Biomedical waste management

1. Biomedical Waste
Management (BMW)
Let the waste of the sick not contaminate
the lives of healthy
For MBBS IV Semester
26th April 2017
By: Dr Puneet Kumar Gupta
Assistant Professor, Microbiology

2. Layout
• Definition
• What’s need of BMW?
• Contribution of different waste type
• Various things required in management
• Rule governing
• Categories, Segregation, Transportation
• Modality of treatment
• Do & Don’t

3. Definition
Waste generated during laboratory diagnosis,
treatment or immunization of human being or
animals, or in research activity pertaining thereto, or
in production of biologicals

4. What’s Need for BMW?
• Attracts flies, insects, birds and animals
• Filthy and unhygienic conditions
• Injury(NSI) and infection
• Reuse of disposables
• Harmful chemicals and radioactive materials(
contaminate wells and tanks)
• Animals & insects may get inf./ become carriers.
• Survival & mutation of pathogenic microbes→
epidemics, increase in communicable diseases in
the community

5. Contribution of different waste type
Hospital Waste
Non- hazardous Hazardous
Bio degradable Non-bio degradable Potentially Toxic Potentially Infectious
Chemical Radioactive Organic Lab
Pharmaceutical Sharps
80-85% 15-20%
Waste generation in
Developing countries 0.5-2 Kg/bed/day
Developed 1-5 Kg/bed/day
15%
5%

9. Rule governing
• Biomedical Waste Management & Handling
Rule 1998
• Amended
– 2000
– 2003
– 2011
• Biomedical Waste Management Rule 2016

11. Bio-Medical Waste
Management Rules, 2016

12. Following Waste Not covered under
BMW Management Rule 2016
Waste Covered under
Solid waste Solid Waste Management Rules, 2016
E waste E-Waste (Management) Rules, 2016
Radioactive wastes Atomic Energy Act, 1962(33 of 1962) and the rules
made there under
Hazardous chemicals Manufacture, Storage and Import of Hazardous
Chemicals Rules, 1989 made under the Act
Construction and
demolition waste
Construction and Demolition Waste Management
Rules, 2016
Lead acid batteries Batteries (Management and Handling) Rules, 2001
Hazardous wastes Hazardous and Other Wastes (Management and
Transboundary Movement) Rules, 2016
Hazardous
microorganisms,
genetically engineered
microorganisms and
Manufacture, Use, Import, Export and Storage of
Hazardous Microorganisms, Genetically Engineered
Microorganisms or Cells Rules, 1989 made under the
Act

13. Segregation
Biomedical Waste
Management Rule 2016

14. 4 category of waste:
• Yellow
• Red
• Blue
• White (Translucent)

15. Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used
Yellow Soiled Waste (Items contaminated with
blood, body fluids):
• Dressings, Bandage, Gauze, Linen
• Plaster casts,
• Cotton swabs
• Bed Protection pads
• Bags containing residual or discarded
blood and blood components including
blood set tubing’s
• Diapers, Napkins
• Discarded linen, mattresses, beddings
Yellow coloured
non-chlorinated
plastic bags
common Bio-
medical Waste
treatment facility

16. Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used
Yellow Human Anatomical Waste:Human tissues,
organs, body parts and fetus below the
viability period (as per MTP act)
[copy of official MTP certificate from
Obstetrician or the MS of hospital or
healthcare establishment must be given]
Yellow coloured
non-chlorinated
plastic bags
common Bio-
medical Waste
treatment facility

17. Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used
Yellow Animal Anatomical Waste:
Experimental animal carcasses, body parts,
organs, tissues, including the waste
generated from animals used in
experiments or testing in animal houses
Yellow coloured
non-chlorinated
plastic bags
common Bio-
medical Waste
treatment facility
Expired or Discarded Medicines (Except
cytotoxic drugs)
Pharmaceutical waste like antibiotics

18. Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used
Yellow Cytotoxic drugs including all items
contaminated with cytotoxic drugs along
with glass or plastic ampoules, vials etc
Yellow coloured
non-chlorinated
plastic bags with
cytotoxic label
common Bio-
medical Waste
treatment facility

20. Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used
Yellow Chemical Liquid Waste:
• Liquid waste generated due to use of
chemicals in production of biological and
used or discarded disinfectants,
• Silver X-ray film developing liquid,
• Discarded Formalin,
• Infected secretions,
• Aspirated body fluids,
• Liquid from laboratories and floor
washings, cleaning, house-keeping and
disinfecting activities etc.
Separate collection
system leading to
effluent
treatment system

21. • Lab & highly infectious BMW generated shall be pre-
treated by equipment like autoclave or microwave
• Microbiology waste and all other clinical laboratory waste
shall be pre-treated by sterilisation to Log 6 or
disinfection to Log 4, as per the WHO & NACO
guidelines before packing & sending to CBMWTF
• Use of Non-chlorinated chemicals
• No chemical pretreatment before incineration, except for
microbiological, lab & highly infectious waste

