I YR B BSC NURSING

1. BIOMEDICAL WASTE MANAGEMENT
PRESENTED BY : MRS BEMINA JA
ASSISTANT PROFESSOR
ESIC COLLEGE OF NURSING
KALABURAGI
NURSING FOUNDATION

2. INTRODUCTION
 Medical care is vital for our life, health and well being. But
the waste generated from medical activities can be
hazardous, toxic and even lethal because of their high
potential for diseases transmission.
 The hazardous and toxic parts of waste from health care
establishments comprising infectious, bio-medical and radio-
active material as well as sharps (hypodermic needles,
knives, scalpels etc.) constitute a grave risk,
 If these are not properly treated/disposed or is allowed to get
mixed with other municipal waste.
 Its propensity to encourage growth of various pathogen and
vectors and its ability to contaminate other
 Nonhazardous/non-toxic municipal waste jeopardises the
efforts undertaken for overall municipal waste management.

3.  The rag pickers and waste workers are often worst
affected, because unknowingly or unwittingly,
they rummage through all kinds of poisonous
material while trying to salvage items which they
can sell for reuse.
 At the same time, this kind of illegal and
unethical reuse can be extremely dangerous and
even fatal.
 Diseases like cholera, plague, tuberculosis,
hepatitis (especially HBV), AIDS (HIV),
diphtheria etc. in either epidemic or even endemic
form, pose grave public health risks.
 Unfortunately, in the absence of reliable and
extensive data, it is difficult to quantify the
dimension of the problem or even the extent and
variety of the risk involved.

4.  With a judicious planning and management, however,
the risk can be considerably reduced.
 Studies have shown that about three fourth of the total
waste generated in health care establishments is non-
hazardous and non-toxic. Some estimates put the
infectious waste at 15% and other hazardous waste at
5%.
 Therefore with a rigorous regime of segregation at
source, the problem can be reduced proportionately.
Similarly, with better planning and management, not
only the waste generation is reduced, but overall
expenditure on waste management can be controlled.
 Institutional/Organisational set up, training and
motivation are given great importance these days.
Proper training of health care establishment personnel
at all levels coupled with sustained motivation can
improve the situation considerably.

5.  The rules framed by the Ministry of Environment
and Forests (MoEF), Govt. of India, known as
‘Bio-medical Waste (Management and Handling)
Rules, 1998,’ notified on 20th July 1998, provides
uniform guidelines and code of practice for the
whole nation.
 It is clearly mentioned in this rule that the
‘occupier’ (a person who has control over the
concerned institution / premises) of an institution
generating bio-medical waste (e.g., hospital,
nursing home, clinic, dispensary, veterinary
institution, animal house, pathological laboratory,
blood bank etc.) shall be responsible for taking
necessary steps to ensure that such waste is
handled without any adverse effect to human
health and the environment.

10. TERMINOLOGIES
 Hospital waste: refers to all waste, biological or
non biological that is discarded and is not
intended for future use.
 Medical waste: refers to material generated as a
result of patient diagnosis, treatment,
immunization of human being 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 specimen along their container.

11. DEFINITION:
 Bio hazardous waste is that waste that is capable of producing an
infectious disease in humans and includes at a minimum blood,
body fluids, discarded sharps, inoculated culture media, tissues
and slides.
 “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, including the categories mentioned in Schedule I
appended to BMW rules 2016” -World Health Organization
 Bio-Medical Waste, means any waste, which generated during the
diagnosis, treatment or immunization of human being or animals
or in research activities and is governed by the Bio-Medical Waste
(Management and Handling) Rules, 1998.

12. Components of Bio-medical waste
 Human anatomical waste (tissues, organs, body parts etc.),
 Animal waste (as above, generated during
research/experimentation, from veterinary hospitals etc.),
 Microbiology and biotechnology waste, such as, laboratory
cultures, micro-organisms, human and animal cell cultures, toxins
etc.,
 Waste sharps, such as, hypodermic needles, syringes, scalpels,
broken glass etc.,
 Discarded medicines and cyto-toxic drugs
 Soiled waste, such as dressing, bandages, plaster casts, material
contaminated with blood etc.,
 Solid waste (disposable items like tubes, catheters etc. Excluding
sharps),
 Liquid waste generated from any of the infected areas,
 Incineration ash,
 Chemical waste.

