Biomedical Waste- Hospital waste and its components, biomedical waste and types, sources, Principles of BMW, Schedules and Classification of BMW, Colour coding and types of containers used for BMW management, Waste management process, issues of managing general waste during COVID-19, BMW guidelines for COVID-19, BMW treatment and disposal techniques, Benefits of BMW, Challenges of Healthcare waste management practice in India.

1. Issues And Challenges In
Hospital Waste
Management
BY: DR. KUNAL RAWAL
SENIOR FACULTY, HOSPITAL ADMINISTRATION,
SGT UNIVERSITY, GURUGRAM
EMAIL-
CONTACT NO- 9713942150
kunalrawal02@gmail.com

2. Introduction
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 methods for its handling.
Inadequate and inappropriate handling of Hospital & Health care wastes may have serious public
health consequences and a significant impact on the environment. Therefore, Appropriate
management of health care waste is a crucial component of environmental health protection.
In hospitals medical waste, otherwise known as clinical waste, normally refers to waste product
that cannot be considered general waste.
Here we discuss the process of handling, segregation, mutilation, disinfection, storage,
transportation and final disposal of such waste.

3. Hospital waste
Hospital waste any waste produced in the course of healthcare activities by healthcare
facilities like physician’s offices, hospitals, dental practices, laboratories, medical research
facilities and veterinary services.
Biomedical waste means any waste which is generated or has been used in the diagnosis,
treatment or immunization of human beings or animals, in research or which may contain
infectious agents and may pose a substantial threat to health.
BMW consist of solid, liquids, sharps , and laboratory waste that are potentially infectious or
dangerous.
India generates around 977 tons of medical waste daily by 2020
An alarming data has been recorded during covid-19 which states that the quantity of
medical waste have been doubled during covid-19.
Out of it 75 to 90% of all medical waste is non-hazardous and general 10 to 25% is
hazardous

4. Types of Biomedical waste

5. Solid
Catheters and tubes
Disposable masks and scrubs
Disposable tools
Medical gloves
Wound dressings

6. Liquids
Blood
Body fluids and tissues secretions
From cleaning and washing water channelled into the drain
Photographic chemicals (fixer and developer)

7. Laboratory waste
Animal carcasses
 Urine, stool, sputum of infected patients
culture plates,
Drug sensitivity plates, culture material with bacterial growth in liquid or solid media in
tubes, bottles
specimens from patients
Hazardous chemicals reagents

8. INFECTIOUS WASTE: Waste suspected to contain pathogens.
For e.g. Laboratory cultures ; waste from isolation wards, tissues (swabs), materials
PATHOLOGICAL WASTE: Waste containing Human tissues or fluids
For e.g. Body parts ; blood and other body fluids.
SHARPS WASTE :
For e.g. Needles ; infusion sets; scalpels; knives; blades; broken glass
PHARMACEUTICAL WASTE; Waste containing pharmaceuticals
For e.g. pharmaceuticals that expired or no longer needed ; items contaminated by or
containing pharmaceuticals (bottles, boxes).

9. GENOTOXIC WASTE: Waste containing substances with genotoxic properties.
For e.g. waste containing cytostatic drugs (often used in cancer therapy) ; genotoxic chemicals
PRESURIZED CONTAINERS: Gas cylinders; gas cartridges.
CHEMICAL WASTE: Waste containing chemical substances
For e.g. laboratory reagents ; film developer ; disinfectants that are expired or no longer needed ;
solvents.
WASTE WITH HIGH CONTENT OF HEAVY METALS: Batteries; broken thermometers ; blood-
pressure gauges ; etc.
RADIOACTIVE WASTE: Waste containing radioactive substances
For e.g. unused liquids from radiotherapy or laboratory research ; contaminated glassware or absorbent
paper ; urine and excreta from patients treated or tested with unsealed radionuclides

11. Components of Hospital Waste

12. PERCENTAGE CONSTITUTION OF
HOSPITAL WASTE
CONSTITUENTS APPROX. %
Pathological waste – 5 %
Infectious material – 10 %
General Non-Infectious – 50 %
Kitchen waste – 30 %
Recyclable materials (paper, plastic, metal) – 4-5 %

