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Biomedical Waste Management I Hospital Waste Management I Dr.Singh
Biomedical Waste Management: Safeguarding Health and the Environment Biomedical Waste Management (BMWM) is a critical aspect of healthcare systems aimed at ensuring the safe handling, segregation, storage, transport, treatment, and disposal of waste generated during diagnosis, treatment, and research activities. Biomedical waste includes any waste containing infectious or potentially infectious materials such as human tissues, sharps, blood-soaked items, laboratory waste, and used medical devices. Improper management of biomedical waste poses significant health risks to healthcare workers, patients, waste handlers, and the general public. It can also lead to environmental pollution and the spread of infectious diseases such as HIV, hepatitis B and C, and other blood-borne infections. Therefore, scientific and systematic management of biomedical waste is not only a legal requirement but also an ethical responsibility of every healthcare institution. The Biomedical Waste Management Rules, 2016 (amended in 2018 and 2019), notified by the Ministry of Environment, Forest and Climate Change (MoEFCC), Government of India, provide a comprehensive regulatory framework for BMWM. These rules apply to all health care facilities including hospitals, clinics, laboratories, veterinary institutions, and research institutions. Biomedical waste is categorized into four main color-coded groups for segregation at the source: Yellow: Human and animal anatomical waste, soiled waste, expired/discarded medicines, chemical waste, microbiology and biotechnology waste. Red: Contaminated non-plastic and recyclable items such as tubing, bottles, intravenous sets. White (Translucent): Sharps waste including needles, scalpels, and blades. Blue: Glassware and metallic body implants. Segregation at source is the most crucial step in BMWM. Each category of waste should be collected in appropriate color-coded bins with proper labeling and barcoding to ensure traceability. The waste should then be treated through various methods such as autoclaving, incineration, deep burial, chemical disinfection, or shredding, based on the type of waste. Hospitals and clinics are required to maintain records, ensure staff training, and follow safety protocols including the use of personal protective equipment (PPE). They must also have agreements with Common Biomedical Waste Treatment Facilities (CBWTFs) for the final treatment and disposal of waste. Monitoring and compliance are enforced through regular inspections, audits, and mandatory reporting to State Pollution Control Boards. Non-compliance with BMWM rules can lead to penalties, legal action, and cancellation of healthcare facility licenses. Despite regulations, India faces challenges in BMWM such as lack of awareness, inadequate infrastructure in smaller facilities, poor segregation practices, and overburdened CBWTFs.
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Biomedical Waste Management I Hospital Waste Management I Dr.Singh
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- 2. 2 Contents • Defination ofBiomedical Waste & General Waste • Sources, Quantity & Distribution of Healthcare Waste • Objectives of the waste management system • Health Hazards due to Biomedical Waste • Bio-Medical Waste Management in India • Steps in Management of Biomedical Waste • Technologies for Waste Treatment • References
- 3. 3 Biomedical Waste • Anywaste, which is generated during the diagnosis, treatment or immunization of human-beings or animals, or research activities pertaining thereto or in the production or testing of biologicals.
- 4. 4 General Waste • Itconsists of all the waste other than biomedical waste and which has not been in contact with any hazardous or infectious, chemical, or biological secretions and does not include any waste sharps. • Regulated by Solid Waste Management Rules & Construction and Demolition Waste Management Rule. Dry Waste Wet Waste • Paper, Boxes • Plastic Bottles • Aluminium cans • Packaging materials • Food containers • Construction & Demolition Waste • Organic wastes • Waste Food
- 5. 5 Sources Healthcare Establishments • Governmenthospitals • Private hospitals • Nursing homes and Dispensaries • Primary health centres • Blood banks and collection centres • Medical research and training establishments • Mortuaries • Animal houses • Slaughter houses • Laboratories • Research organizations • Vaccinating centres • Biotechnology institutions/production units
- 6. 6 Quantity of SolidWaste Produced • Government Hospital – ½ to 4 Kgs per bed per day • Private Hospital - ½ to 2 Kgs per bed per day • Nursing Homes - ½ to 1 Kgs per bed per day • Carries a higher potential for infection and injury than any other type of waste.
