Biomedical waste management (handling & treatment)

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DEPARTMENT OF SWASTHVRITTA & YOGA
Rani Dulliaya Smriti Ayurved PG College & Hospital,
Bhopal (M.P.)

 “Bio-Medical waste” is the waste that 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
biological or in health camps, including the categories
mentioned in Schedule I appended to BMW rules 2016”
 “Any solid and/ liquid waste including its container
and any intermediate product, which is generated during
the diagnosis, treatment or immunization of human
beings or animals”. 2

CONTINUE
 According to the environment protection act 1986, Biomedical Waste
(Management and Handling) Rules, 28 July 1998 And it was
amended in 2000 & 2003. the bio medical waste rules in July 1998,
subsequently revised in 2011 & now the “bio medical waste
management rules in 2016” are in the attestation to the commitment of
the Gov. of India.
 Waste in India - 484 tonnes/day of bmw from 1,68,869 health care
centres
 Average 1-2kg/bed/day.
https://www.thebetterindia.com/50225/biomedical-waste-
treatment/(seen 11-3-2018) 3

NEED FOR BMW MANAGEMENT
TYPE OF WASTE Health HAZARD
Human/ Anatomical waste/ soiled waste HIV, HBV, Cholera, T.B, Pneumonia Rabies
e.t.c.
Sharps HIV, HBV, HCV, Injuries
Cytotoxic/ radioactive Cancer, Birth defect
Chemical waste Poisning, dermatitis, conjuctivitis
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The hospital waste, in addition to the risk for
patient & personal who handle these
waste poses a threat to public health &
enviroment.

PRESENT SENERIO
Acc. To the M.O.E.F. & CC (Ministry of Environment and
Forests )-
 Gross generation of BMW in india is 484 tone/ day from
1,68,869 health care facilities (hcf), out of which 447 tone/
day is treated, which means that almost 38 tone/ day of the
wastes is left untreated & not disposed finding its way in
dumps or water bodies & re-enters our system.
6

BIO-MEDICAL WASTE MANAGEMENT & HANDLING
RULES NOTIFICATIONS AND AMENDMENTS
 On 20th July 1998 Ministry of Environment and Forests
(MoEF), Govt. of India, Framed a rule known as ‘Bio-
medical Waste (Management and Handling) Rules,
 1st Amendment Dated 06/03/2000
 2nd Amendment Dated 17/09/2003
 The MoEF&CC has notified the new BMW (M) Rules, 2016
on 28TH March, under the Environment (Protection) Act,
1986 to replace the earlier Rules (1998) and the
amendments thereof.
7

WHO ESTIMATES
 85% of hospital waste is non hazardous
 10% is infectious
 5% is non-infectious
8

85%
10%
3% 1%
1%
Bio-Medical Wastes
Non Infectious waste 85%
Pathological & Infectious
waste, 10%
Chemical &
Phermaceutical waste, 3%
Sharps, 1%
Radioactive, Cytotoxic &
heavy metals, 1%
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BIO HAZARDOUS WASTE
 Infectious waste – 10% (sharp, non sharp, plastics, disposables, liquid
waste)
 Non infectious waste – 5% (radioactive waste, discarded glass,
chemical waste, incinerated waste)
 WHO has estimated that 16 billion injection are administered every
year. Not all needles & syringes are disposed properly.
 Despite this progress, In the year 2010, unsafe injection were still
responsible for as many as 33,800 new HIV infections, 1.7 million
hepatitis B infections & 3,15,000 hepatitis C infections.
 Any infectious or non infectious Bio hazardous waste mixed with
general waste renders the whole bio hazardous waste .
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WHO’S AT RISK
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 Doctor’s & Nurses
 Patients
 Hospital support staff
 support staff Waste collection &
disposal staff
 General public and the
Environment

SOURCES OF BIO-MEDICAL WASTE
Major Sources Minor Sources
 All Hospitals Clinics (Dental & Ayu.)
 Labs Cosmetic clinics
 Research centers Home care
 Animal research Paramedics
 Blood banks Funeral services
 Nursing homes
 Mortuaries
 Autopsy centers
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HOSPITAL WASTE DISPOSAL
Basic principal is that the wastes are disposed in most hygienic &
cost effective manner, by methods which at all stages, minimize
risk to healthy environment, Gov, of India has prescribed certain
procedures and guidelines as follows:
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 Source Segregation
 Collection of wastes
 Storage
 Transport
 Treatment
Disposal

BIO MEDICAL WASTE MANAGEMENT RULES
Acc. To BMW Rules of 1998 The duty of every “occupier”
i.e. A person who has the control over the institution or its
premises, to take all steps to ensure that waste generated is
handled without any adverse effect to human health &
environment. It consists of six schedule-
Schedule – 1
Schedule – 2
Schedule – 3
Schedule – 4
Schedule – 5
Schedule – 6 14

