INDEX

Introduction 02-03
Effect on human 04
Biomedical waste 05
Classification of biomedical waste according to WHO 06
Major sources of biomedical waste 07
Minor sources of biomedical waste 08
Need of biomedical waste management in hospitals 09
Benefits of biomedical waste management 10
Biomedical waste management process 11
On-site versus off-site 12
Generation and accumulation 13
Storage and handing 14
Treatment 15-16
Six steps of biomedical waste management 17
Table – colour coding of biomedical waste management 18
Salient features of biomedical waste rules 2016 19-21
Suggestions 22-23
Conclusion 24
References 25-26

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 INTRODUCTION
Biomedical waste is any kind of waste either solid or liquid containing
infectious, potentially infectious materials of medical, laboratory or research
origin from activities such as diagnosis, prevention & treatment of diseases.
Bio-medical waste has a higher potential of infection and injury to the
healthcare worker, patient and the surrounding community. It consists of
human anatomical waste, animal waste, microbiology & biotechnology
waste, waste sharps, discarded medicines & cytotoxic drugs, soiled waste,
liquid waste, incineration ash & chemical wastes. Common generators of
biomedical waste include hospitals, clinics, medical & veterinary colleges,
blood banks, mortuaries, autopsy centers, biotechnology institutions,
research laboratories, home health care & funeral homes. Hazardous
chemicals & radioactive waste though non- infectious require proper
disposal. World Health Organization states that 10% of hospital waste are
infectious & 5% are non-infectious but hazardous waste. World Health
Organization has classified medical waste into 8 categories which include
general, pathological, radioactive, chemical, infectious, sharps,
pharmaceuticals & pressurized wastes. In India, Biomedical waste
(Management & Handling) Rules 1998 along with further amendments
regulate biomedical waste management. It consists of 6 schedules which
includes Category of Biomedical waste, Colour coding & type of container,
Label for Biomedical waste containers or bags which should be non-
washable & prominently visible, Label for transport of Biomedical waste
containers or bags, Standard for treatment & disposal, Schedule for waste
treatment facilities like Incinerator, Autoclave, Microwave System.
Operating Standards like combustion efficiency & Emission Standards are
defined. The present review article focused on basic issues as definition,
categories, problems relating to biomedical waste and procedure of handling
and disposal method of Biomedical Waste Management .
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Hospital is one of the complex institutions which is frequented by people
from every walk of life in the society without any distinction between age,
sex, race and religion. This is over and above the normal inhabitants of
hospital i.e patients and staff. All of them produce waste which is increasing
in its amount and type due to advances in scientific knowledge and is
creating its impact. 1Hospitals produce waste, which is increasing over the
years in its amount and type.

The hospital waste, in addition to the risk for patients and personnel who
handle them also poses a threat to public health and environment.
Biomedical waste (BMW) is any waste produced during the diagnosis,
treatment, or immunization of human or animal research activities pertaining
thereto or in the production or testing of biological or in health camps. It
follows the cradle to grave approach which is characterization, quantification,
segregation, storage, transport, and treatment of BMW. The basic principle of
good BMW practice is based on the concept of 3Rs, namely, reduce, recycle,
and reuse.2Due to the increase in the procedures that are carried out at the
various health care setups, excessive amounts of waste have been generated
at the centers of care. India approximately generates 2kg/bed/ day and this
biomedical waste encompasses wastes like anatomical waste, cytotoxic
wastes, sharps, which when inadequately segregated could cause different
kinds of deadly infectious diseases like Human immunodeficiency virus
(HIV) hepatitis C and B infections, etc, and also cause disruptions in the
environment, and adverse impact on ecological balance.

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Effects on human

Disposal of this waste is an environmental concern, as many medical

wastes are classified as infectious or biohazardous and could potentially lead to
the spread of infectious disease. The most common danger for humans is the
infection which also affects other living organisms in the region. Daily exposure
to the wastes (landfills) leads to accumulation of harmful substances or
microbes in the person's body.

