Comprehensive Biomedical Waste Management in Healthcare Settings

BIOMEDICAL WASTE
MANAGEMENT
Moderator: Dr. PRAGYA PATHAK
AP, CON, AIIMS
Presenter: KAVITA YADAV
M.Sc. Nursing 2ND
Year

INTRODUCTION
 The last century witnessed the rapid mushrooming of
hospitals dictated by the need of the expanding
population, and the advent and acceptance of
“disposable” has made the generation of hospital
waste a significant factor in biomedical waste
management.
 Safe disposal of waste is very difficult
 The need of proper hospital waste management
system is of prime importance and is an essential
component of quality assurance.

Waste characteristics
About 10-15% of health care waste is
infected waste.
 Mixing of infected waste with household waste should
not be allowed.
Waste quantity
Depends on type of health care setting & services
offered.
 Estimated waste generated in Indian hospitals
is 1.59-2.2 kg/bed/day.

DEFINITION
 Biomedical waste means 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.
(Biomedical Waste Management and Handling Rules1998, India)
 Biomedical waste management is sorting of medical
waste in hospital.

PURPOSES OF WASTE
MANAGEMENT SYSTEM
 To reduce hazardous nature of waste
 To reduce volume of waste
 To prevent misuse or abuse of waste
 To ensure occupational safety and health
 To consider aesthetics
 To reuse items that can be of repeat utility

PURPOSES CONTD…
 To recycle waste where possible for another
utility item
 Maintain order and cleanliness in hospital
 Maintain healthy environment
 Prevent spread of infectious diseases
 Project good impression of management
 Attract more clientele

SOURCES-HEALTH CARE WASTE
 Government and Private hospitals
 Nursing homes
 Physician’s office/clinics
 Dispensaries
 Primary Health Centres
 Medical research and training establishments
 Mortuaries

CLASSIFICATION OF
HEALTHCARE WASTE
 Bio Medical Waste [ 10%]
 General Waste[85%]
 Other Wastes[10%]

📘 Schedule I – Waste categories and disposal methods
📘 Schedule II – Standards for treatment and disposal
📘 Schedule III – Labeling and color-coding norms
📘 Schedule IV – Bar-coding of bags and containers
📘 Schedule V – Liquid waste treatment standards
📘 Schedule VI – Incinerator standards
📘 Schedule VII – Duties of occupier, operator & authorities
📘 Schedule VIII – Accident reporting & record maintenance formats
SCHEDULE OF BIOMEDICAL WASTE
MANAGEMENT

2.General Waste
 General waste consists of all the waste other than
bio-medical waste and which has not been in
contact with any hazardous or infectious, chemical
or biological secretions and does not includes any
waste sharps.

GENERAL WASTE INCLUDES -
 News paper, paper and card boxes (dry
waste)
 Plastic water bottles (dry waste)
 Aluminum cans of soft drinks (dry waste)
 Packaging materials (dry waste)
 Food Containers after emptying residual food
(dry waste)
 Organic / Bio-degradable waste - mostly food
waste (wet waste)

3. OTHER WASTES
 Used electronic wastes
 Used batteries
 Radio-active wastes which are not covered under
biomedical wastes

CLASSIFICATION OF
BIOMEDICAL WASTE
INFECTIOUS WASTE:
Suspected to contain pathogens.
E.g. lab cultures, wastes from isolation wards, tissues,
materials, equipment that have been in contact with
infected patients, excreta.

SHARPS:
E.g. needles, infusion sets, scalpels, knives, blades,
broken glass.

 GENOTOXIC WASTE:
Substances with genotoxic properties,
wastes containing cytotoxic drugs,
genotoxic chemicals.

PATHOLOGICAL WASTE:
Human tissues or fluids. E.g. body
parts blood and other body fluids.

PHARMACEUTICAL WASTE:
E.g.-pharmaceuticals that are expired or
no longer needed. Items contaminated
by or containing pharmaceuticals.

CHEMICAL WASTE:
Containing chemical waste E.g. lab
reagents, film developers, disinfectants
that are expired, no longer needed
solvents

WASTES WITH HIGH CONTENT OF
SOLVENTS:
Batteries, broken thermometers, BP
gauges, etc.

