A quick refresher of the different waste categories as defined in the Bio-Medical Waste Rules 2016 (short BMW Rules) and its amendment BMW Rules 2018. The presentation also describes standards as per these rules for some of the disposal methods such as incineration, autoclave, deep burial and sharps waste pit. A small section on COVID-19 PPE waste disposal has been included in this update

1. How to Deal with Bio-Medical Waste
Welcome to the world of Incineration, Autoclaving,
Encapsulated Waste and Deep Burial
Updated : 06-Jun-2020
As per Indian BMW Rules 2016 + amd. 2018
Disclaimer: This presentation is intended as a quick refresher for those
dealing with Bio-medical waste. For detailed guidelines please refer to the
BMW Rules 2016 + amd . 2018 and the instructions from your CBMWTF

2. Contents
- basic concepts
- why segregate medical waste
- BMW Rules 2016 + amd. 2018*
- waste categories
- final disposal methods
- COVID-19 PPE Disposal Guidelines
* Please refer BMW Rules 2016 and amendment 2018 for complete set of requirements

3. Bio-Medical Waste Generators
BIOMEDICAL WASTE
• Hospitals
• Dental Clinics
• Nursing homes
• Pathological Laboratories
• Blood Banks
• Veterinary institutions
• Bio-Medical & Biotech Research centers
Basic Concepts
• Never mix infectious waste with normal municipal waste
• Segregation and safe containment at health facility level
• Processing and storage for terminal disposal
https://www.merriam-webster.com/medical
Refer this Medical Dictionary for medical terms

4. segregation is expensive
Its too complicated
I don’t have space
Why Segregate
Bio-medical Waste?

5. What Makes BMW Hazardous?
• Waste Chemical-medications & Solutions
• Infectious microbes
• Chemicals such as formaldehyde, waste anesthetic gases, etc.
• Used disposables, equipment and Chemotherapeutic agents
• Laser Smoke and aerosolized medications
BIOMEDICAL WASTE
Only 15- 25% of Hospital Waste is actually hazardous that can be
harmful to humans, animals and the environment.
This waste might be
• Infectious Bio-hazard - Infectious in nature
• Sharps that may lead to secondary infections
• Toxic Bio-hazard - Cytotoxic in nature
• Radiation Bio-hazard Radioactive in nature
Typical Composition of Hospital Waste
Source: http://www.cpcbenvis.nic.in/envis_newsletter/BMW%20Newsletter.pdf

6. Why Segregate?
Key Challenges in Bio-medical waste
• speed of data availability
• under-reporting of waste generated and handling
capacity
• operation of healthcare facility without authorisation
• lack of awareness among various sections of the staff
Unearthing the Growth Curve and Necessities of Bio Medical Waste
Management in India-2018
Inadequate waste management can cause
- pollution of soil and water
- growth and multiplication of vectors like insects, rodents and
worms
- may lead to transmission of diseases like typhoid, cholera,
hepatitis and AIDS through syringes and needles
- reuse of contaminated devices and PPE such as syringes,
gloves and masks by unscrupulous persons
- makes non-hazardous hospital waste also to become
infectious
BIOMEDICAL WASTE

7. Bio-Medical Waste Management Rules 2016 (amd. 2018)
Salient Features
• Bio-medical waste has been classified into 4 categories instead of 10 categories
• Phase-out the use of chlorinated plastic bags, gloves and blood bags within two years ( by 2019)
• Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags
• Provide training to all its health care workers and immunize all health workers regularly
• Establish a Bar-Code System for bags or containers containing bio-medical waste for disposal
• Report major accidents like needle stick injuries, broken mercury thermometer, accidents caused by
fire, blasts during handling of bio-medical waste and the remedial action taken
• Stringent standards for incinerator to reduce the emission of pollutants in environment
• No hospital/ healthcare facility shall establish on-site treatment and disposal facility, if a service of
CBMWTF is available at 75Km
• Operator of a CBMWTF to ensure the timely collection of bio-medical waste and assist the healthcare
facility in conducting training.
BIOMEDICAL WASTE

