Biomedical waste management 2016

BMWM act 2016 and a few innovations made by me and my team

1. by
Dr D.S.Chandel
Ex-Director Health Services
Mail:[email protected]
Mobile: [phone]

2. WHY WE NEED PROPER
BIOMEDICAL WASTE
MANAGEMENT?

4. Safety from occupational hazards
Clean environment; motivates staff
Cleanliness: satisfaction of clients.
Confidence: more utilization of services
Reduces chances of HAI

5. Healthcarefacility:Aplacewhere,diagnosis,
treatment&immunizationactivitiesare
performed,irrespectiveofthetypeandsizeof
healthtreatingorresearchsystem
Pointofgeneration:WheretheBMWis
generated&accumulated&isunderthecontrol
ofthegenerator.
Storage:HoldingBMWfortemporaryperiod,at
theendofwhich,itistreatedordisposed.

6. GOIhasnotifiedBio-MedicalWaste(Management
andHandling)Rule1998,revisedin2016.
Theserulesapplytoallpersonswhogenerate,collect,
receive,store,transport,treat,disposeorhandlebio-
medicalwasteinanyformincludinghospitals,nursing
homes,clinics,dispensaries,veterinaryinstitutions,
animalhouses,pathologicallaboratories,blood
banks,AYUSHhospitals,clinicalestablishments,
researchoreducationalinstitutions,healthcamps,
medicalorsurgicalcamps,vaccinationcamps,blood
donationcamps,firstaidroomsofschools,forensic
laboratoriesandresearchlabs.27.

7. 1998 2016
Occupierfor <1000 OPD/month need not to
get authorization.
Everyoccupier is exempted.
Rules apply only to those who handleBMW
without further definition.
WhogenerateBMW,includingallvet.
institutions,labs,AYUSHhospitals,Blood
donation/vaccination/surgicalcamps.First
aidroominschools,forensiclabs,research
labs,patientsindomiciliarycare.
Authorization requiredunder BMWM Act
1998 only.
BMWM Act 2016.rule 25 of water Pollution
& control of pollution Act 1974 and 21 of Air
P&C of P Act 1981.
Occupier’s duties not defined in relationto
the operator
Both can report to PCB; if either of them not
followingthe guidelines. More duties
described now.
Operator’s dutiesnot specified. Operator’s dutiesspecified in more detail.

8. 1998 2016
Reporting period30
th
January , for the
calendar year.
Reporting period 30
th
June for the financial
year.
Duties of BMWM committee not well
defined.
Duties of BMWMcommittee/person well
defined. Weekly round. Meeting every six
months/SOS.
Accident reporting not welldefined. Accident reporting to PCB within 24 hours
along with ATR
Record maintenance manual. Creation of HCF website and to upload the
record& reporting online, within 1 year.
Training schedule not well defined. Training in BMWM at the time of induction
& once in a year.
Guidelinesfor use of gloves & bags not well
defined.
Chlorinated bags/gloves not to be used
after 2 years. (May 2018)
No identificationof bag, after it is taken out
from the store of HCF.
Bar coding and globalpositioning system to
be developed for bags.

9. 1998 2016
No instruction for use of Hg equipments.Phaseout such equipments.
BMW divided in 10 categories. Only 4 categories.
Surgeon’s glovessegregated into yellow
bag.
Segregation into red bag.
Bags with residual blood segregatedinto red
bag.
Segregation into yellow bags.
General waste to be segregated into black
bags.
Green bags.
Storage & disposal of sharps not well
defined.
Now it is well defined.
No ETF. ETF in all HCF.
Calcium/sodium hypochlorite solution with
1 % available chlorine.
10 % chlorine. No calcium hypochlorite.

10. 1998 2016
Contact time of hypochlorite sol.30 minutes.20 minutes.
Bins/bags emptied/removedwhen full 2/33/4
Schedule I,II,III,IV,V,VI. ScheduleI,II,III,IV.
Forms I,II,III. FormsI,II,III,IV,V.
Nospecific storage facility was definedProper storage facility defined.
Residencetime 1 sec. 2 secs.
SPM in incinerator emission 150 ng/nm3 50 nm/nm3.

11. Meanspermissiongrantedbytheprescribed
authorityforthegeneration,collection,
reception,storage,transportation,treatment,
disposaland/orotherformofhandlingbio-
medicalwasteinaccordancewiththeserules
andanyguidelinesissuedbytheCentral
Government.FormIII.
AuthorizationisrequiredunderBMWMact2016
co-terminustooperateunderrule25ofwater
(prevention&controlofpollution)act1974
andunderrule21ofair(prevention&controlof
pollution)act1981.

12. Meansanoccupieroroperatorauthorizedby
theprescribedauthoritytogenerate,collect,
receive,store,transport,treat,dispose
and/orhandlebio-medicalwastein
accordancewiththeserulesandany
guidelinesissuedbytheCentralGovernment.

13. Meansanywaste,whichisgenerated
duringthediagnosis,treatmentor
immunizationofhumanbeingsor
animalsorresearchactivities
pertainingthereto;orinthe
productionortestingofbiologicalorin
healthcamps.

14. •AnywasteotherthanBMW,whichhas
not been incontactwith
hazardous/infectiouswaste,chemicalor
biologicalsecretionsand;
•Itdoesnotincludewastesharps.

15. CBWTFmeans any facility wherein
treatment/disposal of bio-medical
waste or processes, incidental to
such treatment or disposal is
carried out.

16. “Occupier”inrelationtoanyinstitutiongenerating
biomedicalwaste,whichincludesahospital,nursing
home,clinic,dispensary,veterinaryinstitution,
animalhouse,pathologicallaboratory,bloodbank,
healthcarefacilities,bywhatevernamecalled,
meansapersonwhohascontroloverthat
institutionand/oritspremises.
“Operatorofabiomedicalwastefacility”meansa
person,whoowns/controls/operatesafacilityfor
collection,reception,storage,transport,treatment,
disposaloranyotherformofhandlingofbio-
medicalwaste.

