BIOMEDICAL WASTE

MANAGEMENT

Dr VISHWANATH
DEPARTMENT OF MICROBIOLOGY
AIIMS, NEW DELHI
18/01/21
 what is biomedical waste management

 As per the act passed by the Ministry of Environment and Forests in 1986 & notified
the Bio Medical Waste (Management and Handling) Rules in July 1998 and
amended in 2016, it is 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 and environment.

 Hospital waste: 
refers to all waste, biological or non ‐ biological that is discarded and not intended for
further use.

 Bio-medical waste:
means 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, and including categories mentioned in Schedule I, of the BMW
rules, 2016.
 Why biomedical waste management is so important?

 Injuries from sharps leading to infection in all categories of hospital personnel and
waste handlers.

 Nosocomial infections in patients due to poor infection control practices and poor
waste management.

 Risk of infection outside the hospital for waste handlers and scavengers and at times,
for the general public living in the vicinity of hospitals.

 Risks associated with hazardous chemicals and drugs to the persons handling wastes
at all levels.

 "Disposable" being repacked and sold by unscrupulous elements without even being
washed.

 Drugs that have been disposed of, being repacked, and sold off to unsuspecting
buyers.

 The risk of air, water, and soil pollution directly due to waste, or due to defective
incineration emissions and ash.
Bio-Medical Waste rules 2016 doesn’t apply to the following types of
wastes as they are covered under different acts enumerated below:

 Radioactive waste
 Hazardous chemicals
 Lead acid batteries
 Hazardous wastes
 E-wastes
 Municipal solid waste
 Hazardous microorganisms, genetically modified microorganism and cells
Bio-medical waste has been classified into 4 categories to improve the
segregation of waste at source
 BIOMEDICAL WASTE MANAGEMENT IN OUR TB LAB
Biomedical Wastes Segregation and disposal in the lab

Contaminated waste of rubber and plastic origin, Red colored bag

such as gloves, masks, cartridges, transfer pipettes,
filter tips, sample containers, syringes without
needles etc.
materials soiled with contaminated waste such as Yellow colored bag
bandages, dressings, cotton swabs soiled with body
fluids, biopsy tissue, organ parts, expired drugs,
cultures, chemical waste, reagent bottles, blood bags
etc.

Liquid wastes such as sputum, pus, BAL, gastric Wide mouth discard bottle with 5% phenol or 5%
aspirate etc. and waste generated after processing of Lysol
samples.

Glass slides, ampoules, broken glass etc. Puncture proof, leak and tamper proof white card
board container with blue markings.

Sharps, needles, syringes with fixed needles, blades, White translucent puncture proof, leak and tamper
scalpel etc. proof container with 1% hypochlorite solution

Uncontaminated plastic waste such as cover of the Black bag

gloves, plastic coverings of laboratory materials
General waste such as paper cups, paper plates, tissue Black bag
papers etc.
TREATMENT OF BIOMEDICAL WASTE
 Treatment of biomedical waste

Incineration:
This is the process of burning of waste in temperatures ranging from 1,800°F to 2,000°F
(982°C to 1093°C). 

Autoclaving:
Autoclaving or steam sterilization, is the most commonly utilized alternative to
incineration.  It is both less costly and carries no documented health impacts. Bags of
waste are placed in a chamber and steam is introduced for a determined period of time at
a specified pressure and temperature.  This assures the destruction of microorganisms.

Gas sterilization:
In this process, medical waste is fed into an evacuated air-tight chamber and treated with
a sterilizing agent (such as ethylene oxide or formaldehyde). The gas that comes into
contact with the waste will kill harmful, infectious agents.

Thermal inactivation:
This process involves heating waste to temperatures at which infectious agents are killed.
 It is used for treating large volumes of liquid clinical wastes.  A chamber is preheated to
an intense, specified temperature and held for a specified time, then released.
 Treatment of biomedical waste

Chemical disinfection:
This process involves the use of chemical agents for disinfection, such as chlorine.
 Chemical disinfection processes are most appropriate for liquid wastes, although they
can still be used to treat solid wastes.
Note - grinding of medical waste before exposing it to a liquid chemical
disinfectant can be done. Grinding ensures sufficient exposure of the
chemical agent to all parts of the waste and assists in easy disposal of
any residues. 

Microwave:
The application of microwave technology treatment also can disinfect
waste. Waste is first shredded, and then mixed with water and internally
heated to neutralize all present biologicals. 

Irradiation:
This method involves sterilizing waste by exposing it to a cobalt source.
Cobalt gives out gamma radiations that destroy all microbes in waste.  
FROM GENERATION TO DISPOSAL AT AIIMS…..
FROM GENERATION TO DISPOSAL AT AIIMS…..
FROM GENERATION TO DISPOSAL AT AIIMS…..
FROM GENERATION TO DISPOSAL AT AIIMS…..
FROM GENERATION TO DISPOSAL AT AIIMS…..
 BENEFITS OF BMW MANAGEMENT
 Cleaner and healthier surroundings.

