Biomedical Waste Management

Why manage Hospital Waste?

 Need for Managing Waste
• Danger to the patients
– Many patients have poor immunological status
– Resistance to antibiotics
• Vulnerability of Hospital Staff
• Danger to the community
– Spread of infection through waste
– Access of waste to animals
– Spread of Infection through recycling trade
– Problems caused by Incinerators/ burning
– Contamination of Water-table
What is Biomedical Waste
 Definition of Biomedical
Waste
Biomedical waste has been defined as “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” as per Biomedical waste
(management & handling rules) 1998.
 Definition of Biomedical
Waste
Biomedical waste has been defined as “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 or in health camps, including the
categories mentioned in Schedule I appended to these
Rules” as per Biomedical Waste Rules 2016.
 Identify Bio Medical Waste

Placenta Used Syringes

Kitchen Waste Glass Slides Established Procedures

Lab Samples Fixer & Developer in Xray
Linen
Blood Bags X Ray Films
Catheter
Medicine Card Boxes Expired Medicines
Vaccines Condemned X
Lead Batteries Ray Machine
Stained Cotton Swabs
Sanitary Napkin
 BMW (Management &
Handling) Rules 1998
• Was applicable to any hospital/ health centre/O.P.D.
facility/clinic, where more than 1000 patients are seen/
treated/ investigated in a month
• Segregation, disinfection and mutilation of waste
• No storage of waste beyond 48 hrs
• No incineration of chlorinated plastics
• No chemical pre-treatment before incineration
• Proper labelling of waste with Biohazard symbol
 BMW (Management &
Handling) Rules 1998
• Introduction of new treatment options with CPCB approval
• Municipal authorities to pick up general waste and treated
(disinfected) Biomedical waste
• Centralised facilities preferred
• Standards for Incinerators & Deep Burial Pit
• Penalty as under EPA
 Biomedical waste rules
2016
• Gazetted on 28th March 2016
• Replaces Biomedical Waste (Management &
handling) Rules 1998
• Major Changes –
 Scope – also includes Ayush Health Facilities, Vaccination
Camps, First-Aid Rooms of Schools, Forensic Labs, etc.
 Constitution of a new committee at the state level
 Small facilities less than thirty beds may designate a
qualified person to review and monitor the activities
relating to bio-medical waste management
 Biomedical waste rules
2016
• Bar Code System for bags & containers (after 28 th March 2017)
• Phase-out Chlorinated bags and Non-chlorinated plastic bags after 28 th
March 2018
• On-site disinfection of laboratory waste, microbiological waste, blood
samples & blood bags
• Treatment & disposal of Liquid waste in accordance with the water
(Prevention & control of Pollution) 1974
• ‘On-site’ Waste Management can be established if nearest CTF is 75 kms
away
• Segregated collection – Four Categories
• Prior Approval for ‘Deep Burial’
 Categories of BMW
(as per BMW Rules 1998)
Category Waste
1 Human Anatomical
2 Animal
3 Microbiology & Biotechnology
4 Sharps
5 Discarded Medicines & Cytotoxic Drugs
6 Soiled (Contaminated with Blood & Body Fluids)
7 Solid (Disposable Items other than Sharps)
8 Liquid
9 Incineration Ash
10 Chemical
 Colour Coding for Collection
System
(BMW Rules 1998)
Colour Coding Type of Container Waste Category Treatment options
Categories 1, 2, 3 & Incineration deep
Yellow Plastic Bag
6. burial
Autoclaving/Micro-
Red Plastic Bag Categories 3, 6, 7 waving Chemical
Treatment

Autoclaving/Micro-
Blue/ White Plastic Bag waving/ Chemical
/puncture-proof Cat. 4, Cat. 7 Treatment &
Translucent containers Destruction /
shredding

