Govt of Karnataka

DISTRICT QUALITY ASSURANCE UNIT BELAGAVI

DH/CHC/PHC/UPHC

----------------------------------
STANDARD OPERATING
PROCEDURE FOR BIO MEDICAL
WASTE MANAGEMENT
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

1.STANDARD OPERATING PROCEDURE FOR BIO MEDICAL WASTE MANAGEMENT

PURPOSE

To provide guidelines for BIO MEDICAL WASTE MANAGEMENT

SCOPE

Hospital wide

RESPONSIBILITY

Matron/Incharge nurse/Non Clinical Supervisor/

PROCEDURE

1. Records for functional linkage with CWTF (PHC non 24x7 –C2.1, PHC 24x7 –C2.1,
DH/TH/CHC – C2.3 )

2. Disinfection of broken/discarded glassware/medicine vials/contaminated glass/ampules

(except that of attenuated vaccines) (PHC non 24x7 –C3.1, PHC 24x7 –C3.1,
DH/TH/CHC- C3.1)

3. Biomedical Waste segregation chart (PHC 24x7 –C1.2,Non 24x7 PHC C1.1,
DH/TH/CHC- C2.2)
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

As “Kayakalp” Scheme is inclined towards ensuring cleanliness and hygiene in health facilities it becomes
imperative for them to manage the waste generated in an appropriate manner which ensures that
facilities are clean and free from any risk which may arise due to improper waste management.

Health facilities needs to streamline and standardise the entire activities required to manage waste right
from its inception to its final disposal. This includes collection, transport, treatment and disposal of waste
together with monitoring and regulation. It also encompasses the legal and regulatory framework that
relates to waste management.

This section of these guidelines encompasses all the requirements which hospitals need to meet for
proper management of bio medical and general waste in the hospital. These requirements are subdivided
into following sections:

Implementation of BMW Rules, 2016 & 2018 (Amendment)

Segregation, Collection and Transportation of BMW
Sharp Management
Storage of Bio Medical Waste
Disposal of Bio Medical Waste
Management of Hazardous Waste
Solid General Waste Management
Liquid Waste Management
Equipment and Supplies for BMW Management
Statutory Compliances

IMPLEMENTATION OF BIO MEDICAL WASTE RULES, 2016 & 2018 (Amendment)

BMW management rules were revised through a gazette notification by the Central Government in 2016
& 2018 (Amendment) and it has become mandatory for health facilities to manage bio medical waste
generated from the health facilities as per the new rules.

The bio medical waste as defined by the BMW Rules, 2016 is any waste which is generated during the
activities of diagnosis, treatment and immunisation of human beings or any research activities pertaining
there to or in the production or testing of biological or in the health camps.

For implementation of the BMW Rules, 2016 & 2018 (Amendment) the health facilities need to be aware
of the key changes that are incorporated in the BMW Rules vis-a-vis BMW Rules, 1998. The health
facilities need to ensure that it has a copy of new BMW Rules for ready reference and as a guiding
document for BMW management.
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

For implementation of the BMW Rules 2016 & 2018 (Amendment) the health facilities needs to ensure
the following:STE
MANAGEMENT
Bio medical waste generated from the health facilities is segregated as per the new colour coding
scheme specified in the BMW Rules, 2016 & 2018 (Amendment)
All the health facilities which are situated within 75 km radius of Common Bio Medical Waste
Treatment Facility (CBMWTF), need to have a formal agreement with the CBMWTF for final treatment
and disposal of the bio medical waste
Health facilities which do not lie within 75 km radius of CBMWTF need to have approval for deep burial
pit, used for disposal of waste from the Pollution Control Board office
Health facilities also need to ensure that the pre-treat the waste at the health facilities as per BMW
Rules before handing over the same to CBMWTF or before the final disposal
Each health facility also needs to ensure that only non-chlorinated bags ( excluding blood bags) are
used by the hospital for collection of waste in the hospital
Health facilities also need to ensure that they monitor the activities of BMW management through a
committee formed at the facility. This committee should meet at least once in six months and all the
records related to the same need to be maintained by the health facility.

SEGREGATION, COLLECTION & TRANSPORTATION OF BMW

The key activities that a hospital performs for the management of BMW include segregation of the waste
at the point of generation, timely collection of waste and transportation of the waste from the interim
storage areas of the hospital to the central storage area and transportation of the waste from the central
storage area to the deep burial pits (in case of facilities not having agreement with CBMWTF).

