HOSPITAL WASTE MANAGEMENT (OMD552)

UNIT 2: BIOMEDICAL WASTE MANAGEMENT

INTRODUCTION (BMW)
 Since beginning, the hospitals are known for the treatment of sick persons but we

are unaware about the adverse effects of the garbage and filth generated by them on

human body and environment.

 Now it is a well-established fact that hospital waste is a potential health hazard to the

health care workers, public and flora and fauna of the area.

 The act was passed by the Ministry of Environment and Forests in 1986 & notified

the Bio Medical Waste (Management and Handling) Rules in July 1998.

 In accordance with these rules, 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.
 
DEFINITIONS

1. Hospital waste refers to all waste, biological or non‐ biological that is

discarded and not intended for further use.

2. 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.

3. Infectious waste: The wastes which contain pathogens in sufficient

concentration or quantity that could cause diseases. It is hazardous
e.g. culture and stocks of infectious agents from laboratories, waste
from surgery, waste originating from infectious patients.
Bio Medical waste consists of
• Human anatomical waste like tissues, organs and body
parts
• Animal wastes generated during research from
veterinary hospitals
• Microbiology and biotechnology wastes
• Waste sharps like hypodermic needles, syringes, scalpels
and broken glass
• Discarded medicines and cytotoxic drugs
• Soiled waste such as dressing, bandages, plaster casts,
material contaminated with blood, tubes and catheters
• Liquid waste from any of the infected areas
• Incineration ash and other chemical wastes
 Types of wastes, major and minor sources of
biomedical waste
Classification of Bio‐Medical Waste
1. Non-hazardous waste (75 – 90%)
2. Hazardous waste (10 – 25%)
a). Infectious waste (15 – 18%)
Non sharps, Sharps, Plastic disposables, Liquid
wastes…
b). Non Infectious waste (10 – 25%)
Radioactive waste, Discarded glass, chemical
waste, cytotoxic waste, Incinerator ash,
Pressurized containers etc.
 SOURCES OF BIO MEDICAL WASTE
• Hospitals
• Nursing homes
• Clinics
• Medical laboratories
• Blood banks
• Mortuaries
• Medical research & training centers
• Biotechnology institution/production units
• Animal houses etc.
 Categories and classification of biomedical waste

Option Waste Category Treatment & Disposal

Category No. I Human Anatomical Waste (human tissues, organs, body parts) Incineration/deep burial

Animal Waste (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and
Category No. 2 experimental animals used in research, waste generated by veterinary hospitals colleges, Incineration/deep burial
discharge from hospitals, animal houses)

Microbiology & Biotechnology Waste (wastes from laboratory cultures, stocks or specimens
of micro‐ organisms live or attenuated vaccines, human and animal cell culture used in
Category No 3 local autoclaving/micro‐ waving/incineration
research and infectious agents from research and industrial laboratories, wastes from
production of biologicals, toxins, dishes and devices used for transfer of cultures)

Waste sharps (needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts. Disinfection (chemical treatment/autoclaving
Category No 4
This includes both used and unused sharps) g/microwaving and mutilation/shredding

Discarded Medicines and Cytotoxic drugs (wastes comprising of outdated, contaminated and Incineration@/destruction and drugs disposal
Category No 5
discarded medicines) in secured landfills

Soiled Waste (Items contaminated with blood, and body fluids including cotton, dressings,
Category No 6 Incineration/ autoclaving/microwaving
soiled plaster casts, lines, beddings, other material contaminated with blood)

disinfection by chemical
Solid Waste (wastes generated from disposable items other than the waste sharps such as
Category No. 7 treatment/autoclaving/ microwaving and
tubing’s, catheters, intravenous sets etc.).
mutilation/ shredding
Liquid Waste (waste generated from laboratory and washing, cleaning, house‐ keeping and disinfection by chemical treatment and
Category No. 8
disinfecting activities). discharge into drains

Category No. 9 Incineration Ash (ash from incineration of any bio‐medical waste) disposal in municipal landfill
Chemical Waste (chemicals used in production of biologicals, chemicals used in disinfection, Chemical discharge into drains for liquids and
Category No. 10
as insecticides, etc.) secured landfill for solids
Need for disposal of biomedical waste
Indiscriminate disposal of BMW or hospital waste and exposure
to such waste pose serious threats to the environment and human
health; hence, such waste requires specific treatment and
management prior to its final disposal.
Biomedical waste minimization
Measures for waste minimization
 As far as possible, purchase of reusable items made of glass
and metal should be encouraged.
 Select non PVC plastic items.
 Adopt procedures and policies for proper management of
waste generated, the mainstay of which is segregation to
reduce the quantity of waste to be treated.
 Establish effective and sound recycling policy for plastic
recycling and get in touch with authorized manufactures.
 Hazard of biomedical waste
Hazards related to pathological waste: There are many diseases which are caused by
injurious pathogens present in the contaminated hospital waste are as follows

CATEGORIES TYPES SOURCES

Skin infections Streptococcus spp Pus
Genital infections Neisseria gonorrhoeae, herpesvirus Genital secretions