- 7. 7 Distribution of HealthcareWaste • 80 % - General Waste • 15 % - Infectious/ Pathological Waste • 1 % - Sharp Waste • 3 % - Pharmacological & Chemical Waste • <1 % - Special Waste ( Radioactive/ Cytotoxic/ Pressurized Containers/ Broken Thermometeres/ Batteries)
- 8. 8 OBJECTIVES OF THEWASTE MANAGEMENT SYSTEM • To reduce the infectious/hazardous nature of the waste • To reduce the volume of the waste • To prevent misuse or abuse of the waste • To ensure occupational safety and health • To consider esthetics • To reuse the items that can be of repeat utility • To recycle the waste so that it can serve as another utility item.
- 9. 9 SAFE WASTE MANAGEMENT PRACTICESHELPS • To maintain order and cleanliness in the hospital • To maintain a healthy environment for patients, staff and public • To prevent spread of infectious diseases • To project good impression of the management • To generate revenue for the institution.
- 10. 10 Health Hazards • Populationat risk - Doctors, Nurses, Hospital maintenance personnels, Patients, Visitors, Workers in support services allied to healthcare (Laundries, Waste handling, Transportation), Workers in waste disposal facilities (Land fills, Incinerators, Scavengers) • Route of Transmission - Inhalation of dust particles containing germs Intact/ Non Intact Skin or Mucous membrane Ingestion of contaminated food and water
- 11. 11 Hazards from Infectiouswaste and Sharps Organisms Disease Related Waste Items Virus HIV, Hepatitis A/B/C, Arbovirus, Enterovirus, Herpes Virus AIDS, Infectious Hepatitis, Dengue, JE, Ocular Infectiuons, Genital Infections Infected Needles Body fluids (Blood, Eye secretions, Genital secretions) Human Excreta Blood Bacteria Salmonella typhi Vibrio cholera Clostridium tetani Pseudomonas Streprococcus Typhoid Cholera Tetanus Wound Infections Septicemia Rheumatic fever Endocarditis Skin and soft tissue infections Human excreta and body fluids Needles, surgical blades Parasites Wucheraria bancrofti Plasmodium Cutaneous leishmaniasis Filariasis Kala Azar Malaria Human excreta, blood and body fluids in poorlymanaged sewage systems
- 12. 12 Hazards from Chemicaland Pharmaceutical Waste • Chemicals and pharmaceutical wastes – Can be Toxic, genotoxic, Corrosive, Flammable, Reactive, Explosive. • It can cause intoxication, injuries and burns. • Eg. Disinfectants, Acids
- 13. 13 Hazards from GenotoxicWaste • Highly hazardous substances that are mutagenic, teratogenic or carcinogenic. • Eg. Cytotoxic drugs used in cancer treatment and their metabolites
- 14. 14 Hazards from RadioactiveWaste • It depends on type and extent of exposure. • Symptoms – Headache, Dizziness, Vomitting, Genotoxic
- 15. 15 Public Sensitivity • VisualImpact on civillians. • Eg. Anatomical Wastes
- 16. 16 Bio-Medical Waste Managementin India • Biomedical waste (Management and Handling) Rule came into act on 28th July 1998 and it was given by Ministry of Environment and Forests. • It applies to all those who generate, collect, receive, store, dispose, treat or handle biomedical waste in any manner. • It was amended in 2000 and 2003. • The Act is now superceded by Bio-Medical Waste Management Rules 2016 (BMWM Rules 2016).
- 17. 17 Bio-Medical Waste ManagementRules 2016 • Establishment of Bar code system for bags/containers for proper disposal. • BMW is classified into 4 categories instead of 10. • Ambit of rules has been expanded to include Vaccination camps, blood donation camps, surgical camps or any other healthcare camps. • Phasing out the use of chlorinated plastic bags, gloves, blood bags in 2 years. • Pretreatment of laboratory waste/blood samples and bags/ Microbiological waste. • Training and Immunization of all health care workers. • Simplified authorization procedure. • Inclusion of emission limits of Dioxins and Furans.