13. BIOHAZARDOUSWASTEINCLUDESTHEFOLLOWINGCATEGORIES
 Blood and body fluids
 Infectious Sharps waste
 Laboratory waste
 Medical sharps
 Some isolation waste
 Some animal waste

16. HEALTHHAZARDSASSOCIATEDWITHPOORMANAGEMENTOFBIO-MEDICAL
WASTE
 Injury from sharps to staff and waste handlers
associated with the health care establishment.
 Hospital Acquired Infection(HAI)(Nosocomial)
of patients due to spread of infection.
 Risk of infection outside the hospital for waste
handlers/scavengers and eventually general
public.
 Occupational risk associated with hazardous
chemicals, drugs etc.
 Un authorised repackaging and sale of disposable
items and unused / date expired drugs

18. 1. Blood/Blood Products
•Serum,
•Plasma
•Other blood components
2. Body Fluids
•Semen
•Vaginal secretions
•Cerebrospinal fluid
•Pleural fluid
•Peritoneal fluid
•Pericardial fluid
•Amniotic fluid
•Any other body fluid visibly contaminated with blood
3.Does NOT Include
•Urine, unless visible blood is present
•Feces, unless visible blood is present
•Vomit, unless visible blood is present

21. SOURCES OFHEALTH CARE WASTE:
 Private hospitals
 Nursing homes
 Physician offices, clinics
 Dental clinics
 Dispensaries PHC
 Medical research and training centers
 Mortuaries
 Blood banks and collection centers
 Slaughter houses
 Vaccine centers
 Biotechnological and industrial production units

22. GROUPAT RISK
 Doctors, nurses, health care auxiliary
 Hospital maintenances personnel
 Visitors
 Laundries waste handling
 Landfills/ incinerators

23. OVERVIEWOFHEALTHCAREWASTE MANAGEMENT
 SHARPS:
Needles, infusions sets, Scalpels, knives, blades
 WASTE WITH HIGH HEAVY METAL CONTENT:
Batteries, broken thermometers, Blood pressure gauges
 PATHOLOGICAL WASTE:
Body parts, blood & other fluids
 CHEMICAL WASTE:
Lab reagents, Disinfectants, solvents
 INFECTIOUS WASTE:
Lab Cultures, waste from isolation wards, tissues, etc.
 PHARMACEUTICAL WASTE:
Expired or no longer needed pharmaceuticals.
 GENOTOXIC WASTE:
Cytotoxic drugs, geno toxic chemical.
 PRESSURIZED CONTAINERS:
Gas cylinders, Cartridges & aerosol cans.

31. HEALTH HAZARDS OF HOSPITALWASTE
 PROLIFERATION OF RODENTS
 BREEDING OF FLIES AND INSECTS
 AIR POLLUTION
 LAND POLLUTION
 WATER POLLUTION
 TRANSMISSION OF INFECTIONS LIKE
HIV, HEPATITIS-B, OTHER MICROBES
 BAD ODOUR

32. TREATMENT TECHNOLOGIES:
1. INCINERATION
 High temperature and dry oxidation process that
reduces organic and combustible waste to inorganic
and incombustible matter and results in significant
reduction in waste volume and weights
 Usually used for the waste that can not be reused,
recycled or disposed of in landfill site.
 The incinerator should be installed and made
operational as per specification under the BMW rules
1998
 Certificate may be taken from CPCB/State Pollution
Control Board
 Category 1, 2, 3, 5, and 6 can be incinerated.

33. Waste types not to be incinerated are:
 Pressurized gas containers.
 Large amount of reactive chemical wastes.
 Silver salts and photographic or radiographic
wastes.
 Halogenated plastics such as PVC.
 Waste with high mercury or cadmium content
such as broken thermometers, used batteries.
 Sealed ampoules or ampoules containing
heavy metals.

34.  Double chamber pyrolytic incinerators
 Single‐chamber furnaces
 Rotary kilns
 Double-chamber pyro lytic incinerators specially
designed to burn infectious health-care waste
 Single-chamber furnaces with static grate, used
only if pyro lytic incinerators are not affordable
 Rotary kilns operating at high temperature,
capable of causing decomposition of geno toxic
substances and heat-resistant chemicals.

38.  2. DISINFECTION
 CHEMICAL DISINFECTION
 Destruction of most of pathogens from liquids.
 By using chemical disinfectants such as
bleaching powder, glutaraldehyde, alcohols or
quaternary ammonium compounds.
 Best for treating liquid wastes such as
blood,urine,stools or hospital sewage.

39. 3. STERILIZATION
 Steam sterilization: autoclave used to disinfect waste.
 Microwave irradiation: (2450 MH3 wave length 12.24 m ) water is heated with waste and then
infectious component is destroyed by heat conduction.
 MICROWAVING
•Heat is generated inside equipment during bombardment of EM waves into the retaining molecules
of waste.
•Waste should have some water content to enhance molecular mobility.
•Highly efficient
•30-40% weight reduction.
•Minimal environmental pollution and occupational risk. •Cost effective.
WET THERMAL TREATING(AUTOCLAVE)
 The infectious wastes are steam heated at specified temperature and pressure for specific period of
time.
 Decontamination occurs when steam penetrates the waste. Autoclaves which functions within
specified range of temperature, pressure etc is used.
DRY THERMAL TREATMENT (SCREW FEED TECHNOLOGY)
 Waste is treated in a rotating auger.
 Waste is reduced by 80% in volume and 20- 30% in weight.
 Suitable for treating infectious wastes and sharps.
 Not used to process pathological, cytotoxic, or radioactive waste.

