types of biomedical waste, segregation, classification, sources, hazards and treatment like incineration, inertization, chemical treatment, biomedical waste rule

1. Bio-Medical Waste Management

2. • The waste produced in the course of health-care
activities carries a higher potential for infection and
injury than any other type of waste. Therefore, it is
essential to have safe and reliable method for its
handling.
• Inadequate and inappropriate handling of health-care
waste may have serious public health consequences
and a significant impact on the 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.

3. Definition
• According to Bio-Medical 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
in research activities pertaining thereto or in
the production or testing of biologicals, and
including categories as mentioned in schedule
I in Table 4 (1).

5. • Between 75 to 90 per cent of the waste produced by
the health-care providers is non-risk or “general”
health-care waste, comparable to domestic waste.
• It comes mostly from administrative and house keeping
functions of the health- care establishments, and may
also include waste generated during maintenance of
health-care premises.
• The remaining 10—25 per cent health-care waste is
regarded as hazardous and may create a variety of
health risk.
• The classification of health-care waste is summarized in
Table 1.

6. Sources of health-care waste
• The institutions involved in generation of bio-medical waste are:
• — Government hospitals.
• — Private hospitals.
• Nursing homes.
• Physician’s office/clinics.
• Dentist’s office/clinics.
• Dispensaries.
• Primary health centres.
• — Medical research and training establishments.
• — Mortuaries.
• — Blood banks and collection centres.
• — Animal houses.
• — Slaughter houses.
• Laboratories.
• Research organizations.
• Vaccinating centres, and
• Bio-technology institutions/production units.
• All these health-care establishments generate waste and are therefore, covered under Bio-Medical
Waste (BMW) Rules .

7. Health-care waste generation
• Several surveys have provided an indication of
typical health-care waste generation, and it
shows that this differs not only from country to
country but also within the country.
• Waste generation depends on numerous factors
such as established waste management methods,
type of health-care establishment, hospital
specializations, proportion of reusable items
employed in health-care, and proportion of
patients treated on a day-care basis.

8. • In middle and low income countries health-
care waste generated is lower than in high-
income countries.
• Developing countries that have not performed
their own surveys of health-care waste, find
the following estimates for an average
distribution of health-care wastes useful for
preliminary planning of waste management.

9. • 80 per cent general health-care waste, which may
be dealt with by the normal domestic, and urban
waste management system;
• — 15 per cent pathological and infectious waste;
• — 1 per cent sharps waste;
• — 3 per cent chemical and pharmacological
waste;
• — Less than 1 per cent special waste, such as
radioactive or cytotoxic waste, pressurized
containers, or broken thermometers and used
batteries.

10. • Table 2 shows average composition of waste
obtained from 10 large hospitals in Mumbai,
Kolkata, Delhi, and Nagpur during the period
1993—1996.

12. • A survey done in Bangalore revealed that the quantity
of solid wastes generated in hospitals and nursing
homes generally varies from 1/2 to 4 kg per bed per
day in Govt. hospitals, 1/2 to 2 kg per bed per day in
private hospitals, and 1/2 to 1 kg per bed per day in
nursing homes.
• The total quantity of hospital wastes generated in
Bangalore is about 40 tonnes per day.
• Out of this nearly 45 to 50 per cent is infectious.
• Segregation of infectious wastes from non- infectious
wastes is done only in about 30 per cent of hospitals.

13. Health hazards of health-care waste
• Exposure to hazardous health-care waste can
result in disease or injury due to one or more of
the following characteristics
• (a) it contains infectious agents;
• (b) it contains toxic or hazardous chemicals or
pharmaceuticals;
• (c) it contains sharps;
• (d) it is genotoxic; and
• (e) it is radio-active.

14. • All individuals exposed to such hazardous health-care waste
are potentially at risk, including those who generate the
waste or those who either handle such waste or are exposed
to it as a consequence of careless management.
• The main groups at risk are
• — medical doctors, nurses, health-care auxilliaries, and
hospital maintenance personnel;
• patients in health-care establishments;
• — visitors to health-care establishments;
• — workers in support service allied to health-care
establishments such as laundries, waste handling and
transportation; and
• — workers in waste disposal facilities such as land-fills or
incinerators including scavengers.

15. 1. Hazards from infectious waste arid
sharps
• Pathogens in infectious waste may enter the
human body through a puncture, abrasion or cut
in the skin, through mucous membranes by
inhalation or by ingestion.
• There is particular concern about infection with
HIV and hepatitis virus B and C, for which there is
a strong evidence of transmission vo health-care
waste.
• Bacterias resistant to antibiotics and chemical
disinfectants, may also contribute to the hazards
created by poorly managed waste.

