Bio Medical Waste

BIO MEDICAL WASTE 

Introduction

• Definition: Waste refers to any material that is discarded, unwanted, or no longer useful and requires disposal. It can be solid, liquid, or gaseous, generated from human activities.
• Sources of Waste:
• Domestic (household)
• Industrial
• Commercial
• Agricultural
• Hospitals & healthcare institutions
• Construction & demolition
• Mining & hazardous chemical industries
• Types of Waste:
• Solid Waste – municipal, household
• Liquid Waste – sewage, effluents
• Hazardous Waste – toxic chemicals, radioactive, biomedical
• E-waste – electronic & IT waste
• Categories:
• Biodegradable (food, organic)
• Non-biodegradable recyclable (plastic, paper, metal, glass)
• Non-biodegradable non-recyclable (hazardous chemicals, biomedical waste)

Hospital Waste

• Definition: All waste, solid or liquid, generated by hospitals including infectious, hazardous, and general waste.
• Sources:
• Outpatient and inpatient departments
• Operation theatres
• Diagnostic labs, blood banks, radiology
• Pharmacies
• Canteens & kitchens
• Administrative and housekeeping areas
• Importance:
• Essential to protect patients, staff, visitors, and community.
• Prevent nosocomial infections and environmental pollution.
• Legal compliance with Biomedical Waste (Management & Handling) Rules.
• Enhances hospital image and accreditation standards.

Biomedical Waste (BMW)

• Definition: Any waste generated during diagnosis, treatment, or immunization of humans/animals, or research activities, or production/testing of biologicals.
• Categories (As per BMW Rules 2016):
• Human anatomical waste – tissues, organs, body parts
• Animal waste – carcasses, body parts
• Microbiology & biotechnology waste – lab cultures, specimens
• Sharps waste – needles, syringes, scalpels
• Discarded medicines & cytotoxic drugs
• Soiled waste – cotton, dressings, bedding
• Liquid waste – lab effluents, blood
• Incineration ash
• Chemical waste – disinfectants, heavy metals

Hospital Waste Management Program

Steps

1. Waste generation reduction
2. Segregation at source
3. Collection in proper containers
4. Intramural transportation
5. Storage in designated area
6. Treatment (chemical, thermal, biological, mechanical)
7. Extramural transportation
8. Final disposal
9. Monitoring & reporting

Implementation

• Develop policy & guidelines
• Constitute a Biomedical Waste Management Committee
• Prepare BMW Manual
• Conduct staff training
• Ensure infrastructure (bins, bags, trolleys, PPE)
• Assign responsibilities
• Monitor compliance regularly

BMW Committee

• Chairperson: Hospital Medical Superintendent
• Members: Infection control officer, nursing superintendent, microbiologist, engineer, housekeeping head, store officer, etc.
• Functions:
• Policy formulation
• Monitoring segregation & disposal
• Training & awareness
• Liaison with Pollution Control Board
• Annual reporting

BMW Manual

• Hospital-specific guide on:
• Categories of waste
• Colour coding
• Collection, storage, transportation
• Treatment & disposal procedures
• Safety guidelines

Waste Management Policy

• Legal compliance with BMW Rules
• Commitment to patient & staff safety
• Adoption of 3Rs: Reduce, Reuse, Recycle
• Clear segregation guidelines
• Zero tolerance for non-compliance

Risks of Poor BMW Management

• Nosocomial infections
• Needle-stick injuries
• Spread of resistant organisms
• Chemical poisoning
• Radiation hazards
• Legal penalties, closure of facility
• Community/environmental pollution

Nosocomial Infections

• Infections acquired during hospital stay
• Sources: contaminated instruments, linens, waste
• Examples: MRSA, C. difficile, Pseudomonas, Hepatitis B & C, HIV

Segregation of Waste

Definition

Process of separating different categories of waste at the point of generation to ensure safe handling and appropriate treatment.

Factors Influencing Segregation

• Training & awareness of staff
• Availability of bins/bags with proper colour codes
• Monitoring & supervision
• Hospital policies
• Workload & compliance culture

Colour Coding Criteria (BMW Rules 2016)

• Yellow: Human/animal anatomical waste, soiled waste, expired medicines, chemical waste
• Red: Contaminated recyclable waste (tubes, bottles, IV sets, catheters)
• White (translucent, puncture-proof): Sharps including metals
• Blue: Glassware, metallic implants

Collection & Storage of Waste

Definition

Systematic gathering of segregated waste into designated containers for temporary storage before treatment or disposal.

Prerequisites

• Clearly labelled containers
• Puncture-proof, leak-proof, covered bins
• Dedicated storage area (away from patient areas)
• Daily clearance schedule

Characteristics of Good Containers

• Strong, leak-proof
• Colour coded as per rules
• Easy to clean/disinfect
• Safe for handling & transport
• Biohazard symbol labelled

Transportation of Waste

Definition

Movement of waste from collection points to treatment/disposal sites within or outside hospital.

Types

• Intramural: Within hospital premises (wards → storage/treatment)
• Extramural: From hospital to Common Biomedical Waste Treatment Facility (CBWTF)

Transport to Final Disposal Site

• Dedicated trolleys/vehicles with biohazard symbol
• Leak-proof, covered, disinfected regularly
• Compliance with local pollution control board regulations

Treatment of Waste

Definition

Processes applied to waste to reduce its hazard potential and make it safe for disposal or recycling.