RADIOACTIVE WASTE CONTAINING
RADIOACTIVE SUBSTANCES :
Unused liquids from radiotherapy Lab, research
contaminated glassware, packages and
absorbent paper, patients tested or treated.

LEGISLATIVE FRAMEWORK
Basic principles
Segregation of waste at the health facility level.
 Processing and storage for terminal disposal.
Bio-medical waste shall not be mixed with other
wastes.
Bio-medical waste shall be segregated into
containers/ bags at the point of generation in
accordance with BMW Rules 1998 prior to its storage,
transportation, treatment and disposal.

BASIC PRINCIPLES
 Color coding to support segregation at source
 Untreated bio-medical waste not to be stored beyond a period of
48 hours.
 Transport waste safely to pick up site.
 Identify destination for each type of waste and ensure safe
disposal.
 Every authorised person shall maintain records related to any
form of handling of biomedical waste.

INDIAN LEGISLATIONS
 The Environment Protection Act 1986
 The biomedical waste(management and handling) rules in 20th
July
1998, subsequently revised in 2000, 2003, and 2011.
Now Ministry of Environment, Forest and Climate change in March 2016
have amended the BMWM rules
 The "the biomedical waste management rules 2016" are an attestation to
the commitment of the Govt of India.
 Further the BMW rules amended in 16th
march 2018.
 BMWM RULES 2nd
amendement on 19th
February 2019,

BMW MANAGEMENT RULE
 These new rules have increased the coverage, simplified the categorization and
authorization while improving the segregation, transportation and disposal
methods to decrease environmental pollution.
 According to Bio-medical Waste Management Rules, 2016, the Central
Pollution Control Board and the State Pollution Control Committees have the
authority to cancel the consent to operate and the authorization of healthcare
institutions, for non-compliant hospitals. Indeed, there have been such
instances in India.

Application of BMW management
rule
Bio-medical Waste Management rules are applicable
to all persons who generate, segregate, collect,
receive, store, treat, transport, dispose, or handle
bio medical waste in any form.

RESEARCH INPUT
Knowledge, attitude, and practices of Bio-medical Waste Management
rules, 2016 , 2018 among health-care workers in a tertiary care setup
Annapurna et .al
Result - Only 68% of the participants knew that the most important step in
waste management is waste segregation. Eighty-two percent of the HCWs
working in this setup knew of the different color-coded bins used for
segregation so that researcher concludes that Training aspects of health-
care waste management should be strengthened so that the current,
existing, and future regulations are practiced diligently and uniformly.

MAJOR SALIENT FEATURES OF BMW MANAGEMENT RULES,
2016 ALONG WITH BIOMEDICAL WASTE MANAGEMENT
(AMENDMENT) RULES, 2018

FEATURES OF BMW RULE,2016 ALONG
WITH BMWM (AMENDMENT) RULES,2018
 Scope 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, sterilization
on-site in the manner as prescribed by WHO or NACO.

 Provide training to all its health care workers and immunize
all health workers regularly against diseases like tetanus and
Hepatitis B.
 Establish a Bar-Code System for bags or containers
containing biomedical waste for disposal
 Report major accidents like needle stick injuries, accidents
caused by fire, blasts during handling of biomedical waste

 Procedure to get authorization is simplified.
 New rules prescribe more stringent standards for
incinerator to reduce the emission of pollutants in
environment.
Before – the acceptable SPM emission - 150 mg/Nm3
Now – the acceptable SPM emission – 50 mg /Nm3

 No hospital/ healthcare facility (occupier) shall establish
on-site treatment and disposal facility, if a service of
“common bio-medical waste treatment facility’’
(CBMWTF) is available at seventy-five kilometres.
 Operator of a common bio-medical waste treatment and
disposal facility to ensure the timely collection of bio-medical
waste from the healthcare facility and assist the healthcare
facility in conducting training.

