BIOMEDICAL
WASTE
MANAGEMENT
CONTENT
• DEFINITION
• STEP TO MANAGE WASTE
• NEED FOR BIOMEDICAL WASTE MANAGEMENT
• PRESENT SCENARIO
• NOTIFICATIONS AND AMENDMENTS
• MAJOR DIFFERENCE BETWEEN BMW RULES 1998 , 2016
& 2018.
• CONCLUSION
Session objectives
• Why manage Hospital Waste?
• Discuss the principles of India’s Bio-Medical Waste
Management Programme
• Understand the need for proper waste disposal
Definition of Biomedical Waste
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.
Purpose of Infection Management and Environment Plan
(IMEP)
Inappropria
te
disinfection
Unhygienic and
unsanitary
Poor
conditions and sterilization
inadequate water at
healthcare facilities. techniques,
Poor bio-medical Inadequate
waste handling, use of
treatment and protective
disposal practices gears,
Health care waste facts….
It means all waste generated from hospital
85% non-hazardous wastes
10% infectious wastes
5% non-infectious but hazardous
Persons at risk:
Medical doctors, nurses, health care, auxiliary and
hospital maintenance personnel
Workers in support service – lab, imaging services,
laundries and transportation
Workers in waste disposal facilities – hospital workers
Patients in health care institutions
Visitors to health care institutions
Standard Workplace Precautions 26
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
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
Biomedical waste rules 2016
• Bar Code System for bags & containers (after 28th March 2017)
• Phase-out Chlorinated bags and Non-chlorinated plastic bags after 28 th 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 CBMWTF is 75 kms
away
• Segregated collection – Four Categories
• Prior Approval for ‘Deep Burial’
Operationalisation of
Waste Disposal: Key Strategies
Segregati
on of
Waste
Treatment
and
Disposal
Collection
and
Storage
Transp
ortation
Standard Workplace Precautions 28
Operationalisation of Waste Disposal
Strategies in the institutions
Generation of waste
Source segregation in color coded bags
Collection from all the hospital facilities
Onsite treatment (where ever necessary)
Storage in the designated storage room
Weighing
Transportation by private / govt. agency
Standard Workplace Precautions 29
Types of Bio-Medical
Hazardous Waste
Infectious
All Body Fluids
Anatomical parts and lab specimens
Sharps
Toxic
Chemicals and pharmaceuticals
Genotoxic waste
Radioactive
Genotoxic waste
Standard Workplace Precautions 30
Categories of waste
Waste
Treatment and
Categor Waste Category Type
Disposal Options
y No
1 Human Anatomical Waste Incineration / deep burial
2 Animal Waste Incineration / deep burial
Microbiology and Autoclaving / microwaving /
3
Biotechnological Waste incineration
Incineration / destruction and
4 Waste Sharps
disposal in secured landfills
Discarded Medicines & Incineration / destruction and
5
Cytotoxic drugs disposal in secured landfills
Courtesy: Tamilnadu Health System Project
Standard Workplace Precautions 31
Categories of waste
Waste
Treatment and
Categor Waste Category Type
Disposal Options
y No
6 Soiled wastes Incineration / deep burial
Disinfection / auto /
7 Solid wastes micro waving and
mutilation/shredding
Disinfection and discharge
8 Liquid wastes
into drains
9 Incineration ash Disposal municipal landfill
Disinfection and discharge
10 Chemical waste
into drains
Courtesy: Tamilnadu Health System Project
Standard Workplace Precautions 32
Colour Coding
Colour Container
Waste category Treatment Final
coding for Type
Type at Hospital Disposal
bags/bins
Waste sharps Plastic bag auto
Blue Broken glass, claving /
1% sodium
Ampoules, vials & sutures microwaving
hypochlorit
15L Broken needles, Puncture proof and
e solution
25L needles, blades, scalpels, container (twin mutilation /
50L lancet, etc bin system) shredding
Solid waste auto
Disposable waste items claving /
like tubing’s, catheters, 1% sodium
Red (big) microwaving
intra venous sets, plastic Plastic bag hypochlorit
50L and
saline bottles, pouches e solution
mutilation /
etc., shredding
Micro biology and
Red
biotechnology waste Incineration /
(small)
6.Soiled waste Plastic bag NIL deep burial
15 L
Blood and body fluid
25L
contaminated items
Standard Workplace Precautions
Colour Coding
Colour Container
Waste category Treatment Final
coding for Type
Type at Hospital Disposal
bags/bins
Yellow
Human waste
Incineration /
15L Plastic bag NIL
deep burial
25L Animal waste
50L
Expiry drugs,
Black
cytotoxic drugs Disposal in
Incineration ash Plastic bag NIL secured
15L
landfill
25L
Chemical waste
Green
As
undertaken