17. Totakeallstepstoensurethatsuchwasteis
handledwithoutanyadverseeffecttothehuman
healthandtheenvironment.
EnsurepropersegregationofBMWasprescribed,at
thepointofgenerationetc.
Makeprovisionforsafe,secureventilatedstorage
arrangementforBMW.
EstablishETF&ensurepre-treatlab/microbiological
waste,bloodsamples,bloodbagsetc.before
transportationtoCBWTF………..bywhen?

18. Phaseoutchlorinatedbags,glovesetc.in2years.
Establishproperbarcoding&globalpositioning
systemforthebags/containersgoingoutof
premiseswithin1year.
ImmunizationofthestaffagainstHepatitis&
Tetanus.
Developasystemofhandlingofworkplace
accidents&itsreportingtoPCBwithin24hoursand
withannualreport(includingnilreport).FormI.
BudgetaryprovisionforBMWM.

19. TrainingofthestaffinBMWMatthetimeof
inductionandatleastonceinayear.
Documented.
ProvideconstantsupplyofPPE’sforthestaff.
Annualhealthcheckupofthestaff.
Renewalofauthorizationunderwater(P&CO
P)act1974&air(P&COP)1981act.
EnsuresthatBMWisnotstoredfor>48hours,if
unavoidable,takemeasuressothatnoadverse
effectsonhumanhealth/environment.
PermissionfromSPCB.Not>72hours

20. ConstituteBMWMcommittees.Meetingevery6
months/SOS
Dailymaintenanceofrecord/logbooks.
Annualonlinereportingby30
th
June.FormIV.
Createhospitalwebsiteandputmonthly/annual
recordinit.
InformPCB,ifoperatordoesn’tcollectBMWon
alternateday.
Establishsystemformonitoring&evaluationof
BMWMinthehospital.

21. StatePollutioncontrol,whichworksunderState
Govt.
TheoccupierappliesonlineonFormIIto
prescribedauthority(Pollutioncontrolboard)
alongwiththefee,forgrantofauthorization
andtheprescribedauthorityshallgrantthe
provisionalauthorizationinFormIIIandthe
validityofsuchauthorizationforbeddedhealth
carefacilityandoperatorofacommonfacility
shallbesynchronizedwiththevalidityofthe
consents.

22. Fornon-beddedoccupierstheauthorization
shallbeonetime,whichshallbedeemedto
havebeengranted,ifnotobjected,within90
daysw.e.f.dateofreceiptofapplication.

23. Canbecancelled/suspendedatany
timegivingreasonsinwriting,after
givingopportunity.
Refusalaftergivingproperhearing
andreasonsinwriting.

24. If aggrieved by
the decision of
the prescribed
authority, the party
can file an appeal
to the Appellate
authority
{Secretary
(environment)
to GOHP} with
in 30 days
on form V.

25. TheHIshallmaintaintherecordofhandling
ofBMWintheinstitution,andputitonthe
websiteandshallalsobeproducedtothe
inspectingauthorityfromtimetotime,when
askedfor.
AnnualreportshallbesenttothePAby30
th
JuneeveryyearinformnoIV.
Recorddisposalafter5years.

26. Incaseofanymajor
accidentintheinstitution
whilehandlingtheBMW,
ithastobereportedto
theprescribedauthority
within24hoursandwith
theannualreportalong
withactiontakenreport
(includingnilreport).

27. Major:
BMWtransportingvehiclemeetsanaccident.
AccidentalreleaseofBMWintoawaterbody.
Accidentalfireinthefacility.
Blast.
Damageofthestoragepit,duetofloodor
soilerosion.
Minor:needlestickinjury,splash,spills.

28. Let it bleed, don’t squeeze.
Wash with soap water
Cover it
Report it

29. Rinse eyes with water/saline several
times or do it by using water jet.
Clean the wound with soap & water
Rinse with water several times, spit it
out

30. Immediatefirstaid:cleaningofthewoundwith
soapandwater,noantisepticuse,dressing.Inj.
Tetanus/ATSshouldbegiven.
Immediatereportingtotheinfectioncontrolofficial/
officerandrecorded.
Thepatientidentifiedwithcompleteaddressand
phoneno.Followupofthepatientisveryessential.
Thepatient’sbloodtestaftercounsellingtoensure
theHIVstatusandthenagainafter3and6months,
ifthetestisnegative.
Immediatepostexposureprophylactictreatment
(PEPT)shouldbestarted.

31. Ifexposurecodeis1(intactskin,fewdrops,
shortduration)andsourcecodeis1(sourceis
HIV-tive)thennoneedofPEP.
Takeconsentofthestaffontheformat.
Starttreatmentwithin2-72hours.
TLE:Tenofovir300,Lamivudine300,Effervinz
600ODX28days;2-3hoursafterdinner.
Avoidfattyfood.
GIsideeffects.

32. Immunizationwithin7days.
Ifstaffhasbeenimmunizedforhepatitis,then
booster.Lifelongimmunityreported.
Ifnotimmunized:threedosesofhepatitis
(0,1,6).
IfHBsAgtitrelevel<10i.u.,thenHBIg:0.05to
0.07ml/kgIM,indeltoidorlateralthighregion,
within6-48hoursfollowedbyvaccination.
Ifdoctorrecommends:specialmedicalleaveup
to6weeks.
Antibioticsifsignsofsecondaryinfection.

33. 28%
25%14%
11%
11%
11%
Injections
Venepunture
Suturing
Manipulating IV inj. Port
Inserting IV catheter
Other medical
procedures

35. ThestateHighCourt:
onlycourt,competent
to
hearthecases
pertainingtoBMWM.

36. Anypersonisfoundguilty,
byname&notbydesignation,
ispunishable.
Imprisonmentrangingfrom
6monthstooneyear&fine
uptoRs.1lac.

