BIOMEDICAL WASTE MANAGEMENT IN HEALTHCARE FACILITY

1. Biomedical Waste
Management
Dr. UPENDRA KUSHWAH
(CPHC-Consultant)
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2. Waste
BMW
General/
MSW
Bio-
degradable
Non-
Biodegrada
ble
Liquid
Sewage
Sullage
Run-off
Hazardous
E-waste
Radio active
Mercury

3. What are Biomedical
wastes?
Biomedical waste has been defined as “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 biological or in health camps,
including the categories mentioned in Schedule I
appended to these Rules” as per Biomedical Waste
Rules 2016.
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4. MAJOR SOURCES
 Hospitals/Nursing
Homes/Dispensaries.
Primary health
centres.
 Medical collages and
research Centre.
MINOR SOURCES
 Physician /dentists
clinic Blood donation
camps.

5. Why manage Hospital Waste?

6. Need for Managing Waste
 Danger to the patients
 Many patients have poor immunological status
 Resistance to antibiotics
 Vulnerability of Hospital Staff
 Danger to the community
 Spread of infection through waste
 Access of waste to animals
 Spread of Infection through recycling trade
 Problems caused by Incinerators/ burning
 Contamination of Water-table

7. BMW (Management & Handling) Rules
1998
 Was applicable to any hospital/ health centre/O.P.D.
facility/clinic, where more than 1000 patients are seen/
treated/ investigated in a month
 Segregation, disinfection and mutilation of waste
 No storage of waste beyond 48 hrs
 No incineration of chlorinated plastics
 No chemical pre-treatment before incineration
 Proper labelling of waste with Biohazard symbol

8. BMW (Management & Handling) Rules
1998
Introduction of new treatment options with CPCB
(Central Pollution Control Board) approval.
Municipal authorities to pick up general waste and
treated (disinfected) Biomedical waste.
Centralised facilities preferred.
Standards for Incinerators & Deep Burial Pit.
Penalty as under EPA(Environmental Protection
Agency).

9. Biomedical waste rules 2016
 Gazetted on 28th March 2016
 Replaces Biomedical Waste (Management & handling)
Rules 1998
 Major Changes –
Scope – also includes Ayush Health Facilities, Vaccination
Camps, First-Aid Rooms of Schools, Forensic Labs, etc.
Constitution of a new committee at the state level
Small facilities less than thirty beds may designate a
qualified person to review and monitor the activities
relating to bio-medical waste management

10. Biomedical waste rules 2016
 Bar Code System for bags & containers (after 28th March
2017)
 Phase-out Chlorinated bags and Non-chlorinated plastic bags
after 28th March 2018
 On-site disinfection of laboratory waste, microbiological
waste, blood samples & blood bags
 Treatment & disposal of Liquid waste in accordance with the
water (Prevention & control of Pollution) 1974
 ‘On-site’ Waste Management can be established if nearest
CTF is 75 kms away
 Segregated collection – Four Categories
 Prior Approval for ‘Deep Burial’

11. Identify Bio Medical Waste
Used Syringes
Blood Bags
Vaccines
Stained Cotton Swabs
Placenta
Expired Medicines
Fixer & Developer in Xray
Established Procedures
Linen
Glass Slides
Sanitary Napkin
Medicine Card Boxes
Lab Samples
Lead Batteries
Condemned X Ray
Machine
Kitchen Waste
Catheter
X Ray Films

12. 12
What are the different hospital waste
categories?

13. Categories of BMW
(as per BMW Rules 1998)
Category Waste
1 Human Anatomical
2 Animal
3 Microbiology & Biotechnology
4 Sharps
5 Discarded Medicines & Cytotoxic Drugs
6 Soiled (Contaminated with Blood & Body Fluids)
7 Solid (Disposable Items other than Sharps)
8 Liquid
9 Incineration Ash
10 Chemical

