Biomedical Waste Management

Deals with the Practices, regulations and the issues related to proper waste management in the Hospitals and other similar facilities

1. Disposal of
Hospital & Bio-Medical Wastes
[Bio-Medical Waste Management]
Dr. Gunwant Joshi
Chief Chemist
Madhya Pradesh Pollution Control Board

2. What Causes wastes from Hospital premisesWhat Causes wastes from Hospital premises
HAZARDOUS?HAZARDOUS?
1.1.Waste Chemical-medications, Solutions, or Waste Chemical-medications, Solutions, or
2.2.Infectious microbes,Infectious microbes,
3.3.Chemicals such as formaldehyde, Chemicals such as formaldehyde,
waste anesthetic gases, etc.,waste anesthetic gases, etc.,
4.4.Used disposables, Wasted equipments and Used disposables, Wasted equipments and
Chemotherapeutic agents, Chemotherapeutic agents,
5.5.Laser Smoke and aerosolized medicationsLaser Smoke and aerosolized medications

3. Apart from HospitalsApart from Hospitals
Infectious wastes are also generated atInfectious wastes are also generated at
Dental Chambers Dental Chambers
Nursing homes Nursing homes
Path. LaboratoriesPath. Laboratories
Blood BanksBlood Banks
Veterinary institutionsVeterinary institutions
Bio-Medical & Biotech Research centersBio-Medical & Biotech Research centers

The work environments similar to The work environments similar to
Hospital environment.Hospital environment.

4. 44
Recurrence of
Older infectious deceases
& Advent of Newer infections
Prompted improvements
in Medical technology and
Centralized Medicare,
Brought huge volumes of
Toxic & Hazardous Waste
Situation forced a serious
rethinking & necessited
an appropriate Legislation

5. 55
Who’s at Risk ?
• Doctors and nurses
• Patients
• Hospital support staff
• Waste collection and disposal staff
• General public and
• the Environment

6. 66

The Biomedical Waste The Biomedical Waste
(Management & Handling) Rules, (Management & Handling) Rules,
19981998

The Municipal Solid Waste The Municipal Solid Waste
(Management & Handling) Rules, (Management & Handling) Rules,
20002000

7. To minimize the potential for spread of disease To minimize the potential for spread of disease
from a medical settings to the general public; from a medical settings to the general public;
To reduce the overall amount of infectious To reduce the overall amount of infectious
medical waste produced.medical waste produced.
Infectious agents may become toyes of terrorists, Infectious agents may become toyes of terrorists,
as Bioweapons of Mass Destructionas Bioweapons of Mass Destruction

8. Prospective BioweaponsProspective Bioweapons
Biological AgentsBiological Agents
AnthraxAnthrax
Smallpox Smallpox
BotulismBotulism
PlaguePlague
TularemiaTularemia
Hemorrhagic FeversHemorrhagic Fevers
Q FeverQ Fever
GlandersGlanders
CholeraCholera
E.Coli E.Coli O157:H7 O157:H7
Chemical AgentsChemical Agents
Nerve AgentsNerve Agents
Vesicants or Blister AgentsVesicants or Blister Agents

9. 99
Never mix Infectious Bio waste in to Never mix Infectious Bio waste in to
Municipal wastes Municipal wastes
[The entire waste lot shall become infectious][The entire waste lot shall become infectious]
Segregation and safe containment Segregation and safe containment
(packing) of waste at health facility level (packing) of waste at health facility level

 Processing and storage for Processing and storage for
terminal disposalterminal disposal
Basic Concepts of Basic Concepts of
Hospital waste managementHospital waste management

10. Hospital Wastes are dangerous and Hospital Wastes are dangerous and
require more careful attentionrequire more careful attention
These are heterogeneous waste, These are heterogeneous waste,
both solid & liquid, primarily both solid & liquid, primarily
from Health Care Facilitiesfrom Health Care Facilities
The available techno-economic The available techno-economic
options for the disposal are options for the disposal are
largely determined by Nature largely determined by Nature
of activity of HCF and volume of activity of HCF and volume
of the various waste of the various waste
componentscomponents

11. Liquid wastesLiquid wastes
Approx. Quantity : 4 to 250 liters / bed / dayApprox. Quantity : 4 to 250 liters / bed / day
1. Domestic Effluents and sewage1. Domestic Effluents and sewage
2. 2. Sewage from isolation wards, ICU’s Sewage from isolation wards, ICU’s
toilets & urinals, Bed-bath, bathrooms toilets & urinals, Bed-bath, bathrooms

and hospital’s laundryand hospital’s laundry
3.3. Wash waters from laboratories,OPD, Wash waters from laboratories,OPD,
Dressing rooms & Operation theaters.Dressing rooms & Operation theaters.

