This document provides an overview of biomedical waste management. It begins with introductions and definitions. It then discusses the historical background, classifications, risks, and rationale for proper disposal of biomedical waste. Key points of the BMWM rules in India are outlined. The document reviews generation sources and amounts of waste. It describes the steps in management including minimization, collection, segregation, storage, transportation, treatment and disposal. Common treatment and disposal techniques like incineration are also summarized. The document concludes with a discussion of dental office waste management.

1. BIO MEDICAL WASTE
MANAGEMENT
Presented by:
Dr. Rohma Yusuf
MDS
Dept. Of Public Health Dentistry

2. CONTENTS
 Introduction
 Terminologies
 Historical background
 Classification of biomedical wastes
 Risks to human health & problems associated with
BMW
 Rationale for biomedical waste disposal
 Salient features of BMWM rules 2016 (India)

3.  Generation and sources of BMW
 Steps in biomedical waste Management
 Dental office wastes management
 Conclusion
 References
3

4. INTRODUCTION
4

5. • The waste produced in the course of health care activities carries a
higher potential for infection & injury than any other type of waste.
• Inadequate & inappropriate handling of health care waste may
have serious public health consequences and it has a very
significant impact on environment.
• Appropriate management of health care waste is thus a crucial
component of environmental health protection and it should
become an integral feature of health care services.
5

6. TERMINOLOGIES
6

7. WASTE
•That which is not or cannot be used.
•An unusable or unwanted substance or material.
•Regarded or discarded as worthless or useless.
BIO-MEDICAL WASTE
•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 biologicals and
including categories mentioned in schedule I.
(Bio-medical waste – Management and Handling rules,2016, India)
7

8. Clinical waste
Any waste coming out of medical care
provided in hospitals or other health care
establishments, but does not include waste
generated at home.
Hospital waste
It refers to all waste, biological or non-
biological that is discarded and is not
intended for further use in the hospital.
8

9. Health care waste
Apart from the hospital waste, it is the
waste originating from ‘minor’ or
‘scattered’ sources- such as laboratories,
blood banks etc, and including home
care.
9
Hazardous waste
Is that which has a potential threat to
human health and life.
E.g. In hospitals, the chemicals,
cytotoxic drugs and radioactive
elements constitute the hazardous
waste.

10. Historical Background
10

11. • The provision of potable water, disposal of odour from
sewage and refuse were considered the important factors
in causing epidemics.
• The invention of water closet by John Harrington (1561-
1612) facilitated flushing away human waste and helped
to keep some dwellings clean.
• In the late 1980s, illegally disposed medical waste begins
washing ashore of the Atlantic Coast.
11

12. • The U.S. Congress passed the Medical Waste Tracking
Act of 1988 which set the standards for government
regulation of medical waste.
• After the Act expired in 1991, States were given the
responsibility to regulate and pass laws concerning the
disposal of medical waste.
• On 1st March 1996 Supreme Court of India, passed the
judgement in connection with safe disposal of hospital
waste.
12

13. • The ministry of environment and forest, Government of
India, in exercise of the powers conferred under
environment (protection) act, 1986 issued draft rules called
‘bio-medical waste (management and handling) rules, 1998.
• The rules were further amended in the year 2011, 2015 and
2016.
13

14. CLASSIFICATION OF BIO-MEDICAL WASTES
14

15. Classification By High Power Committee On
Urban Solid Waste Management In India
1.General or non hazardous waste
2.Hazardous waste
15

16. 16
1. General or non hazardous waste
• Constitutes 80-85% of the waste
• Non-risk, least infection potential
• Comparable to domestic waste
• Disposed off by municipal authorities

17. 2.Hazardous waste
•Constitute 10-15% of the waste
•Create a variety of health risks
 Sub-divided into
•Potentially infectious waste
•Potentially toxic waste
17

18. Potentially infectious waste :
• Dressings, blood and body fluids
• Lab samples, cultures
• Instruments used for diagnosis and treatment
• Needles or sharps
• Tissues, organs, placenta
• Animals used for diagnosis or research purposes
Potentially toxic waste:
• Radioactive wastes
• Chemical wastes
• Pharmaceutical wastes
18

