WASTE
MANAGEMENT
by
Dr D.S.Chandel
Ex-Director Health
Services
SHIMLA (H.P.)
INDIA

2. GIVE A THOUGHT !
WHY WE NEED
PROPER BIOMEDICAL
WASTE
MANAGEMENT?

4. Proper BMWM:Our neccesity!
Safety from occupational hazardsSafety from occupational hazards

5. Definitions:
 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. ENVIRONMENT PROTECTION ACT
1986
 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. Major difference between BMW rules
1998/2016 (1)
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.

8. Difference 1998/2016 (2)
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)

9. Difference 1998/2016 (3)
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
10 % chlorine. No calcium
hypochlorite.

10. Difference 1998/2016 (4)
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. AUTHORIZATION
 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. AUTHORIZED PERSON
 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. What is BIOMEDICAL
WASTE?
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. General waste
•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. Common BMW treatment &
disposal facility:
CBWTF means any facility
wherein
treatment/disposal of bio-
medical waste or
processes, incidental to
such treatment or
disposal is carried out.

16. DEFINITIONS CONTD.
 “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. DUTIES OF OCCUPIER
 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. DUTIES OF OCCUPIER
 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.

19. DUTIES OF OCCUPIER
 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. DUTIES OF OCCUPIER
contd.
 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. Prescribed authority
 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. Procedure Contd. Non-
bedded HI
 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. Procedure contd.
Can be cancelled/suspended
at any time giving reasons in
writing, after giving
opportunity.
Refusal after giving proper
hearing and reasons in
writing.

24. APPEAL
 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 form V.

25. Maintenance of record
 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. ACCIDENT REPORTING
 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. Types of accidents in r/o
BMWM
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,

28. Protocol of needle stick
injury
Let it bleed, don’t squeeze.Let it bleed, don’t squeeze.

29. Protocol for splash into eyes/
open wound/ mouth
Rinse eyes with water/saline several timRinse eyes with water/saline several tim

30. Response to exposure or
Accident reporting
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. Post exposure prophylactic treatment
(PEPT)
 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. Exposure to Hepatitis
virus
 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. Procedures commonly associated with
needle prick injury
28%
25%14%
11%
11%
11% Injections
Venepunture
Suturing
Manipulating IV
inj. Port
Inserting IV
catheter
Other medical
procedures

34. NOT RECOMMENDED! Why?-
2 reasons

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

36. Punishment
 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: except
kitchen? & office:
SOURCE
S OF
BMW
INDOOR L.ROOM & OT
OUTDOO
R
CASUALIT
Y
MINOT OT/ PLASTER
ROOM
INJ. / DRESSING
ROOM
MCH
MEDICINE
STORE
LABORATORY
RADIOLOGY
BLOOD BANK

38. Nature of hazards?
Injuries due to sharps to staffInjuries due to sharps to staff

39. PERSONS AT RISK
Hospital clinical staffHospital clinical staff

40. HAZARDS TO ANIMALS
VULTURESVULTURES

41. HAZARDS TO PUBLIC
RAG PICKERSRAG PICKERS

42. HAZARD TO
ENVIRONMENT
OZONE LAYEROZONE LAYER

43. Categorization: Schedule I.
Category Yellow
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. Yellow category
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. Category Yellow
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. Category Red
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. Category White
translucent:
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. Category Blue
•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. Green (general waste)
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. IMPORTANT DIRECTIONS
 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. IMPORTANT DIRECTIONS
 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. Disposal: Yellow
category
•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. Disposal: Yellow
category
 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. Disposal: Category red
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. Use of plastic in
hospitals
 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. RECYCLING OF PLASTIC
WASTE
Movement of liquid vapors into the
condenser
Tapping of liquid fuel (as a
product)
COLLECTION & SEGREGATION OF PLASTIC
WASTE
SHREDDING OF WASTE
STORING OF PLASTIC WASTE
Tapping of vessel tarry
waste
FEEDING INTO HOPPER
Flow of waste into heating vessel in the presence
of catalyst

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

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

59. INCINERATION ASH
Disposal in secured
landfill.

60. General waste-green
oDisposal through
municipality by
recycling/
decomposition in
secured land fills.

61. Schedule I
Red
Whit
e
Blue
Yello
w
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. Radiological waste:
hazardous
 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. BIOMEDICAL WASTE

65. How to minimize?
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. HOW TO MINIMIZE?
REDUCE

67. HOW TO REDUCE?
 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. How to reduce?
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. Indications of injections:
Patient is..
Nil orally
Unable to
retain orally
Unable
to take
orally
Unable
to
absorb
No oral
preparati
on of
drug
Doubtful
compliance
Child/psychiat
ric
Semi/unconscio
us-oral feeding
not possible
Acute severe
pain/high
conc. Of drug
required

70. REUSE
 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. RECYCLE
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. Universal precautions:
(1)
 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. Universal precautions
(2)
 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. Universal precautions:
(3)
 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. Universal precautions:
(4)
 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. Supplies: (1): PPE’S:
General
• Caps,
• Mask,
• Gowns,
• Goggles,
• Gum boots,
• Gloves (surgeons),
Rubber aprons
• Heavy duty gloves (PVC gloves lined with cloth) for
sweepers.