Ocular infections Herpesvirus Eye secretions

Respiratory Mycobacterium tuberculosis, measles virus, Inhaled secretions, saliva
infections streptococcus pneumonia

Hemorrhagic RNA virus of Arena viridae family All bloody products

fevers and secretions
Anthrax Bacillus anthracis Skin secretions
Gastro enteric Entero-bacteria Example: Salmonella, Faeces and from vomit
infections Shigella spp., Vibrio cholerae, helmenths
AIDS Human immune deficiency Blood and sexual
Meningitis Neisseria meningitides Cerebrospinal fluid
Hepatitis A Hepatitis A virus Faeces
 Need of BMW Management in Hospitals
Given below are the reasons due to which there is a great need for the management of hospital waste
 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.
 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.

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.
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.
Biomedical waste segregation
According to BMW (Management & Handling) Rules, 1998 of India
“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 biologicals.
Segregation refers to the basic separation of different categories
of waste generated at source and thereby reducing the risks as well as
cost of handling and disposal. Segregation is the most crucial step
in bio-medical waste management.
Why is it advisable to segregate wastes?
Waste segregation is included in law because it is much easier to
recycle. Effective segregation of wastes means that less waste goes to
landfill which makes it cheaper and better for people and the
environment. It is also important to segregate for public health.
 Biomedical labeling

Color coding Type of container Waste categories

Cat 1 human anatomical waste
Yellow Cat 2 Animal Waste
Plastic bags
Cal 3 Microbiological Waste
Cat 6 Solid Waste

Red Cat 3 Microbiological

Disinfected container plastic bags
Cat. 6 Soiled Dressing

Blue/white Plastic bags, puncture proof Cat. 4 Waste sharp

containers Cat.7 Plastic disposable
Cat. 5 Discarded medicine
Black
Do Cat. 9 Incineration ash
Cat 10 Chemical Waste
 Biomedical waste handling

Which is the best method to handle biomedical waste?

Here are just a few of the most successful medical waste disposal solutions currently used in the industry today.

Autoclaving — which uses a heated container to destroy waste — is one of the most effective ways to deal with

biohazard wastes.

1.Chemical Disinfection.

2.Encapsulation.

3.Conclusion.
The Biomedical 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 Rules.

It shall be the duty of every occupier of an institution generating bio-medical waste which includes a hospital,

nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank

by whatever name called to take all steps to ensure that such waste is handled without any adverse effect to human

health and the environment.

 STEPS FOR WASTE MANAGEMENT

•   Step 1: segregation

Step 2: Collection and storage

Step 3: Transportation

Step 4: Treatment and disposal

Segregation
1. Bio-medical waste shall not be mixed with
other wastes.

2. Bio-medical waste shall be segregated into

containers/bags at the points of generation in
accordance with Schedule II prior to its storage
transportation, treatment and disposal.

The containers shall be labeled according to

Schedule III.
 COLLECTION, STORAGE, TRANSPORTATION AND TREATMENT
TRANSPORTATION AND STORAGE

1. STORAGE
The waste may be temporarily stored at the central storage area of the hospital
and from there it may be sent in bulk to the site of final disposal once or twice
a day depending upon the quantum of waste.
A storage location for health-care waste should be designated inside the
health-care establishment or research facility.
The waste, in bags or containers, should be stored in a separate area, room, or
building of a size appropriate to the quantities of waste produced and the
frequency of collection.  
Ensure that waste bags/containers are properly sealed and labeled.
Bags should not be filled completely, so that bags can be picked up by the
neck again for further handling.
BMW should be kept only in a specified storage area.
No untreated bio‐medical waste shall be kept stored beyond a period of 48
hours.
Unless a refrigerated storage room is available, storage times
for healthcare waste (i.e. the delay between production and
treatment) should not exceed the following:
Temperate climate: 72 hours in winter
48 hours in summer
Warm climate: 48 hours during the cool season
24 hours during the hot season
Cytotoxic waste should be stored separately from other
health-care waste in a designated secure location.
Radioactive waste should be stored in containers that prevent
dispersion, behind lead shielding. Waste that is to be stored
during radioactive decay should be labelled with the type of
radionuclide, the date, and details of required storage
conditions.
 Recommendations for storage facilities for health-care waste