19. 19

20. WHO CLASSIFICATION
Classified into 7 categories:
1. General waste
2. Pathological waste
3. Radioactive waste
4. Chemical waste
5. Infectious waste
6. Sharps
7. Pharmaceutical wastes
20

21. General waste
•Largely composed of domestic or household type of waste.
•Non- infectious
Eg. Kitchen waste, packaging materials, waste water from laundries
Pathological waste
•Infectious
Eg. Tissues, organs, body parts, human foetus, blood and body fluids.
Radioactive waste
•Waste contaminated with radio nuclides generated from in vitro
analysis of body tissues and fluids, in vivo body organ imaging and
tumor localization and therapeutic procedures.
21

22. Chemical waste
•Discarded chemicals from diagnostic and experimental work,
cleaning, house keeping and disinfecting procedures.
E.g. Lab reagents, film developers, disinfectants
22

23. Infectious waste
•Wastes suspected to contain pathogens
E.g. Lab cultures, waste from isolation wards, tissues, wastes from
surgeries and autopsies
Sharps
•Wastes which have the capability to injure by piercing and
cutting the skin
E.g. Needles, scalpels, blades, broken glass
Pharmaceutical wastes
•Wastes containing pharmaceutical products
E.g. Expired drugs, spilled drugs, boxes with drugs
23

24. Risks To Human Health

26. • Genotoxicity & Cytotoxicity:
• Irritating to the skin & eyes
• May have mutagenic, or carcinogenic properties
• Eg. Vomit, urine or faeces from patients treated with
radioactive materials, chemicals.
26

30. Public sensitivity:
Apart from health hazards, general public is sensitive
to visual impact of healthcare wastes.
30

31. Rationale For Bio-medical Waste Disposal
31

32. •It is a part of hospital hygiene and maintenance activities.
•To prevent threat to life and health of not only patients
and hospital staff but also to community at a larger scale.
•To protect the environment outside the hospital.
Why should the biomedical waste be disposed off
safely?
32

33. 33

34. Improper handling, treatment and disposal of waste
leads to serious problems like:
•The un-seggregated and untreated waste can convert the
non-infectious waste into infectious waste.
•Disposal of hospital waste in municipal dumpsite can cause
diseases in animals when they feed on them.
•Ineffective disinfection and sterilization during treatment
can spread infection among hospital workers and the general
public.
34

35. •Increase in incidence and prevalence of infectious diseases
like AIDS, hepatitis B and C, tuberculosis.
•Mosquitoes, flies, rats and stray dog menace.
•Risk of pollution of water, soil and air beside esthetic
problems.
35

36. SALIENT FEATURES OF BMWM RULES 2016 INDIA
36

37. 37
Salient features of BMW Management Rules, 2016
The ambit of the rules has been expanded to include
vaccination camps, blood donation camps, surgical camps
or any other healthcare activity.
Phase-out the use of chlorinated plastic bags, gloves and
blood bags within two years.
Pre-treatment of the laboratory waste,
microbiological waste, blood samples and blood bags
through disinfection or sterilisation on-site in the manner as
prescribed by WHO or NACO(National AIDS control
organisation).
Provide training to all its health care workers and
immunise all health workers regularly.

38.  Establish a Bar-Code System for bags or containers
containing bio-medical waste for disposal.
 Report major accidents
 Bio-medical waste has been classified in to 4
categories instead 10 to improve the
segregation of waste at source.
 Procedure to get authorisation simplified. Automatic
authorisation for bedded hospitals. One time
Authorisation for Non-bedded HCFs(healthcare facility).
38

39.  The new rules prescribe more stringent standards
for incinerator to reduce the emission of
pollutants in environment.
 Inclusion of emissions limits for Dioxin and furans.
 State Government to provide land for setting up
common bio-medical waste treatment and disposal
facility.
 No occupier shall establish on-site treatment and disposal
facility, if a service of `common bio-
medical waste treatment facility is available at a distance
of seventy-five kilometer.
 Operator must ensure the timely collection of bio-
medical waste from the HCFs (healthcare facility centre)
and assist the HCFs in conduct of training . 39

40. 40

41. 41
United Kingdom
In the UK, clinical waste and the way it is to be handled is closely
regulated.
Applicable legislation includes the Environmental Protection Act
1990 (Part II), Waste Management Licensing Regulations 1994, and
the Hazardous Waste Regulations (England & Wales) 2005, as well
as the Special Waste Regulations in Scotland.