12. Solid wastesSolid wastes
Approximate Quantity : 0.3 to 3.5 kg/bed/dayApproximate Quantity : 0.3 to 3.5 kg/bed/day
1.Garbage1.Garbage 5555%%
((Bulk Density :330 kg/mBulk Density :330 kg/m
33
,Cal.Value:1000 K.cal / kg, Moisture :40%,Cal.Value:1000 K.cal / kg, Moisture :40%))
2.Bio-medical waste 2.Bio-medical waste (sensu stricto)(sensu stricto) 1313%%
A. Wasted body remains A. Wasted body remains 05% 05%
(Blood,Cultures,Anotomicals)(Blood,Cultures,Anotomicals)
B. Pharmaceutical & Chemical Wastes. 02%B. Pharmaceutical & Chemical Wastes. 02%
C. Pathological wastes C. Pathological wastes (may be infectious). (may be infectious). 06% 06%
3.Sharp Objects3.Sharp Objects 2020%%
4.4.Pressurized Containers & Discarded InstrumentsPressurized Containers & Discarded Instruments 0202%%
5.Radioactive Wastes5.Radioactive Wastes 0.30.3%%

13. Key to proper Bio - Medical Waste Key to proper Bio - Medical Waste

Management is the segregationManagement is the segregation
as individual categories of waste as individual categories of waste
are to be treated & disposed off are to be treated & disposed off
in different specific waysin different specific ways

14. 1.1.Out rightly send Domestic Effluents Out rightly send Domestic Effluents
to to ....the municipal sewersthe municipal sewers
  2. Isolate & Collect the infectious liquid 2. Isolate & Collect the infectious liquid
wasteswastes((streams 2 & 3streams 2 & 3),), Disinfect completely Disinfect completely
and then send to municipal sewersand then send to municipal sewers
  

15.   3. 3. Pack the Segregated Solid Waste Pack the Segregated Solid Waste
according according to prescribed modeto prescribed mode
andand

16. May be May be

Where,Where,
The BMW shall be treated usingThe BMW shall be treated using
Standard methods such as Incineration, Standard methods such as Incineration,
Autoclaving, Micro- waving, and Chemical Autoclaving, Micro- waving, and Chemical
& Mechanical techniques& Mechanical techniques
and the treated waste residue shall be and the treated waste residue shall be
finally disposed off in a secured finally disposed off in a secured
LandfillLandfill

17. Hospital Waste classificationHospital Waste classification

18. Hazardous waste:Hazardous waste:
Only 10-25% of Hospital waste is actually
hazardous and can be injurious to humans or
animals and deleterious to environment.
This may be either
A. Infectious Bio-hazard
Infectious in nature
B. Sharps that may lead to
secondary infections
C. Toxic Bio-hazard
Cytotoxic in nature
D. Radiation Bio-hazard
Radioactive in nature

19. Other Potentially Infectious MaterialOther Potentially Infectious Material
Any body fluid with visible bloodAny body fluid with visible blood
Amniotic fluidAmniotic fluid
Cerebrospinal fluidCerebrospinal fluid
Pericardial fluidPericardial fluid
Peritoneal fluidPeritoneal fluid
Pleural fluidPleural fluid
Saliva in dental proceduresSaliva in dental procedures
Semen/vaginal secretionsSemen/vaginal secretions
Synovial fluidSynovial fluid
Anywhere body fluids that are indistinguishableAnywhere body fluids that are indistinguishable

20. Blood and Fluid Borne Pathogen Blood and Fluid Borne Pathogen
Exposures may typically occurExposures may typically occur
by one of the following ways:by one of the following ways:

Puncture from contaminated needles, broken glass, Puncture from contaminated needles, broken glass,
or other sharpsor other sharps
Contact between non-intact (cut, abraded, acne, or Contact between non-intact (cut, abraded, acne, or
sunburned) skin and infectious body fluidssunburned) skin and infectious body fluids
Direct contact between mucous membranes and Direct contact between mucous membranes and
infectious body fluidsinfectious body fluids
Example: A splash in the eyes, nose, or mouthExample: A splash in the eyes, nose, or mouth