SEGREGATION
GENERAL REQUIREMENTS
It is imperative for healthcare organisations to segregate the waste generated from the facilities at the
point of generation only
Segregation of the waste is the responsibility of the waste generator only
The waste generated from different areas of the hospital needs to be segregated as per the colour
coding provided in the BMW Rules, 2016 & 2018 (Amendment).
The general waste generated should not to be mixed with the bio medical waste.
The work instructions are displayed at appropriate areas of the hospital for proper segregation of the
waste as per the colour coding.
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

Table 11: Segregation of BMW Waste as per BMW Rules, 2016 & 2018 (Amendment)

S. No. Category Type of Waste Colour & Type of Container

1 Yellow Category Human Anatomical Waste Yellow colour non chlorinated
Soiled Waste plastic bags or
Discarded or Expired containers
Medicine
Chemical Liquid Waste
Chemical Laboratory
Waste
Chemotherapy Drug Vials

2 Red Category Contaminated Waste Red colour non chlorinated plastic

(Recyclable) bags and containers

3 White Category Waste Sharps including White colour puncture proof, leak
metals proof, tamper proof containers
ue

4 Blue Category Glassware Puncture proof and leak proof boxes

Metallic Body Implants or containers with blue coloured
marking (2018 Amendment)
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

COLLECTION OF WASTE
GENERAL REQUIREMENTS
All the bags used for waste collection need to be sealed once they are full to 3/4th of their capacity and
transported to the central waste storage area or interim storage areas Collection of the waste needs to
be done in closed covered containers which are sturdy preferably wheelbarrows
Collection time needs to be fixed and size of the bins need to be appropriate to the quantity of waste
produced in each area of the healthcare facility
General waste should not be collected at the same time or in the same trolley as infectious or other
hazardous wastes
Collection of the waste should be done daily, with collection timed to match the pattern of waste
generation during the day
The collection timings should enable the HCF to minimise or nullify the use of interim storage of waste
in the departments
The collection of the waste should be done by the waste handlers only after downing of the appropriate
PPE i.e. gum boots, heavy duty gloves, face masks and eye wear
All the bags needs to be labelled with biohazard or cytotoxic hazard symbol along with date of
generation and area of generation for easy traceability.

TRANSPORTATION OF WASTE
BMW generated from the health facilities should be transported in covered wheelbarrow based sturdy
trolleys through a route which has low traffic flow of patients and visitors (whenever possible)
The waste transportation trolleys should be dedicated for the purpose of waste transportation only
The transportation trolleys need to be separate for general waste and for BMW
It is preferable that the trolleys used for transportation should be as per the colour coding, as provided
in the New BMW Rules.
All the trolleys used for the transportation of the waste should be labelled with bio hazard logo
After every transportation cycle, ensure trolley should be washed, disinfected & dried up
Route of transportation to the BMW holding/disposal area should preferably be planned in such a way
that ensures:
o it does not include transportation through high risk areas
o supplies and waste are transported through separate routes.
o waste is not transported through areas having high traffic of patients and visitors
o central waste collection area can be easily accessed through this route
o provide safe transportation of waste to avoiding spillage and scattering of waste
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

STORAGE OF BIOMEDICAL WASTE

The BMW generated from the hospital needs to be stored in a dedicated central waste storage area,
before handing over the same to the CBMWTF. The minimum requirements that are needed to be
ensured by hospitals for central waste storage area as listed as follows:

The location of central waste collection station should be away from the public/visitors access
The planned space should also include space provisions for storage of waste collection trolleys
Such centre should be roofed and manned through lock and key under the responsibility of designated
person
The entrance of this centre should be accessible through a concrete ramp for easy transportation of
waste collection trolleys
During construction it is to be ensured that the centre is kept ventilated through the use of exhaust fan
or by use of wire meshes for ventilation
There should also be provision of water supply adjacent to central waste storage area for cleaning and
washing of this station, trolleys and also for hand washing for the staff
The entrance of this station should be labelled with “ENTRY FOR AUTHORISED PERSONNELL ONLY”
and logo of BMW Hazard.
It is desirable that for new health facilities under construction, the drainage system of this central
waste collection is attached to the Effluent Treatment System of the health facilities
It is to be ensured that no general waste is stored in the central waste collection area
The hospital should ensure that waste generated from the hospital should not be stored beyond a
period of 48 hours
To ensure there is no pilferage of recyclables, it is to be ensured that central storage area is under lock
and key, guarded by a designated person
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

Health facilities need to maintain the record of waste handed over to the CBMWTF and also for
recyclable waste generated and handed over to the authorised recyclers
To ensure protection from animals, it is to be ensured that there is no stray animal in the health facility
premises and cattle traps have been installed at the entrance of the health facility.

60
DISPOSAL OF BIOMEDICAL WASTE

Hospitals need to ensure that they have adequate arrangements for the disposal of BMW generated from
the health facility.
The final disposal of the BMW generated from the health facility can be taken up by the CBMWTF or
through deep burial and sharp pits.