43. PLASMA TORCH TECHNOLOGY
 It consists of a flame at about 2,200 to 13,900 °C
 It takes various types of garbage and vaporizes into 4th state
of matter ,plasma (plasma pyrolysis).
 It reduces thrash that otherwise would fill up landfills.
 It can dispose bio hazardous wastes safely.
 It is extremely costly and needs a complex set up.
HYDROCLAVE
 An advanced autoclave method for treating infectious waste,
utilizing steam, but much faster and with much heat
penetration.
 It is a double walled cylindrical vessel mounted horizontally.
 The vessel is fitted with a mixing arm that rotates slowly
inside vessel.
 It totally sterilizes the waste.
 complete dehydration of waste ,reduces volume by 70%.
 Very low operating cost.

45.  LAND DISPOSAL
 Compacting: reducing size and volume of
waste (useful for general non hazardous
waste)
 Shredding: breaking the material into smaller
pieces by grinding /cutting/granulation
 Landfill: oldest method of waste disposal
 Encapsulation :filling containers with waste
adding an immobilizing material (plastic
foam/ bituminous sand/cement mortar/clay
material) and sealing containers

46. 4. LANDFILL OR LAND DISPOSAL
 Land filling means disposal of residual solid wastes on land
in a facility designed with protective measures against
pollution of ground water, surface water, air and ground.
 Open dumps: not recommended.
 Sanitary landfills: Disposing of certain types of health-care
waste (infectious waste and small quantities of
pharmaceutical waste) in sanitary landfills is acceptable.
 Sanitary landfills are specially constructed for disposal of
non biodegradable infectious hospital wastes.
 It should have an impermeable clay and pebble base.
 Stored earth for covering at the end of each disposal
operation.
 Frequent spray of insecticide is done.

51.  WORM COMPOSTING
 Biodegradable general waste from areas like
kitchen, dining places, cafeteria which mostly
contain organic wastes, peelings of vegetables
etc collected in white containers with black
stripes are disposed off.
 Rectangular pit of 1 m deep bound by brick
wall is built.
 A few 100 earthworms are introduced to earth
bed on which waste is dumped and some
water sprinkled daily.

52.  DEEP BURIAL
 Wastes belonging to category 1,3,6 collected
in yellow containers are disposed by this
method.

54.  5. INERTIZATION:
 Mixing waste with cement and other
substances before disposal.
 65% pharmaceutical work
 15% lime
 15% cement
 5% waters

58. HANDLING OF BIOHAZARDOUS WASTE
 1.GENERATION,
 2.WASTE SEGREGATION,
 3.COLLECTION
 4.TRANSPORTATION,
 5.STORAGE,
 6.END TREATMENT OR DISPOSAL

59.  Segregation of waste
 Segregation is the essence of waste
management and should be done at the source
of generation of Bio-medical waste e.g. all
patient care activity areas, diagnostic services
areas, operation theaters, labour rooms,
treatment rooms etc.
 The responsibility of segregation should be
with the generator of biomedical waste i.e.
doctors, nurses, technicians etc. (medical and
paramedical personnel).

66.  Transportation
 Within hospital, waste routes must be
designated to avoid the passage of waste
through patient care areas.
 Separate time should be earmarked for
transportation of bio-medical waste to reduce
chances of it’s mixing with general waste.
 Desiccated wheeled containers, trolleys or
carts should be used to transport the
waste/plastic bags to the site of storage/
treatment .

72. RATIONALEOFHOSPITALWASTEMANAGEMENT
 Injuries from sharps leading to infection to all categories of
hospital personnel and waste handler.
 Nosocomial infections in patients from poor infection
control practices and poor waste management.
 Risk of infection outside hospital for waste handlers and
scavengers and at time general public living in the vicinity of
hospitals.
 Risk associated with hazardous chemicals, drugs to persons
handling wastes at all levels.
 "Disposable" being repacked and sold by unscrupulous
elements without even being washed.
 Drugs which have been disposed of, being repacked and sold
off to unsuspecting buyers.
 Risk of air, water and soil pollution directly due to waste, or
due to defective incineration emissions and ash

73. PRECUTIONS TAKEN DURING BIOMEDICALWASTEMANAGEMENT
 1)Never overload bins used for storing Bio
Medical Waste
 2)General waste to be put in black container.
 3)Display the Bio-Hazardous Symbol and the
types of waste to be put in each container as
per Schedule
 4)Never transfer sharps directly from person
to person
 5)Do not inhale chemicals directly. Use
always mask