 Reduction in the incidence of hospital-acquired and general infections.

 Reduction in the cost of infection control within the hospital.

 Reduction in the possibility of diseases and deaths due to reuse and

repackaging of infectious disposables.

 Low incidence of community and occupational health hazards.

 Reduction in the cost of waste management and generation of revenues

through appropriate treatment and disposal of waste.

 Improved image of the health care establishment and betterment in the

quality of life. 
 Let the waste of “the
sick” not contaminate
the lives of “the healthy”

THANK YOU
STERILIZATION AND
DISINFECTION

Dr VISHWANATH
DEPARTMENT OF MICROBIOLOGY
AIIMS, NEW DELHI
20/01/21
Introduction

Disinfection
-Elimination of all pathogenic microorganism except
spores
High level
◦ Destroys all micro-organism except high no. of bacterial spore
Intermediate level
◦ Destroys vegetative bacteria, mycobacteria, most viruses,
most fungi, but not bacterial spores
Low- level
◦ Destroys vegetative bacteria, some fungi and viruses but
not mycobacteria or spores
Guidelines for disinfection and
sterilization in healthcare facilities,
CDC (updated Feb. 2017)
Introduction

Sterilisation
-Elimination of all pathogenic microorganism including
spores
-results in reduction of 106 CFU

-can be achieved by a physical or chemical

agent

Guidelines for disinfection and

sterilization in healthcare facilities,
CDC (updated Feb. 2017)
 Spaulding classification
Critical items
◦ High risk of infection
◦ Objects entering sterile tissue or vascular system
◦ Surgical instruments, catheters, implants etc
◦ Should be free from all forms of micro-organism
◦ Demands sterilization

Semi-critical items
◦ Items contact mucous membrane or nonintact skin
◦ Endoscopes, laryngoscope blades, cystoscopes etc
◦ Should be free from all micro-organism
◦ Small no. of bacterial spore are permissible
◦ Requires High level of disinfection
Non critical items
 Contact with intact skin but not mucous membrane

 Intact skin acts as effective barrier

 Requires Low level disinfection

 Noncritical patient care items

◦ Bedpans, blood pressure cuffs, crutches etc
 Noncritical environmental surfaces
◦ Bed rails, bedside table, furniture and floors
Characterization of disinfectants according to their
class
Spectrum of action Required for Examples

Sterilants all microorganisms, critical instruments heat, steam, higher concentrations of

including bacterial that penetrate tissue hydrogen peroxide and peracetic
spores or present a high risk acid, glutaraldehyde (in 6 –10 h)
if non-sterile

High-level almost all semi-critical items hydrogen peroxide, glutaraldehyde,

disinfectants microorganisms, formaldehyde, ortho-phthalaldehyde,
but not spores peracetic acid

Intermediate- almost all non-critical items that alcohols, hypochlorites, iodine and
level vegetative bacteria, touch intact skin (e.g. iodophor disinfectants
disinfectants fungi, tubercle thermometers and
bacilli and viruses hydrotherapy tanks)

Low-level not efficient for non-critical items: phenolics, quaternary ammonium

disinfectants most bacteria, items such as compounds
tubercle bacilli, stethoscopes bedpans,
spores, fungi and blood pressure cuffs
viruses and bedside tables

Ana C. Abreu et al, J Antimicrobial Chemotherapy 2013

Decreasing order of resistance of microorganisms to
disinfection and sterilization (with the disinfection levels
indicated)

Guidelines for disinfection and

sterilization in healthcare facilities,
CDC (updated Feb. 2017)
 Properties of ideal disinfectant/ sterilant
• Broad spectrum
• Fast acting
• Not affected by environmental factors
• Nontoxic
• Surface compatibility
• Residual effect on treated surfaces
• Easy to use with clear label direction
• Odourless
• Economical
• Solubility and stability
• Cleaner and environmental friendly

Guidelines for disinfection and

sterilization in healthcare facilities,
CDC (updated Feb. 2017)
Factors affecting efficacy of disinfectant/
STERILANT

• Number and location of micro-organism

• Nature of organisms
• Concentration (chemical agent) or Temperature

(heat sterilization)
• Physical and chemical factors
• Organic and inorganic matter
• Duration of exposure
• Biofilms Guidelines for disinfection and
sterilization in healthcare facilities,
CDC (updated Feb. 2017)
Physical methods of sterilization/ disinfection
Heat

Dry heat
 Flaming

Items are held in the flame of Bunsen burner

 Incineration
Used for disposal of biomedical waste (860-1200°C)