37. SOURCES
OF BMW
INDOOR L.ROOM & OT OUTDOOR
MINOT OT/ PLASTER
ROOM
INJ. / DRESSING
ROOM
MCH LABORATORY
BLOOD BANK

38. Injuries due to sharps to staff
Hospital associated infections
Change in microbial ecology
Antibiotic resistance
Harms due to chemicals

39. Hospital clinical staff
PATIENTS
VISITORS TO HOSPITAL
HOUSEKEEPING STAFF

40. VULTURES
DOGS & WILD ANIMALS
GRAZING ANIMALS

41. RAG PICKERS
GARBAGE WORKERS
ANIMAL GRAZERS
General public

42. OZONE LAYER
FOUL SMELL: A
NUISANCE

43. 1.Humananatomicalwaste:tissues,organs
&bodyparts.Nonviablefetus.
2.Animalwaste:animaltissue,organs,body
parts,carcasses,bleedingparts,fluids,
blood&experimentalanimalsusedin
research,wastegeneratedbyveterinary
hospitals/colleges.Dischargefromanimal
houses.

44. 3.Microbiological&biotechnologywaste:wastefromlab
cultures,stocksorspecimensofmicroorganisms,liveor
attenuatedvaccines,human&animalculturesusedin
research,infectiousagentsfromresearchandindustriallabs/
biologicaltests/toxins/dishes/devicesusedfortransferof
culture.Sputumcups,discardedvaccines.
4.Soiledwaste:Itemcontaminatedwithblood,bodyfluids,
cotton,dressing,POPcasts,residual/discardedblood/its
components.
5.Discarded/expired/contaminatedmedicines&cytotoxic
drugs.

45. 6.Pathologicalliquidwastedecontaminated&flushedinto
drains.E.g.pleuralfluid,urine.
7.Chemicalliquidwaste:generatedduringproductionof
biologicalactivities,used/discardeddisinfectantsduring
washing/cleaning/housekeeping/disinfectingactivitiesafter
treatmentinETP&thenintothedrains.
8. Chemical solid waste: according to the nature. Special
incineration. Rare. e.g. DDT.
9.Discardedlinen,beddings,sheets,coats,clothingsetc.
contaminatedwithbloodorbodyfluids.

46. Contaminatedsolidwaste:Waste
generatedfromdisposableplastic/rubber
itemsotherthansharps:Ryle’stube,urine
bags,catheter,microtips,microtestwells,IV
sets,plasticbottlesusedforfluids/reagents,
syringewithoutneedle,gloves.

47. Wastegeneratedfrominfectedsharp
material:(WISM):Sharpsincludingmetal
needles,syringeswithfixedneedles,
scalpel,blades,dentalaccessories
(reamers,files&burs)etc.,whichmay
causepuncture/cuts.
Itincludesusedandunuseditems.

48. •Brokenglass&contaminatedglasswares
liketesttubes,syringes,vials,ampoules,
foilsofthemedicinesetc.;
•Needles,syringewithneedles,blades,
dentalburs&reamers;
•Anythingwhichcausescut.
•Metallicimplants.

49. General waste generated in the
hospital/ office. Paper, newspaper,
plastic water bottles, aluminum canes of
soft drinks, food containers, covering of
different material, compostable general
waste.

50. 1%/10%Sodiumhypochloriteisusedto
decontaminate
BMW.{1/available%)X1000=.....ml/1000 ml
water}.
BMWshouldbemutilated/shreddedtoensure
thatitisnotreused.
Halogenatedplasticsarenottobeincinerated.
Incinerationashisdisposedintosecuredland
fills.
Nochemicalpre-treatmentisrequiredbefore
incineration.

51. Syringeswithfixedneedlesaredisposedintowhite
translucentcontainer.
Sharpsarestoredintopunctureproofcontainerand
whenfullby3/4,itisdecontaminated,sealedand
removedtoBMWstorefortransport.
Thetissuelikeplacentashouldbeputinthebagafter
eachdelivery,whichistightlyclosedandshiftedto
thestore.
Liquidwastegeneratedfromlab,washing,
housekeeping/disinfectingactivitiesandchemical
wastedonotrequireanycontainer/bagandare
disposedaccordingtodischargestandards.
Effluenttreatmentfacility(ETF)ineachHI.

52. •Storedinyellowcolorednon-chlorinatedbags.
•Disposalbyincineration.
•Chemicalliquidwaste(CLW)dischargedintodrainsafter
complyingwitheffluenttreatmentnorms.
•Linenetc.byincineration.
•Microbiological(expired/leftoutvaccines)autoclaving.Final
disposalbyincineration/plasmapyrolysis.
•Expiredmedicinesinseparateyellowbagwiththelist&aletter
tothemanufacturer/CBMWTF.Incineration(1200°)

53. Pathologicalliquidwaste(PLW):decontaminated&
thenflushedintodrains.
Chemicalsolidwaste(CSW):accordingtonatureof
thesalt.Specialincinerators.
Untreatedliquidwasteshouldnotbeusedfor
agricultural,aquaculture,drinkingorrecreational
purpose.
EveryhospitalshouldhaveitsEffluenttreatment
plant(ETP)

54. Storedinnon-chlorinatedred
bags/containers.
Treatedwithautoclaving/microwaving/
chemicaltreatmentfollowedby
mutilation/shredding.
FinaldisposalbyRecyclingbyregistered
agency.

55. Polyethylene (PE):Water proof sheets, bags, jars,
bottles, gloves, tubing material, caps.
Polypropylene (PP):Test tubes, beakers, dishes,
bottles.
Polystyrene (PS): Bottles, Petri dishes, culture tubes.
Polyvinyl chloride (PVC):Blood products &
transfusion, collection of body fluids, IV therapy/renal
therapy/ respiratory products.