- 18. 18 Bio-Medical Waste ManagementRules 2016 • The rule contains 4 schedules and 5 forms. Schedule I – BMW Categories and their segregation, collection, treatment, processing and disposal options. Schedule II – Standards of treatment and disposal of BMW. Operating Standards Emission Standards Standards for autoclaving, microwaving, deep burial, liquid waste Standards for efficacy and chemical disinfection
- 19. 19 Bio-Medical Waste ManagementRules 2016 Schedule III – List of prescribed authorities and their corresponding duties. Schedule IV – Part A – Label for BMW containers/ bags biohazard and cytotoxic hazards Part B – Label for transporting BMW bags/containers
- 20. 20 Bio-Medical Waste ManagementRules 2016 • The rule contains 4 schedules and 5 forms. Form I – Accident reporting Form II – Application for authorization/ renewal of authorization Form III – Authorization Form IV – Annual Report Form V - Application for filling appeal against order passed by prescribed authority.
- 21. 21 Steps in Managementof Biomedical Waste
- 22. 22 Occupier • Person havingadministrative control over the institutions and the premises generating BMW which includes all the healthcare establishments. • Duties & Responsibilities i.Proper collection ,Pre-treatment (highly infectious wastes) and Segregation of BMW at the point of generation in designated color coded bin/containers. ii.Transporting the segregated waste to the Central storage point inside the healthcare establishment and hand it over to CBWTF Operator.
- 23. 23 Operator • Regular collectionof the waste stored (atleast once in every 48 hours) from central storage point and its transportation to final sterilization/disposal point as per BMW rules.
- 24. 24 Survey of WasteGenerated • Survey determines the quantity, type and source of waste generation in the healthcare establishment. • Also helps in determining level of disinfection in the hospital. • Gives an insight of disposal practices being followed by hospital staffs.
- 25. 25 Segregation of HospitalWaste • Seperation of different types of wastes by sorting. • Should be done at the point of generation. • Helps in separating hazardous and non hazardous waste so that special attention can be given for their treatment and disposal.
- 26. 26 Storage and Transportation •Storage – Holding of BMW for such period of time, at the end of which waste is treated and disposed of. • Storage Area – should be protected from all sides and have a clear warning sign and should be accessible only to authorized persons. Should have adequate storage space for atleast 2 days waste.
- 27. 27 Storage and Transportation •Characteristics of Storage Container i. Should be sturdy, hard plastic or metal and leak and puncture proof. ii. Adeqaute size, secure lid with designated color coding iii. Bags should be made of non chlorinated plastic material with correct color coding and with a biohazard symbol. • Transportation is a vital link between site of waste generation and final disposal point. • Vehicles used should be of robust construction, has adequate space, leak proof and covered from all sides.
- 28. 28 Norms of Colorcoding containers
- 29. 29 Color Category -Yellow • Type of bag/container used – Non Chlorinated plastic bags Type of Waste Treatment & Disposal Options a. Human Anatomical waste – Human tissue, organ, body part, fetus Incineration/ Plasma pyrolysis/ Deep burial b. Animal Anatomical waste – Animal body parts, organs, tissues and waste generated from animals used in experiments in veterinary hospitals/colleges/animal houses Incineration/ Plasma pyrolysis/ Deep burial c. Soiled Waste – Items contained with blood and body fluids like dressing, plaster cast, cotton swab, discarded blood bag Incineration/ Plasma pyrolysis/ Deep burial In absence autoclaving/microwaving/hydroclaving followed by sterilization and shredding. Treated waste should be sent for energy recovery.