Disposal in secured
Black Plastic Bag Categories 5, 9, 10
landfill.
 Categories of Waste:
Schedule I (BMW Rules 2016)
Category Type of Waste Bag/ Container Treatment/ Disposal
1. Yellow a. Human Anatomical Incineration/ Plasma
Pyrolysis/ Deep-burial
b. Animal Anatomical
c. Soiled Waste Incineration/ Plasma
Pyrolysis/ Deep-burial
OR Autoclave/ Microwave/
Yellow colour Non-chlorinated Hydoclave
Plastic Bag or Containers
d. Expired Drugs Return/ Plasma Pyrolysis

e. Chemical Incineration/ Plasma

Pyrolysis
f. Chemical liquid Separate Collection System Pre-treatment then
leading to Effluent treatment discharge
system
g. Discarded linen Non-Chlorinated Yellow Colour Incineration/ Plasma
bags or suitable packing Pyrolysis OR Shredding &
material mutilation
h. Microbiology Autoclave Safe bag NACO/ WHO Norms (On-
site)
 Categories of Waste:
Schedule I (BMW Rules 2016)
Category Type of Waste Bag/ Container Treatment/ Disposal
Red Contaminated Waste Red Coloured non-chlorinated Autoclave/ Microwave/
(Recyclable) plastic Hydroclave followed by
shredding or mutilation
or combination

White SHARPS including Puncture Proof/ Leak Proof/ Autoclave/ Dry Heat
Metals Tamper proof Sterilisation or shredding
or Mutilation or
Encapsulation

Blue Glassware Cardboard Boxes with Blue Disinfection by Sodium

colour marking Hypochlorite solution or
Autoclaving/
Microwaving/
Hydroclaving

Metallic Body Implant

Identify Bio Medical Waste Colour

Placenta Used Syringes

Kitchen Waste Glass Slides Established Procedures

Lab Samples Fixer & Developer in Xray
Linen
Blood Bags X Ray Films
Catheter
Medicine Card Boxes Expired Medicines
Vaccines Condemned X
Lead Batteries Ray Machine
Stained Cotton Swabs
Sanitary Napkin
 Impact on cost
• Training of all workers on joining and at least once in a
year
• Bar-coded of bags & containers (High cost)
• Non-chlorinated bags after 2 years (High cost)
• Uploading of Annual report on Web-site after 2 years
• Retrofitting of Incinerator to comply with (a) Dioxins &
Furans Norms (b) retention time of 2 seconds in secondary
chamber - 2 years
• Monitoring of Gaseous emissions once in three months
• Monitoring of Dioxins & Furans once in a year
• Record maintenance for five years
 Annual report
• On Form IV before 30th June every year
• Details of training - programmes conducted, number of
personnel trained and number of personnel not undergone
• Major Accidents including Nil report in Form I to the
prescribed authority and also along with the annual report
• Review committee’s minutes of the meetings
• Record of recyclable wastes referred to in sub-rule (9)
which are auctioned or sold and the same shall be submitted
to the prescribed authority as part of its annual report.
 Important Administrative
Provisions
• Reporting of ‘Non-compliance’ by CTF Operator
• Committee at the State level & District level
• Land for development Common Facility
• Annual Report
• Reporting through Website
 Segregation
• Different types of waste should be collected
separately
• Should be done at point of generation
• Different coloured bins are to be used
• Segregation ensures occupational and health
safety
• Segregation also reduces the cost of treatment and
disposal
CONSTITUENTS OF HOSPITAL WASTE

Human Tissue
Plastic Infectious
1.831%
2.555% 4.859%

General
90.755%
 ESTIMATED PROPORTION OF INJECTIONS
ADMINISTERED WITH A
SYRINGE RE-USED WITHOUT STERILIZATION

Former socialist
economies of Europe
Middle East crescent

sub-Saharan Africa

India

China

Other Asia and Pacific

0% 10% 20% 30% 40% 50% 60%

Simonsen et al, Bull WHO 1999

Sharp Injuries
 APPROX 1200 CRORES INJECTIONS
ADMINISTERED ANNUALLY WORLDWIDE
Who is at risk for sharps
injuries?
Any worker who may come
in contact with
contaminated sharps is at
risk, including nurses,
ANMs, lab workers, doctors
and waste handlers.