56. Movement of liquid vapors into the condenser
Tapping of liquid fuel (as a product)
COLLECTION & SEGREGATION OF PLASTIC WASTE
SHREDDING OF WASTE
STORING OF PLASTIC WASTE
Tapping of vessel tarry waste
FEEDING INTO HOPPER
Flow of waste into heating vessel in the presence of catalyst

57. Stored in puncture proof
containers.
Judicious use of hub cutters.
Chemical disinfection/ autoclaving
followed by shredding/ mutilation.
Final disposal to registered
recyclers.

58. Stored in puncture proof containers.
Needles not to be cut.
Chemical disinfection/ autoclaving
followed by shredding/ mutilation.
Final disposal to registered
recyclers.

59. Disposal in secured landfill.

60. oDisposal through municipality
by recycling/ decomposition in
secured land fills.

61. Red
White
Blue
Yellow
Soiled plastic waste: catheters, urobags, IV set,
gloves, syringes without needle, rules tube, bottles.
Human /animal anatomical, soiled solid waste, expired
medicine, chemical solid waste, chemical liquid waste,
pathological liquid waste, microbiological.
Metallic sharps like needles & blades, syringe with
fixed needle
Broken/unbroken glass bottles/ ampoules/ vials,
implants.

62. Fixertoregisteredvendor-3000-8000p.p.m.
silver.
Unuseddevelopertomanufacturer/regd.
vendor---hydroquinone.
Useddeveloperintodrains.Flushwithplentyof
water.
X-rayfilms(non-MLC)tomanufacturer/
registeredvendorafteraperiod.Mindthe
privacyofinformation.
Leadfoils/leadaprons/leadboxes/shields/
screen:tothemanufacturer/registeredvendor.

63. HOSPITAL
WASTE
BIOMEDICAL
WASTE
15-20%
GENERAL
80-85%

65. TheaveragequantityoftheBMW,
producedinIndia,rangesfrom1.5to2.2
kg/day/bed(average2kg/day/bed)
Wemustremember3R’s—Reduce,
Reuse&Recycle.
Sosegregationatthepointof
generationismostimportanttoreduce
thewaste.

66. REDUCE
REUSE
RECYCLE

67. MinimumInjectionsprescribed.Dataindicatesthat65%
oftheinjections,prescribedinIndia,areunwanted.
Propersegregation.
Allthecolourcodedbinsplacedatthepointof
generation,keptoutofthereachofthepatientsand
theattendants.
Separategreencolouredbinsgeneraluseatonesideof
theward.
Visitorsarenotallowedtobringfoodinplasticpacks.
Sievedcontainersplacedinthetoiletsofthe
maternity/femalewardstoputthe“pads”whichshould
betransferredtothe“BMW-Bins”atregularintervals.

68. More injections-more waste
Injections are given for fever, cough, diarrhea
1 Injection= appx. 40-60gms BMW;(Needles(2)-6gm;
syringe-5gm; ampoule/SD vial/MD vial=3/10/20 gm; gloves-
20gm;cannula=20gm)
2005-Delhi produced 65 tons in 1 year BMW due to injections

69. Nil orally
Unable to retain
orally
Unable to
take orally
Unable to
absorb
No oral
preparation
of drug
Doubtful
compliance
Child/psychiatric
Semi/unconscious-
oral feeding not
possible
Acute severe
pain/high conc. Of
drug required

70. Repeateduseofinstruments,linen,caps,
gowns,sheets,etc.afterproper
disinfection/sterilization.
Toothbrusheskeptforcleaningthe
instruments.
Thesputumslidesnotre-used.
Reusableitemscostmoreinitiallyas
comparedtodisposable,butthelongterm
effectsareclear.

71. Plasticmaterialafterdecontamination&
propershredding.
Generalwastelikeplasticbottles/cans,
paper,cartons,inkcartridges,wooden
boxes,used/wastepaper,metallictins
etc.

72. AlltheBMWtreatedaspotentiallyinfectious
andhazardous.
Mercuryshouldnotbetouchedevenwithgloved
hands.
EarlyandpropersegregationoftheBMWatthe
pointofgeneration.
Propercolourcodedbinsused.
PropertrainingofthestafftohandletheBMW.
Provisionanduseof“PersonalProtective
Equipments”(P.P.E.’s).

73. ProperhandlingoftheBMW.
PropertransportationoftheBMW.The
bins/bagsshouldnotbefilleduptomorethan
3/4ofitscapacitytoavoidaccidentsduring
handling/transportation.
Immediateresponsetotheexposure/accident.
ImmunizationofthestaffagainstHepatitis,
Tetanus.
Bleachingpowdershouldnotbeputinthepits
asitwilldelaytheprocessofdecomposition.

74. Sharpsshouldbehandledwithutmostcareto
avoidanyinjury.Nodirecthandingover.No
recappingofsyringes.
Sharpsstoredinpunctureproofcontainers.
Reusableitemsdisinfectedbeforereuse.
BMWshouldnotbetoucheddirectly.
Bins/bagsshouldneverbedraggedduring
transportation.

75. Habitofproperhandwashing.
Nevercorrecterrorsduringsegregation.
Ifgeneralandhazardouswasteareaccidentlymixed,
themixtureshouldbetreatedashazardouswaste.
Smallamountsofchemicalandpharmaceuticalwaste
maybecollectedtogetherwiththeinfectiouswaste.
Largequantitiesofobsoleteandexpireddrugsshould
betransportedinyellowbagswithdetailreport.
Largequantitiesofchemicalwasteshouldbepacked
inthechemicalresistantcontainersandsenttothe
specializedtreatmentfacility.

76. •Caps,
•Mask,
•Gowns,
•Goggles,
•Gumboots,
•Gloves(surgeons),
Rubberaprons
•Heavydutygloves(PVCgloveslinedwithcloth)for
sweepers.

77. Gloves,
Thyroid shield,
Gonad shield,
Abdominal shield,
Lead apron,
Lead screen,
Lead lining of the room &
TLD badges.

78. Bins:Hardplasticbinswithlids/withfoot-
operatedlids.Colourcodedbins:Yellow,blue,
red,green,whitetranslucentpunctureproof
containers.