- 30. 30 Type of WasteTreatment & Disposal Options d. Expired / Discarded Medicines – Antibiotics, cytotoxic drugs (Glass, plastic ampoules, vials) Return to manufacturer Incineration after permission from State pollution Control Board e. Chemical Waste – chemicals used in production of biologicals and discarded disinfectants Incineration/ Plasma pyrolysis Encapsulation in hazardous waste treatment,storage and disposal facility f. Chemical Liquid Waste – infected secretions and aspirated body fluids/ liquids for lab and floor washing, discarded disinfectants. (Collection – Separate collection systemand disposal into effluent treatment system) Pretreatment before mixing with other wastes and discharged.
- 31. 31 Type of WasteTreatment & Disposal Options g. Discarded linen and mattresses, beddings contaminated with blood and body fluids Treated with non chlorinated chemical disinfection followed by Incineration/ Plasma pyrolysis. In absence Combination of sterilization and shredding. Treated waste should be sent for energy recovery. h.Microbiology, Biotechnology and other clinical laboratory waste – blood bags, cell cultures, stock or specimens of microbes Treated by Autoclaving/ Hydroclaving / Microwaving
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- 33. 33 Color Category -Red • Type of bag/container used – Non Chlorinated plastic bags Type of Waste Treatment & Disposal Options Contaminated waste (recyclable) – Disposable items like tubing, bottles, intravenous tubes, catheters, urine bags, syringes (without needle or fixed needle syringes), gloves Autoclaving/ Hydroclaving / Microwaving followed by shredding and mutilation or combination of sterilization and shredding. Treated waste should be sent for energy recovery. Plastic wastes should not be sent to landfill sites.
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- 35. 35 Color Category -White • Type of bag/container used – Translucent and puncture proof containers Type of Waste Treatment & Disposal Options White Sharps including Metals – Needles, syringes with fixed needles, needles from needle tip cutter, scalpel, blades, any contaminated sharp objects Autoclaving/Dry heat Sterilization followed by Shredding/ Mutilation/ encapsulation in metal or cement container Final disposal to sanitary landfills/ designated concrete waste sharp pit.
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- 37. 37 Color Category -Blue • Type of bag/container used – Puncture proof boxes/containers/bags with blue coloured marking Type of Waste Treatment & Disposal Options a. Glassware – broken/discarded and contaminated glass (medicine vials, ampoules), bottles, slides, petri dishes Disinfection with 2% sodium hypochlorite after cleaning with detergent and water Autoclaving/ Hydroclaving / Microwaving b. Metallic body implants. Disinfection with 2% sodium hypochlorite after cleaning with detergent and water Autoclaving/ Hydroclaving / Microwaving
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- 40. 40 Technologies for WasteTreatment • Incineration • Chemical Disinfection • Wet & Dry Thermal Treatment Autoclaving Screw-feed technology • Deep Burial and Landfilling • Microwave irradiation • Inertization • Hydroclave
- 41. 41 Incineration • Also calledMass Burn Technology. • It is the process of burning combustible solids at a very high temperature in a furnace. • Used mainly for wastes that can’t be recycled/ reused or disposed in landfill. • Burning is followed by passing cleaning of flue gases through several pollution control devices. • End product is devoid of infectious organisms and organic wastes. • Volume and mass of the waste is reduced upto 80-95%
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- 43. 43 Types of Incinerator •Double Chamber Pyrolytic Incinerators (Buring of infectious healthcare waste) • Single chamber furnaces • Rotary kilns (Decomposition of genotoxic substances and heat resistant chemicals)
- 44. 44 i.Double Chamber PyrolyticIncinerators • Also called Controlled air incineration • Designed to burn the infectious health care waste, at temperatures between 900 and 1200°C and has pollution control devices • The waste is thermally decomposed through an oxygen deficient, medium temperature of 800 to 900°C, producing solid ashes and gasses. • The gasses produced in the primary chamber are then burnt in the second, post- combustion chamber at 900- 1200°C, using an excess of air to minimize smoke and odors.