42. 42
United States
In addition to on-site treatment or pickup by a biomedical waste
disposal firm for off-site treatment, a mail-back disposal option exists
in the United States.
In mail-back biomedical waste disposal, the waste is shipped through
the U.S. postal service instead of transport by private hauler but it is
limited to very strict postal regulations (i.e., collection and shipping
containers must be approved by the postal service for use) and only
available by a handful of companies.

43. 43

44. 44

45. • In the year 2015, forms VI and VII were added.
• Form VI was about, application for filing appeal against
order passed by the prescribed authority.
• Form VII was about, report of the operator of the common
bio-medical waste treatment and disposal facility on the
health care facility or health care establishment not handing
over bio-medical wastes for the dates _____ the month of
________ , the year of _______.
• In the year 2016, form V is removed which was about
(authorization for operating a facility for generation,
collection, reception, treatment, storage, transport and
disposal of biomedical wastes.)
• Form VII is also removed
45

46. GENERATION AND SOURCES OF
BIOMEDICAL WASTE 46

47. Major sources of health care waste
•Hospitals
•Nursing homes
•Dispensaries
•Laboratories
•Medical /dental colleges and research centre
•Veterinary colleges and animal research centre
•Mortuaries
•Autopsy centre
•Old age homes
47

48. Minor sources
• Physcian’s/ Dentists’ clinics
• Animal houses/ slaughter houses
• Blood donation camps
• Vaccination centre
• Acupuncturists
48

49. WHO STATISTICS
• Developed countries:
1-5 kg/bed/day
In india:
1-2 kg/bed/day with variation among government &
private establishments.
49

50. 50
MoEF & CC: ministry of enviroment and forest & climate change
TPD: tonns per day

51. 51
CBMWF: common biomedical waste treatment
facilities

52. STEPS IN BIOMEDICAL WASTE MANAGEMENT
52

53. 1.Minimize waste
2.Collection
3.Segregation
4.Storage
5.Transportation
6.Treatment
7.Disposal
53

54. Minimize waste
1. By source reduction (avoiding wastage)
2. Use of recyclables (e.g. Using sterilizable glass ware)
3. Segregation at source (Separating biomedical plastics,
glass, metal at source for autoclaving and shredding before
recycling)
4. Stock management ( replacing IV fluids, blood and drugs so
that there is no wastage due to spoilage)
54

55. COLLECTION
•Wastes should not be allowed to accumulate at the point of
production.
•Routine programme for collection has to be established.
•Collect waste daily and transport it to the central storage
site.
•Bags should not be removed unless they are labeled.
•Bags or containers should be replaced when they are three
quarter full .
•A supply of fresh collection bags should be available at the
site of production. 55

56. Segregation, packaging and labeling
Segregation is the key to minimization and effective waste
management.
•Segregation reduces the amount of waste that needs special
handling and treatment
•Effective segregation process prevents the mixture of
medical waste like sharps with the general municipal waste.
•Prevents illegal reuse of certain components of medical
waste like used syringes, needles and other plastics.
56

58. Clinical waste: recommended labeling and
color coding
COLOR CODING TYPE OF
CONTAINER
WASTE CATEGORY TREATMENT OPTIONS
YELLOW Plastic bag Human anatomical waste, animal
waste, microbiological & biotech.
waste.
Incineration / deep burial
RED Disinfected
container /
plastic bag
Microbiological & biotech waste,
disposable items other than waste
sharps, such as tubings, catheters, i.v
sets, solid waste. Solid waste (items
contaminated with blood/body fluids,
eg. Cotton, soiled dressing, etc.)
Autoclaving /
microwaving / chemical
treatment
BLUE / WHITE
TRANSULECT
Plastic bag /
puncture proof
container
Waste sharps, solid waste ( tubing's,
catheters, intravenous sets etc.)
Autoclave / microwave /
chemical treatment &
destruction / shredding
BLACK Plastic bag Discarded medicines, cytotoxic drugs,
incineration ash, chemical waste.
Disposal in secured
landfill.