79. Syringe/hubcutters,
Digitalweighingmachine(incaseof
incineration),
SSBowelfordecontaminatinginstruments,
Scissors(tailor’sscissorsSSwithblack/blue
handle),
Phial/serratedknifetocutampoules,
Sieveddustbinsfortoiletstostoresanitarypads
infemalewards.
Measuringtumbler.
Autoclaveforbloodbank.

80. Punctureproof,leakresistant,imperviousto
moisture.
Strongenough(55micronsgauge)toprevent
tearingorbursting,andsealed/tiedsecurely.
Thecolourofthebagmustmatchthecolourof
thecontainer.
ShouldbearthelogoofBMW/Hazardouswaste.
Non-chromium,non-halogenated.
Replacedwhen2/3full.
Storedfor<48hours.

81. Useuppershelfforkeepinginjectionrelated
items&traysforusedsyringes&usedswabs
andloweroneforBMWM:blue,green,red
bins.
Usedsyringesarekeptinatrayinone
directiononlyandareshredded,whenthe
trayisfullby3/4orattheendoftheinjection
round.

82. Sodiumhypochloritesolution(5%or10%).
Causticsoda(NaOH/Sodiumbisulphate)
usedfordeactivategluteraldehyde.
Phenyl/QUACorQUATS.
20% Calcium sulphide/sodium
thiosulphate.(Hgneutralizingagents).
Glycine.

83. GENERATOR
(HOSPITAL)
IN HOUSE
SEGREGATION IN COLOR
CODED BINS
WASTE WATER TO ETP
TRANSPORTATION
(IN APPROVED
VEHILCE)
BMW STORE
RE-USE
DISPOSAL
(RECYCLING/LANDFILL)
UNLOADING &
TEMPORARY STORAGE
IN CBWTF STORE
TREATMENT
AUTOCLAVING, SHREDDING,
INCINERATION

84. Segregation at the
point of generation
Collection & storage of
BMW in Color coded
bins/bags
Pre treatment of lab &
highly infectious waste
Treatment in EFT/
disposal
Transportation from
sections to main
store
Central storage
Transportation &
Final disposal

85. Itisthekey.
ReducesthequantityofBMW
ProperdisposalofBMW.
Doneatthepointofgeneration.
Colourcodedcontainerskeptatthepointof
generation.
Thesegregationistheresponsibilityofthe
generator.
Ensureuninterruptedsupplyofbagsetc.

86. At the point of generation
Workable height (2 ½ ft.)
Awayfromthereachofchildren.
Dedicatedscissorswithblack/
bluehandleforuseinBMWM
only,atthepointofgeneration.
Responsibilityofthegenerator.
Needleisremovedassuch&putintothewhite
container.
Hubofthesyringeiscut,pistonisbroken,
followedbydisposalintotheredbin.

87. (1%)10%Sodiumhypochloritesolution:
contacttime20minutes.Stability3hours.If
themethodofdisposalisdumping,thenthe
tissues/infectiousmaterial(yellow)neednotto
bedisinfected,asitwilldelaythe
decomposition.
Ifthemethodofdisposalisincineration,
infectiousmaterialshouldnotbedisinfected
exceptincaseofmicrobiological/lab/highly
infectiouswaste.

88. UndertheBMWact2016,(1%)10%solution.
Concentrationof>500ppm.iscorrosiveto
metals,alloys&thermoplastics.
Sideeffectstohumans:Eyes:irritationof
eyes/maycausedamage;skin:blistering/peeling
ofskin;inhalation:irritationofnose,throat,
cough,breathingdifficulty;ingestion:burning
throat,abdominalcramps,N&V)
Storeindryplaceatroomtemperature.Donot
keepthecontainer/packopen.

89. PutonPPE’s.Switchoffelectricappliances.
Assemblematerialrequiredforthespillmanagement.
(SMkit)
Inspecttheareaaroundthespillforanysplatteror
splashes.
Restricttheactivityaroundthespilluntiltheareais
cleaned,disinfectedandiscompletelydry.Placea
signboard“Stop—danger-BMWahead”
Confineandcontainthespill;wipeupanybloodor
bodyfluidspillimmediately,usingdisposabletowel.
Disposeitintotheyellowbin.

90. Disinfecttheentireareaasperguidelines:
covertheareawithabsorbentcotton/news
paperandpour10%hypochloritesolutionX
20minutesremoveit&disposeitinyellow
bin.
Wetmoptheareawith5%phenyl.
Caremustbetakentoavoidsplashoraerosol
formationduringthecleaningprocess.
Removegloves,cutthemdisposeintored
bag.Washhands.

91. Canbedecontaminated
with10%hypochlorite
solutionfor20minutes,
followedbywipingitwith
paperanddisposingitin
yellowbin.

92. Disinfectionofthesputumcups:The
sputumcupisfilledwith5%phenolfor18
hours.Itscoveristightlyclosedandthenitis
putinthecontainerhaving10%SHCsolution.
Cupsarethenshredded.

93. Decontaminationoftheblankets:byexposure
toformaldehydevapoursorautoclaving.Dry
cleaningoftheblanketsdoesnotkillHIV.
Damageditemsincinerated.
Decontaminationandwashingofmattresses:-
-coverallthemattresseswithwaterproofrexin
orplastic.Carbolizewith5%lysoldaily.Washing
canbedonemanually.Damagedmattresses
incinerated.
Crackedmattresscoversreplacedand
incinerated.

94. Thepipettesarenotinusenowastheseare
fittedwithdisposablemicrotips.
DisinfectionofHb/WBC/RBCpipettes:
Thesearedisinfectedbyrinsingwith2.5%
(450in1000ml)SHCsolutionseveraltimes,
followedby95%alcoholtwotimes,then
acetonetwotimesandthenairseveraltimes
todryitup.