15L Municipal Waste Plastic bag NIL
by municipal
25L
Standard Workplace Precautions 34 agencies
50L
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Segregation of Waste
• Make available colour-coded
bins and bags in patient care
areas
• Segregation should take
place at source
• Follow colour-codes for
different categories of waste Image Courtesy GHTM, Tambaram, Chennai
• Personnel should use Follow the colour codes, as
advised by the respective state
protective gear while governments
handling the waste
35
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Standard Workplace Precautions
Transport
Standard Workplace Precautions
• SCHEDULE III
(See rule 8 (4))
LABEL FOR TRANSPORTING BIO-MEDICAL WASTE BAGS OR CONTAINERS
Day ............Month ..............
Year ...........
Date of generation ...................
Waste category No ........
Waste quantity…………
Sender's Name and Address Receiver's Name and Address:
Phone No ........ Phone No ...............
Fax No ............... Fax No .................
Contact Person ........ Contact Person .........
In case of emergency please contact :
Name and Address :
Phone No.
Note : Label shall be non-washable and prominently visible.
Treatment and disposal
Safety Precautions
for Waste Management
Training and education of waste handlers and
drivers
Strict protocols on sharps handling and disposal
Written protocols/colourful posters as reminders
for the health care staff
Limit access to only trained persons with personal
protective gear
Eliminate steps that require unnecessary handling
hazardous wastes
Standard Workplace Precautions 36
Commonly used disinfectants
in the laboratory
Technicians should know the procedures
to prepare the following
disinfectants:
Ethyl alcohol (70%)
Glutarldehyde (2%)
Sodium hypochlorite solution (1%, 10%)
Polyvidone Iodine (PVI) 10%
Standard Workplace Precautions 37
Recommended strength of the
Sodium hypochlorite solution
Spills [10%]
Surface contamination
1% (smooth surface)
10% (porous surface)
Liquid infectious waste
(with large amount of organic matter) [10%]
Sharp container for sharps [1%]
Standard Workplace Precautions 38
43
Management of spills
Put absorbent material down on spillage area
Flood with 10% sodium hypochlorite solution upon and
around the spill and leave for 30 minutes
Place the absorbent material in the biohazard bag
meant for infectious waste
Reapply the disinfectant solution to all exposed
surfaces
Thorough wash of the area with soap and water
Standard Workplace Precautions 39
No to Recapping of Needles
Standard Workplace Precautions 40
Sharps safety
Standard Workplace Precautions 41
Splashes to the EYE
Demonstrate how to do it
Flush the eye for 5 minutes with clean water
(for microorganisms)
Flush at least for 15 minutes (for chemicals)
Standard Workplace Precautions 42
Handling & Disposal of
HIV positive dead body
Avoid direct contact with blood and body fluids
Wear protective gear- gloves, apron. Disinfect with
1% sodium hypochlorite all needle puncture holes,
wound drainage and dress with impermeable
dressings
Plug all orifices with swabs soaked in 1% sodium
hypochlorite solution. Wash and disinfect the body
with 1% sodium hypochlorite solution
Do not embalm the body. Cover the body with
robust plastic sheet (150um thick) and cover it
tightly with tapes or zipper
Standard Workplace Precautions 43
Handling & Disposal of
HIV positive dead body
Clean the outside plastic sheet with 0.1% sodium
hypochlorite if soiled. Soiled linen should be
bagged and sent to laundry
It should be disinfected with sodium hypochlorite
before washing. Hands should be washed
thoroughly after removing gloves and protective
clothing
Standard Workplace Precautions 44
Bio-Medical Waste Management
(Amendment) Rules March 16, 2018
Original provision Amended provision
• Rule ( 4c) -It shall be the duty of • It shall be the duty of every
every occupier to pre-treat the occupier to pre-treat the laboratory
laboratory waste, waste, microbiological waste, blood
microbiological waste, blood samples and blood bags through
disinfection or sterilization on-site
samples and blood bags through
in the manner as prescribed by the
disinfection or sterilization on- World Health Organization (WHO)
site in the manner as prescribed guidelines on Safe management of
by the World Health wastes from health care activities
Organization (WHO) or and WHO Blue Book, 2014 and
National AIDs Control then sent to the Common bio-
Organization (NACO) medical waste treatment facility
guidelines and then sent to the for final disposal.