GUIDELINES FOR MANAGEMENT OF HEALTHCARE
WASTE AS PER BIOMEDICAL WASTE MANAGEMENT
RULES, 2016

WASTE MANAGEMENT AT COMMUNITY
LEVEL
 WASTE GENERATED AT SUB CENTRE
LEVEL

WASTE GENERATED AT
PRIMARY HEALTH CENTRE
LEVEL

S.
No
.
Areas of
Waste
generation
Activities
performed
Types of
Waste generated*
Consumable
s used for
Managing
Waste
1. Operation
Theatre
Surgical
procedures
and
Emergency
Obstetric
Care like
Caesarean
and other
medical
intervention
Placenta, other pathological
tissues, blood and body
fluids, soiled waste, swabs,
cotton, syringes and needles,
blades, tubings and IV sets,
gloves, masks, empty blood
bags and urine bags
Coloured bags,
bins, hub
cutter/destroyer,
1% bleaching
powder
solution,
Puncture Proof
Container.

2. Labour
Room
Child birth
(Deliveries)
Placenta, blood and body
fluids, soiled waste, cotton,
swabs, syringes and needles,
blades, tubings and IV sets
masks and gloves
do-
3. Neonatal
Care
Care of the new
born
Tubings, IV sets, gloves,
syringes and needles do-
4. Laboratory Malaria, HIV,
TB, and other
disease testing
facilities along
with essential
laboratory
services
Blood and body fluids,
syringes and needles, gloves,
slides, AFB slides chemical
waste, sputum, sputum cups
and liquid waste
do-
5. Injection
Room
Immunization
and curative
injections
Syringes and needles,
ampoules, vials, broken
glasses and gloves
-
do-

6. Wards In-patient
services
Blood and body fluids,
syringes and needles, slides,
ampoules, vials, wine bags,
broken thermometers, plaster
casts, chemical waste and
liquid waste
-
do-
7. OPDs and
Stores
Out patient
services, rotine
examination of
patients
Blood and body fluids, syringes
and
needles, slides, ampoules, vials,
broken
thermometer, plaster cast
chemical waste
and liquid waste,
Discarded medicine
Coloured bags,
bins, hub
cutter/destroyer,
sodium
hypocholoride
solution,
Puncture
Proof
Container.
Black bagsand
bin

 WASTE GENERATED AT COMMUNITY
HEALTH CENTRE LEVEL

HEALTH HAZARDS
 HEALTH HAZARDS ASSOCIATED WITH POOR BMWM
Hospital acquired infections(HAI)/ Nosocomial infections
Blood borne diseases like Hep.B, Hep.C, HIV.
Epidemics
Cancer
 Physical injury

HEALTH HAZARDS CONTD…
 Injury from sharps to staff and waste handlers
associated with the health care establishment.
 Risk of infection outside the hospital for waste
handlers/scavengers and eventually general public.
 Occupational risk associated with hazardous chemicals,
drugs etc.
 Unauthorised repackaging and sale of disposable items
and unused / date expired drugs

HEALTH HAZARDS
Main risk groups:
 Medical doctors
 Nurses
 Health care auxiliaries & hospital
maintenance personnel
 Patients & Visitors
 Workers coming in contact with bio-medical
waste

MOHFW RECOMMENDATIONS ON
BMW MANAGEMENT
 The Ministry of Health and Family Welfare (MoHFW) of
India has provided recommendations and guidelines on
Biomedical Waste Management (BMW) to ensure the safe and
proper disposal of waste generated from healthcare activities.
 These guidelines are in line with the Biomedical Waste
Management Rules, 2016, issued by the Ministry of
Environment, Forest, and Climate Change (MoEFCC). Here
are key points from the MoHFW recommendations:

1. Categorization of Waste: Biomedical waste is categorized into different
groups based on its nature and hazard potential:
 Yellow Category: Human anatomical waste, animal anatomical waste, soiled
waste (dressings, cotton, etc.), expired medicines, chemical waste, and
discarded linen.
 Red Category: Contaminated waste like tubes, catheters, IV sets, gloves, etc.,
that can be recycled.
 White (Translucent) Category: Waste sharps such as needles, syringes,
scalpels, etc.
 Blue Category: Glassware like broken or discarded bottles and metallic body
implants.