8. Waste Categories
INCINERABLE WASTE
• Human Anatomical Waste
• Animal Anatomical Waste
• Soiled Waste such as
bandages, cotton waste
• Surgical waste
• Dressings
• Expired medicines
• Cytotoxic drugs
• Chemical waste
• Solid plaster casts
• Discarded contaminated
linen/mattresses
• Microbiology, biotechnology
and other clinical laboratory
waste
• Masks (amd 2018)
• Gowns (amd 2018)
BIOMEDICAL WASTE
AUTOCLAVE WASTE
Waste from disposable items
• Tubings
• Saline Bottles
• Intravenous tubes and sets
• Catheters
• Urine bags
• Syringes (without needles)
• Vacc utainers (needles cut)
• Stents
• Aprons
• Gloves
SHARPS WASTE
Used or Discarded Sharp objects
• Needles
• Syringes with fixed needles
• Needles from needle tip
cutter or burner
• Scalpels
• Blades or
• Any other used/discarded
contaminated sharp objects
GLASSWARE/IMPLANTS
• Broken or discarded and
contaminated glass
• Medicine vials ampoules
except those contaminated
with cytotoxic waste
• Metallic body implants
LIQUID WASTE
• Chemicals in production
of biological
• Used or discarded
disinfectants
• Silver X-ray film
developing liquid
• Discarded formalin
• Infected secretions
• Aspirated body fluids
• Liquid from laboratories
and floor washings
Other General Hospital
Waste than above to
be managed as per
SWM Rules 2016

9. Incinerable Waste
INCINERABLE WASTE
• Human Anatomical Waste
• Animal Anatomical Waste
• Soiled Waste such as
bandages, cotton waste
• Surgical waste
• Dressings
• Expired medicines
• Cytotoxic drugs
• Chemical waste
• Solid plaster casts
• Discarded contaminated
linen/mattresses
• Microbiology, biotechnology
and other clinical laboratory
waste
• Masks (amd 2018)
• Gowns (amd 2018)
Yellow colored Non-
chlorinated plastic bags
COLLECT IN
Yellow colored containers
Incineration or
Plasma Pyrolysis or
deep burial*
DISPOSAL
INCINERABLE WASTE
Expired cytotoxic drugs and items
contaminated with cytotoxic drugs to
be returned back to the manufacturer
or supplier for incineration at
temperature >1200C
Chemical Waste Disposed of by
incineration or Plasma Pyrolysis
or Encapsulation at HWTSDF
Micro-bioloigical waste -Pre-treat to
sterilize with non-chlorinated
chemicals on-site as per WHO or
NACO guidelines
*Disposal by deep burial is permitted only in
rural or remote areas where there is no access
to common bio-medical waste treatment
facility. (refer to BMW Rules 2016 for more info)

10. Autoclave Waste
Red colored Non-
chlorinated plastic bags
or containers
COLLECT IN
Autoclaving or micro-
waving/ Hydroclaving
Followed by shredding
or mutilation *
DISPOSAL
AUTOCLAVE WASTE
AUTOCLAVE WASTE
Waste from disposable items
• Tubings
• Saline Bottles
• Intravenous tubes and sets
• Catheters
• Urine bags
• Syringes (without needles)
• Vacc utainers (needles cut)
• Stents
• Aprons
• Gloves
• Eye protection (Goggles)
* or combination of
sterilization and shredding.
Plastic waste should not
be sent to landfill sites
Treated waste to be sent to
registered or authorized recyclers
for energy recovery or
plastics to diesel or
fuel oil (or) for road
making, whichever is possible.