13. Objectives
To prevent transmission of disease from patient to patient, from patient to health
worker and vice versa
To prevent injury to the health care worker and other staff in support services,
while handling biomedical waste
To prevent general exposure to the harmful effects of the cytotoxic, genotoxic and
chemical biomedical waste.
To reduce handling & disposal of waste by volumes/costs without compromising
health of hospital staff

14. SOURCES OF BMW
The institutions involved in generation of bio-medical waste are :
Government Hospitals
Private Hospitals
Nursing Homes
Physicians’ office/ clinics
Dentist’s office/ clinics
Dispensaries
Primary Health Centers
Bio- technology institutions/production unit
Medical research and training establishments
Mortuaries

15. Contd…
Blood banks and collection centers
Animal houses/ Slaughter houses
Laboratories and collection centers
Healthcare Research organizations
Vaccinating centers
Quarantine wards
Quarantine Homes
Dedicated COVID-19 Hospitals
Dedicated COVID-19 Labs (meant for covid-19 testing only)

16. Handling Of Biomedical Waste
Most of Hospitals are using Special Precaution For Bio-Medical Waste Handlers
 All employee of the Hospital, even those who are directly responsible for handling
Biomedical Waste must be vaccinated against hepatitis B and tetanus and Universal
precautions should be taken if treated HIV patients
Proper segregation of sharps are done at the site of generation and then they placed in a
puncture proof container.
It’s noticed that most of the sharp injuries occur at the time of their use and the time of
disposal, So extreme care must be taken with needles and other sharps.
Clipping, bending or breaking the sharps and needle with hand must be avoided to avoid
any accidental sharp injuries and the needles are destroyed with needle destroyer.

17. Handling Of Biomedical Waste
For proper disinfection all the disposal items must kept in any disinfectant solution (according to Hospital)
In Operating room, for the transfer of instrument, tray or bowl must be used instead to hand
The infectious and non-infectious waste should not be mixed
The wastes are put in the bag in such a manner that it does not spill.
Excessive weight of the waste bag should be avoided to prevent spillage and other of tearing of bag, for that
the bag is filled by waste only ¾, then tied and properly labeled
Many hospitals put their eyes on quality of the generation waste.
Large amount biomedical waste in hospital means more burden, more cost and more efficient system.

18. Biomedical Waste Rules
The hospital authority implemented proper segregation and collection of bio-medical waste from all
patient care area and it is monitor properly.
The segregation of Bio-medical waste is done at the point of generation.
The hospital waste are segregated and collected in different colour code bag and containers as per the
provision.
Pictures/posters of Bio-medical waste segregation are displayed near the bins.
Proper training are given to all the staff during induction and in service education periodically on the
appropriate segregation and collection of bio-medical waste.

19. Contd…
Most of the Hospital follows that segregation is done by the person who are responsible for
the generating the waste like doctor, nurse, technician etc. Not by the cleaning staff.
The individual color coded bags are marked with the area of generation, date, time, of
collection before they are sent to the temporary storage area.
Printed bio-hazardous symbols put on bio-hazardous bins. The bio-hazardous bins are not
openly transported within the hospital it should be transported in a closed container.
The staffs responsible for transporting the waste must use Personal Protective device
Every hospital must have Infection Control Committee
Includes doctor, infection control nurse , quality coordinator, HOD of every departments like
cardiology, pediatric, urology etc.

20. Basic principles:
Bio medical waste not mixed with other waste in Hospital settings
Segregation of waste should be at source both ward & unit level
Bio medical waste shall be segregated into container bags at the point of generation in
accordance with schedule II.
The containers shall be labeled according to schedule III
waste should be Transported safety according to schedule IV
Identify final disposable and treatment for each type of waste according to the prescribed
form

21. Salient points of Bio Medical Waste Rules
Segregation,
Collection,
Storage,
Packaging,
Transportation,
Treatment & disposal,
Authorization/ registration,
Annual report,
Maintenance of Records and
Accident reporting

22. Schedule I : Classification of BMW into different Categories
Schedule II : Color coding & type of container for disposal of waste
Schedule III: Label of Bio Medical Waste container/beg.
Schedule IV :Label for Transport of Bio-Medical Waste Containers/Bag
Schedule-V :Standards for Treatment and Disposal Of Bio-Medical Wastes
Standards For Incinerators
Schedule-VI :Schedule for Waste Treatment Facilities like Incinerator/ Autoclave/
Microwave
Schedule of Bio Medical Waste Management
and Handling