2. Segregation at Source:All biomedical waste must be segregated at the point of
generation into the specified color-coded bins.Segregation is crucial to prevent the
mixing of hazardous and non-hazardous waste, and to facilitate effective treatment
and disposal.
3. Handling and Storage:Waste should be collected in properly labeled
containers/bags based on the categorization.Waste must not be stored for more than
48 hours before it is treated or disposed of.
4. Transportation:Biomedical waste should be transported in dedicated vehicles
that prevent spillage and are designed as per prescribed safety standards.Vehicles
should carry proper labeling and follow specific routes to avoid public exposure

5. Treatment and Disposal:Incineration or plasma pyrolysis is recommended
for yellow category waste, especially human and animal anatomical
waste.Autoclaving or microwaving is suggested for infectious waste in the
red category to make it safe for recycling.Sharp waste must be shredded after
disinfection.Liquid biomedical waste should be properly treated before being
discharged into sewers or water bodies.
 6. Record Keeping and Monitoring:Healthcare facilities are required to
maintain records of the generation, collection, treatment, and disposal of
biomedical waste.Periodic audits and inspections are essential to ensure
compliance with the rules.Institutions generating biomedical waste must
obtain authorization from the State Pollution Control Board

7. Training and Awareness: Regular training for healthcare workers, waste
handlers, and support staff on safe handling, segregation, and disposal of
biomedical waste.Awareness programs must emphasize the importance of
proper waste management to prevent health hazards
8. COVID-19 Specific Guidelines:The MoHFW has provided special
guidelines for handling waste generated from COVID-19 treatment
facilities, including quarantine centers, isolation wards, and
laboratories.Separate color-coded bins for COVID-19 waste, ensuring
proper disinfection and containment.PPE waste is to be treated and disposed
of under the yellow category with incineration or deep burial options
These guidelines are designed to prevent infection, reduce the
environmental impact, and ensure the safe disposal of hazardous biomedical
waste. Regular compliance with these recommendations is crucial for public
health and environmental safety.

WHAT IS BIOSAFETY?
 Biosafety is essentially a preventive concept and
consists of wide variety of safety precautions that are
to be undertaken, either singly or in combination,
depending on the type of hazard by all medical, nursing
& paramedical workers as well as by patients,
attendants, ancillary staff & administrators in a
hospital.

STRATEGIES FOR WASTE
MANAGEMENT
 Waste reduction strategy
 Waste assessment strategy
 Waste recycling strategy
 Hospital waste disposal

 Waste reduction strategy
Main objectives:
 Reducing waste quantity
 Recycling paper & cardboard waste
 Enhancing hospital’s reputation

Waste assessment strategy
 Main objectives:
Assessing type & amount of waste
 Planning disposal strategies
 Gather information by:
 A walk through the hospital
 Interviewing workers
 Examining records

Waste recycling strategy
Main objectives:
Prolonging life of material
 Helping in cost saving & waste volume
reduction
 Ensuring that reusables are properly sterilized

Hospital waste disposal
Main objectives:
 Disposing waste in most hygienic & cost
effective manner.
Using methods that minimize risk to environment.

STEPS OF WASTE
MANAGEMENT
1. • Seggregation
2.
• Collection and
storage
3. • Transportation
4.
• Treatment and
Disposal

SEGGREGATION
DO’s
1) Seggregation at source
2) Seggregation of infectious waste

Don’ts
 Never mix infectious and non-infectious
waste either at :
 Source of generation
 During waste collection
 Waste storage
 Waste transportation
 During final disposal of waste

COLLECTION AND STORAGE
 Do’s
 1. Always collect the waste in covered bins
 2. Fill the bins upto the 3/4th level
 3. Clean the bins regularly with soap and
water/disinfect the bins regularly
 Don’ts
 1. Never overfill the bins
 2. Never mix infectious and non-infectious
waste in the same bin
 3. Never store waste beyond 48 hrs

TRANSPORTATION
 Do’s
 1. Always carry/transport the waste in closed
containers
 2. Use dedicated waste collection
bins/trolleys/wheel barrows for transporting
waste
 3. Transport waste through a pre-defined route
within the health care facility
 Don’ts
 1. Never transport the waste in open containers
or bags, it may spill and lead to spread of
 infections
 2. Never transport waste through crowded areas