11. Sharps Waste
Puncture proof,
Leak proof, tamper
proof containers
COLLECT IN
Autoclaving or Dry
Heat Sterilization
followed by shredding
or mutilation
DISPOSAL
SHARPS WASTE
* or encapsulation in metal container
or cement concrete;
combination of shredding cum
autoclaving; and sent for final
disposal to iron
foundries (or) sanitary
landfill (or) designated
concrete waste sharp
pit
SHARPS WASTE
Used or Discarded Sharp objects
• Needles
• Syringes with fixed needles
• Needles from needle tip
cutter or burner
• Scalpels
• Blades or
• Any other used/discarded
contaminated sharp objects
• Syringe needles must be
cut at the point of use
itself
• Fill container only up to
or below the line
indicated on box
IMPORTANT

12. Glassware Waste
COLLECT IN DISPOSAL
GLASSWARE WASTE
Disinfection (by
soaking the washed
glass waste after
cleaning with
detergent and Sodium
Hypochlorite
treatment)
GLASSWARE/IMPLANTS
• Broken or discarded and
contaminated glass
• Medicine vials ampoules
except those contaminated
with cytotoxic waste
• Metallic body implants
Puncture Proof and
Leak Proof boxes or
containers with Blue
colored marking
or through autoclaving
or microwaving or
hydroclaving and then
sent for recycling.

13. Liquid Waste
COLLECT IN DISPOSAL
LIQUID WASTE
After resource
recovery, the chemical
liquid waste shall be
pre-treated before
mixing with other
wastewater.
LIQUID WASTE
• Chemicals in production
of biological
• Used or discarded
disinfectants
• Silver X-ray film
developing liquid
• Discarded formalin
• Infected secretions
• Aspirated body fluids
• Liquid from laboratories
and floor washings
Separate collection system
leading to effluent treatment
system
The combined discharge shall
conform to the discharge norms
given in Schedule-II of BMW Rules
2016
STANDARDS FOR LIQUID WASTE*
* Please refer to notes in BMW Rules AMD. 2018 for detailed requirements for specific size of facilities

14. Incinerator Standards
as prescribed by BMW Rules 2016
INCINERATOR
Batch Incinerators
Source: http://www.incinerators-ati.com/medical-waste.php

15. Incinerator Standards – ii
as prescribed by BMW Rules 2016
INCINERATOR
Please refer BMW Rules 2016 for complete set of requirements
Schematic of Typical Controlled Air Dual Chamber Incinerator
Source: https://www.ec.gc.ca/gdd-mw/default.asp?lang=En&n=8A09EA04-1

16. Plasma Pyrolysis/Gasification Standards
as prescribed by BMW Rules 2016
PLASMA PYROLYSIS
Emission Standards are same as for Incineration Equipment
Please refer BMW Rules 2016 for complete set of requirements
Schematic of Plasma Pyrolysis System
Source: https://vinit.com.vn/en/plasma-
pyrolysis-for-medical-waste/

17. Deep Burial Standards
as prescribed by BMW Rules 2016
DEEP BURIAL
Please refer BMW Rules 2016 for complete set of requirements
• A pit or trench should be dug about two meters deep half filled with waste,
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 any access to burial sites. Covers
of galvanised iron or wire meshes may be used.
• On each occasion, when wastes are added to the pit, a layer of 10 cm of soil
shall be added to cover the wastes.
• Burial must be performed under close and dedicated supervision.
• The deep burial site should be relatively impermeable and no shallow well
should be close to the site.
• The pits should be distant from habitation, and located so as to ensure that
no contamination occurs to surface water or ground water. The area should
not be prone to flooding or erosion.
• The ground water table level should be a minimum of six meters below the
lower level of deep burial pit
• The location of the deep burial site shall be authorised by the prescribed
authority.
• The institution shall maintain a record of all pits used for deep burial. Typical Design of Deep Burial Pit for Disposal of
Yellow Category BMW
Source:http://www.cpcbenvis.nic.in/envis_newsletter/BMW%20Newsl
etter.pdf

18. Autoclave Standards
as prescribed by BMW Rules 2016
Please refer BMW Rules 2016 for complete set of requirements
Gravity Flow Autoclave
Residence
Time (min)
Temperature ( C) Pressure (PSI)
> 60 121 15
> 45 135 31
> 30 149 52
Vacuum Autoclave
Residence
Time (min)
Temperature ( C) Pressure (PSI)
> 45 121 15
> 30 135 31
• Medical waste shall be subjected to a minimum of three pre-vacuum pulse to purge the autoclave of all air
• Air removed during the pre-vacuum cycle should be decontaminated by means of HEPA and activated
carbon filtration, steam treatment, or any other method to prevent release of pathogen.
AUTOCLAVE WASTE