The main issue is

contamination from blood
or other potentially
infectious materials.
Categories of staff exposed to Needle
stick Injuries
Staff prone to needle-stick Relative % of
injuries injuries
Staff nurses 34.6%
Interns 15.7%
Residents 11.7%
Trainee nurses 8.5%
Technical Staff 6%
Workers responsible for waste 19%
management / cleaning
Others 4.5%
HIPL
ESTIMATED RISK OF INFECTION FOLLOWING A
NEEDLESTICK FROM AN INFECTED SOURCE-
PATIENT

35% 30%
30%
25%
20%
15%
10%
5% 3%
0.30%
0%
Hepatitis B Virus Hepatitis C Virus HIV
Source: Needlestick injuries studies among healthcare workers
Exposure to Toxic
Metals: Mercury
 Mercury Fact Sheet

• A thermometer contains approx.

0.6 gm of mercury
• In a study by Toxics Link, it was
found that approx. 70
Thermometers break in a month
in a large hospital
• Mercury disposed by one hospital
per year-840 gm only through
breakage of thermometers
 Symptoms of Mercury
poisoning
• Impairment of peripheral vision
• Disturbance of sensations
• Lack of coordination of movements
• Impairment of speech or hearing
• Skin rashes
• Mood swings & mental disturbance
• Abnormal brain development
MANAGING MERCURY SPILL
LIQUID WASTE
MANAGMENT
KARNATKA
Liquid disinfection unit
Liquid Disinfectant unit for DH, TLH, CHC
Further improvements
 Understanding Terms
 Solid
• Hospital Waste/ Biomedical Waste/ Healthcare Waste
• General Waste / Municipal Waste
• Hazardous Waste -
• Radioactive Waste -
• E-waste – Electrical and electronic equipment, whole or in part
discarded as waste by the consumer or bulk consumer as well as
rejects from manufacturing, refurbishment and repair processes.
 Liquid
• Sewage – Black Water
• Sullage – Grey Water
• Effluent
• Runoff – It is described as the part of the water cycle that flows over
the surface before it joins sewer, main municipal drain or water body
 Hazardous Waste
It means any waste which by reason of characteristics such as physical,
chemical, biological, reactive, toxic, flammable, explosive or corrosive,
causes danger or is likely to cause danger to health or environment,
whether alone or in contact with other wastes or substances, and shall
include -
i. waste specified under column (3) of Schedule I;
ii. waste having equal to or more than the concentration limits specified
for the constituents in class A and class B of Schedule II or any of the
characteristics as specified in class C of Schedule II; and
iii. wastes specified in Part A of Schedule III in respect of import or
export of such wastes or the wastes not specified in Part A but exhibit
hazardous characteristics specified in Part C of Schedule III;
 Radioactive Waste

Material, whatever its physical form, left over from

practices or interventions for which no further use
is foreseen (a) that contains or is contaminated
with radioactive substances and has an activity or
activity concentration higher than the level for
clearance from regulatory requirements, and (b)
exposure to which is not excluded from regulatory
control
 Waste

Hazardous
E-waste
BMW General/ MSW Liquid
Radio active
Mercury

Bio-degradable Sewage

Non-
Sullage
Biodegradable

Run-off
 Solid Wastes
• Governed by Solid Waste Management Rules 2016,
notified on 8th April 2016
• Definition of Solid Waste - It means and includes solid
or semi-solid domestic waste, sanitary waste,
commercial waste, institutional waste, catering and
market waste and other non residential wastes, street
sweepings, silt removed or collected from the surface
drains, horticulture waste, agriculture and dairy waste,
treated bio-medical waste excluding industrial waste,
bio-medical waste and e-waste, battery waste, radio-
active waste generated in the area under the local
authorities and other entities mentioned in rule 2;
 Classification of General
Waste
1. Bio-degradable
2. Non-biodegradable
3. Domestic Hazardous Waste
 Management of
Biodegradable General Waste
 Removal of local municipality
 Management by Health facility
• Sanitary land fill
• Composting
• Vermicomposting
• EM (Effective Microorganisms) Technology
• Bio-gas plan
• Incineration
• Salvaging
 Waste hierarchy
Waste hierarchy refers to 3 Rs
Reduce, Reuse, Recycle
THANK YOU

• Thank you

07/31/2025 QI NHSRC 46