According to biomedical waste (management and Handling 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 research activities pertaining thereto or in the production or testing of biological or in health camps. https://www.slideshare.net/SonamAggarwal7/biomedical-waste-management-and-biohazards-by-dr-sonam-aggarwal

1. Biomedical Waste
Management
Dr. Sonam Aggarwal
MD Community Medicine

2. Contents:
• Introduction
• Definition
• Sources of Biomedical Waste
• Need For Biomedical Waste Management
• Biomedical Waste Management Process
• Biomedical Waste Management Rules 2016
• Major Difference Between BMW Rules 1998 and 2016
• Situational Analysis
• e- waste and healthcare
• Conclusion
• Bibliography

4. Biomedical Waste
According to biomedical waste (management and Handling 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
research activities pertaining thereto or in the production or testing of
biological or in health camps.

5. Sources Of Biomedical Waste

6. Health Care Waste categorization

7. Biomedical Waste categorization

8. Need for biomedical waste
management
• Prevent Nosocomial infections
• Control misutilization of left over
drugs.
• Minimize the risk of air, water and
soil pollution directly due to
waste, or due to defective
incineration emissions and ash.
• Check the risk of infection outside
hospital for waste handlers and
scavengers, other peoples.

11. Biomedical Waste Management Process
1. Source Identification.
2. Segregation.
3. Collection and storage.
4. Transport.
5. Treatment and Disposal.

12. Source Identification
• Identification of source required both at -
1. At the Macro level. (Institutes that generates wastes)
2. At the Micro level. (Points and activities within the institution).

13. Segregation
• “Separation of different types of waste as per treatment and
disposal options.”
• It is the key to the active process of scientific waste management.

14. Collection and Storage
• Storage of waste refers to storage within wards or collection points
within the departments.
• Collection centers are planned between 2-3 wards.
• Central collection.
• Common Treatment Facility (CTF)
• No untreated biomedical waste shall be kept stored beyond period of
48 hours.
• If any reason it is necessary then permission of the prescribed
authority is essential.

15. Transport
• Transportation system should
be secured with special
containers and well defined route
with minimum patient influx.
• The containers should have
non-washable and prominently
visible label showing the type of
waste it contains – Cytotoxic or
Biohazrds.

16. Treatment and Disposal
• Treatment is the process
that modify the waste in
some way before it finally
disposed off.
• The main objectives of
treatment are –
- disinfection and
decontamination.
- volume reduction.

17. Incineration
• Method of choice for most
hazardous health care waste.
• High temp dry oxidation
process.
• Reduces organic and combustible
waste to inorganic and
incombustible material.
• Significant reduction in waste
volume and weight.

19. Chemical disinfection
• Most suitable for treating liquid waste such as infected blood, urine,
stools, or hospital sewage.
• Chemicals are added to waste to kill the pathogens.

20. Autoclaving
(Wet and Dry Thermal techniques)
• Autoclaving is efficient thermal
disinfection process.
• Commonly used for reusable
medical equipment's.
• Research has shown that effective
inactivation of all the micro-
organism and bacterial spores at 134
degree C temperature and 30 psi
pressure for 3 minutes holding time.

21. Microwave irradiation
• Microorganisms are destroyed
by the action of microwave at -
- a frequency of about 2450 MHz
and
- a wavelength of 12.24 nm.

22. Land disposal
• Whatever may the modality
of waste treatment, final
product has to be taken to the
land.
• Two types of methods –
• 1. Open dump.
• 2. Sanitary landfill.

23. Inertization
• Mixing of waste with cement and other substances .
• Commonly used for the pharmaceutical waste.
• A typical proportion of mixture is –
- 65 % of Pharmaceutical waste.
- 15 % lime
- 15 % cement and
- 5 % water.

24. Biomedical Waste Management Rule
• Prescribed by Ministry of Environment and Forest affairs.
• Came into force on 28th July 1998.
• 1st amendment was done on 6th march 2000.
• 2nd amendment was done on 17th September 2003.
• Recent amendment was done on 28th March 2016 and published on
Gazette of India.

25. Applicable
• to all persons who generate, collect , receive, store, transport, treat, dispose,
or handle bio medical waste in any form.
Rule is not applicable for –
• Radioactive waste
• Municipal solid waste
• E-waste
• Hazardous micro-organisms and cells
• Lead acid batteries
• Hazardous waste

26. Bio-Medical Waste Management Rules, 2016
• came into force on the date of their publication in the Official Gazette,
New Delhi i.e. on 28th March, 2016
RULES : I – XVIII
SCHEDULE : I – IV
FORMS : I - V

27. Rules
1. Short title and commencement 2. Application
3. Definitions 4. Duties of the Occupier
5. Duties of the operator of a common bio-medical waste treatment and disposal
facility 6. Duties of authorities 7. Treatment and disposal
8. Segregation, packaging, transportation and storage
9. Prescribed authority 10. Procedure for authorization
11. Advisory Committee 12. Monitoring of implementation of rules in
health care facilities
13. Annual report 14. Maintenance of records.
15. Accident reporting 16. Appeal.
17. Site for common bio-medical waste treatment and disposal Facility
18. Liability of the occupier, operator of a facility

28. Forms
1. Accident reporting
2. Application for authorization or renewal of authorization
3. Authorization
4. Annual report
5. Application for filing appeal against order passed by the prescribed
authority

29. Schedules
1. Biomedical wastes categories and their segregation, collection ,
treatment, processing and disposal options.
2. Standards for treatment and disposal of bio-medical wastes.
3. List of prescribed authorities and the corresponding duties.
4. Label for bio-medical waste containers or bags & label for
transporting bio-medical waste bags or containers.