TREATMENT AND DISPOSAL
Do’s
 Always remember to disinfect and mutilate the waste
before its final disposal
 Remember the following while treating the waste streams
a. Anatomical waste to be deep buried
b. Syringes to be cut (with hub cutters) and
chemically disinfected with 1% bleaching powder
solution at source of generation before final disposal
into sharps pit

ELEMENTS OF BIOMEDICAL
WASTE MANAGEMENT
1) Waste management team
2) Waste management plan
3) Training on biomedical waste management
4) Waste segregation
5) Waste collection
6) Waste storage
7) Transportation
8) Treatment
9) Disposal

WASTE MANAGEMENT TEAM
 Head of hospital
forms
 Waste management team
develop
 Waste management plan(WMP)

 The staff typically involves:
 Head of hospital(Chairperson)
 Heads of hospital departments
 Infection control officer/nurse
 Chief pharmacist
 Matron or senior nursing officer
 Hospital manager/administrator
 Hospital engineer/technician

 A Waste management officer(WMO) is
also appointed
 WMO,s responsibilities:
 Waste management plan formulation
 Subsequent day-to-day operation
 Monitoring of waste disposal system
 Produces a draft

 The draft address following issues:
 Present situation regarding waste management
 Quantities of waste generated, the points of generation, the type of waste at
each point
 Possibilities for waste minimization, reuse &recycling
 Waste segregation, on-site handling, transport &
storage practices
 Identification & evaluation of waste treatment/disposal options
 Training
 Estimation of costs relating to BMWM
 Strategy for implementation of plan

WASTE MANAGEMENT
PLAN (WMP)
 Comprises of the complete outline of waste
management process
 WMP is reviewed annually
 Periodic auditing & evaluation of waste
management methods is performed

TRAINING ON BIOMEDICAL
WASTE MANAGEMENT
Overall aim of training:
 To develop awareness of health, safety and
environmental issues relating to health care
waste.
 Roles & responsibilities of health care
personnel in overall management program
should be highlighted.

WASTE MANAGEMENT
Four main categories for which separate
training activities are designed:
1. Hospital managers & administrative staff
2. Medical doctors
3. Nurses & assistant nurses
4. Cleaners, porters, auxiliary
staff &waste handlers

WASTE MANAGEMENT
 Staff education programs
 Information given on:
 All aspects of health care waste policy
 Role & responsibilities of each hospital staff
member.
Relevant technical instructions
Adequate education & training of
health personnel about handling waste

WASTE SEGREGATION
Done at the source of waste generation
Responsibility of generator of waste.
segregation as per categories
applicable.

COLOR CODING & TYPE OF CONTAINER/ BAGS TO
BE USED FOR WASTE SEGREGATION & COLLECTION

WASTE COLLECTION
 Done by sanitary worker daily
 Collected on daily basis at a fixed interval of time
 Sharp items collected together safely in
puncture-proof plastic container and tightly sealed

WASTE COLLECTION CONTD..
 To discourage abuse, containers should be tamper-proof
(difficult to open or break)and needles and syringes
should be rendered unusable.
 Where plastic or metal containers are unavailable or too
costly, containers made of dense cardboard are
recommended (WHO, 1997);

COLLECTION TIMINGS
 Wards - Every morning
 Operation theatre (OT)- Each operation /
surgical procedure
 OPD, ICU, Emergency, Laboratories - Each shift
 Pharmacy - Once a day
 Administrative unit and central store- Once a
day
 Surrounding premises and garden-Once a day
 Dialysis unit-Each procedure
 Radiation unit- Each procedure

BIOMEDICAL WASTE
PACKAGING
 Bio-medical waste bags and sharps containers should be filled to no
more than three quarters full.
 Plastic bags should never be stapled instead use tie and tapes
 Replacement bags or containers should be available at each waste-
collection location.
 Colour coded waste bags and containers should be printed with the bio-
hazard symbol, labelled with details such as date, type of waste,
waste quantity, senders name and receivers’ details as well as bar coded
label to allow them to be tracked till final disposal.