A 1990 report by the United States Agency for Toxic Substances and Disease
Registry concluded that the general public is not likely to be adversely affected
by biomedical waste generated in the traditional healthcare setting. They found,
however, that biomedical waste from those settings may pose an injury and
exposure risks via occupational contact with medical waste for doctors, nurses,
and janitorial, laundry and refuse workers. Further, there are opportunities for
the general public to come into contact medical waste, such as needles used
illicitly outside healthcare settings, or biomedical waste generated via home
health care

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Biomedical waste (BMW) is a major issue of concern in modern times.3,4
As per WHO 15 -25% of the waste generated in the hospital is dangerous
and hazardous to health as it poses a risk to health of individual .As per
estimates 32% of new Hepatitis B infection, 40 % of Hepatitis C
infections and 5 % of new HIV infections occur every year due to
contaminated sharps and syringes.5 Health care waste consists of solid,
liquid and gaseous waste contaminated with organic and inorganic
substance including pathogenic radionuclide generated from in vitro
analysis of body microorganisms. Hospital waste possesses serious tissues
and fluid. WHO (1999) reported that, about 85% of health hazard to the
health workers, public and air hospital waste is non-hazardous, 10%
infective and 5% flora on the area not infective but hazardous.6 The
Government of India (notification, 1998) specifies that Hospital Waste
Management is a part of hospital hygiene and maintenance activities.
This involves management of range of activities, which are mainly
engineering functions, such as collection, transportation, operation or
treatment of processing systems, and disposal of wastes

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 Classification of Bio-Medical Waste according to World
Health Organization
The World Health Organization (WHO) has classified medical waste
into eight categories: ´

1. General Waste

2. Pathological

3. Radioactive

4. Chemical

5. Infectious to potentially infectious waste

6. Sharps

7. Pharmaceuticals

8. Pressurized containers

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Major Sources of bio-medical waste.

 Govt. hospitals/private hospitals/nursing homes/

dispensaries.

 Primary health centers.

 Medicalcolleges and researchcenters/ paramedic services.

 Veterinary colleges and animal research centers.

 laboratories and research centres

 mortuary and autopsy centres

 animal research and testing laboratories

 blood banks and collection services

 nursing homes for the elderly

 Biotechnology institutions.

 Production units.

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 Minor Sources of bio-medical waste.

 Physicians/ dentists’ clinics

 Animal houses/slaughter houses.
 Blood donation camps.
 Vaccination centers.
 Acupuncturists/psychiatric
 clinics/cosmetic piercing.
 Funeral services.
 Institutions for disabled persons

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 Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of

hospitals waste such as:

1. Injuries from sharps leading to infection to all categories of hospital

personnel and waste handler.

2. Nosocomial infections in patients from poor infection control

practices and poor waste management.

3. Risk of infection outside hospital for waste handlers and scavengers

and at time general public living in the vicinity of hospitals.

4. Risk associated with hazardous chemicals, drugs to persons handling

wastes at all levels.

5. Disposable being repacked and sold by unscrupulous elements without

even being washed.

6. Drugs which have been disposed of, being repacked and sold off to
unsuspecting buyers.

7. Risk of air, water and soil pollution directly due to waste, or due to
defective incineration emissions and ash.

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Benefits of Biomedical Waste Management

1. Cleaner and healthier surroundings.

2. Reduction in the incidence of hospital acquired

and general infections.

3. Reduction in the cost of infection control within

the hospital.

4. Reduction in the possibility of disease and death due to reuse and

repackaging of infectious disposables.

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. Improved image of the healthcare establishment and increase the quality

of life.