95. Allinfectedbloodbags,inthebloodbank,
shouldbeautoclavedfirst&thendisposedof.
Temperature121ºCelsius–Pressure15
Ibs./sq.inchfor60minutes.
Temperature135ºCelsius–Pressure31
Ibs./sq.inchfor45minutes.
Temperature149ºCelsius–Pressure52
Ibs/sq.inchfor30minutes.

96. Cytotoxic, hazardous and
radioactivewaste,animalcarcasses
andbodypartsandlargemetal
itemsshouldnotbedisinfectedby
thismethod.

97. Sterilablesareusedtoensure
completeandefficientsterilization.
Bacillus stearothermophilus
capsules.

98. Somedo’s&don’ts:
Mercuryinallforms(organicorinorganicforms)is
hazardous.
Compoundsunstableat600ºC.
Itshouldneverbetouched,evenwithgloved
hands,asitsvapourscanpenetratethegloves.
Methylmercury-veryhazardous--Canenterinto
thebodyin15secs.evenwithgloved
hands…..death.
Onethermometercontains300to5000mgof
mercury.

100. OneLEDlampcontains3.5to6mg.(5mg=tip
ofballpointpen).
Neverheatthecloggedamalgamcarriersor
anyotherinstrumentwithamalgamdebris
withanopenflameasthemercurywould
evaporate.
Replacemercury thermometers/BP
apparatusbynon-mercuryitems.
Moredangerous,whenitsvapoursare
inhaled.

101. Small/simplespill<10gms.
Large/complexspill>10gms,
Whenspilled,electricdeviceslikefansand
heatersareswitchedoffimmediately.
Closeallinteriordoors&windowsandopenall
exteriordoors&windows.
Donotbroom/vacuumcleanthearea.
Removealltypesofjewellery/watchandput
onPPE’s(latex/HD),mask,goggles,
disposableshoecovers.

102. Mark&restricttheareabyplacing“dangersign”.
Locatethesmallbeadswiththehelpofaflashlight
thrownatlowangleonthefloorindarkenedroom
orsprayZincorsulphurpowder.
Startcollectingthespillfromtheouterperimeter.
Collectthebeadsandglasspieceswiththehelpof
twopiecesofcardboards&confineinasmallarea.
Removebrokenglasspieceswiththehelpofforceps
toavoidanyinjuryandputintobluecontainer.
Removethemercurybeadsbysuckingwitha
syringe.Storeinanunbreakablebottlewithscrew
capunderwaterseal.

103. Handitovertoregisteredagency.
Puttheusedgloves/syringe/cardboards
/towel/contaminateditemsinasealedleakproof
plasticbag/containerandhandovertothewaste
collector.
Donotburn/washthem.
Washtheareawithmercuryneutralizingagents
like20%calciumsulphideorsodium
thiosulphatesolution(ifthechemicalsare
available).
Keeptheroomventilatedforaminimumof48
hours.

104. DisposalofDDT:Storedinairtight
containerswhichshouldthenbedumped
deepintothesoil.Orincineratedinspecial
incineratorsmadeforthispurposeonly.
Handlingofextractedtoothwithamalgam
filling:Generally,itisafixedcompoundand
mercurycanbereleased/willevaporate,only
ifitisheatedformorethan600°C.

105. Usedasadisinfectantinhospitals,as1%or2%
aqueoussolution,todisinfectendoscopes,
bronchoscopes,dentalandotherinstrumentsby
immersingtheminclosedcontainers.
Usedas2.4%aqueoussolutionafteractivatingit
withanactivator(Potassiumnitrite).Sodium
bicarbonatecanalsobeused.
Solutiononceactivatedcanbeusedupto2weeks.
Availableas2.45%(Cidex14days)solutionand5
literpackingforuseinhospitals.110mlofactivator
isaddedto5litersofgluteraldehyde(11mlin500
ml).
Alsoavailableas3.4%.(Cidex28days)

106. Thesolutionturnsgreenandisreadyforuse.
Instrumentsshouldbedryandfreefromany
organicmatter,beforetheseareimmersedin
it.
Contacttime:20minutesfordisinfection
and10hoursforHLD.
Aftertakingtheinstrumentfromthe
solution,itshouldberinsedwithsterile
water/saline.
Storedbelow30°C.

107. It is used in developer of the X-Ray
films, to shorten the drying cycle.
Used as fixative in histology and
microscopy in 1.5 to 6% aq.
Solution.
It is used to treat common or plantar
warts as 10% w/w solution.

108. Inflammableandevaporatesreadilythevapors
areharmfulforthehumanhealth.Itevaporates
intotheatmosphereandishydrophilicandthus
dissolvesintherainwater.Sokeepitcovered.
Biodegradabilityis80%in15hours.
Healthhazards:Irritanttoskin,eyesand
respiratorysystemcausingskinsensitization,
contactdermatitis,allergicreactionsand
occupationalasthma.Carcinogenic.

109. Keepawayfromfoodarea,childrenandeyes.
Wearappropriategloves(Nitrile/Butylrubber
glovesforhandlinghighconcentrationand
polyethyleneorlatexglovesforlow
concentration.PVCglovesarenot
recommended).Donothandlewithoutusing
PPE’s.
Instrumentswithcarboncontentsandlowgrade
platingshouldnotbeimmersedinit.
Thecontaineriskeptcovered.
Donotmixwithotherchemicals.
Theroomshouldbewellventilated.

110. Sodiumbisulfite/sodiumhydroxide(caustic
soda)areusedasdeactivating/reducing
agents.
½ozor15gms.of“Gluteout”isaddedto4
litersofgluteraldehyde.
Waitfor5minutes,whenthesolutionturns
intoredorange.
Discardintothedrainsandruncoldwater
freelyafterdisposal.

111. Available in 0.55% concentration.
No activation is required. Less time required for
disinfection. Less harmful.
HLD Time 12 minutes at 20ºC.
Once the container is opened: shelf life 75 days.
Mark the date of opening.
If put in secondary container: shelf life 14 days.
Deactivate with 25 gmsof glycineper gallon
(4.5 liters) of OPA for 1hour.
Pour it into drains & flush with plenty of water.