23. Classification and Management
Category Waste Type Treatment and Disposal Method
Category 1
Human Wastes (Tissues,
organs, body parts
Incineration / deep burial
Category 2 Animal Waste Incineration / deep burial
Category 3
Microbiology and
Biotechnology waste
Autoclave/microwave/incineration
Category 4 Sharps
Disinfection (chemical
treatment)+/autoclaving/microwaving
and mutilation shredding
Category 5
Discarded Medicines and
Cytotoxic Drugs
Incineration/ destruction and drugs
disposal in secured landfills

24. Contd…
Category Waste Type Treatment and Disposal Method
Category 6 Contaminated solid waste Incineration/autoclaving / microwaving
Category 7
Solid waste (disposable items other
than sharps)
Disinfection by chemical treatment+
microwaving/autoclaving & mutilation shredding
Category 8
Liquid waste (generated from
laboratory washing, cleaning,
housekeeping and disinfecting
activity)
Disinfection by chemical treatment+ and discharge into
the drains
Category 9 Incineration ash Disposal in municipal landfill
Category10 Chemical Wastes
Chemical Treatment + and discharge in to drain for
liquids and secured landfill for solids

25. Schedule-II
Color coding Type of bag category
Yellow Disinfected bag 1,3,6,7
Red Plastic bag 3,6,7
Blue/white Puncture proof or
plastic bag
4,9,10
Black Plastic bag 9,10

26. COLOR CODING FOR SEGGREGATION OF
BMW

27. Sharps should be collected in puncture proof container.
 Highly infectious waste should be sterilized by autoclave.
 Cytotoxic waste to be collected in leak proof containers.
Needles and syringes should be destroyed.
 Waste bags are to be closed when they are three quarters full.

28. Average Composition of HCGW In India
MATERIALS PERCENTAGE (WET-WEIGHT
BASIS)
Paper 15
Plastics 10
Rags 15
Metal (sharps etc.) 1
Infectious waste 1.5
Glass 4.0
General waste (food waste , sweepings from hospital premises etc. ) 53.5

29. Waste management Process in Hospital

30. ISSUES OF MANAGING GENERAL
WASTE DURING COVID-19
Segregation of different categories as per SWM rules 2016 especially home healthcare and
Biomedical waste is a big challenge.
Availability, cost, quality, replacement of personal protective equipment (PPE) is major
concerned in current situation
Dedicated staff and dedicated vehicles for collection of waste from quarantine
centers/COVID-19 homes to CBWTF & ULB facilities.
Safety of workers from asymptomatic carriers and people fearing sigma and ostracization.
Salaries of workers in case of extra shifts, their health check-ups, any pre-prophylactic
medicines and COVID-19 testing once in 10-14 days.

31. BMW GUIDELINES FOR COVID19
Microbiologically contaminated surfaces can serve as reservoirs of potential
pathogens
Contaminated surfaces not directly associated with transmission of infections but
potential source of infection to either staff or patients
Transfer of pathogenic agents from surfaces to patients or HC professionals is
mostly via hand contact with the surface
Hand hygiene and frequent hand washing is important to minimize the impact and
transmission of infection
Cleaning and disinfecting environmental surfaces is important in reducing
Healthcare-Associated Infections

32. These Guidelines are based on current knowledge on COVID-19 & existing practices in management of infectious
waste generated in hospitals while treating viral & other contagious diseases like HIV, H1N1, etc.
According to the guidelines, healthcare facilities having isolation ward for COVID-19 patients need to keep separate
colour coded bins/bags/containers in wards and maintain proper segregation of waste as per BMWM Rules.
As precaution double layered bags (using 2 bags) should be used for collection of waste from COVID-19 isolation
wards so as to ensure adequate strength and no-leaks.
Collect and store biomedical waste separately prior to handing over the same to Common Bio-medical Waste
Treatment and Disposal Facility (CBWTF).
Use a dedicated collection bin labelled as 'COVID-19' to store COVID-19 waste and keep separately in temporary
storage room prior to handing over to authorized staff of CBWTF.