21. Under Environment Protection Act,1998Under Environment Protection Act,1998
BIO-MEDICAL WASTE (Management & handling) RULES 1998BIO-MEDICAL WASTE (Management & handling) RULES 1998
11
stst
Amendment Rules vide S.O.201(E) Dated 06/03/2000 Amendment Rules vide S.O.201(E) Dated 06/03/2000
22
ndnd
Amendment Rules vide S.O.1069(E) Dated 17/09/2003 Amendment Rules vide S.O.1069(E) Dated 17/09/2003
The Authorization is required forThe Authorization is required for
Generation/Collection/Reception/StorageGeneration/Collection/Reception/Storage
TransportationTransportation
Treatment/DisposalTreatment/Disposal
 or any other form of handling.or any other form of handling.

22. Classification and managementClassification and management
CategoryCategory Waste Type Waste Type Treatment and Disposal Method Treatment and Disposal Method
Category 1 Category 1
Human Wastes Human Wastes
(Tissues, organs, body (Tissues, organs, body
parts parts
Incineration / deep burial Incineration / deep burial
Category 2 Category 2 Animal WasteAnimal Waste Incineration / deep burial Incineration / deep burial
Category 3 Category 3
Microbiology and Microbiology and
Biotechnology waste Biotechnology waste
Autoclave/microwave/incinerationAutoclave/microwave/incineration
Category 4 Category 4 SharpsSharps
Disinfection (chemical treatment)Disinfection (chemical treatment)
+/autoclaving/microwaving and +/autoclaving/microwaving and
mutilation shreddingmutilation shredding
Category 5 Category 5
Discarded Medicines Discarded Medicines
and Cytotoxic Drugs and Cytotoxic Drugs
Incineration/ destruction and drugs Incineration/ destruction and drugs
disposal in secured landfills disposal in secured landfills
Schedule-ISchedule-I

23. CategoryCategory Waste Type Waste Type Treatment and Disposal Method Treatment and Disposal Method
Category 6 Category 6
Contaminated solid Contaminated solid
waste waste
Incineration/autoclaving / Incineration/autoclaving /
microwaving microwaving
Category 7 Category 7
Solid waste (disposable Solid waste (disposable
items other than items other than
sharps) sharps)
Disinfection by chemical treatment+ Disinfection by chemical treatment+
microwaving/autoclaving & microwaving/autoclaving &
mutilation shreddingmutilation shredding
Category 8 Category 8
Liquid waste Liquid waste
(generated from (generated from
laboratory washing, laboratory washing,
cleaning, housekeeping cleaning, housekeeping
and disinfecting and disinfecting
activity)activity)
Disinfection by chemical treatment+ Disinfection by chemical treatment+
and discharge into the drains and discharge into the drains
Category 9 Category 9 Incineration ash Incineration ash Disposal in municipal landfillDisposal in municipal landfill
Category10Category10Chemical Wastes Chemical Wastes
Chemical Treatment + and Chemical Treatment + and
discharge in to drain for liquids and discharge in to drain for liquids and
secured landfill for solids secured landfill for solids
Classification and managementClassification and management
Schedule-I. contd…Schedule-I. contd…

24. Schedule-IISchedule-II
Colour coding and Type of Containers forColour coding and Type of Containers for
Different Biomedical WastesDifferent Biomedical Wastes
Colour Colour
codingcoding
Type of Type of
containercontainer
Waste Waste
categorycategory
Treatment /Treatment /
Disposal Disposal
Plastic Plastic
BagsBags
Incineration/Incineration/
Deep BurrialDeep Burrial
DisinfectedDisinfected
Container /Container /
Plastic Plastic
BagsBags
Autoclaving, Autoclaving,
Microwaving andMicrowaving and
Chemical TreatmentChemical Treatment
Plastic Plastic
Bags Bags
/Puncture /Puncture
ProofProof
ContainersContainers
Autoclaving, Autoclaving,
Microwaving and Microwaving and
Chemical TreatmentChemical Treatment
Destruction/ shreddingDestruction/ shredding
Plastic Plastic
BagsBags
Disposal in the Disposal in the
Secure LandfillSecure Landfill

25. Yellow Dustbin & BagsYellow Dustbin & Bags
From OT: Amputated Limbs,
Placenta, Intestine, Uterus
Ovary etc.
From Labs: Live or Attenuated
vaccines, Infected Samples
and cultures, Culture Plates,
Wastes from production of
Biologicals,Toxins.
MANAGEMENT OF HOSPITAL WASTE