112. Thebags/binswhenfilledupto3/4ofthe
capacityshouldimmediatelybetiedup,
removedandreplacedwiththenewsamecolour
bag.UsePPE’s.
Fixedtimingsofremovalofbags,preferably
afterthevisitinghours.
Containersforsharpshouldberemovedwhen¾
full,afterdecontamination.
Barcodelabellingofthebagsshouldbedone.
Thelabelshouldbenon-washableand
prominentlydisplayed.
Bagshouldbearthe“logo”ofBMW.

113. If there is no bar coding facility: then paste a
sticker:
Date of generation.
Type of waste.
Quantity in kg.
Name & address of HI.
Name & phone no. of contact person
Contacts & details in case of emergency.
Receiver’s contact details, address & phone
no.

114. Thebins/bagsshouldneverbedraggedto
avoiddamageandthusanyinjury.
Thebags,onceclosed,shouldnotbeopened.
Loadingandunloadingdone,onebyoneonly
Transportationshouldnotbethroughthe
patientarea/hightrafficarea/highriskareas.
Ensurenospillage/scatteringofwasteduring
transportation.

115. Properlydesigned.
Stableandshouldnotproducenoise,
whilebeingused.
Itshouldnothavesharpedgesand
shouldbeeasytodisinfectanddrain,
andeasytohandle.
Covered.

119. In-housestorefortheBMW.
Justawayfromtheindoor/outdoor/diagnostic
sections/secludedplaceinthebuilding(e.g.
basement)andneartheparkingpoint.
Thefloorelevated,non-slipperyand
impermeable(tiled)withproperslope.
Facilityofhandwashingwithelbowoperated
taps.
24x7watersupply.
Roomwashingfacilitywithproperdrainage
system(drainagepipesofnotlessthan6"
diameter).

120. Properpowersupplyandoneexhaustfan,
propercrossventilationsystem.
Windowshavingfourparts—eachparthaving
twosetsofpans-oneglassandonemeshed.
Thedoorsandwindowstightlyclosedwith
facilityoflockingofthedoorstopreventthe
entryofanyunauthorizedperson,animals,
reptilesandrodents.
Aceilinghooktohangtheweighingmachine.
Awayfromthekitchenandcanteen.
SeparateareatokeepthePPE’s.
AsignboardwithBMWlogo.Restrictedentry.

123. The vehicle should be a closed van,
having a logo of BMW covered under
MVA, 1988.
The occupier shall ensure that there is
no secondary handling of the waste.
The occupier shall ensure that the waste
is not kept in the store >48 hours.

124. Itshouldbedeep.Bleachingpowdershould
notbeputinsidethepit.BMWshouldbe
coveredwitha10cmlayerofsoil,everytime
thewasteisputinto,toavoidfliesand
emissionofobnoxiousgases.
Waterlevelshouldbeatleast6metersbelow
thefloorofthepit.

127. SNParameters Permissible limits
1 pH 6.5-9
2 Suspended solids 100 mg/l
3 Oil & grease 10mg/l
4 BiochemicalO2 demand (BOD) 30 mg/l
5 Chemical O2Demand (COD) 250mg/l
6 Bioassay test 90% survival of fish after96 hours is 100%

128. Incinerationisahightemperaturedryoxidation
processthatreducesorganic,combustiblewaste
toinorganic,non-combustiblematterand
resultsinaverysignificantreductionofthe
volumeandweight.
Usedtotreatwastethatcannotberecycled/
reused/disposedinthelandfillsite.
Producesmainlygaseousemissionse.g.,steam,
carbondi-oxide,nitrogenoxidesandcertain
toxicsubstances(metals,halogenicacids)and
particulatematter.

129. Twochamberswiththetemperaturegoingupto
800+_50ºCand1050+_50ºCrespectively.
Lesstemperaturewillcauseincomplete
combustion.
Incompleteincinerationwillproduceharmful
compounds—carbonmono-oxide,dioxins,furans
andco-planar,whichaffectourimmunesystemand
causedevelopmentaldefectsofnervous,endocrinal
(Hypothyroidism,Thymus atrophy)and
reproductivesystemsandmaycauseacne,skin
lesions,sarcomas.

130. Dioxinscanbeinhaledoringestedorally
throughfood&waterchain.
Thestackheightofthechimney;notless
than30metersfromtheground.
Thehealthdepartmentshouldavoid
installingitsownincinerators.
BagswithChromium,ifincineratedcause
ulcersinthenasalmucosa,irritationoflungs,
kidneydamage,andskinrashes.

132. In-houseincineratorisnotallowed.Incase
thereisnofacilitywithin75km,permission
fromPCBhastobetakenbeforeinstallation.
IftheCommonbiomedicalwastetreatment
facility(CBMTF)isavailablewithin75Km.
(twodistrictsinhillyareas)thentheHCFshall
outsourcethedisposalofBMW.

133. LeachingofDEHP(Di-2ethylhexylphthalate)in
humanbodyfromI.V.cannula/Ryle’stubescancause
lowfertility,lowbirthweight,abnormalityofskeleton
andkidneyfunctions,ifkeptinsitu>24hrs.
ThefinaldisposaloftheBMWshouldbeoutsourced
totheoperator,empanelledbythePCB.
Theratesmaybedecidedbycallingopen
tenders/negotiations.
Theincinerationashisalsohazardousasitmay
containheavymetals,soitshouldbedisposedby
deepburial.

134. Pressurizedcontainers
Largeamountofreactivechemicalwaste
Silversaltsandphotographicorradiographic
waste
Halogenatedplastics–PVC.
Wastewithhighmercury,cadmium
contents—thermometers,
Usedbatteries,leadlinedwoodenpanels.
Sealedampoules,vials.