- 45. 45 Operating Standards • Combustionefficiency at least 99.99 percent. • Primary chamber temperature 800 ± 50°C. • Secondary chamber gas residence time at least one second; temperature at 1050 ± 50°C; minimum 3 percent oxygen in the stack gas. • Temperature of the waste gas leaving the secondary Emission Standards
- 46. 46 ii.Single Chamber Incinerator •Incinerate infectious waste (including sharps), pathological waste and general health care waste (similar to domestic refuse). • Temperature is 300 to 400°C. • Atmospheric emissions are volatile organic chemicals and acid gases such as sulphur dioxide, hydrogen chloride and hydrogen fluoride, black smoke, carbon monoxide, nitrogen oxide, etc
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- 48. 48 iii.Rotary Kiln Incinerator •Comprises of a rotating oven and a post-combustion chamber. • Used to burn the chemical waste such as infectious waste (including sharps) and pathological waste at 1200 to 1600°C.
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- 50. 50 Chemical Disinfection • Involvesdestruction of pathogens from the surface of the wastes, by using chemical disinfectants such as bleaching powder, glutaraldehyde, alcohols or quaternary ammonium compounds, etc • Used in i. Sharps contaminated with blood and body fluids ii. Instruments and equipments used to cut & pierce (Needles, syringes, Endoscopes)
- 51. 51 Wet Thermal Treatment(Autoclaving) • Low heat process – Steam at high temperature is brought into contact with microorganisms for a specific time period to disinfect the waste matter. • Types a. Gravity displacement type autoclave – Operates at a temperature of 121 C and has a cycle time of 60-90 minutes. b. Prevacuum type autoclave - Operates at a temperature of 132 C and has a cycle time of 30-60 minutes. Vacuum pumps are used to evacuate the air in chamber and steam under pressure is pushed in.
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- 53. 53 Dry Thermal Treatment(Screw-feed Technology) • Non burning process. • The Waste is heated in a rotating auger. The waste is reduced by 80 percent in volume and 20-35 percent in weight. • This process is suitable for treating infectious waste and sharps.
- 54. 54 Deep Burial • Apit or trench should be dug about 2 meters deep with 1.5 mtr square. • The site should be impermeable, away from habitation and not prone for flooding or erosion and authorized by the prescribed authority. • The pit is half filled with waste, then covered with lime within 50 cm of the surface, before filling the rest of pit with soil. • On each occasion of adding waste to the pit, a layer of 10 cms of soil shall be added to cover the wastes. • It must be ensured that animals do not have any access to burial sites. Covers of galvanized iron/wire meshes may be used.
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- 56. 56 Microwave Irradiation • Microwavesare electromagnetic waves in the 300- 3,00,000 MHz in the electromagnetic spectrum. • In this process heat is generated inside the equipment during bombardment of electromagnetic waves into the rotating molecules of the waste. • The waste should have some water content to enhance molecular mobility. • Water contained within the waste is rapidly heated by the microwaves and the pathogens are destroyed. • Advantages : i. high efficiency, ii. 30 to 40 percent volume reduction iii. minimal environmental pollution and occupational risk iv. Cost-effectiveness.
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- 58. 58 Inertization • The wasteis mixed with other substances like cement, lime and water, in the ratio of 65, 15, and 5 percent before disposal. • Risk of toxic substances migrating into the surface water or ground water is minimized. • Homogeneous mass is formed and then transported to suitable sites.
- 59. 59 Hydroclave • It isa steam sterilization technology in which steam is used as an indirect heating source thus allowing total dehydration of waste materials. • It contains a double walled cylindrical container which has doors at the top and bottom for loading and unloading waste matter. • Holding time for waste 15 minute at 132 C 30 minute at 121 C
- 60. 60 Advantages of Hydroclave •Totally sterilizes the waste (for treating non pathological waste). • Treats all infectious waste (except anatomical and cytotoxic waste), even bulk liquid and pathological. • Complete dehydration of the waste, reducing the volume by 70 percent. • No harmful emissions. • Very low operating cost. • Steam is not lost. It is returned back to the boiler in the form of clean, hot water, ready for reuse.
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- 62. 62 Pros and Consof Different Techniques