The storage area should have an impermeable, hard-standing floor with

good drainage; it should be easy to clean and disinfect.
There should be a water supply for cleaning purposes.
The storage area should afford easy access for staff in charge of handling
the waste.
It should be possible to lock the store to prevent access by unauthorized
persons.
Easy access for waste-collection vehicles is essential.
There should be protection from the sun.
The storage area should be inaccessible for animals, insects, and birds.
There should be good lighting and at least passive ventilation.
The storage area should not be situated in the proximity of fresh food
stores or food preparation areas.
A supply of cleaning equipment, protective clothing, & waste bags or
containers should be located conveniently close to the storage area.
2. TRANSPORTATION
During transportation following points should be taken care
of:
 Ensure that waste bags/containers are properly sealed and
labeled.
 Bags should not be filled completely, so that bags can be
picked up by the neck again for further handling.
 Hand should not be put under the bag.
 At a time only one bag should be lifted.
 Manual handling of waste bags should be minimized to reduce
the risk of needle prick injury and infection.
 After removal of the bag, clean the container including the lid
with an appropriate disinfectant.
 Waste bags should be transported in a covered wheeled
containers or large bins in covered trolleys.
a. On-site transport
Health-care waste should be transported within the hospital or
other facility by means of wheeled trolleys, containers, or carts
that are not used for any other purpose and meet the following
specifications:
 easy to load and unload;
 no sharp edges that could damage waste bags or containers
during
 loading and unloading;
 easy to clean.
The vehicles should be cleaned and disinfected daily with an
appropriate disinfectant . All waste-bag seals should be in place
and intact at the end of transportation.
Different types of vehicle for the onsite transportation of health-
care waste are shown in Fig.
b. Off-site transportation of waste
Regulation and control system
• The health-care waste producer is responsible for
safe packaging and adequate labelling of waste to
be transported off-site and for authorization of its
destination.
• The bags or containers should be appropriately
robust for their content (puncture-proof for sharps,
for example, or resistant to aggressive chemicals)
and for normal conditions of handling and
transportation, such as vibration or changes in
temperature, humidity, or atmospheric pressure.
c. Transport to final disposal site
Transportation from health care establishment to
the site of final disposal in a closed motor vehicle
(truck, tractor‐trolley etc.) is desirable as it
prevents spillage of waste on the way.
Vehicles used for transport of BMW must have the
“Bio‐Hazard” symbol and these vehicles should
not be used for any other purpose.
3. TREATMENT AND DISPOSAL OF BMW
1. Deep burial: Category 1 and 2 only In cities having less than 5 lakh population
& rural area.
• A pit or trench should be dug about 2 m deep. It should 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 must be ensured that animals do not have access to burial sites.
• Covers of galvanized iron/wire meshes may be used.
• On each occasion, when wastes are added to the pit, a layer of 10cm of soil be
added to cover the wastes.
• Burial must be performed under close and dedicated supervision.
• The site should be relatively impermeable and no shallow well should be close
to the site.
• The pits should be distant from habitation, and sited so as to ensure that no
contamination occurs of any surface water or ground water.
• The area should not be prone to flooding or erosion.
• The location of the site will be authorized by the prescribed authority.
• The institution shall maintain a record of all pits for deep burial.
2. Autoclave and microwave treatment Standards for the autoclaving and microwaving are also
mentioned in the Biomedical waste (Management and Handling) Rules 1998. All equipment
installed/shared should meet these specifications. Category 3, 4, 6 and 7 can be treated by these
techniques.
(Note: Label shall be non‐washable & prominently visible)
Autoclaving
• The autoclave should be dedicated for the purpose of disinfecting and treating biomedical
waste.
• When operating a gravity flow autoclave, medical waste shall be subjected to:
– A temperature of not less than 121o and pressure of about 15 pounds per square inch
(psi) for an autoclave residence time of not less than 60 minutes; or
– A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave
residence time of not less than 45 minutes; or
– A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave
residence time of not less than 30 minutes.
Microwaving
• Microwave treatment shall not be used for cytotoxic, hazardous or radioactive wastes,
contaminated animal carcasses, body parts and large metal items.
• The microwave system shall comply with the efficacy tests/routine tests
• The microwave should completely and consistently kill bacteria and other pathogenic
organism that is ensured by the approved biological indicator at the maximum design
capacity of each microwave unit.
3. Shredding: The plastic (I.V. bottles, I.V. sets,
syringes, catheters etc.), sharps (needles, blades,
glass etc.) should be shredded but only after chemical
treatment/microwaving/autoclaving. Needle
destroyers can be used for disposal of needles
directly without chemical treatment.

5.  Secured/Sanitary landfill: The incinerator ash,

discarded medicines, cytotoxic substances and solid
chemical waste should be treated by this option.
6. Coordination between hospital and outside agencies Municipal
authority :
As quite a large percentage of waste (in India up to 85%), generated
in Indian hospitals, belong to general category (non‐toxic and non‐
hazardous), hospital should have constant interaction with municipal
authorities so that this category of waste is regularly taken out of the
hospital premises for land fill or other treatment.

7. Co‐ordination with Pollution Control Boards:

To search for better methods technology, provision of facilities for
testing, approval of certain models for hospital use in conformity with
standards 'aid down. To search for cost effective and environmental
friendly technology for treatment of bio ‐medical and hazardous waste.
To search for suitable materials to be used as containers for bio‐
medical waste requiring incineration/autoclaving/ microwaving.
 8. Disposal of sharp materials
• Blades and needles waste after disinfection should
be disposed in circular or rectangular pits.
• Such pits can be dug and lined with brick,
masonry, or concrete rings.
• The pit should be covered with a heavy concrete
slab, which is penetrated by a galvanized steel
pipe projecting about 1.5 m above the slab, within
internal diameter of upto 20 mm.
• When the pipe is full it can be sealed completely
after another has been prepared