HOSPITALS UNDER CONTRACT WITH CBMWTF

All the hospitals, which are situated within a distance of 75 km of CBMWTF, need to have a formal
bagreement/contract with the CBMWTF for transportation and disposal of BMW generated from the
hospital. These hospitals have to hand over the waste to the CBMWTF for final disposal and should
ensure that waste is not disposed of in the deep burial and sharp pits.
Hospitals need to ensure that the disposal of the BMW generated from the hospital is disposed of as per
Schedule I of the BMW Rules, 2016. & 2018 (Amendment)

HOSPITALS NOT UNDER CONTRACT WITH CBMWTF

Hospitals which are situated outside 75 km areas of the CBMWTF should ensure that they have the
facility of disposal of waste within the premises of the hospital i.e. deep burial and sharp pits.
Hospitals need to have approval from Pollution Control Board office for all the deep burial pits and sharp
pits created in the hospital and records of the same need to be maintained by the hospital.
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

The deep burial pits created in the hospital should meet the requirements as listed in the New BMW
Management Rules.

STANDARDS FOR DEEP BURIAL

A pit or trench should be dug about two meters deep. It needs to be half filled with waste, and then
covered with lime within 50 cm of the surface, before filling the rest of the pit with soil
It should be ensured that animals do not have any access to burial sites. Covers of galvanised iron or
wire meshes may be used
On each occasion, when wastes are added to the pit, a layer of 10 cm of soil shall be added to coverthe
wastes
Burial should be performed under close and dedicated supervision
The deep burial site should be relatively impermeable and no shallow well should be close to the site
The pits should be distant from habitation, and located so as to ensure that no contamination occurs to
surface water or ground water. The area should not be prone to flooding or erosion
The ground water level should be a minimum of six meters below the lower level of deep burial pit.

61
Suggested Standard for Disposal of Sharp
A sharp pit should be constructed within the hospital premises to dispose of the sharp waste generated
from the facility
Sharp pit should be a 1mt×1mt×1mt concrete lined protected pit with a cemented lid
Disposal of the sharp containers need to be done by discarding the containers in entirety into the sharp
pits
Encapsulation of the waste sharp for prevention of reuse may be done with use of binding material like
cement or clay. The filled needle containers can be placed in the sharp pits up to 3/4th of the capacity of
the pit. An immobilising material such as cement or clay is added to the pit. Once dry, thesharp pit is
sealed. Another sharp pit is created for further use.
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

Figure24: Disposal of sharp waste containers into sharp pits

HANDLING OF METAL SHARPS

Sharps of metals like blades, scalpels, needles, burnt needles and syringes with fixed needles are included
under the white category of BMW, as per BMW Rules, 2016 & 2018 (Amendment). This category of the
waste is handled as following:
All the waste generating sites need to be provided with needle cutter/burner for cutting/burning of the
needles and cutting of the injection tips
All the waste generating areas of the hospital are provided with leak proof, tamper proof and puncture
proof white translucent containers having narrow mouth (the hand should not go in it)
The burnt/cut needles, blades, scalpels and syringes with fixed needles are collected and stored in the
white translucent containers which should be leak proof, puncture proof and tamper proof
The sharp containers should be handed over to the CBMWTF or sharps can be disposed off in sharp pits.

General Instructions for Handling the Sharps

Sharps should always be handled carefully, in accordance with the following principles:
Needles should not be bent, sheared, broken, recapped (by using both hands), removed from
disposable syringes, or otherwise manipulated before disposal
Always get help when using sharps on a confused or agitated patient
Never pass sharps from person to person by hand
Never walk around with sharps in your hand
Never leave sharps lying around – dispose them off yourself
Dispose of sharps at the point of use – take a sharps container with you. Never collect used sharps and
try to segregate/dispose them together
Dispose off syringes and needles as a single unit – do not remove the needle first
Do not pick up broken glass with hands, use mechanical means such as a brush and dustpan, tongs, or
forceps.
 Name of the Facility……………………………….
Doc No:SOP/Kayakalpa
STANDARD OPERATING
Issue date:01/04/2018
PROCEDURE
Issue No.:01
BIO MEDICAL WASTE Rev. date: 0
MANAGEMENT Rev No.:0

HANDLING OF GLASSWARE
All the glassware generated from the hospital including broken glasses, medicine vials, contaminated
glass, ampules (except that of attenuated vaccines), are covered under the Blue Category of BMW waste
as per BMW Rules, 2016 & 2018 (Amendment). The blue category also includes all the metallic body
implants being used in the hospital.

Steps of Handling
The glassware waste generated from the hospital needs to be first pre-treated in the hospital before
handing it over to the CBMWTF or disposing in the sharp pits. Pre-treatment of the waste is carried out
by immersing the waste in the 1% chlorine solution (having 30% residual chlorine) for at least 20
minutes or by use of autoclave meeting the specifications as specified in Schedule II of BMW Rules, 2016
& 2018 (Amendment). Hypochlorite must be prepared fresh before immersion

All the glassware needs to be collected and stored in Puncture proof and leak proof boxes or containers
with blue coloured marking ( 2018 Amendment)

These boxes are handed over to the CBMWTF for final treatment and disposal.