136. Twotypesofpits,whichshouldbewellcovered.
Forsharps:A“pucca”/concretepit,ofthesizeof
2X2meterswithconcreteroofwithan
outlet/manholeof2´x2´diameter,whichiskept
coveredwithametal/concretecover.
Fordecomposablematerial:A“kuchcha”/non-
concretepitofthesamesizecoveredwitha
steelstructureofthesizeof2.75X2.75meters,
sothatthereisnoaccesstowildanimals,flies,
birdsandrainwater.

137. Fourangleironsatthecorners—appx.ht.4to5feet.
Angleironsarewelded/joinedwitheachotheratits
upperendandappx.onefootabovethelowerend
whichiskeptfreetofixitinthesoil.
Sidesareclosedwiththeironmesh-size16mesh
wirespersq.cm.Adoor,withabolt,iskeptonone
side,forputtingtheBMWinsidethepit.
Theroofiswell-coveredwiththetinsheets.Whenthe
pitgetsfilledupto2/3ofitscapacity,thenitshouldbe
closedbyputting35cm.oflimeandrestsoil.

139. Awrittenagreementhastobesignedbythein-
chargeoftheinstitution(MS/SMO/BMO)withthe
operatorbeforeoutsourcing.
AnyHIwhichfallswithin75kmrangeofCBWTF,
shallhavesenttheBMWtothisfacility.
Atpresent,thereisthepracticeoffinalizingthe
ratesafternegotiationsbythein-chargeofthe
institutionwiththeoperator,whohasbeen
empanelledbythestatePCB.

140. TheoperatorwilllifttheBMWonthealternate
day,fromthefacility.BMWcannotbestoredfor
morethan48hrs.
If>48hrs:permissionformPCB,onlyupto72
hours;stepshavetobetakenbytheoccupierso
thatthereisnoharmfuleffecttothehumans
environment.

141. ForHIwith>30bedscapacity:BWM
committeeisconstituted.Meetingevery6
months/SOS.Documentationoftheminutes
ofthemeeting.
ForHIwith<30bedscapacity:onlyone
personisdesignatedtotakecareofBMWM.
EnsurethatalltheBMWishandledasper
guidelinesfromPCBanditisthedutyofthe
generatortosegregateorshredtheBMW.

142. Teamwork:InadditiontotheMS/SMO/membersof
BMWCommittee.,doctorsandparamedicalin-
chargesofvariousdepartmentsshouldalsosupervise
BMWMondaytodaybasisandanyshortcomingin
thesystemispointedouttothestaff,thereandthen,
alongwiththesuggestionstocorrectit.
TheBMWcommitteeshouldtakeweeklyroundofthe
hospitalanditshouldberecordedintheround
register.

143. In-chargeofthemedicalcampresponsiblefor
safehandlinganddisposalofBMWasper
guidelinesfromthePCBeitherbyonsitedeep
burialorhandingovertotheoperator.

144. P.P.E.’s:shouldbeprovidedtothestaff.
Properhandling:develophabit.
Immunization:againstHepatitis,Tetanusand?Typhoid.
AllBMWispotentiallyhazardous.Donottoucheddirectly.
Behaviourchange:Ahabitofproperhandwashingafter
handlingthepatient.Properhandlingofthesyringesby
staff.Hazardousandgeneralwasteshouldnotbemixed.
Managementpractices:Propersegregation,shredding,
treatment,transportationanddisposalofBMW.Afool-proof
systemofreportingofaccidents.

145. Allthecategoriesof
staffmembersincluding
sanitationworkerin
BMWM-technical&
behaviouralchangeto
handlethepatientand
theBMW.
Followedbydailysupervision,whichisthe
mostessentialkey&mostoftenlacking.

146. Staff training is a never ending process.
It is a Continuous Education.

147. Todevelopawareness:
regardingprovisionofPPE’Stosanitation
staffbythecontractor.
abouthealth,safetyandenvironmentissues.
ofthestaffregardingsafetyatthework
place.
Tomakethemunderstandtherolesand
responsibilityofallthecategoriesofthestaff
membersinBMW.

148. Topreventexposureofscavengers/handlersor
accidentsinhospitals.
Tocreateawarenessamongthehospital
patientsandthevisitors,regardinghygieneand
BMWM.
ToeducatethepeopleabouttherisksofBMW,
focusingonthepeoplelivingorworkinginclose
proximityto,orvisitinghospitals/familiesofthe
patientsbeingtreatedathome,orscavengers
onthewastedumps.

149. Asystemattheleveloftheinstitution,which
evaluatesandshowsthatthereisanimprovement
intheBMWM.
BMWMcommitteesatHIlevelshouldrecordany
shortcomingonaregisterandshouldtake
correctiveactionandfollowitup,sothatitisnot
repeated.
Thereshouldbedecreaseinthenumberof
workplaceaccidents.
Thepremisesandthecampusaroundthehospital
buildingshouldlookcleanandwithoutanyBMW
lying,hereandthere.

150. You are not only protecting yourself, but also
those around you.

151. Scissors three-black/blue for BMW, orange
–miscellaneous work, steel large-for
cotton/gauze.
Extra bowel of chlorine solution in
LR/OT/MOT for instruments.
Availability of deactivators.
Measuring tumblers.
Pressure pumps.

152. Brush. Unlocking of instruments before
cleaning
Jars for sharps.
Black only in radiology and Chief Pharmacist
(medicine store).
Serrated knife.
Spill management.
Decontamination of Hbpippets. REPLACE
WITH MICROTIPS.
Non mercury thermometer/BP apparatuses.

153. Form I: Accident reporting
Form II: Application for registration.
Form III: Authorization by PA.
Form IV: Annual report by occupier.
Form V: Application for filing appeal.

154. Schedule I: Color coding.
Schedule II: Standards for CTF.
Schedule III: List of authorities and their
duties.
Schedule IV: Logo.

157. last river has been poisoned;
last tree has been cut down;
last fish has been caught;
only then, you will find that;
money cannot be eaten.