59. •Provides an opportunity for recycling certain components
of medical waste like plastics after proper and thorough
disinfection.
•Of the general waste, the biodegradable waste can be
composed within the hospital premises and can be used for
gardening purposes.
•Recycling is a good environmental practice, which can
also double as a revenue generating activity.
•Reduces the cost of treatment and disposal (80 per cent of
a hospital’s waste is general waste, which does not require
special treatment, provided it is not contaminated with
other infectious waste)
59

60. LABELING
Why is labeling necessary?
•In cases of liability issues, full and correct labeling allows
the origin of waste to be traced.
•Labeling warns hospital staff and the general public of
the hazardous nature of the waste.
•Hazards posed by container contents can be quickly
identified in case of accident, enabling emergency services
to take action.
60

61. Schedule III
Label for biomedical waste containers/bags
Biohazard symbol Cytotoxic hazard symbol
61

62. Waste containers should be labeled with the following
information:
•Waste category
•Date of collection
•Place in hospital where produced (e.g. wards)
•Waste destination
62

63. STORAGE
•Is the delay between production and treatment.
•A storage location should be designated inside the health
care establishment.
•Storage time for health care waste should not be beyond
48 hours.
•Cytotoxic waste should be stored separately from other health
care waste.
63

64. TRANSPORTATION
•Transport from the areas of generation at regular
intervals.
•Designated staff should be aware of the hazards
of the material they handle.
•They should be provided with adequate personal
protective equipment.
64

66. On-Site transportation
•Wheeled trolleys, containers or carts which are not used for
any other purpose are used.
Specifications
•Easy to load and unload
•No sharp edges that could damage waste bags during
loading or unloading
•Easy to clean
66

67. Off-Site transportation
•Waste transporting organization should be registered with the
waste regulation authority.
•Vehicles used for transportation of health care waste should
not be used for any other purpose.
•The international hazard sign should be displaced on the
vehicle.
•The vehicle should be steam cleaned.
•Protective clothing, disinfectants, cleaning equipment should
be carried in a separate compartment in the vehicle.
•Waste container bags can be directly placed in the vehicle or
they can be placed within cardboard boxes or lidded plastic or
galvanized bins.
67

68. 68

69. Treatment and Disposal of Biomedical waste
69

70. TREATMENT
•May be defined as the process that changes the character
of hazardous waste to render them less hazardous or
non-hazardous.
DISPOSAL
•Is placing the biomedical waste in it’s final resting place.
70

71. Treatment and Disposal techniques
1. Incineration
2. Autoclaving/steam sterilization
3. Chemical disinfection
4. Dry thermal treatment
5. Microwave irradiation
6. Hydroclaving
7. Plasma technology
8. Inertization
9. Land disposal and deep burial
71

72. INCINERATION:
It is a high temperature dry oxidation process that reduces Organic
and combustible waste to inorganic, incombustible matter and
results in a very significant reductionOf waste volume and weight.
Types of incinerators:
1. Double chamber pyrolytic incinerators
2. Single chamber furnaces
3. Rotary kilns

73. Wastes that should not be incinerated are
Pressurized Containers: Explosion may occur and cause damage
to equipment
Halogenated Plastics (Pvc): Exhaust gases may contain toxics like
hydrogen chloride and dioxins.
Waste With High Content Of Heavy Metals: e.g. thermometers
and batteries
Waste causing emission of toxic metals (e.g. lead, cadmium and
mercury) into the atmosphere.
75