WASTE STORAGE
 Storage facility should be located within
hospital premises.
 It should have sufficient capacity.
 Radioactive waste must be stored separately.
 Untreated biomedical waste not to be kept beyond 48 hrs.
 Permission required for more than 48 hrs.
 Take measures for protecting human health &
environment.

WASTE TRANSPORTATION
Points to be remembered:
Before taking the bags it should be tied and labelled.
 Waste handlers should not touch any other articles.
 A covered cart with a biohazard symbol to carry the
waste to the central area of collection.

 SAFETY MEASURES FOR CLEANING AND
TRANSPORTATION STAFF:
 Display of illustrated notices.
 Issuance of protective gears.
 Provision of hand washing articles
 Provision of wash area.
 Sterilisation of all equipment and issue of only properly sterilised equipment
and tool to the medical personnel.
 Regular medical check-up.
 Provision of disinfectant of the right quality.

WASTE TREATMENT
AND DISPOSAL
 Available Treatment and Disposal Methods
 Chemical Technology
 Thermal Technology
 Autoclave
 Hydroclave
 Incinerator
 Microwave
 Screw feed
 Mechanical Technology
 Compaction
 Grinding/ Shredding
 Pulverization
 Inertization

WASTE TREATMENT AND
DISPOSAL
 Biological Method
 Plasma torch Technology
 Deep burial
 Land filling
 Open dumps
 Sanitary land fill
 Worm composting

WASTE TREATMENT AND DISPOSAL
Chemical Technology
 It uses chemicals to destroy pathogenic organisms from any
inanimate objects
 Mostly suitable for liquids- blood, urine etc.
 Solid- microbiological cultures, sharps.

 Thermal Technology
 Autoclaving
Operate at high temp. and pressure to generate
steam(biocidal)
temperatures of 121°C & has cycle time of approx.
60-90 minutes.

Hydroclave
 Steam sterilization technology.
Steam is used as indirect heating source
allowing total dehydration of waste material.
Holding time for waste is 15 minutes at 132°C
or 30 minutes at 121°C.
Performs sterilization faster , greater heat
penetrance.

Incinerator
 High heat, dry oxidation process of
burning combustible solids at very high
temperature in a furnace.
Reduces waste volume and weight
Not for pressurized containers, reactive
chemicals, silver mercury cadmium
waste

 Microwave
 Low heat system.
 Uses microwaves to heat up the waste material from
inside.
 Electromagnetic waves that lie between 300 to 300,000
MHz range in the electromagnetic radiation spectrum.
 The heat produced at
95 - 100°C for a holding
period of 25 minutes.
 Efficacy checked by
bacteriological, virological test

 Screw feed technology
Waste shredded & heated in a rotary auger.
Waste reduced by 80% in volume & by 20-35% in weight.
Used for treatment of infectious waste & sharps.
Not suitable for:
 Pathological waste
 Cytotoxic waste
 Radioactive waste

Mechanical Technology
Compaction
 Compacting is carried out by a hydraulic ram against
a hard surface.
Grinding / Shredding
Waste material is broken down into smaller
particles under negative pressure to avoid any
spillage outside the chamber.
COMPACTION SHREDDING

Pulverization
 Waste is mixed with large volume of water
and bleach solution.
1. Waste is torn to shreds
2. Fed to an ultra high speed hammer
mill with large spin blades.
3.Pulverize the matter into small, safe particles

 Inertization
 Process of mixing waste with other substance like
cement, lime & water.
 Risk of toxic substances migrating into surface
water or ground water is minimum.
 Proportion of mixture:-
 Pharmaceutical waste - 65%
 Lime - 15%
 Cement - 15%
 Water - 5%
 Homogenous mass formed into cubes or pellets.

 Irradiation Technology
Wastes exposed to ultraviolet or ionizing radiation in an enclosed
chamber.
Require post shredding to render the waste unrecognizable.
 Biological Processes
Use biological enzymes for treating medical waste.
Not only decontaminate the waste but also cause the destruction
of all the organic constituents.

Comprehensive Biomedical Waste Management in Healthcare Settings