33. Biomedical waste collected in such isolation wards can also be lifted directly from ward into CBWTF
collection van
In addition it mandatory labelling, bags/containers used for collecting biomedical waste from COVID-
19 wards, should be labelled as 'COVID-19 Waste as per Solid Waste Management Rules, 2016.
Maintain separate record of waste generated from COVID-19 isolation wards.
Use dedicated trolleys in COVID-19 isolation wards. A label 'COVID-19 Waste' to be pasted on these
items also.
The (inner and outer) surface of containers/bins/trolleys used for storage of COVID-19 waste should be
disinfected with 1 per cent sodium hypochlorite solution daily.

34. The CPCB said that faeces from COVID-19 confirmed patient, who is unable to use toilets and excreta
collected in diaper, must be treated as biomedical waste and should be placed in yellow bag/container.
 However, if a bedpan is used, then faeces is to be washed into toilet and cleaned with a neutral detergent and
water, disinfected with a 0.5 pc chlorine solution, then rinsed with clean water.
Collect used PPEs such as goggles, face-shield, splash proof apron, plastic coverall, nitrile gloves into red
bag.
Collect used masks (including triple layer mask, N95 mask, etc.), head cover/cap, shoe-cover, disposable
linen gown, non-plastic or semi-plastic coverall in Yellow bags.
However, the persons responsible for operating Quarantine camps/centers/home-care for suspected COVID-
19 persons need to follow the below mentioned steps to ensure safe handling and disposal of waste.

35. General solid waste (household waste) generated from quarantine centers or camps should be handed over to waste
collector identified by Urban Local Bodies or as per the prevailing local method of disposing general solid waste.
According to CPCB, Biomedical waste if any generated from quarantine centers/camps should be collected
separately in yellow colored bags.
The CPCB clarified that quarantine camps, quarantine homes are places where suspected cases or the contacts of
suspected or confirmed cases who have been directed by authorized hospitals or local authorities to stay at home for
at least 14 days or more for observation for any symptom of COVID-19.
Biomedical waste generated from quarantine camps/quarantine home/home care would be treated as 'domestic
hazardous waste' as defined under Solid Waste Management Rules, 2016, and shall be disposed as per provisions
under Biomedical Waste Management Rules, 2016 and these guidelines.

36. Used masks and gloves generated from home quarantine or other households should be kept in
paper bag for minimum of 72 hours prior to disposal of the same as general waste.
It’s advisable to cut the mask prior to disposal to prevent reuse.
In case, stats not having CBWTFs as well as rural or remote areas, not having access to
CBWTFs, the existing captive facilities of any hospital may be identified for disposal of
COVID-19 waste as general waste, as per provision under BMWM rules 2016 and these
guidelines.
This may include permitting use of deep burial pits for disposal of yellow category waste as
per standards prescribed in Schedule II of BMWM Rules 2016.

37. Cleaning/Disinfection of Medical Equipment
AREA INPUTS PROCESS METHOD/PROCEDURE
Stethoscope Alcohol-based
rub/Spirit swab
Cleaning
• Should be cleaned with detergent and water
• Should be wiped with alcohol based rub/spirit swab before each patient contact
BP cuffs & covers • Detergent Hot
water
Washing • Cuffs should be wiped with alcohol- based disinfectant and regular laundering is
recommended for the cover
Thermometer Detergent and water
Alcohol rub
Individual
thermometer holder
Cleaning • Should be stored dry in individual holder
• Clean with detergent and tepid water and wipe with alcohol rub in between patient use
• Store in individual holder inverted
• Preferably one thermometer for each patient
Injection and
dressing trolley
Detergent and water
Duster
Disinfectant (70%
alcohol)
Cleaning • To be cleaned daily with detergent and water
• After each use should be wiped with disinfectant

38. PPE (Personal Protective Equipment) Kits
Personal Protective Equipment (PPEs)
are protective gears designed to
safeguard the Health of workers by
minimizing the exposure to a biological
agent.
Components of PPE are goggles, face-
shield, mask, gloves, coverall/gowns
(with or without aprons), head cover and
shoe cover.