74. AUTOCLAVING/WET THERMAL TREATMENT/STEAM
STERILIZATION
Principle: Destruction of micro-organisms by steam under
pressure.
•Temperature of not less than 1210 c and pressure 15 psi and
time not less than 60 mins.
OR
•Temperature of not less than 1350 c and pressure 31 psi and
time not less than 45 mins.
74

75. Vacuum type autoclave
•Steam is generated outside the chamber loaded with
waste.
Wastes treated by autoclaving
•All infectious wastes
•Plastic disposables like blood bags and urine bags.
75

76. Advantages
•Environmentally sound.
•Low investment and operating costs.
Disadvantages
•Operation requires qualified technicians.
•Inadequate for pharmaceutical and
chemical waste and
• waste that is not readily steam permeable.
76

77. CHEMICAL DISINFECTION
Chemicals are added to wastes to kill or inactivate the
pathogens it contains.
Factors influencing the effectiveness:
•Type of disinfectant used
•Quantity and concentration
•Contact time with the waste
Chemicals commonly used for disinfection:
•Formaldehyde 6-8%
•Gluteraldehyde, Hydrogen peroxide 6-30%
•Chlorine dioxide, chlorine, hypochlorites, cholramines
77

78. Advantages
•Relatively inexpensive.
Disadvantages
•Highly qualified technicians are required
•Uses hazardous substances that require comprehensive
safety measures.
•Ineffective for pharmaceutical and chemical waste.
78

79. DRY THERMAL TREATMENT
Screw feed technology: It is the basis of a non-burn, dry
thermal disinfection process in which waste is shredded
and heated in a rotating auger.
•Reduction in 80% in volume and 25-30% by weight.
•Suitable for infectious wastes and sharps.
•Not suitable for pathological, cytotoxic and radioactive
waste.
79

80. MICROWAVE IRRADIATION
•Microwave radiation is that portion of the electromagnetic
radiation spectrum lying between the frequencies of 300 and
3,00,000 MHz.
•Microbial inactivation occurs due to thermal effect of the
radiation.
•Microwaves of a frequency penetrate materials at 97 to 100
0 c for 25 minutes.
80

81. •Suitable for treatment of most infectious waste.
•Not suitable for metal items, cytotoxic and radioactive
waste.
Advantages
•Good disinfection efficacy under appropriate operating
conditions
•Drastic reduction in waste volume
•Environmentally sound
Disadvantages
•High investment and operating cost
•Potential operation and maintenance problems
81

82. HYDROCLAVING
•Expansion of autoclave technology with some disinfection
features added.
•Steam does not actually come in contact with the waste.
•It is indirect heating by providing steam into the outer
jacket while the waste is kept inside another chamber
and turned mechanically.
82

83. PLASMA TECHNOLOGY:
•It is based on high temperature pyrolysis process/ plasma
gasification using plasma torch which allows complete
destruction of wastes.
•The process takes place at 2000-3000oc where the material
attains a plasma state during which there is total
destruction of the material.
83

84. Advantages
•It produces fewer exhaust gases, no hazardous residue and
is an environment friendly technology.
•80-85% reduction in volume and 65-70% reduction in
weight is achieved.
•Short time is required to attain the desired temperature
and reaction to take place.
84

85. INERTIZATION
•The process involves mixing waste with cement and other
substances before disposal in order to minimize the risk of
toxic substance contained in the wastes migrating into the
surface water or ground water.
•A typical proportion of the mixture is :
i. 65% pharmaceutical waste
ii. 15% lime
iii. 15% cement
iv. 5% water 85

86. •A homogenous mass is formed and cubes or pellets
are produced on site and transported to storage sites.
Advantage
Relatively inexpensive
Disadvantage
Not applicable to infectious waste
86

87. DISPOSAL OF SHARPS
•Blades and needle waste after disinfection
should be disposed in circular or rectangular pits.
•Such pits can be dug and lined with brick, or
concrete rings.
•The pit should be covered with a heavy concrete
slab, which is penetrated by a galvanized steel
pipe projecting about 1.5 m above the slab,
within internal diameter of up to 20 mm.
•When the pipe is full it can be sealed completely
after another has been prepared.
87