 Hot air oven

Glasswares: test tubes, flask
Surgical instruments: scalpel, forceps
Chemicals: paraffin, glycerol, oil, glove powder
160°C for 2 hours
Control:Bacillus atrophaeus
Physical methods of sterilization/ disinfection

Moist heat

 Temp. below 100°C

Pasteurisation
Holders method: 63°C for 30 min
Flash method: 72°C for 20 sec

Waterbath
Vaccines : 60°C for 1 hr
Serum : 56°C for 1 hr

Inspissation
Heating for 3 successive days: 80-85°C for 30 min.
Used for Egg and serum based media
Physical methods of sterilization/ disinfection

Moist heat

 Temp. at 100°C
Boiling
Boiling item in water for 15 min
Kills most vegetative form
Steaming
Perforated tray used
Article exposed to 100°C for 90 min
Tyndallisation
Heating for 3 successive days: 100°C for 20 min.
Used for gelatin, egg, sugar, serum based media
Physical methods of sterilization/ disinfection

Moist heat

 Temp. above 100°C

Autoclave
Principle:
Exposes load to saturated steam at pressure > Atm
Steam condenses on the cooler load, release both thermal
energy and moisture
Denature all microbial protein

Atm pressure ∞ Temp

Indicator:
Sterilization condition Geobacillus
121°C for 15 mins at pressure of 15 psi
stearothermophilus
126°C for 10 mins at pressure of 20 psi
133°C for 3 mins at pressure of 30 psi
 Disinfectants
Alcohol
 Ethyl alcohol and isopropyl alcohol
 Bactericidal
◦ Tuberculocidal, fungicidal, and virucidal
◦ Do not destroy bacterial spores
 Optimum bactericidal conc. 60%- 90%
 Mode of action: denaturation of protein

 Uses in disinfection of
◦ Oral and rectal thermometers, scissors, stethoscope, BP
cuff

Guidelines for disinfection and

sterilization in healthcare facilities,
CDC (updated Feb. 2017)
 Disinfectants
Aldehydes

Formaldehyde
 Preservation of anatomical specimen (40%)
 Preparation of toxoid from toxin

Glutaraldehyde (2%)
 Used for endoscopes, cystoscopes etc
 Fogging of OT (combined with QAC)

 Ortho-pthalaldehyde(0.55%)
Guidelines for disinfection and
sterilization in healthcare facilities,
CDC (updated Feb. 2017)
phenolics
 Phenol (carbolic acid) was the first widely
used antiseptic and disinfectant
 Introduced in surgery in 1867 by Joseph

Lister
 Mode of action:
◦ Disrupts cell wall and precipitates cell protein
 Uses: on environmental surfaces
◦ Bedside tables, bedrails
◦ Laboratory surfaces and floors

Guidelines for disinfection and

sterilization in healthcare facilities,
CDC (updated Feb. 2017)
Chlorine and chlorine compounds

 Most widely used form is hypochlorite

◦ liquid (sodium hypochlorite) or solid (calcium hypochlorite)
 Microbicidal activity is attributed to hypochlorous acid
 Efficacy decrease with increase in pH

 Mode of action: multiple factors

◦ Oxidation of sulfhydryl enzymes and amino acid
◦ Loss of intracellular content
◦ Inhibition of protein synthesis
◦ Breaks in DNA and depressed DNA synthesis

Guidelines for disinfection and

sterilization in healthcare facilities,
CDC (updated Feb. 2017)
 Uses: widely used in healthcare for disinfection of
◦ Tonometer head
◦ Countertops and floors
◦ Blood spills
◦ Water treatment
 Quaternary ammonium compound
 Widely used disinfectants
 Water hardness and cotton and gauze pads make them

less microbicidal
Mode of action:
◦ Inactivation of energy producing enzymes
◦ Denaturation of essential cell proteins
◦ Disruption of cell membrane
 Uses: disinfection of
◦ Floors, furniture, walls
◦ Medical equipment that contact intact skin
 Eg: benzalkonium chloride

Guidelines for disinfection and

sterilization in healthcare facilities,
CDC (updated Feb. 2017)
common chemical disinfectant used in
hospital
Ultraviolet radiations
 Wavelength of UV radiation- 328 to 210nm
 Maximum bactericidal effect- 240 to 280nm
 Mercury vapour lamp emit >90% radiation at 253.7nm
◦ Near the maximum microbicidal activity
Mode of action:
◦ Destruction of nucleic acid – induction of thymine dimers
 Uses: disinfection of
◦ airborne organism and micro-organism on surfaces
(isolation room, operating room, biosafety cabinet)
◦ Drinking water
◦ Titanium implants
◦ Contact lenses

Guidelines for disinfection and

sterilization in healthcare facilities,
CDC (updated Feb. 2017)
Thank you