SCHEDULE – 1 NEW 8 CATEGORIES OF BMW IN 1998
CATE
GORY
TYPE OF WASTE PANCHA-
KARMA
WASTE
TREATMENT &
DISPOSAL
Catego
ry 1
Human anatomical wastes Vomitus Incineration/ deep burial
Catego
ry 2
Animal wastes Incineration/ deep burial
Catego
ry 3
Microbiology & biotechnology
waste, Liquid wastes,
waste from Laboratory,
blood banks, hospitals,
house etc.
Blood Local autoclaving/
microwaving/
incineration/
Disinfection by
chemicals
Catego
ry 4
Waste sharps like needles,
syringes, scalpels, blades,
glass etc.
Needle Disinfection
(Chemical/autoclaving/
micro waving &
mutilation/shredding)
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CATEG
ORY
TYPE OF WASTE PANCHA-
KARMA
WASTE
TREATMENT &
DISPOSAL
Catego
ry 5
Discarded Medicines &
cytotoxic drugs
Incineration/
destruction & disposal
in land fills
Catego
ry 6
Soiled wastes
Items contaminated with
blood, body fluids including
cotton, dressings etc
Cotton,
Dressing
material
Incineration,
autoclaving,
microwaving
Catego
ry 7
Solid wastes like catheters,
IV sets etc
Catheter Disinfection by chemical
treatment/autoclaving/
micro waving and
mutilation & shredding
Catego
ry 8
Liquid Waste Disinfecting by
chemical T/t and
discharge into drains
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CATEGORY TYPE OF WASTE PANCHA-KARMA
WASTE
TREATMENT &
DISPOSAL
Category 9 Incineration Ash Disposal in
municipal landfill
Category 10 Chemical wastes Oil Chemical
treatment &
discharge into
drains for liquid
and secured land
fills for solids.
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Colour Coding Type of container to
be used
Waste Category
Number
Treatment
Yellow plastic bags Category 1,2,3,6 Incineration,
Deep burial
Red Disinfected container
/ plastic bags
Category 3,6,7 Autoclaving,
Microwaving,
Chemical T/t
Blue /
white
plastic bags/
puncture proof
container
Category 4&7 Autoclaving,
Microwaving,
Chemical T/t &
Shredding
Black plastic bags Category 5,9,10 Disposal in
secured landfill
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If you are not measuring
it, you are not
managing it.
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SCHEDULE- 3
LABEL FOR BIO-MEDICAL WASTE
CONTAINERS/BAGS (PART- A)
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BIO HAZRDS
SYMBOL
CYTOTOXIC
SYMBOL
BIO HAZARDS WASTE
WITH CARE
NOTE - LABLE SHALL BE NON WASHABLE &
PROMINANTELY VISIBLE

Day ............ Month .............. Year ...........
Date of generation ...................
Waste category No ........
Waste class Waste description
Sender's Name & Address-
Phone No...........Telex No .... Fax No .................
Receiver's Name & Address-
Phone No ……..Telex No ...........Fax No ...............
Contact Person ........ In case of emergency
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SCHEDULE - 5
Standards for T/t & disposal of bio
medical wastes standards for incinerators.
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SCHEDULE - 6
Schedule for waste T/t facilities like
incinerator/ autoclave/ microwave system.
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PRECAUTIONS
 Medical, Paramedical & Sanitation staff should be vaccinated against
Hepatitis B
 Using especially heavy duty gloves, Aprons, Masks, Boots while
dealing with infectious wastes
 Recapping needles should be discouraged. In case, if unavoidable
single handed method should be used
 Segregation of Biomedical Waste & Safe disposal.
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HANDLING DEVICES
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 Trolleys
 Wheelbarrows

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BAD- Don’t carry waste in open bag’s &
never carry it through crowded area
GOOD- Always carry the waste in
secure sealed container/ bags

TRANSPORTATION
 Untreated bio medical waste should be transported in
specially designed vehicles
 Trolley or in covered wheel barrows.
 Manual loading should be avoided as far as possible.
 The bags /container containing biomedical waste should
be tied /lidded before transportation.
 Before transportation, signed document by doctor /nurse
maintaining date, shift, quantity & destination.
 Special vehicle must be used to prevent access direct
contact with the transportation operators, the scavengers
& the public. 34

 The transport containers should be properly enclosed.
 Driver must be trained regarding the procedures
followed during the accidental spillage.
 Wash the interior of the containers thoroughly.
 Biohazard symbol should be painted on the trolley.
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WASTE TREATMENT PROCESS
CATEGORIES
 Five broad categories:
(1) Mechanical processes
(2) Thermal processes
(3) Chemical processes
(4) Irradiation processes
(5) Biological processes.
37