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 Biomedical Waste Management Process

Mismanagement of hospital waste implies a combination of improper

handling of waste during generation, collection, storage, transport and treatment.
Improper handling comprises several unsafe actions, such as handling without
personal protective equipment (PPE), poor storage (e.g., high temperature
conditions combined with prolonged storage times before treatment), manual
transport for longer distances, use of uncovered containers instead of closed
plastic bags, etc. Other examples include exposure times beyond acceptable.

limits, lack of worker and equipment decontamination procedures, etc., all of

which affect hospital workers in different ways. There is a big network of
Health Care Institutions in India. The hospital waste like body parts, organs,
tissues, blood and body fluids along with soiled linen, cotton, bandage and
plaster casts from infected and contaminated areas are very essential to be
properly collected, segregated, stored, transported, treated and disposed of in
safe manner to prevent nosocomial or hospital acquired infection.

Biomedical waste must be properly managed and disposed of to protect the

environment, general public and workers, especially healthcare and sanitation
workers who are at risk of exposure to biomedical waste as an occupational
hazard. Steps in the management of biomedical waste include generation,
accumulation, handling, storage, treatment, transport and disposal.

The development and implementation of a national waste

management policy can improve biomedical waste management in health
facilities in a country.

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On-site versus off-site

Disposal occurs off-site, at a location that is different

from the site of generation. Treatment may occur on-site or off-site. On-site

treatment of large quantities of biomedical waste usually requires the use of

relatively expensive equipment, and is generally only cost effective for very

large hospitals and major universities who have the space, labour and budget to

operate such equipment. Off-site treatment and disposal involves hiring of a

biomedical waste disposal service (also called a truck service) whose employees

are trained to collect and haul away biomedical waste in special containers

(usually cardboard boxes, or reusable plastic bins) for treatment at a facility

designed to handle biomedical waste.

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Generation and accumulation
Biomedical waste should be collected in containers that are leak-proof and
sufficiently strong to prevent breakage during handling. Containers of biomedical
waste are marked with a biohazard symbol. The container, marking, and labels
are often red.

Discarded sharps are usually collected in specialized boxes, often called needle
boxes.
Specialized equipment is required to meet OSHA 29CFR 1910.1450 and EPA 40
CFR 264.173. standards of safety. Minimal recommended equipment includes
a fume hood and primary and secondary waste containers to capture potential
overflow. Even beneath the fume hood, containers containing chemical
contaminants should remain closed when not in use. An open funnel placed in the
mouth of a waste container has been shown to allow significant evaporation of
chemicals into the surrounding atmosphere, which is then inhaled by laboratory
personnel, and contributes a primary component to the threat of completing
the fire triangle. To protect the health and safety of laboratory staff as well as
neighbouring civilians and the environment, proper waste management
equipment, such as the Buerkle funnel in Europe and the ECO Funnel in the U.S.,
should be utilized in any department which deals with chemical waste. It is to be
dumped after treatment.

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Storage and handling
Storage refers to keeping the waste until it is treated on-site or transported off-

site for treatment or disposal. There are many options and containers for

storage. Regulatory agencies may limit the time for which waste can remain in

storage. Handling is the act of moving biomedical waste between the point of

generation, accumulation areas, storage locations and on-site treatment

facilities. Workers who handle biomedical waste must observe standard

precautions.

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Treatment
The goals of biomedical waste treatment are to reduce or eliminate the waste's
hazards, and usually to make the waste unrecognizable. Treatment should
render the waste safe for subsequent handling and disposal. There are several
treatment methods that can accomplish these goals.It include secregating the bio
waste

Biomedical waste is often incinerated. An efficient incinerator will destroy

pathogens and sharps. Source materials are not recognizable in the resulting ash.
Alternative thermal treatment can also include technologies such as
gasification and pyrolysis including energy recovery with similar waste volume
reductions and pathogen destruction.

An autoclave may also be used to treat biomedical waste. An autoclave uses

steam and pressure to sterilize the waste or reduce its microbiological load to a
level at which it may be safely disposed of. Many healthcare facilities routinely
use an autoclave to sterilize medical supplies. If the same autoclave is used to
sterilize supplies and treat biomedical waste, administrative controls must be
used to prevent the waste operations from contaminating the supplies. Effective
administrative controls include operator training, strict procedures, and separate
times and space for processing biomedical waste.