16. 2. Hazards from chemical and
pharmaceutical waste
• Many of the chemicals and pharmaceuticals used in
health-care establishments are toxic, genotoxic,
corrosive, flammable, reactive, explosive or shock-
sensitive.
• Although present in small quantity they may cause
intoxication, either by acute or chronic exposure, and
injuries, including burns.
• Disinfectants are particularly important members of
this group.
• They are used in large quantities and are often
corrosive, reactive chemicals may form highly toxic
secondary compounds.

17. 3. Hazards from genotoxic waste
• The severity of the hazards for health-care worker
responsible for handling or disposal of genotoxic
waste is governed by a combination of the
substance toxicity itself and the extent and
duration of exposure.
• Exposure may also occur during the preparation
of or treatment with particular drug or chemical.
• The main pathway of exposure is inhalation of
dust or aerosols, absorption through the skin,
ingestion of food accidentally contaminated with
cytotoxic drugs, chemicals or wastes etc.

18. 4. Hazards from radio-active waste
• The type of disease caused by radio-active
waste is determined by the type and extent of
exposure. It can range from headache,
dizziness and vomiting to much more serious
problems. Because it is genotoxic, it may also
affect genetic material.

19. 5. Public sensitivity
• Apart from health hazards, the general public
is very sensitive to visual impact of health-care
waste particularly anatomical waste.

20. Treatment and disposal technologies
for health- care waste
• Incineration, used to be the method of choice
for most hazardous health-care wastes, and is
still widely used.
• However, recently developed alternative
treatment methods are becoming increasingly
popular.
• The final choice of treatment should be made
on the basis of factors, many of which depend
on local conditions.

21. 1. Incineration
• Incineration is a high temperature dry oxidation
process, that reduces organic and combustible
waste to inorganic incombustible matter and
results in a very significant reduction of waste-
volume and weight. The process is usually
selected to treat wastes that cannot be recycled,
reused or disposed off in a land fill site.
• The flow diagram of incinerator is as shown in
Fig. 1.

23. • Incineration requires no pre-treatment, provided that
certain waste types are not included in the matter to be
incinerated.
• Characteristics of the waste suitable for incineration are
• (a) low heating volume — above 2,000 kcal/kg for
single—chamber incinerators, and
• Above 3,500 kcal/kg for pryolytic double-chamber
incinerators;
• (b) content of combustible matter above 60 per cent;
• (c) content of non-combustible solids below 5 per cent;
• (d) content of non-combustible fines below 20 per cent;
and
• (e) moisture content below 30 per cent .

24. • Waste types not to be incinerated are
• (a) pressurized gas containers;
• (b) large amount of reactive chemical wastes;
• (c) silver salts and photographic or radiographic wastes;
• (d) Halogenated plastics such as PVC;
• (e) waste with high mercury or cadmium content, such
as broken thermometers, used batteries, and lead-
lined wooden panels; and
• (f) sealed ampules or ampules containing heavy
metals.

25. • TYPES OF INCINERATORS
• Incinerators can range from very basic
combustion unit that operates at much lower
temperature to extremely sophisticated, high
temperature operating plants. It should be
carefully chosen on the basis of the available
resources, the local situation, and the risk-
benefit consideration.

26. • Three basic kinds of incineration technology are
of interest for treating health-care waste
• (a) Double-chamber pyrolytic incinerators which
may be especially designed to burn infectious
health-care waste;
• (b) Single-chamber furnaces with static grate,
which should be used only if pyrolytic
incinerators are not affordable; and
• (c) Rotary kilns operating at high temperatures,
capable of causing decomposition of genotoxic
substances and heat-resistant chemicals.

27. II. Chemical disinfection
• Chemicals are added to waste to kill or inactivate
the pathogens it contains, this treatment usually
results in disinfection rather than sterilization.
• Chemical disinfection is most suitable for treating
liquid waste such as blood, urine, stools or
hospital sewage.
• However, solid wastes including microbiological
cultures, sharps etc. may also be disinfected
chemically with certain limitations.

28. Ill. Wet and dry thermal treatment
• WET THERMAL TREATMENT: Wet thermal
treatment or steam disinfection is based on
exposure of shredded infectious waste to high
temperature, high pressure steam, and is
similar to the autoclave sterilization process.
• The process is inappropriate for the treatment
of anatomical waste and animal carcassess,
and will not efficiently treat chemical and
pharmaceutical waste.

29. • SCREW-FEED TECHNOLOGY: Screw-feed
technology is the basis of a non—burn, dry
thermal disinfection process in which waste is
shredded and heated in a rotating auger.
• The waste is reduced by 80 per cent in volume
and by 20—35 per cent in weight.
• This process is suitable for treating infectious
waste and sharps, but it should not be used to
process pathological, cytotoxic or radio-active
waste.

30. IV. Microwave irradiation
• Most microorganisms are destroyed by the action
of microwave of a frequency of about 2450 MHz
and a wave length of 12.24 nm.
• The water contained within the waste is rapidly
heated by the microwaves and the infectious
components are destroyed by heat conduction.
• The efficiency of the microwave disinfection
should be checked routinely through
bacteriological and virological tests.