26. Red Dustbin & BagsRed Dustbin & Bags
Cotton pads, Swabs, Gauge
Pieces, Dressings,
Bandages, Cloths, Bedsheets
and Plaster castes
Soiled with blood, Pus,
Vomits, Sputum and other
Body Fluids.
MANAGEMENT OF HOSPITAL WASTE

27. Wastes comprising of out dated, Wastes comprising of out dated,
contaminated and discarded contaminated and discarded
medicines, solid chemicals used medicines, solid chemicals used
for disinfection in Lab & for disinfection in Lab &
Hospitals as insecticidesHospitals as insecticides
Black Dustbin & Bags
MANAGEMENT OF HOSPITAL WASTE

28. Blue Dustbins & BagsBlue Dustbins & Bags
Needles, Scalples,
Blades, Glass ampoules
and Syringes etc. that
may cause puncture and
cuts. This includes both
used and unused sharps
MANAGEMENT OF HOSPITAL WASTE

29. May also be put forMay also be put for
All disposable items like
I.V.Sets, S.V.Sets, Venflon,
Catheter, I.V.Fluid Bottles
Uro-bags, Ryles tube,
Drainage Tube and Bags,
Empty blood bags and Dialysis
and other plastic disposable.
A separate Blue Dustbins & Bags

30. Containers Colour Containers Colour
Tells other staff what is in the containerTells other staff what is in the container
Tells the contractor what to do with the wasteTells the contractor what to do with the waste
Can apply to both sacks and rigid containersCan apply to both sacks and rigid containers
Safe for Disposal to
General Waste
Carcass, anatomical
Sharps
Cytotoxic

31. Colour-Coded Bins for Segregation Colour-Coded Bins for Segregation
of Bio Medical Wasteof Bio Medical Waste

32. Schedule-IIISchedule-III
Label for Containers of Bio-Medical WasteLabel for Containers of Bio-Medical Waste
Bio HazardBio Hazard Cyto-Toxic SubstanceCyto-Toxic Substance

33. Schedule-IVSchedule-IV
Label for Transportation of Label for Transportation of
Bio-Medical Waste Containers / BagsBio-Medical Waste Containers / Bags
Waste category No.Waste category No. Day -------- Month -------- Day -------- Month --------
Waste classWaste class Year -------- Year --------
Waste description Waste description Date of generation----------- Date of generation-----------
Sender's Name & Address Sender's Name & Address Receiver's Name & AddressReceiver's Name & Address
Phone No. ...........................Phone No. ........................... Phone No. ........................... Phone No. ...........................
Telex No. ............................Telex No. ............................ Telex No. ............................ Telex No. ............................
Fax No. ...............................Fax No. ............................... Fax No. ............................... Fax No. ...............................
Contact Person ...................Contact Person ................... Contact Person ................... Contact Person ...................
In Case of Emergency, Please Contact:In Case of Emergency, Please Contact:
Name & AddressName & Address
Phone No.Phone No.

34. Schedule -VSchedule -V
a - a - STANDARD FOR LIQUID WASTESTANDARD FOR LIQUID WASTE
pH pH 6.5 to 9.06.5 to 9.0
Suspended SolidsSuspended Solids 100 mg/l. 100 mg/l.
Oil & greaseOil & grease 10 mg/l.10 mg/l.
BODBOD 30 mg/l.30 mg/l.
CODCOD 250 mg/l.250 mg/l.
Bio assayBio assay 90 % Survival of fish after 90 % Survival of fish after
96 hours in 100% effluent96 hours in 100% effluent
Send Domestic Effluents to municipal sewersSend Domestic Effluents to municipal sewers
Disinfect the infectious liquid waste and then Disinfect the infectious liquid waste and then
send it to municipal sewerssend it to municipal sewers

35. Bio Medical Liquid Wastes DisinfectionBio Medical Liquid Wastes Disinfection
by Sodium Hypochloriteby Sodium Hypochlorite

36. Bio Medical Liquid Wastes TreatmentBio Medical Liquid Wastes Treatment by by
an Effluent Treatment Plantan Effluent Treatment Plant

37. Garbage Wastes Collection &TransportGarbage Wastes Collection &Transport

38. Sharp ManagementSharp Management
Always
Remember
Not to recap
the Needle
and cut it
Immediately
after the use
Sharp Sign

39. Unauthorised
Use/Reuse
Unsafe collection

Unsafe disposal
Sharps IssuesSharps Issues
Must be collected at the point of generation, in a
leak-proof and puncture-resistant container
Containers must bear the international biohazard
symbol and appropriate wording
Containers should never be completely filled, nor
filled above the full line indicated on box.