Factors Affecting Treatment Method

• Type & category of waste
• Volume of waste
• Availability of technology
• Cost & feasibility
• Environmental impact
• Regulatory requirements

Equipment Selection Criteria

• Efficacy against pathogens
• Capacity matching hospital size
• Maintenance needs
• Cost-effectiveness
• Regulatory approval

Treatment Methods

Chemical Methods

• Oxidation/Reduction – for detoxifying chemicals
• Neutralization – for acidic/alkaline wastes
• Precipitation – for heavy metals
• Hydrolysis – for complex chemicals
• Ion Exchange – for liquid effluents
• Disinfection – sodium hypochlorite, phenol

Thermal Methods

• Autoclaving – steam sterilization
• Hydroclaving – pressurized steam with agitation
• Microwave irradiation – heating & disinfection
• Incineration – combustion at 800–1200°C (not for chlorinated plastics)

Mechanical Methods

• Compaction – volume reduction
• Grinding/Shredding – size reduction
• Pulverization – fine powdering

Biological Methods

• Use of enzymes, microorganisms for biodegradation of organic waste

Advanced Methods

• Molten Salt Oxidation
• Plasma Torch Technology
• Infrared Radiation
• Detoxification processes
• Wet Oxidation
• Dry Heat Sterilization
• Electro Thermal Deactivation
• Thermal Hydrolysis

Costs Involved

• Capital costs: infrastructure, equipment
• Operational costs: fuel, chemicals, electricity, manpower
• Maintenance costs: repairs, replacement
• Monitoring & compliance costs

Waste Disposal Methods

• Landfill – disposal in secured pits
• Surface Impoundments – liquid waste containment
• Safe Burial on Hospital Premises – rural/remote areas
• Inertization – mixing waste with cement/lime before disposal
• Encapsulation – sealing sharps/medicines in containers

PPE, Government Authority & Other Waste

Personal Protective Equipment (PPE)

• Gloves, masks, goggles, aprons, boots
• Prevent direct exposure to infectious waste

Government Authority Roles

• Ministry of Environment, Forest & Climate Change (MoEFCC) – policy making
• Central & State Pollution Control Boards – monitoring & authorization
• Local health authorities – implementation, inspection
• Biomedical Waste Treatment Facility operators – compliance

Awareness & Education

• Regular training sessions
• Posters, charts near collection areas
• Orientation for new staff
• Public awareness campaigns

Liquid BMW

• Treated with chemical disinfectants
• Passed through Effluent Treatment Plant (ETP) before release

Radioactive Waste

• Generated in nuclear medicine, radiology
• Managed as per Atomic Energy Regulatory Board (AERB) guidelines
• Stored in lead-lined containers, allowed decay before disposal

Waste Reduction Activities in Hospitals

• Rational use of consumables
• Avoid unnecessary disposables
• Encourage reusable items (where safe)
• Proper inventory management
• Adoption of “Green Hospital” policies

Biomedical Waste (Management & Handling) Rules

Biomedical Waste Rules, 1998 – Schedules

Schedule I – Categories of BMW

• 10 categories of BMW (Human anatomical waste, Animal waste, Microbiological waste, Sharps, Discarded medicines, Soiled waste, Solid plastics, Liquid waste, Incineration ash, Chemical waste).
• Also specified treatment & disposal methods (incineration, autoclave, chemical treatment, deep burial, secured landfill).

Schedule II – Standards for BMW Treatment/Disposal

• Standards for incineration, autoclaving, microwaving, deep burial.
• E.g., Incinerator temp: 850–1100 °C, residence time 1 sec, CO < 100 mg/Nm³.

Schedule III – Prescribed Authorities

• Identified State Pollution Control Board (SPCB) as the prescribed authority.

Schedule IV – Prescribed Timeline

• Time limits for compliance by hospitals.

Biomedical Waste Management Rules, 2016 – Schedules

Schedule I – Categorization & Disposal of BMW

• Only 4 categories (Yellow, Red, White, Blue).
• Each with type of waste + treatment/disposal method.

Example:

• Yellow: Human/animal anatomical waste, soiled waste → Incineration/deep burial.
• Red: Contaminated plastics → Autoclave/microwave → Recycle.
• White (translucent): Sharps → Autoclaving/dry heat sterilization → Shredding/mutilation.
• Blue: Glassware, implants → Disinfection/autoclaving → Recycling.

Schedule II – Standards of Treatment & Disposal

• Detailed technical standards for:
• Incinerators (850–1050 °C, dioxins/furans limits).
• Autoclaves (steam sterilization cycles & parameters).
• Microwaves (waste exposure parameters).
• Plasma pyrolysis (alternative to incineration).
• Effluent standards (for liquid BMW before discharge).

Schedule III – Prescribed Authorities

• Specifies Central Pollution Control Board (CPCB) & State Pollution Control Boards (SPCBs) as authorities for authorization, monitoring, reporting, accident handling.

Schedule IV – Annual Report

• Format of Annual Report every HCF must submit to SPCB.
• Includes data:
• Quantity of waste generated (kg/day).
• Method of disposal.
• Accidents, training, immunization of staff.

Schedule V – Accident Reporting

• Format for reporting accidents related to BMW handling:
• Date, time, type of accident, causes, injuries, remedial measures.

Schedule VI – Labeling & Barcoding

• Specifications for labeling bags/containers:
• Biohazard symbol.
• Cytotoxic hazard (if applicable).
• Barcode system (mandatory).
• Ensures traceability & accountability.

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