19. Sharps Standards
as prescribed by BMW Rules 2016
Please refer BMW Rules 2016 for complete set of requirements
Typical Design of Sharps Pit
Source: missions-acf.org
Waste sharps can be treated by dry heat sterilization at a
temperature not less than 1850C, at least for a residence
period of 150 minutes in each cycle, which sterilization
period of 90 minutes.
There should be automatic recording system to monitor
operating parameters.
SHARPS WASTE

20. COVID-19 PPE Disposal
PPE ITEM
• Surgical Masks
• N95 Respirators
• Examination Gloves
• Surgical Gloves
• Isolation Gowns
• Surgical Gowns
• Heavy duty Apron*
* Heavy duty aprons might be
reusable after disinfection.
Please consult manufacturer
instructions.
Use ony Non-chlorinated plastic bags
COLLECT IN
Incineration or
Plasma Pyrolysis or
deep burial*
DISPOSAL
COVID-19 PPE WASTE
*Disposal by deep burial is permitted only in
rural or remote areas where there is no access
to common bio-medical waste treatment
facility. (refer to BMW Rules 2016 for more info)
PPE ITEM
• Protective Goggles *
• Face Shield
* Goggles might be reusable
after disinfection. Please consult
manufacturer instructions
Autoclaving or micro-
waving/ Hydroclaving
Followed by shredding
or mutilation *
PPE Doffing Process
https://youtu.be/oUo5O1JmLH0
(source: Public Health England)

21. Reference Links
21
https://www.slideshare.net/gunijo/biomedical-waste-management-16063397 (Slideshare BMW
Management)
http://www.cpcbenvis.nic.in/envis_newsletter/BMW%20Newsletter.pdf (Deep Burial Pit design)
https://www.wikizero.com/en/Autoclavation (Wiki Autoclave functioning)
https://economictimes.indiatimes.com/industry/healthcare/biotech/healthcare/india-to-generate-775-5-
tonnes-of-medical-waste-daily-by-2020-study/articleshow/63426284.cms?from=mdr (ET Report)
https://www.deccanherald.com/content/665443/household-biomedical-waste-adds-hazards.html (DH
Article)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784295/ (J Lab Physicians)
https://www.supplyworks.com/Sku/TOTRMC6400RED/toter-64-gal-plastic-red-medical-waste-basket-
723105803504-rmc64-00red (Supplyworks red bin)
https://www.indiamart.com/replicon-scientific (yellow container)
https://sanypick.com/en/biotrex-50l/ (Sanypick yellow container)
https://youtu.be/LewOdDY3HB0 (Biotrex - Sanypick plastic)
https://www.indiamart.com/proddetail/sharps-disposal-containers-17026519033.html (sharps container
indiamart)
https://www.downtoearth.org.in/news/waste/covid-19-here-is-what-you-should-do-to-safely-dispose-
your-used-mask-71006 (DTE, used masks protocol)
https://slideplayer.com/slide/4463535/ (parenteral medication administration devices)
http://www.bionicsscientific.com/autoclave-sterilizer/dry-heat-sterilizer-depyrogenation-oven.html (dry
heat sterilization)
https://youtu.be/yrBbrErEcRc (Addfield medical waste incinerator)
http://www.plasmaindia.com/Pyrolysis.html (FCIPT - Industrial Plasma Technologies)
https://www.hydroclave.com/technology/ (hyrdroclave technology)
BIOMEDICAL WASTE

22. Happy Segregation,
Incineration and Autoclaving!
www.ragpicker.in
http://www.slideshare.net/ragpickerify
https://www.facebook.com/ragpickertv
http://www.youtube.com/user/ragpickerify
22
For Waste Management Products & Solutions visit www.ragpicker.in