Microwave disinfection can also be employed for treatment of Biomedical

wastes. Microwave irradiation is a type of non-contact heating technologies for
disinfection. Microwave chemistry is based on efficient heating of materials by
microwave dielectric heating effects. When exposed to microwave frequencies,
the dipoles of the water molecules present in cells re-align with the applied
electric field. As the field oscillates, the dipoles attempts to realign itself with
the alternating electric field and in this process, energy is lost in the form of heat
through molecular friction and dielectric loss. Microwave disinfection is a
recently developed technology which provides advantage over old existing

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technologies of autoclaves as microwave-based disinfection has less cycle time,
power consumption and it requires minimal usage of water and consumables as
compared to autoclaves.

For liquids and small quantities, a 1–10% solution of bleach can be used to
disinfect biomedical waste. Solutions of sodium hydroxide and other chemical
disinfectants may also be used, depending on the waste's characteristics. Other
treatment methods include heat, alkaline digesters and the use of microwaves.

For autoclaves and microwave systems, a shredder may be used as a final

treatment step to render the waste unrecognizable. Some autoclaves have built
in shredders.

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Six steps of Bio medical waste Management

1. Waste collection

2. Segregation

3. Transportation and storage

4. Treatment & Disposal

5. Transport to final disposal site

6. Final disposal

Safeguarding the health care workforce against occupational health

risks arising from hospital-waste management calls for effective
infectious waste control measures. In addition to protecting workers
health, such control measures protect public health and the environment
from the hazards posed by hospital waste. Proper management ensures
that infectious waste is handled in accordance with established and
acceptable procedures from the time of generation through treatment of the
waste and its ultimate disposal.

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 Table- Colour coding of BMW

Category Types of Waste Colour and type of Container

Human Anatomical waste
Animal Anatomical waste Yellow colour non

Soiled waste chlorinated plastic bags

Yellow
Discarded or expired having thickness equal to

medicine Laboratory more than 50microns or

waste Chemical waste containers.

Chemical liquid waste

Red colour non chlorinated

Red Contaminated waste plastic bags having thickness
(Recyclable) equal to more than
50microns or containers.
White colour translucent,
White Waste sharps including puncture proof, leak proof,
metals temper proof containers.

Glassware Cardboard boxes with blue

Blue Metallic body implants colour ed marking or blue
coloured puncture proof,
temper proof containers.

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 Salient Features of Biomedical Waste Rules 2016

1. The scope of the rules have been expanded to include various health
camps such as vaccination camps, blood donation camps, and surgical
camps9

2. Duties of the occupier of HCFs have been revised. Occupier is the

person having administrative control over the HCF that is generating
BMW10

a. Compulsory pre-treatment of the laboratory, microbiological waste,

and blood bags on-site before disposal either at CBMWTF or on-site. The
method of sterilization/disinfection should be in accordance with National
AIDS Control Organization (NACO) or WHO

b. The use of chlorinated plastic bags, gloves, blood bags, etc. should be
gradually stopped and this phasing out should be within 2 years from the date
of notification of these rules

c. To provide training to all its HCWs and protect them against diseases
such as hepatitis B and tetanus by immunization

d. Liquid waste to be separated at source by pretreatment before mixing

with other liquid waste

e. To set up a barcode system for BMW containing that is to be sent out of

the premises for treatment and disposal

f. All major accidents including accidents caused by fire hazards, blasts,

during handling of BMW, and remedial action taken by the prescribed
authority should be reported

g. The existing incinerator should be upgraded/ modified to achieve the

new standard within 2 years from the date of this notification

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 h. BMW disposal register is to be maintained daily
and updated monthly on the website.

3. The duties of the operator of a common biomedical waste treatment and

disposal facility (CBMWTF) have been increased. They should assist in
training of HCW from where the waste is being collected. Furthermore, there
should be barcoding and global positioning system established for handling of
BMW within 1 year. Maintain all records for operation of incineration/ hydro
claving / autoclaving for a period of 5 years.