40. Sharp EncapsulationSharp Encapsulation : Sharp Pit : Sharp Pit
• MUTILATE & DISTROY
•DISINFECT:-
Chemically/Autoclave/Microwave
•DISPOSE IN SHARP PIT
•SEAL PIT WHEN 2/3 FULL
•START DISPOSAL IN NEW PIT.
•Alternatively, after Destruction/
Mutilation and Disinfection the
Stored Sharps can be sold as
Scrap

41. Waste Sharp & Syringe DestructionWaste Sharp & Syringe Destruction
The Shredded Needles, The Shredded Needles,
Sharps and Plastics may Sharps and Plastics may
be kept in the secured be kept in the secured
containers and containers and
could be sent to could be sent to
Plastic / MetalPlastic / Metal
Recycling PlantsRecycling Plants

42. Bio Medical Wastes:Bio Medical Wastes:
Segregate and Segregate and
Pack it right at thePack it right at the
point of Generation point of Generation

43. Bio Medical Wastes Collection &TransportBio Medical Wastes Collection &Transport

44. Bio Medical Wastes Collection &TransportBio Medical Wastes Collection &Transport

45. BMW BMW
CTDF CTDF
at Bhopalat Bhopal
Govindpura Industrial AreaGovindpura Industrial Area
Bio Medical Wastes Bio Medical Wastes
Collection &TransportCollection &Transport

by by
Common Common
Treatment Treatment
& Disposal & Disposal
FacilityFacility

46. Inspection & Re-Segregation Inspection & Re-Segregation
It requires to segregate again to ensure the final It requires to segregate again to ensure the final
disposal of BMW as per BMW Rules 1998 (M & H)disposal of BMW as per BMW Rules 1998 (M & H)

47. AutoclaveAutoclave
Validation test :
Spot testing by
Bacillus stearo-
thermophilus spores
on a spores strip
with at least 1 x
10
4
Spores/ml.
Routine test :
Chemical indicator
strip/tape

48. Sharp Storage & DisposalSharp Storage & Disposal

49. Bio Medical Plastic Wastes DisinfectionBio Medical Plastic Wastes Disinfection
by Sodium Hypochloriteby Sodium Hypochlorite

50. Bio Medical Wastes Destruction byBio Medical Wastes Destruction by
Double Chambered Incinerator Double Chambered Incinerator

51. Details of Double Chambered IncineratorDetails of Double Chambered Incinerator

52. Incinerator Ash DisposalIncinerator Ash Disposal

53. Schedule -VSchedule -V
DEEP BURIAL PIT for BMWDEEP BURIAL PIT for BMW

54. Schedule -VSchedule -V
D - D - STANDARD FOR DEEP BURIALSTANDARD FOR DEEP BURIAL
Entry of scavengers to the burial site be Entry of scavengers to the burial site be
prevented may be by using covers of prevented may be by using covers of
galvanized iron/wire mash. galvanized iron/wire mash.
After every burial in the same secured After every burial in the same secured
pit a layer of 10 cm. soil be added . pit a layer of 10 cm. soil be added .
Burial must be performed under close and dedicated supervision.Burial must be performed under close and dedicated supervision.
Deep burial site should be relatively impermeable and Deep burial site should be relatively impermeable and
distant from habitat.distant from habitat.
There should be no well, lake, river etc. close to the site to There should be no well, lake, river etc. close to the site to
avoid contamination of surface water or ground water. avoid contamination of surface water or ground water.
Location of the deep burial site to be authorized by the Location of the deep burial site to be authorized by the
Prescribed Authority. Prescribed Authority.
The occupier shall maintain record for all the pitsThe occupier shall maintain record for all the pits

55. Land Disposal Facility for Cities & TownsLand Disposal Facility for Cities & Towns
with population less than 5 lacswith population less than 5 lacs

56. Other Bio Medical Wastes Treatment OptionsOther Bio Medical Wastes Treatment Options

57. Other Bio Medical Wastes Treatment OptionsOther Bio Medical Wastes Treatment Options
Microwaveing

58. Other Bio Medical Wastes Treatment OptionsOther Bio Medical Wastes Treatment Options
Plasma Pyrolysis Plasma Pyrolysis