MECHANICAL PROCESSES
 Used to change the physical form or
characteristics of the waste
 To facilitate waste handling or to process the
waste in conjunction with other treatment steps.
 Includes- compaction
- shredding
- land fill and burial
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CONTINUE
 Compaction- compressing the waste into containers to
reduce its volume.
 Shredding – includes granulation, grinding, pulping &
the like, is used to break the waste into smaller pieces.
 Health & safety reasons and good practice prohibit
compacting/shredding untreated medical waste, because
of concerns of aerosoling /spilling of micro-organisms.
 However, there are no ill effects if waste is sheredded
after it has been decontaminated in order to make it
unrecognisable. 39

SANITARY & SECURED LAND FILLING
 Deep burial of human anatomical waste, when the
facility of proper incineration is not available.
 Disposal of autoclaved /hydroclaved /microwaved
waste.
 Disposal of sharps.
 Disposal of incineration ash.
40

PIT FOR DEEP BURRIAL
 Depth 2 meter
 Waste fill 1 meter from bottom
 Cover of lime- 50 cm
 Galvanized iron/ wire mesh at the top
 Secure the area
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THERMAL PROCESSES
 Sterilize or destroyes medical waste.
 Two categories-low heat systems & high heat systems
 Low heat systems-use steam, hot water or
electromagnetic radiation to heat & decontaminate the
waste.
 High heat systems-combustion, pyrolysis & high temp.
plasmas to decontaminate & destroy the waste.
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CONT.
Hot air oven:
Temp. OF 160 degree for 2 hour or 170 degree for 1 hour, for
glass ware, & metallic instruments.
Incineration:
Destruction of contaminated materials in the incinerator.
Autoclave
steam sterilisation under pressure by bringing the
Steam into direct contact with the waste material to sterilize it.
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CHEMICAL PROCESSES
 Most chemical waste treatment systems use a
disinfectant solution in combination with shredding to
provide decontamination & disfigurement.
 1% hypochlorite solution with a minimum contact
period of 30 min.
 Pre-shredding of the waste is desirable for better contact
with the waste material.
44

IRRADIATION PROCESS
 Ionizing- Xray, gamma ray, cosmic rays.
 Non ionizing- infra red, ultra violet.
 Swabs, plastic materials, oil, metal foils, etc.
 These system requires post-irradiation shredding to
render the waste unrecognisable.
45

AUTOCLAVE
Principle:
 When water is heated in a closed vessel under
pressure, the boiling point of water rises above 100
degree.
 Water is heated at 2 atmospheric pressure and the
boiling temperature will be 121 degree or at 3
atmospheric pressure and the boiling temperature
will be 134 degree.
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AUTOCLAVING IS HIGLY EFFICIENT BCOZ
 High temperature.
 High penetrating power of the steam under
pressure.
 When steam condenses on the articles, it liberates
latent heat to the articles to be sterilized.
 Non toxic
 Not time consuming.
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INCINERATION
 Incineration fundamentals:
-incineration comes from a greek word meaning
burn to ashes.
-initially incinerators were just uncontrolled single
chamber fire boxes provided with smoke stocks.
-now modern incineration systems are well
engineered, well designed, well controlled, well
monitored
48

CONT.
 Incineration is a high temperature thermal process
employing combustion of the waste under controlled
condition for converting them into inert material &
gases.
 This can be oil fired/electrically powered/
combination.
49

MICROWAVE TREATMENT
 Radiations produced by the microwave are
involved to break apart molecular chemical bonds
& thus disinfect infectious waste.
 Temp-97◦-100◦C
 Cycle time-40-45 min.
 Advantage of disinfecting the waste
 No hazardous emissions.
 Can not be used to treat body parts & tissues.
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ADVANTAGES :
 Absence of harmful air emissions- environment
friendly.
 Absence of liquid discharges.
 Non-requirement of chemicals.
 Reduced volume of waste (due to shredding &
moisture loss)
 Operator safety-worker friendly
 However, the investment costs are high at present.
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RESPONSIBILITY
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Infection control is everyone's business.
You are not only protecting yourself,
but also those around you

CONCLUSION
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 It is just not the law abide compliance but the
Social RESPONSIBILITY of every Health Care
Establishment to say…
NO TO HAZARD OF BIOMEDICAL WASTE
 It will only take..
Proper planning.
Spread Awareness.
Involvement everyone.
Segregation, Pre-treatment at first stage.
Appropriate Storage
Timely Disposal.
All Records…
And………………………….. ALL CLEAN.

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LET THE WASTE OF THE “SICK” NOT
CONTAMINATE THE LIVES OF
“THE HEALTHY”

Biomedical waste management (handling & treatment)

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