22. Autoclave conditions for BMW
handling
• Should not be less than
– 1210C x 15psi x 60 minutes
– 1350C x 31psi x 45 minutes
– 1490C x 52psi x 30 minutes
• Biological Indicator: (Maintain record)
– First Validate with 4 biological indicator
– Then Daily testing with chemical indicator (>1 strips per bag of
discard at different locations
– Once a Week biological indicator testing

23. Biomedical wastes categories and their
segregation, collection, treatment, processing
and disposal options (Schedule 1)
Category Type of waste Container to be
used
Yellow Microbiology, Biotechnology and other clinical
laboratory waste:
• Blood bags,
• Vacutainers containing blood
• Dishes and devices used for cultures
• Laboratory cultures, stocks or specimens of
microorganisms,
• Live or attenuated vaccines,
• human and animal cell cultures used in research,
production of biological,
• Residual toxins
Autoclave safe
plastic bags or
containers
Autoclave/
Microwave
common Bio-
medical Waste
treatment facility

24. Category Type of waste Container to be used
Red Contaminated Waste (Recyclable) Wastes
generated from disposable items such as
• All plastic tubings (Ryle’s, ICD, ET, drains)
• Intravenous tubes and sets,
• Catheters (Foley’s, suction etc)
• Cardiac cannulas
• Plastic iv Bottles
• Uro bags,
• syringes (without needles and fixed needle
syringes)
• vacutainers with their needles cut
Red coloured non-
chlorinated plastic bags
or containers
common Bio-medical
Waste treatment facility

25. Category Type of waste Container to be used
Red • Gloves
• Nebulization masks
• Surgical disposable face mask, caps, gown,
Shoe cover
• Needle caps (If infected)
• Plastic Test tubes
• Pipettes
• Disposable tips
• Plastic Trough
Red coloured non-
chlorinated plastic
bags or containers
common Bio-medical
Waste treatment
facility

26. Category Type of waste Container to be used
White
(Translucent)
Waste sharps including Metals:
• Needles (including Hypodermic
needles, I/v set needles, suture
needles, LP needles etc.)
• Stylets of IV cannula
• syringes with fixed needles,
• Needles from needle tip cutter or
burner,
• scalpels,
• blades,
• Lancets
• Saws
• Any other contaminated sharp object
that may cause puncture and cuts
includes used, discarded and
contaminated metal sharps
Puncture proof, Leak
proof, tamper proof
containers
common Bio-medical
Waste treatment facility

28. Alternative
• Heavy duty plastic containers
• But, they should be
• leak resistant,
• Remain upright during use without sharp able to come out
• Tight fitting, puncture resistant lid
• Translucent which has to be marked
• Examples
• Plastic laundry detergent container,
• Plastic bottles
• Empty detergent metal cans
• Disinfectants empty plastic container
• Empty dry media containers
• A tin or a plastic box with a small opening at top with a lid for closure of the
Box

29. Alternative
• Clearly labelled “Sharp Metallic waste” with “biohazard symbol”
• A line should be drawn on the box to mark ¾ of the volume
• Needles should be filled only till this line

30. Locally made Sharp Waste
containers

34. • Syringes should be either mutilated or needles should be
cut and or stored in tamper proof, leak proof and
puncture proof containers for sharps storage

35. Category Type of waste Container to be used
Blue Glassware:
• Broken or discarded and
contaminated glass including
medicine vials and ampoules except
those contaminated with cytotoxic
wastes
Glassware:
• Broken petri dishes,
• Slides and cover slips,
• Broken pipettes and other glass
material
Metallic Body Implants
Cardboard boxes with blue
colored marking
(If soiled with infectious
waste: treat by disinfectants
or autoclaving)
common Bio-medical Waste
treatment facility

36. Methods of disposal of microbiological
samples & cultures
Disposal of sputum container with specimen
and LJ culture:
Sputum, LJ
media, container
soaked in 5%
phenol
overnight
The container is
autoclaved
The phenol
solution poured
of in to drain
and the
container is sent
to the final
disposal site in
red bag/blue
bag

37. Disposal of blood samples
Blood samples and container
10%sodium hypochlorite
Container sent to disposal site and the
disinfectant to the drain
Clotted blood samples along with the
container
Autoclave
Container sent to the common disposal site in
appropriate bag

38. Other infectious samples
Urine pus
Stool Sputum
5% phenol

39. Disposal of Microbiological cultures
cultures
10%sodium
hypochlorite
overnight
Discharge into the
drain
Petri dishes
1.Autoclave if
reusable or
2. Disposal site for
recycling
Autoclavable bags
Autoclave and reuse
the petri dishes and
the culture medias
can be disposed off
into the drain