89. Grinding and shredding
•This is a mechanical destruction method which is used to
convert biomedical waste into more homogenous form for
easy handling.
•The waste is physically broken down into smaller particles.
Advantages
•Increases the extent of contact between waste and
disinfection by increasing the surface area.
•Renders any body parts unrecognizable and avoids any
adverse visual impact on disposal.
•Reduces the volume of the waste.
89

90. LAND DISPOSAL
The use of a land fill has to be regarded as an acceptable
disposal route when the municipal or medical authorities
genuinely lack the means to treat waste before disposal.
Two types of disposal land:
•Open dumps
•Sanitary land fills
A land fill does not provide an environment conducive to
survival of human pathogens because of :
1. High temperature
2. Oxygen depletion 90

91. •A pit of 1 cubic meter is sufficient for disposal of waste
for a period of 1 month for every 10 beds.
•When fresh waste is added to the pit, a layer of 10 cm
soil is added to cover it.
•A new pit is dug when the waste comes within 50 cm of
the ground surface.
•The pit should be impermeable, distant from any
habitation or source of water
91

92. •A pit or trench should be dug about 2 m deep. It should be
half filled with waste, and then covered with lime within 50
cm of the surface, before filling the rest of the pit with soil.
•It must be ensured that animals do not have access to burial
sites.
•Covers of galvanized iron/wire meshes may be used.
•On each occasion, when wastes are added to the pit, a layer
of 10cm of soil be added to cover the wastes.
•Burial must be performed under close and dedicated
supervision.
DEEP BURIAL
92

93. •The site should be relatively impermeable and no shallow
well should be close to the site.
•The pits should be distant from habitation, and sited so as
to ensure that no contamination occurs of any surface water
or ground water.
•The area should not be prone to flooding or erosion.
•The location of the site will be authorized by the
prescribed authority.
•The institution shall maintain a record of all pits for deep
burial.
93

94. 94
DENTAL OFFICE
WASTES MANAGEMENT

95. Dental wastes:
Any waste product generated by a
dental office, clinic or laboratory
including amalgams, saliva, rinse
water.
 They are potentially harmful to
the enviroment and require special
storage and disposal.
95

96. 96

97. 97
Dental waste
items
Does it contain
metals?( other
than sharps)
Is it a used
chemical?
Is it a biowaste?
Chromium containers
x ray system cleaners:
Dispose off as
hazardous wastes.
Lead foils and sheilds:
Action metal, BFI
Silver, fixer, scrap films:
Silver recovery system,
BFI
Mercury/ Amalgam :
Sybertech waste reduction
Ltd., BFI
Used chemiclave:
Discharge to sanitary
sewer
Disinfectants:
Discharge to sewer
Blood:
Discard as infectious
wastes, garbage
Sharps and other wastes:
Dispose as per local
bylaws
N
N
N
Y
Y
Y

98. 98

99. CONCLUSION
• The Bio-medical Waste generated from the hospitals
and all other sources should be treated without polluting
the environment.
• The new rules are elaborate, stringent and new
provisions have been added.
• New rules have definitely cleared certain ambiguity of
the previous ones but still lacks on many fronts.
99

100. LET THE WASTES OF
‘THE SICK’
NOT CONTAMINATE THE LIVES OF
‘THE HEALTHY’.
100

101. References
1. Park’s text book of preventive and social medicine. K Park 18th
edition, 2005.
2. WHO : Wastes from health-care activities: October 2000
3. A textbook of preventive and community dentistry- 4th edition,
Soben Peter
4. Bio-Medical Waste (Management & Handling) Rules, 1998
5. Bio-Medical Waste (Management & Handling) Rules, 2016
6. Hospital waste management. Dr. AG Chandorkar and Dr. BS
Nagoba : 1st edition, 2003, Paras publishing
101

102. 102
7. Dr. K. Pushpanjali, Dr. KH Shaik Hyder Ali, Dr. BK Srivastava.
Safe management of dental health care waste – a practical
approach IDA 2003, Vol. 74; 29-33.
8. Google.com

103. 103