39. S.no. Setting Activities Risk Recommended PPE
1 Triage area Triaging patients,
providing triple
layer masks
Moderate N 95 masks
Gloves
2 Screening area, help desk,
registration counter
Providing
information to
patients
Moderate N 95 masks
Gloves
3 Temperature recording station Record temperature
with hand held
thermal recorder
Moderate N 95 masks
Gloves
4 Holding area/ waiting room Nurses/paramedic
interacting with
patients
Moderate N 95 masks
Gloves
5 Doctors chamber Clinical
management(doctor
s and nurses)
Moderate N 95 masks
Gloves
6 Sanitary staff Cleaning frequently
touched
surfaces/floor/cleani
ng linen.
Moderate N 95 masks
Gloves
Rational use of PPE
The PPEs are to be used based on the risk profile of the health care worker. The document describes the PPEs to be used in different settings.
Hospital settings:
1. Outpatient Department (Respiratory Clinic, Separate Screening Area)
7 Visitors accompanying young
children and elders
Support in navigating
various service areas
Low Triple layered medical masks

40. 2 INPATIENT SERVICES
S.NO. Setting Activities Risk Recommended PPE
1 Individual isolation rooms Clinical management Moderate N 95 mask
Gloves
2 ICU/Critical care Clinical care High Full complement of PPE
3 ICU/Critical care Dead body packing High Full complement of PPE
4 ICU/Critical care Dead body transfer to
mortuary
Low Triple Layer medical mask
Gloves
5 Sanitation Cleaning frequently
touched
surfaces/floor/changin
g linen.
Moderate N-95 mask
Gloves
6 Other non covid treatment areas
of hospitals
Attending infectious
and non infectious
patients.
Risk as per
assessed profile
of patients
PPE as per hospital infection prevention control
practices.
7 Caretaker accompanying the Taking care of the Low Triple layer medical mask

41. 3. EMERGENCY DEPARTMENT
S.NO. Setting Activities Risk Recommended PPE
1 EMERGENCY Attending emergency cases MODERATE N 95 mask
Gloves
2 Attending to severely ill
patients of COVID
HIGH Full complement of
PPE
4. PRE-HOSPITAL(AMBULANCE) SERVICES
S.NO Setting Activities Risk Recommended PPE
1 Ambulance
Transfer to
designated
Hospital
Transporting patients not on any assisted ventilation Moderate N-95 mask
Gloves
Management of COVID patient while transporting High Full complement of PPE
Driving the ambulance low Triple layer medical mask
Gloves

42. 5. QUARANTINE FACILITY
S.NO. Setting Activities Risk Recommended PPE
1 Persons being
quarantined
Low Triple layer mask
2 Healthcare staff
working at quarantine
facility
Health monitoring and
temperature recording
Low Triple layer mask
Gloves
Clinical examination of
symptomatic persons
Moderate N 95 masks
Gloves
3 Support staff Low Triple layer mask
Gloves

43. 6. HOME QUARANTINE
S.NO Settings Activities Risk Recommended PPE
1 Persons being quarantined Low Triple layered mask
2 Designated family member Taking care of person being
quarantined
Low Gloves
3 Other family No risk No PPE required
⁕Points to remember while using PPE
1. PPEs are not alternative to basic preventive public health measures such as hand hygiene, respiratory
etiquettes which must be followed at all times.
2. Always (if possible) maintain a distance of at least 1 meter from contacts/suspect/confirmed COVID-19
cases
3. Always follow the laid down protocol for disposing off PPEs as detailed in infection prevention and control
guideline available on website of MoHFW.

44. Bio Medical Waste Treatment

45. Biomedical Waste Disposal
WASTE GENERATED
WASTE SEGREGATED
WASTE COLLECTED IN CONTAINER
DIFFERENT COLOUR CODING CONTAINER
DISPOSAL OF WASTES
INFECTIOUS
WASTE BURNT
WASTE DUMBED
IN GARRAGE BIN
WASTE DISPOSED
INDISCRIMINATELY

46. Biomedical Waste Treatment
Health care waste is a heterogeneous mixture, which is very difficult to manage as
such.
But the problem can be simplified and its dimension reduced considerably if a proper
management system is planned.
It includes following type of treatments:-
Incineration technology
Non incineration technology
Microwave radiation
Plasma pyrolysis
Landfilling
Shredding

47. Incineration Technology
This is a high temperature thermal process employing combustion of the waste
under controlled condition for converting them into inert material and gases.
Eg: Human Waste like Tissues, Body Fluids Blood, Animal Waste, Laboratory
Waste, Dressing Materials are incinerated.
 Incinerators can be oil fired or electrically powered or a combination thereof.
Broadly, three types of incinerators are used for hospital waste: multiple hearth
type, rotary kiln and controlled air types.
All the types can have primary and secondary combustion chambers to ensure
optimal combustion.