40. Transportation
• Always collect waste in a covered bin/bags
• Dispose bags every day or whenever ¾ filled
• Handover waste to dedicated waste collection team
• Collection team should tie properly labelled bag, weight,
record particular in waste collection register
• Then collection team should keep the waste
bag/container in transportation trolley/container
• Transportation should be done safely without spillage &
leakage

41. Transportation
• Collection container should then be cleaned with
soap and water/disinfectant by housekeeping staff
and new suitable bag/ container will be applied and
to be checked by staff nurse or technician (OT,
Laboratory) of respective area
• No waste to be stored >24 hours at point of segregation
• Collection team then transport waste in closed container
to storage area in a pre-defined path of least crowding
• Waste in common storage area will be delivered to the
authorised person from common biomedical treatment
facility

42. Every Biomedical waste bags/container must
have biohazard sign and label with details

44. What's differences b/w
1998/2011/2016 BMW Rules?

45. BMW (Management
and Handling) Rules,
1998, 2000, 2003,
2011
BMW Management Rules, 2016
Word Handling Handling word omitted Management’ includes Handling
Not cover these Cover healthcare activity undertaken outside the healthcare facility:
vaccination camps, blood donation camps, surgical camps or any other
----- Additional Duties of occupier Added:
• Provision of safe, ventilated and secured location for storage of
segregated BMW
• Pre-treat the laboratory waste, microbiological waste, blood
samples and blood bags through disinfection or sterilisation on-site
as per WHO or NACO guidelines & then sent to CBMWFs
• Phase out use of chlorinated plastic bags, gloves and blood bags
within two years of notification of rule

46. BMW (Management
and Handling) Rules,
1998, 2011
BMW Management Rules, 2016
------ Additional Duties of occupier Added:
• Immunise all its HCP and others involved in handling of BMW for
protection against diseases including Hepatitis B & Tetanus
• Establish a Bar- Code System for bags or containers
• Report major accidents including accidents caused by fire hazards,
blasts during handling of BMW
-------- Operator of CBMWFs
• Ensure timely collection of BMW from HCFs, assist the HCFs in conduct
of training
------- Not to establish on-site treatment & disposal facility if a service of
CBMWFs available at a distance of 75Km

47. BMW (Management
and Handling) Rules,
2011
BMW Management Rules, 2016
8 category (10 in 1998
Rule)
4 category
No storage beyond 48
hrs
Permission required to
be taken
• Untreated human anatomical waste, animal anatomical waste,
soiled waste and, biotechnology waste shall not be stored beyond a
period of 48 hrs
• In case for any reason it becomes necessary to store such waste
beyond such a period, the occupier shall take appropriate measures
to ensure that the waste does not adversely affect human health &
environment
• Inform the SPCB along with reasons
Hospitals treating ≥
1000 patients/month
to obtain
authorization from
SPCBs/PCCs
• One time Authorisation for Non-bedded HCFs.
• Validity of authorization shall be synchronised with validity of
consent orders for Bedded HCFs

48. BMW (Management
and Handling) Rules,
2011
BMW Management Rules, 2016
To strengthen advisory committee of Government of every State/Union
Territory- Additional members added
• 150 mg/nm3
• 1 sec
• ...Nil..
Emission standards Incineration
• SPM in Incinerator’s Emission 50 mg/nm3
• Residence Time in Secondary chamber of incinerators =2 Sec
• Standards for Dioxin and furans
• 1%
Chemical Treatment
• 10% sodium Hypochlorite
• Black color • Cytotoxic waste in Yellow
• Blue/ white bags • Sharp 2 types

49. • High Temperature Processes
– Incineration
– Pyrolysis
– Plasma Technology
– Gasification
• Non-Burn/Low-Temperature Treatments
– Autoclave
– Hydroclave
– Microwave
– Dry heat
– Steam auger (waste is shredded prior to t/t)

51. • Incineration is a high heat
system process of burning
combustible solids at very
high temperature in a furnace.
• Burning of waste material in 10
Chamber stages (850±500C)
• Followed by combustion of
gases in 20Chamber
(1050±500C)
• Cleaning of flue gas through a
number of pollution control
devices
• End product is devoid of
infectious organisms
• Not to be done: Burning of
Plastic waste & Sharp
-

52. Operates at
Not<121°C at 15psi for not < 60
minutes
• Vacuum pumps are utilized to evacuate
air in the chamber of autoclave
• Steam under pressure is pushed
• Operates at
Not<121°C at 15psi for not < 45 minutes
Not<135°C at 31psi for not < 30 minutes
• Not Recommended for pathological Waste

53. • Expansions of
Autoclave
• Steam sterilization
technology
• Steam Introduced into
hollow walls of
hydroclave
• Steam does not come
in contact with waste
• Volume & Weight
Reduction much more
than autoclave
• Cycle time 1 hr