74. ROLEOFNURSEINBIOMEDICALWASTEMANAGEMENT
 REGULAR VISIT TO ALL WARDS AND HIGH RISK UNITS.
 ENSURING THAT SAMPLES (BLOOD, STOOL, URINE ETC)
ARE COLLECTED AND DISPOSE SAFELY.
 MONITORING AND SUPERVISING THE STAFF WEATHER
THEY ARE DOING SAFE DISPOSAL OF WASTE AS COLOUR
CODED.
 PREVENTION OF HOSPITAL ACQUIRED INFECTIONS BY
FOLLOWING UNIVERSAL PRECAUTIONS.
 • USE PERSONAL PROTECTIVE EQUIPMENT WHILE
HANDLING WASTE.
 • Avoid needle stick injuries.
 • Collect waste when the bin is 3/4th full.
 • Avoid using common lift to move waste.
 • Avoid spillage.
 • Clean spills with disinfectant.

75. NURSE’SROLEANDRESPONCIBILITYINBMWMANAGEMENT
 Nurses are responsible and accountable for professional behavior.
 This involves the application of the nursing process and
cooperation with other concerned authorities within the legislation
affecting the practice of nursing.
 The accountability of nurse should be in accordance with the
profession’s code of ethics and practice and within the context of
the policies of the employing agency.
 It should also comply with the customs and values of the society in
which the nursing care rendered.
 The following guidelines should be followed for effective BMW
management.
 Disinfectant the waste so that it is no longer a source of pathogenic
organisms.
 Reduce the bulk in order to reduce requirement for storage and
transportation.

76.  Make the waste un recognizable for aesthetic reasons
 Make recyclable items unusable, for example, cutting up
syringes and damage the needles.
 Recycling infectious plastic waste can be considered only
after adequate disinfection/sterilization.
 Disposal items, such as gloves, syringes, and the like, should
be mutilated after use to prevent illegal packing and reuse.
 Code coding of bags should be done as per regulation.
 Needles, syringes and other sharp instruments and objects
should be placed in a puncture–resistant plastic/ metal
container at the workstation.
 Alternatively, sharp waste may be transported to a central
site for treatment and container may be reused, but after
cleaning and disinfecting.
 50% of needle stick injuries are as a result of reheating.
Therefore, do not recap the waste.

77.  Chemical disinfectant prior to disposal is required for
sharp, disposal infectious plastic/rubber, and
infectious glassware and blood fluids by 1%
hypochlorite or equivalent disinfectant.
 Always ensure that the right concentration of the
disinfectant is used.
 Ensure that all surfaces come in contact with the
chemical. Contact time should be at least 30 minutes
 Change the chemical solution frequently, or at least
once a day.
 Always handle the waste with gloves and masks,
apron and boots must be used if splashing is expected.
 Use sharp decontaminating units made up of solid
plastic puncture-proof material on the outside and
inner perforated container with handles filled with
one third hypochlorite solution.

78. HOW TO MINIMIZE HOSPITALWASTE?
 As far as possible purchase reusable Items
made of glass and metal
 Select non-PVC plastics
 Strengthen sterilization procedures
 Adopt procedures & policy for BMW
segregation
 Establish effective & sound recycling policy
(authorized manufacturer)
 Special effort to recycle chemical waste
 Be good as gold--buy green

79. COORDINATION BETWEEN, HOSPITAL AND OUTSIDEAGENCIES
 Municipal authority
 Co-ordination with Pollution Control Boards:
 To search for cost effective and environmental
friendly technology for treatment of bio-
medical and hazardous waste
 Development of non-PVC plastics as a
substitute for plastic which is used in the
manufacture of disposable items.

80. KEY MESSAGES
 1. Adhere strictly to Bio-Medical Waste
(BMW) Management guidelines
 2. Always use protective gears
 3. Immunize yourself (HBV and TT)
 4. Never take short cuts in segregation,
collection, transportation or disposal of waste

82.  Training
 Every hospital must have well planned
awareness and training programme for all
category of personnel.
 Training should be conducted in appropriate
language/medium and in an acceptable
manner.
 All the medical professionals must be made
aware of Bio‐medical Waste (Management
and Handling) Rules 1998.

83. CONCLUSION
 Safe and effective management of waste is not
only a legal necessity but also a social
responsibility.
 Proper collection and segregation of biomedical
waste.
 Try to reduce the waste generation.
 Individual awareness and participation.
 Use recycle products.
 Label with agent, concentration and hazard
warnings.
 Communicate about workplace hazards.

84. References:
 The Environment (Protection) Act, 1986
 The Biomedical Waste (Management &
Handling) Rules, 1998
 The Municipal Solid Waste (Management &
Handling) Rules, 2000
 The Hazardous Waste (Management & Handling)
Rules, 1989
 The National Environmental Tribunal Act, 1995
 The Air (Prevention and Control of Pollution)
Act, 1981