48. Non Incineration Technology
Non-incineration treatment includes four basic processes: thermal, chemical,
irradiative, and biological.
Eg: Radioactive Chemical Waste, Pressurized Gas Container, Photographic Waste,
Halogenated Plastic Waste, High Mercury Contain Waste, Heavy Metals Waste are
treated by non-incinerated technology
The majority of non-incineration technologies employ the thermal and chemical
processes.
 The main purpose of the treatment technology is to decontaminate waste by
destroying pathogens.

49. AUTOCLAVING
The autoclave operates on the principle of the standard pressure cooker. The process involves using
steam at high temperatures. The steam generated at high temperature penetrates waste material and kills
all the micro organism
Eg: Any Microbiological, Biotechnological And Infected Disposable Plastic And Rubber Waste Need
Autoclaving.
These are also of three types: gravity type, pre-vacuum type and retort type.
‧Gravity type: air is evacuated with the help of gravity alone. The system operates with temperature of
121 degree C. and steam pressure of15 psi. For 60-90 minutes
Vacuum pumps are used to evacuate air from the pre vacuum autoclave system so that the time cycle is
reduced to 30-60 minutes. It operates at about 132 deg. C.
 Retort type autoclaves are designed much higher steam temperature and pressure.
Autoclave treatment has been recommended for microbiology and biotechnology waste, waste sharps,
soiled and solid wastes.

50. Microwave Irradiation
The microwave is based on the principle of generation of high frequency waves.
 These waves cause the particles within the waste material to vibrate, generating
heat.
 This heat generated from within kills all pathogens.
Eg: The plastic materials like bottles, IV set, syringes etc. are shredded into 1 cm
size for their non-recycling
Chemical methods:-
1%hypochlorite solution can be used for chemical disinfection.

51. Plasma Pyrolysis
Plasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste.
It is an environment-friendly technology, which converts organic waste into
commercially useful by-products.
Eg: cellulose polymer dressings, polyvinyl chloride blood bags, silicon rubber gloves &
catheters and other disposable made of polyethene, polymethyl methacrylate, rubber,
glass, etc. are pyrolyzed.
The intense heat generated by the plasma enables it to dispose all types of waste
including municipal solid waste, biomedical waste and hazardous waste in a safe and
reliable manner.
 Medical waste is pyrolyzed into CO, H2, and hydrocarbons when it comes in contact
with the plasma-arc. These gases are burned and produce a high temperature (around
1200oC).

52. Land filling
In this method Bio Medical Wastes are buried in
the land
Eg: sharp materials like needles, syringes, etc. are buried.

53. Below picture showing the various coloured wastage
containers each for keeping different types of wastes
respectively.

54. Below picture showing a person damaging
the sharp waste with the help of a device.

55. Benefits of Biomedical Waste Management
Cleaner and healthier surroundings.
 Reduction in the incidence of Hospital acquired and general infections.
 Reduction in the cost of infection control within the Hospital.
 Reduction in the possibility of disease and death to reuse and repackaging of
infectious disposables.
Low incidence of community and occupational health hazards.
Reduction in the cost of waste management and generation of revenue through
appropriate treatment and disposal of waste.
Improved image of the Healthcare establishment and
Increase the Quality of life

56. Challenges to Health Care Waste
Management Practices in India
Lack of Segregation Practices
Lack of Proper Operational Strategy
Poor Regulative Measures
Lack of Green Procurement Policy
Waste-picking and Reusing
Lack of Top Management Commitment
Lack of Adequate Facilities
Lack of Institutional Arrangements
Financial Constraints
Inadequate Awareness and Training Programs
Reluctance to Change and Adoption
Inadequate Pressure from Societies

57. Stay home, Stay safe….