54. • Use electromagnetic
waves 300-300,000 MHz
• Radiation produced by
microwave break
molecular chemical
bonds
• Heat up waste material
from inside, unlike the
external heat given in
autoclave & hydro
clave
• Work at temp 97-100 0C
• Cycle time 40-45 min
• Not to be used with
Body parts & tissue

55. Deep Burial Pit
• A pit or trench 2m deep
• 1/2 with waste, then covered with lime within 50 cm of
surface, before filling the rest of pit with soil
• On each occasion, when wastes are added to pit, layer
of 10 cms of soil shall be added to cover the wastes
• Ensure that animals do not have any access to burial
site
• Covers of galvanized iron / wire meshes
• Should be distant from habitation
• Should be relatively impermeable & no shallow well
should be close to the site.
• Burial must be performed under close & dedicated
supervision

56. Sharp Pit
• Dug according to the requirement of hospital
• All sides of the pit should be plastered with cement
• A cylindrical metal pipe of 4 inches diameter or more is fixed at
the ceiling of the pit
• The opening of the metal pipe should have locking facility
• The sharps are deposited in this pit through the pipe from the
puncture proof translucent container after mutilating.

58. Building a protected sharp Barrel

59. Do’s FOR WASTE M/M
• Generate waste when essential
• Segregate waste at source into specified categories of waste
with biohazard logo
• Mutilate waste at source if possible to prevent unauthorized
reuse
• Destroy needle by using needle cutter or needle burner
• Keep the needles in puncture proof, translucent container
• Clean the bins regularly with soap & water and disinfect the
bins regularly.
• All liquid chemical waste should be drained out in to ETP

60. Don’ts
• Do not generate waste unnecessary (e.g. avoid injection by
prescribing oral medicines)
• Never mix infectious & non- infectious waste
• Never mix chlorinated wastes with such wastes those which
have designated for incineration.
• Never overfill the bins.
• Never store waste beyond 48 hrs.
• There should not be any spillage on the way of transport.

61. Don’ts
• Avoid transport of waste through crowded areas
• Do not throw infectious waste into general waste without any
pre- treatment and mutilation
• Don’t dispose the solid waste (plastic) and sharp waste without
mutilation

62. Q1: How much percentage of waste will come
under biomedical waste?
A. 5%
B. 15-20%
C. 25-30%
D. 85%

63. Q2: Nursing sister finds expired chemotherapeutic drugs stored in
glass ampoules in RCC ward. She tells the sister in charge to
dispose those expired drugs . The sister in-charge is confused
regarding the disposal . Suggest the appropriate BMW
management
A. Chemotherapeutic drugs has to be disposed into red bag
B. Chemotherapeutic drugs being in a glass ampoule dispose in a puncture
proof box
C. Chemotherapeutic drugs has to be disposed in black bag
D. Chemotherapeutic drugs has to be disposed in yellow bag

64. Q 3: There was a blood sample from a HIV pateint. The lab
personnel wanted to discard the blood in a safe manner. Tell the
appropriate BMW management
A. Blood sample has to be discarded in yellow bag
B. Blood sample has to be pretreated with 10% sodium hypochlorite and
then disposed
C. Blood samples should be autoclaved and then disposed.
D. Both b and c are correct methods of disposal

65. Q4: A TB patient coming to mycobacteriology lab gives a
sputum sample for drug susceptibility testing. The lab
personnel after processing the sputum sample discards the
sample into 10 % sodium hypochlorite. Is this the appropriate
method of disposal?
A. Yes , as the right chemical pretreatment is 10% sodium hypochlorite
B. No, 5% lyzol should be used.
C. No, 5% phenol should be used.
D. No pretreatment required as it has to be disposed in the sewage effluent
plant .

66. Q5: According to rules 2016, the BMW management should be
done
A. Inside the hospital campus
B. Outsource it if the disposal site is within 125km radius from the hospital
C. Outsource it if the disposal site is within 75km radius from the hospital
D. Can be stored and disposed after a month to the outsourcing unit

67. Q6: Which among these waste is not included under biomedical
waste?
a. expired medicines
b. Laboratory cultures
c. Lead acid batteries
d. e- waste
e. Both c and d

68. Q7:Bags used for the BMW management should be
A. Plastic/ chlorinated
B. Plastic/ nonchlorinated
C. Plastic/ flurinated
D. Nonplastic/ nonchlorinated

70. References
• Biomedical Waste Management Rule 2016
• Safe management of wastes from health-care activities. WHO 2nd
Edition
• 1st Edition of Essential of Medical Microbiology by Apruba Shankar
Sastry & Santhiya Bhat K.
• 5th Edition of Texbook of Microbiology by Dr CP Bhaveja
• NACO Manuals