common bio-medical waste
treatment facility for final
disposal
Original provision Amended provision
• Rule 4 (p) -It shall be the duty of • It shall be the duty of all the health
every occupier to make available care facilities (any number of
the annual report on its web-site beds) shall make available the
and all the health care facilities annual report on its web-site
shall make own website within within a period of two years from
two years from the date of the date of publication of Bio-
notification of these rules. Medical Waste Management
(Amendment) Rules, 2018
• It shall be the duty of every operator
• Rule 5 (c) -It shall be the duty of
of a common bio-medical waste
every operator of a common bio-
treatment and disposal facility to
medical waste treatment and
establish bar coding and global
disposal facility to establish bar positioning system for handling of
coding and global positioning bio- medical waste in accordance
system for handling of bio- with the guidelines issued by the
medical waste within one year Central Pollution Control Board
by 27th March, 2019
Original provision Amended provision
• Rule 7(8) -Every occupier shall • Every occupier shall phase out
phase out use of non-chlorinated use of chlorinated plastic bags
plastic bags within two years from within two years from the date of
the date of publication of these publication of these rules and after
rules and after two years from such two years from such publication of
publication of these rules, the these rules, the chlorinated plastic
chlorinated plastic bags shall not be bags shall not be used for storing
used for storing and transporting of and transporting of bio-medical
bio-medical waste and the occupier waste and the occupier or operator
or operator of a common bio- of a common bio-medical waste
medical waste treatment facility treatment facility shall not dispose
shall not dispose of such plastics by of such plastics by incineration
incineration and the bags used for and the bags used for storing and
storing and transporting biomedical transporting biomedical waste
waste shall be in compliance with shall be in compliance with the
the Bureau of Indian Standards. Till Bureau of Indian Standards. Till
the Standards are published, the the Standards are published, the
carry bags shall be as per the carry bags shall be as per the
Plastic Waste Management Rules, Plastic Waste Management
2011. Rules, 2016.
Original provision Amended provision
• The prescribed authority shall
• Rule 13(2) -The prescribed authority compile, review and analyze the
shall compile, review and analyze the information received and send this
information received and send this information to the Central Pollution
information to the Central Pollution Control Board in Form IVA before
Control Board on or before the 31st
the 31st July of every year.
July of every year.
Along with the changes in the Rules, amendments have also been made
to Schedule I, II and III and the format for submission of the annual
report information on bio-medical waste management has been inserted
as Form IVA.
The Amendment Rules have come into force from March 16, 2018.
[G.S.R. 234 (E)]
URL: http://www.egazette.nic.in/WriteReadData/2018/183847.pdf
.
Key Points
• Compliance with Standard Work Precaution
procedures is the mainstay of preventing exposure to
HIV and other blood borne pathogens
• Follow national guidelines on bio-medical waste
management to safely dispose of infected waste
• Segregate hazards into separate waste streams
at source and disposal of the infected waste to safety
ensure a safe working environment
• Training and reminders ensure compliance to
waste disposal
• Hands that heal should never harm…!
45
Thank you