33. Part -2 (Schedule-I)
1. All plastic bags shall be as per BIS standards as and when published,
till then the prevailing Plastic Waste Management Rules shall be
applicable.
2. Chemical treatment using at least 10% Sodium Hypochlorite having
30% residual chlorine for twenty minutes.
3. Mutilation or shredding must be to an extent to prevent unauthorized
reuse.
4. There will be no chemical pretreatment before incineration, except for
microbiological, lab and highly infectious waste.

34. 5. Incineration ash (ash from incineration of any bio-medical waste) shall be
disposed through hazardous waste treatment, storage and disposal facility,
if toxic or hazardous constituents are present beyond the prescribed limits as
given in the Hazardous Waste (Management, Handling and Tran boundary
Movement) Rules, 2008 or as revised from time to time.
6. Dead Fetus below the viability period (as per the Medical Termination of
Pregnancy Act 1971, amended from time to time)- human anatomical waste
- handed over to the operator of common bio-medical waste treatment and
disposal facility in Yellow bag with a copy of the official Medical
Termination of Pregnancy certificate from the Obstetrician or the Medical
Superintendent of hospital or healthcare establishment.

35. 7. Cytotoxic drug vials shall not be handed over to unauthorized person
under any circumstances- sent back to the manufactures for necessary
disposal at a single point or can be sent for incineration at common bio-
medical waste treatment and disposal facility or plasma pyrolysis is at
temperature >1200 0C.
8. Residual or discarded chemical wastes, used or discarded
disinfectants and chemical sludge can be disposed at hazardous waste
treatment, storage and disposal facility.

36. 9. On-site pre-treatment of laboratory waste, microbiological waste,
blood samples, blood bags should be disinfected or sterilized as per the
Guidelines of World Health Organization or National AIDS Control
Organization and then given to the common bio-medical waste
treatment and disposal facility.
10 .Installation of in-house incinerator is not allowed.

37. 11. Syringes should be either mutilated or needles should be cut and or
stored in tamper proof, leak proof and puncture proof containers for
sharps storage.
12. Bio-medical waste generated in households during healthcare
activities shall be segregated as per these rules and handed over in
separate bags or containers to municipal waste collectors.

38. Schedule-II- Standards for treatment and
disposal of BMW
Standards
a. for incinerators
b. for autoclaving
c. for microwaving
d. for deep burial
e. for efficacy of chemical disinfection
f. for dry heat stabilization.
g. for liquid waste

39. Schedule III-Lists of prescribing authorities
and their corresponding duties
• Ministry of Environment ,forest and climatic change, Govt of India
• State ministry/central ministry of Health and Family welfare, Animal
husbandry and Veterinary
• Ministry of Defence
• Central Pollution control board
• State Government of Health or Union Territory Government or
Administration
• State Pollution Control Boards or Pollution Control Committees
• Municipalities or Corporations, Urban Local Bodies and Gram
Panchayats

46. Situational analysis
As per annual report (2019) by Haryana State Pollution Control Board,
Total BMW generated in Haryana -14810 Kg/ day
Total CBWTF in Haryana -11
Total CBWTF under construction in Haryana- 0

47. • In SHKM GMC, Nuh, total BMW generated per day- 300 Kg
• At GH, Mandikheda BMW 2016 guidelines are being followed.
• CBWTF in district Nuh- Nil
• BMW generated in the district is being disposed/ treated through
CBWTF in Faridabad i.e. M/S Golden Eagle Waste Management.

48. e-waste and healthcare

50. Conclusion
• We need innovative and radical measures to clean up the distressing
picture of lack of civic concern on the part of hospitals and slackness in
government implementation of bare minimum of rules, as waste
generation particularly biomedical waste imposes increasing direct and
indirect costs on society.
• The challenge before us is to scientifically manage growing quantities
of biomedical waste that go beyond past practices.
• Municipality and government should pay importance to disposal of
waste economically.
• Thus educating and motivating oneself first is important and then
preach others about it.

51. Bibliography
1. Park K. Preventive and Social Medicine. 25th Edition. India: M/s
Banarsidas Bhanot Publishers; 2019.
2. Haryana State Pollution Control Board. Annual Report Biomedical
Waste 2019.
3. Biomedical Waste Management Rules, 2016.
4. Central Pollution Control Board, India. Available from: cpcb.nic.in

52. Thank you…
LET THE WASTE OF THE “SICK” NOT
CONTAMINATE THE LIVES OF
“THE HEALTHY”