77. Supplies (2) PPE’S: Radiology
deptt.
 Gloves,
 Thyroid shield,
 Gonad shield,
 Abdominal shield,
 Lead apron,
 Lead screen,
 Lead lining of the room &
 TLD badges.

78. Supplies: (4):Material
 Bins: Hard plastic bins with lids/with
foot- operated lids. Colour coded
bins: Yellow, blue, red, green, white
translucent puncture proof
containers.

79. SUPPLIES (5) Other
supplies
 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. Supplies: Polythene
bags (6)
 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. Supplies: Injection
Trolley (7)
 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. Supplies contd. (9)
Chemicals
 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. BMW FLOW CHART
GENERATO
R
(HOSPITAL)
IN HOUSE
SEGREGATION IN
COLOR CODED BINS
WASTE WATER TO
ETP TRANSPORTATION
(IN APPROVED
VEHILCE)
BMW STORE
RE-USE
DISPOSAL
(RECYCLING/LANDFILL)
UNLOADING &
TEMPORARY
STORAGE IN CBWTF
STORE
TREATMENT
AUTOCLAVING,
SHREDDING,
INCINERATION

84. “7 steps” in BMWM
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
Transportatio
n & Final
disposal

85. 1. SEGREGATION
 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. Shredding: Functional
syringe cutters
 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. 2. Pretreatment:
Decontamination
 (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. Sodium hypochlorite
solution:
 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. Spill management
(large;>10cm)
 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. Spill management
(large;>10cm)
 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. Management of Small spills
(<10cm)
 Can be decontaminated
with 10% hypochlorite
solution for 20 minutes,
followed by wiping it with
paper and disposing it in
yellow bin.

92. Decontamination of sputum
cups
 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
 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. Decontamination of pipettes:
not in use now. If yes…stop it.
 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. Autoclaving
 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. Microwaving
Cytotoxic, hazardous and
radioactive waste, animal
carcasses and body parts and
large metal items should not
be disinfected by this
method.

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

98. HANDLING OF MERCURY
 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

99. How it enters in the food
chain?

100. HANDLING OF MERCURY
 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. HANDLING OF MERCURY
 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. HANDLING OF MERCURY
 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

103. HANDLING OF MERCURY
 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. Handling of chemicals
 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. Use & Disposal of
Gluteraldehyde
 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. Disposal of
Gluteraldehyde
 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. Uses of Gluteraldeyde
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. Chemical properties
 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. SOME DO’D & DON’T’S
 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. DISPOSAL:CHEMICAL
DEACTIVATION
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. Ortho-phthalaldehyde:
Cidex OPA
Available in 0.55% concentration.
No activation is required. Less time required
for disinfection. Less harmful.
HLD Time 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. 3. Collection (1)
 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. Collection (2)
 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. 4.TRANSPORTATION
(within)
 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. Supplies: Cart/trolleys
(8)
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. 5. STORAGE: Room
designs
 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. STORE DESIGN CONTD.
 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.

121. s

122. 6.EFFLUENT TREATMENT
PLANT

123. 7.Transportation to the
CBWTF
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. DISPOSAL by DEEP BURIAL (1)
 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.

125. Incinerator :diagramatic

126. Incinerator: diagramatic

127. Parameters of
permissible limits
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. DISPOSAL by INCINERATION
(2)
 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. Incineration contd.
 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. Incineration contd.
 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. Outsourcing of
incineration
 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. Handling of IV Cannulae/Ryle’s
tubes
 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. BMW not to be
incinerated
 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. CONSTRUCTION OF PITS
 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. Design of steel structure
 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. CONTRACT WITH
OPERATOR
 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

140. CONTRACT WITH
OPERATOR
 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. Supervision
 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. Supervision contd.
 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. Handling of BMW in
Field camps
 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. Health &Safety practices for
BMWM
 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

145. Staff trainings and re-
trainings
 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………..?
 Staff training is a never ending
process.
 It is a Continuous Education.

147. Staff Trainings and re-trainings:
Objectives:
 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. Awareness of community:
Objectives:
 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. Monitoring& Evaluation
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. Responsibility?
 You are not only protecting yourself,
but also those around you.

151. Innovations
 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. Innovations
 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. FORMS
 Form I: Accident reporting
 Form II: Application for registration.
 Form III: Authorization by PA.
 Form IV: Annual report by occupier.
 Form V: Application for filing appeal.

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

157. Only after the…….
 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.