14. Category Type of Waste Treatment and Disposal Options
Category 1
Human Anatomical Waste (Human
tissues, organs, body parts)
Incineration/Deep Burial
Category 2
Animal waste (Animal tissues, organs,
body parts, carcasses, bleeding
parts,blood and experimental animals
used in research)
Incineration/Deep Burial
Category 3
Microbiology and biotechnology
waste(waste from lab culture,
specimens from microorganisms,
vaccines, cell cultures, toxins, dishes,
devices used to transfer cultures)
Local Autoclaving/ Microwaving/
Incineration
Category 4
Waste Sharps (Needles, Syringes,
scalpels, blades, glass)
Chemical Disinfection Autoclaving/
Microwaving, Mutilation and Shredding
Category 5
Discarded medicines and cytotoxic
drugs (outdated, contaminated,
discarded drugs)
Incineration/Destruction and disposal in
land fills
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15. 15
Category Type of Waste Treatment and Disposal Options
Category 6
Soiled waste (contaminated with
blood and body fluids including
cotton, dressings, soiled plasters,
linen)
Autoclaving/ Microwaving/ Incineration
Category 7
Solid waste (tubes, catheters, IV
sets)
Chemical Disinfecion/Autoclaving/
Microwaving, Mutilation and Shredding
Category 8
Liquid waste (Waste generated from
laboratory and washing, cleaning,
disinfection)
Disinfection by chemical treatment and
discharge into the drains
Category 9 Incineration ash Land fills
Category 10 Chemical waste
Chemical disinfection and discharge
into the drains

16. Colour Coding for Collection System
(BMW Rules 1998)
Colour Coding Type of Container Waste Category Treatment options
Yellow Plastic Bag Categories 1, 2, 3 & 6. Incineration deep burial
Red Plastic Bag Categories 3, 6, 7
Autoclaving/Micro-
waving Chemical
Treatment
Blue/ White
Translucent
Plastic Bag /puncture-
proof containers
Cat. 4, Cat. 7
Autoclaving/Micro-
waving/ Chemical
Treatment &
Destruction / shredding
Black Plastic Bag Categories 5, 9, 10
Disposal in secured
landfill.

17. Categories of Waste: Schedule I (BMW Rules 2016)
Category Type of Waste Bag/ Container Treatment/ Disposal
1. Yellow a. Human Anatomical
Yellow colour Non-chlorinated
Plastic Bag or Containers
Incineration/ Plasma Pyrolysis/
Deep-burial
b. Animal Anatomical
c. Soiled Waste Incineration/ Plasma Pyrolysis/
Deep-burial
OR Autoclave/ Microwave/
Hydoclave
d. Expired Drugs Return/ Plasma Pyrolysis
e. Chemical Incineration/ Plasma Pyrolysis
f. Chemical liquid Separate Collection System leading
to Effluent treatment system
Pre-treatment then discharge
g. Discarded linen Non-Chlorinated Yellow Colour bags
or suitable packing material
Incineration/ Plasma Pyrolysis
OR Shredding & mutilation
h. Microbiology Autoclave Safe bag NACO/ WHO Norms (On-site)

18. Categories of Waste: Schedule I (BMW Rules 2016)
Category Type of Waste Bag/ Container Treatment/ Disposal
Red Contaminated Waste
(Recyclable)
Red Coloured non-chlorinated plastic Autoclave/ Microwave/
Hydroclave followed by
shredding or mutilation or
combination
White SHARPS including Metals Puncture Proof/ Leak Proof/ Tamper
proof
Autoclave/ Dry Heat
Sterilisation or shredding or
Mutilation or Encapsulation
Blue Glassware Cardboard Boxes with Blue colour
marking
Disinfection by Sodium
Hypochlorite solution or
Autoclaving/ Microwaving/
Hydroclaving
Metallic Body Implant

19. Different colour coded plastic containers
with waste category:
 Category 1,2,3,5,6
waste will collected
in yellow colour
plastic container.
 Category 4, 7
waste will
collected in red
colour coded
plastic container
 Category 8 waste will
collected in Blue colour
coded plastic container

20.  Municipal waste will collected in Black colour coded
plastic container.
 The collected bio-medical waste will transported to
CBWTF in a fully covered specially designed vehicles (as
per guidelines of CPCB)

21. Segregation
 Different types of waste should be collected separately
 Should be done at point of generation
 Different coloured bins are to be used
 Segregation ensures occupational and health safety
 Segregation also reduces the cost of treatment and disposal

22. CONSTITUENTS OF HOSPITAL WASTE
Infectious
4.859%
Human Tissue
1.831%
Plastic
2.555%
General
90.755%

23.  Collection: biomedical waste will be
collected in the different coded bags or
containers as mentioned in biomedical waste
management rules, 2011.
 Transportation: collected waste will be
transported in closed vehicles from waste
generating site to treatment facility.
 Treatment: collected waste will be treated
with Incineration/Shredder/Autoclave.
 Final Disposal: After treatment of waste ash
from incinerator will be sent to Municipal
Landfill site.