4. The segregation, packaging, transportation, and storage of BMW have been

improved. Biomedical waste has been classified into four categories based on
color. code-type of waste and treatment options. In addition, untreated human
anatomical waste, animal anatomical waste, soiled waste, and biotechnology
waste should not be stored beyond a period of 48 h. In case, there is a need to
store beyond 48 h, the occupier should take all appropriate measures to ensure
that the waste does not adversely affect human health and the environment.

5. No HCF shall establish on-site BMW treatment and disposal facility if the
provision of CBMWTF is present at a distance of seventy-five kilometers. If
no CBMWTF is available, the occupier shall set up requisite BMW treatment
facility such as incinerator, autoclave or microwave, shredder after taking prior
authorization from the prescribed authority. After confirming treatment of plastics
and glassware by autoclaving or microwaving followed by
mutilation/shredding, these recyclables should be given to authorized recycler.

6. Authorization for BMW disposal for nonbedded HCFs is granted to the

occupier at one time only. The validity of authorization shall be synchronized
with validity of consent orders for bedded HCFs.

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7. Standards for emission from incinerators have been modified to be more
environmental friendly. These are permissible limit for SPM-50 mg/nm3 ;
residence time in secondary chamber of incinerator – two seconds; standard for
dioxin and furans – 0.1 ng TEQ/Nm3.

8. Ministry of Environment, Forest, and Climate change will monitor the

implementation of rules yearly. The responsibility of each state to check for
compliance will be done by setting up district-level committee under the
chairpersonship of District Collector or District Magistrate or Additional
District Magistrate. In addition, every 6 months, this committee shall submit its
report to the State Pollution Control Board.

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 Suggestions

The following solutions to remove obstacles to make progress in hospital

waste management are recommended:

1. Calculate and monitor economic benefits from waste minimization in

hospital.

2. More accurate monitoring and controlling of hospital waste

separation process by the ministry of health and medical education and
environmental protection agency.

3. Materials management in a way that the 3 primary criteria of using less,

reusing and recycling to be considered.

4. Review reasonably related laws to facilitate the process of reducing the

danger of hospital waste and removing their problems.

5. Review the laws in the process of the hospital waste separation at

source and related definitions to prevent from confusion of officials
responsible for hospital waste separation.

6. Participation of private sector’s specialists in the process of hospital

waste management.

7. Domestic and foreign investment to import modern technology in the

country by public and private sector.

8. Meetings with managers and officials for a closer relationship and

familiarity with available scientific and practical solutions.

9. Helping of the University to improve the implementation of the

plans and suggests new scientific recommendations.

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 10. Advertising extensively by the public media for
more awareness of the public.

11. Using new technology capable of reducing waste in different parts

of the hospital, especially areas with potential of production of hazardous
wastes.

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Conclusion
Training programs need to focus on empowering the
healthcare professionals on biomedical waste management with broad scope
and practical knowledge in all aspects. Training the staff with checklists and
regular inspections can bring about accountability in the staff. Improper
Biomedical waste management leads to environmental pollution,
multiplication of vectors like insects, rodents & worms leading to
transmission of diseases like typhoid, cholera, plague, hepatitis & AIDS.
Recycling of disposable syringes, needles, intravenous sets, and glass bottles
without proper sterilization leads to hepatitis, tetanus, HIV & viral diseases.
Benefits of biomedical waste management include healthy surroundings,
reduction in hospital acquired infections & cost of infection control, reduction
in reuse of infectious disposables & prevention of occupational health hazards.
Awareness about hazards of biomedical waste & its proper disposal is
required for a safe & healthy future. All health care professionals regardless
of their designation, experience and qualification, designation must be
included in these interventions, so that it can avoid cross infections among the
professionals and patients in the health care sector.

 Conflict of Interest- Nil

 Ethical Clearance- Nil
 Acknowledgment- Nil
 Source of Funding – Nil

References

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