31. V. Land disposal
• MUNICIPAL DISPOSAL SITES: If a municipality or
medical authority genuinely lacks the means to
treat waste before disposal, the use of a landfill
has to be regarded as an acceptable disposal
route.
• There are two types of disposal land—open
dumps and sanitary landfills.
• Health-care waste should not be deposited on or
around open dumps.
• The risk of either people or animals coming into
contact with infectious pathogens is obvious.

32. • Sanitary landfills are designed to have at least
four advantages over open dumps
• geological isolation of waste from the
environment,
• appropriate engineering preparation before
the site is ready to accept waste,
• staff present on site to control operations, and
• organized deposit and daily coverage of
waste.

33. VI. Inertization
• The process of “inertization” involves mixing
waste with cement and other substances before
disposal, in order to minimize the risk of toxic
substances contained in the wastes migrating into
the surface water or ground water.
• A typical proportion of the mixture is: 65 per
cent pharmaceutical waste, 15 per cent lime, 15
per cent cement and 5 per cent water.
• A homogeneous mass is formed and cubes or
pellets are produced on site and then transported
to suitable storage sites.

35. • National legislation is the basis for improving
health-care waste disposal practices in any
country.
• It establishes legal control, and permits the
national agency responsible for the disposal of
health-care waste, usually the Ministry of Health,
to apply pressure for their implementation.
• The Ministry of Environment may also be
involved.
• There should be a clear designation of
responsibilities before the law is enacted.

36. • The United Nations Conference on the
Environment and Development (UNCED) in 1992
recommended the following measures
• (a) Prevent and minimize waste production
• (b) Reuse or recycle the waste to the extent
possible
• (c) Treat waste by safe and environmentally
sound methods, and
• (d) Dispose off the final residue by landfill in
confined and carefully designed sites.

37. Bio-Medical Waste Management in
India
• Bio-Medical Waste (Management and Handling)
Rule 1998, prescribed by the Ministry of
Environment and Forests, Government of India,
came into force on 28th July 1998.
• This rule applies to those who generate, collect,
receive, store, dispose, treat or handle bio-
medical waste in any manner.
• Table 4 shows the categories of bio-medical
waste, types of waste and treatment and disposal
options under Rule 1998.

39. • The bio-medical waste should be segregated
into containers/bags at the point of
generation of the waste.
• The colour coding and the type of containers
used for disposal of waste are as shown in
Table 5.
• Fig. 2 shows the label for bio-hazards symbol
and cytotoxic hazard symbol which should be
prominently visible and non-washable.

42. Bio-Medical Waste Management
Rules 2016
• Biomedical waste comprises human & animal
anatomical waste, treatment apparatus like needles,
syringes and other materials used in health care
facilities in the process of treatment and research.
• This waste is generated during diagnosis, treatment or
immunisation in hospitals, nursing homes, pathological
laboratories, blood bank, etc.
• Total bio-medical waste generation in the country is
484 TPD from 1,68,869 healthcare facilities (HCF), out
of which 447 TPD is treated

43. • Scientific disposal of Biomedical Waste through segregation,
collection and treatment in an environmentally sound manner
minimises the adverse impact on health workers and on the
environment.
• The hospitals are required to put in place the mechanisms for
effective disposal either directly or through common biomedical
waste treatment and disposal facilities.
• The hospitals servicing 1000 patients or more per month are
required to obtain authorisation and segregate biomedical waste in
to 10 categories, pack five colour bacgs for disposal.
• There are 198 common bio-medical waste treatment facilities
(CBMWF) in operation and 28 are under construction.
• 21,870 HCFs have their own treatment facilities and 1,31,837 HCFs
are using the CBMWFs.

44. • The quantum of waste generated in India is estimated to
be 1-2 kg per bed per day in a hospital and 600 gm per day
per bed in a clinic.
• 85% of the hospital waste is non-hazardous,
• 15% is infectious/hazardous.
• Mixing of hazardous results in to contamination and
makes the entire waste hazardous.
• Hence there is necessity to segregate and treat.
• Improper disposal increases :
• risk of infection;
• encourages recycling of prohibited disposables and
disposed drugs; and
• develops resistant microorganisms.

45. 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;
• Provide training to all its health care workers and
immunise all health workers regularly;

46. • Establish a Bar-Code System for bags or containers containing
bio-medical waste for disposal;
• Report major accidents;
• Existing incinerators to achieve the standards for retention
time in secondary chamber and Dioxin and Furans within two
years;
• 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.
• The validity of authorization synchronised with validity of
consent orders for Bedded HCFs.
• One time Authorisation for Non-bedded HCFs;

47. • 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;

48. • 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 of a common bio-medical waste
treatment and disposal facility to ensure the
timely collection of bio-medical waste from the
HCFs and assist the HCFs in conduct of training .