24. LIQUID WASTE
MANAGMENT
KARNATKA

25. What are the disinfectants commonly used
for disinfection of materials contaminated
with blood and body fluids?
High level disinfectants like chlorine
releasing compounds are used for
disinfecting materials contaminated with
blood and blood products. The
recommended dilutions for these
compounds are given as follows:
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27. Liquid disinfection unit

28. Liquid Disinfectant unit for DH, TLH, CHC

29. Further improvements

30. Name of Disinfectant
Available
chlorine
Required
chlorine
Required
chlorine
Contact period
Amount of
disinfectant to be
dissolved in 1 ltr of
water
Sodium hypochlorite 5% 0.5% 30 min 100 ml
Calcium hypochlorite 70% 0.5% 30 min 7.0 gm
Na OCl powder - 0.5% 30 min 8.5 gm
Na
Dichloroisocyanurate
(NaDCC) tablets
60% 0.5% 30 min 4 tabs
Chloramine 25% 0.5% 30 min 20 gm
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31. How is disinfection of the
various items commonly used
in the hospital carried out?
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32. General use items Disinfection
Bath water Add savlon when necessary
Bed pans
Wash with hot water and dry
Disinfect with phenol after use by infected patients
Autoclave
Bowls
Wash with hot water and keep dry
Autoclave
Crockery, Cutlery Wash with hot water/detergent and keep dry
Floors Vacuum clean; No use of broom
Furnitures Damp dust with detergent/phenol/2% Lysol
Mattresses/Pillows
Use water impermeable cover
Wash cover with detergent and keep dry
Disinfect with phenol/2%lysol
Trolley tops
Wipe with warm water and detergent to remove dust and
keep dry
Thermometers Wash with warm water/detergent and keep dry
Endoscopes/ Arthroscopes/ Laparoscopes/
Fiberoptic Endoscopes
Immerse in2% Cidex solution
Use latex gloves, eye protection plastic covering mask
while handling
Alternatively, use ethylene oxide sterilization
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33. General use items Disinfection
Endotracheal suction catheter Should be disposable
Endotracheal tubes Recycled after cleaning and autoclaving
Ambu Bags
Ideally heat disinfect
Immerse in 2% glutaraldehyde and wash with sterile
distilled water to reduce respiratory irritation
Oxygen delivery face mask
Wash and dry
Use 70% isopropyl alcohol to remove mucus
Suction drainage bottles Ideally autoclave
Ventilatory circuits, respiratory
equipment in Neonatal/Pediatric unit
Heat disinfection for 800 F for 30 min
Autoclave
Ethylene oxide sterilization
Incubators
Clean thoroughly wiyh warm water / soap
Use 70% isopropyl alcohol
Humidifiers
Empty daily refill with sterile water
Disinfect when contaminated with 1% Na hypochlorite
Autoclave
Urinary Catheter Should be disposable
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34. How are common hospital instruments
sterilized?
Instruments should be disinfected
for 30 min, cleaned and sent for
sterilization.
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35. Sterilization Methods:
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Dry Heat Autoclave Ethylene oxide
2%
Glutaraldehyd
e
Formaline
Gamma
radiation
Gloves - a - - - a
Plastic Syringe - - a - - -
Glass Syringe - a - - - -
Needles - - - - - -
Endoscopic
instruments
- - - a a -
Suction tubes - - - a - -
Suction bottles - a a a a a
Cautery cable - - a a a a
Cautery points - - - a a a
Laryngoscopes - - - a a a
Endotracheal
tubes
- - a a a a
Catheters - - a a a a
Cath Lab
Material
- - a a - a
Blanket a - - - - -
Mattresses a - - - - -
Suturing

36. ANALYSIS OF PROPOSAL
 Social benefits to the local population
1. Cleaner and healthier environment.
2. Reduction in the incidence of hospital acquired and general infection.
3. Reduction in the cost of infection control within the hospital.
4. Reduction in the possibility of disease and death due to reuse and
repacking of infectious disposal.
5. Low incidence of community and occupational health hazards
6. Reduction in the cost of waste management and generation of
revenue through appropriate treatment and disposal of waste.
7. This project will also give an employment opportunity.
8. We build a pollution free environment and planet earth a better place
to live in.

37. Annual report
 On Form IV before 30th June every year
 Details of training - programmes conducted, number of
personnel trained and number of personnel not
undergone
 Major Accidents including Nil report in Form I to the
prescribed authority and also along with the annual
report
 Review committee’s minutes of the meetings
 Record of recyclable wastes referred to in sub-rule (9)
which are auctioned or sold and the same shall be
submitted to the prescribed authority as part of its
annual report.

38. THANK YOU
By:- Dr. UPENDRA KUSHWAH
(CPHC-Consultant)
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