59. Duties of the OccupierDuties of the Occupier

Occupier / institution generating, collecting, Occupier / institution generating, collecting,
receiving, storing, transporting, treating, receiving, storing, transporting, treating,
disposing and/or handling Bio-medical waste disposing and/or handling Bio-medical waste
To apply for Grant of Authorization in form –I To apply for Grant of Authorization in form –I
to MPPCB which is the Prescribed Authority.to MPPCB which is the Prescribed Authority.
Operator of the Bio - medical Waste Treatment Operator of the Bio - medical Waste Treatment
Facility to apply for Grant of Authorization in Facility to apply for Grant of Authorization in
form –I to MPPCB (The Prescribed Authority).form –I to MPPCB (The Prescribed Authority).

60. Duties of the OccupierDuties of the Occupier
Bio-medical Waste shall be treated and disposed Bio-medical Waste shall be treated and disposed
of in accordance with the Schedule -I and in of in accordance with the Schedule -I and in
compliance with the standards prescribed in compliance with the standards prescribed in
Schedule –V.Schedule –V.
Every Occupier, shall set- up the requisite Bio-medical Every Occupier, shall set- up the requisite Bio-medical
Waste Treatment Facilities like incinerator, Autoclave, Waste Treatment Facilities like incinerator, Autoclave,
Microwave system for treatment of waste, Microwave system for treatment of waste,
or, ensure requisite treatment of waste at common or any or, ensure requisite treatment of waste at common or any
other waste treatment facilityother waste treatment facility

61. Duties of the OccupierDuties of the Occupier
To submit an annual report to in form –I I by 31To submit an annual report to in form –I I by 31
stst

June Every year about the categories and June Every year about the categories and
quantities of Bio-medical Waste handling quantities of Bio-medical Waste handling
during the preceding yearduring the preceding year
To maintain records related to Generation, To maintain records related to Generation,
collection,reception, storage, transportation, collection,reception, storage, transportation,
treatment,disposal and/or handling of Bio-treatment,disposal and/or handling of Bio-
medical waste according the rules & guidelines.medical waste according the rules & guidelines.

62. Duties of the OccupierDuties of the Occupier
All records subject to the inspection & All records subject to the inspection &
verification by the MPPCBverification by the MPPCB
Accident during handling & Transportation Accident during handling & Transportation
of BMW needs to be reported by the of BMW needs to be reported by the
authorized person in Form – III to authorized person in Form – III to
MPPCB forthwith.MPPCB forthwith.

63. Please Remember!Please Remember!
The Primary The Primary
responsibility of responsibility of
the disposal of the the disposal of the
Bio-Medical Waste Bio-Medical Waste
lies with the lies with the
GeneratorGenerator

64. And also do not forget thatAnd also do not forget that
Bio-medical waste shall not be mixed with other Bio-medical waste shall not be mixed with other
Wastes such as Municipal WasteWastes such as Municipal Waste
Segregate the Bio-medical Waste in separate Segregate the Bio-medical Waste in separate
containers at point of generation (schedule-II) containers at point of generation (schedule-II)
and label as prescribed (schedule-III)and label as prescribed (schedule-III)

65. And also do not forget thatAnd also do not forget that
Biomedical waste that are to be transported, Biomedical waste that are to be transported,
must be securely packed, and Labeled as per must be securely packed, and Labeled as per
(schedule-IV).(schedule-IV).
Transportation of BM Waste is allowed only in Transportation of BM Waste is allowed only in
vehicles authorized by the prescribed Authorityvehicles authorized by the prescribed Authority
A day -to -day record of the Quantity under A day -to -day record of the Quantity under
different categories of the Bio – Medical Waste different categories of the Bio – Medical Waste
generated in premises must be maintained generated in premises must be maintained

66. And also do not forget thatAnd also do not forget that
No untreated Bio-medical Waste shall be kept No untreated Bio-medical Waste shall be kept
stored beyond 48 Hrs.stored beyond 48 Hrs.
if for any reason, the Bio-Medical Waste is if for any reason, the Bio-Medical Waste is
required to be stored beyond this time limit, the required to be stored beyond this time limit, the
Authorized person must seek a permission from Authorized person must seek a permission from
Prescribed Authority and take adequate measures Prescribed Authority and take adequate measures
to ensure that waste does not affect the human to ensure that waste does not affect the human
life & environment adversely.life & environment adversely.

67. The contravention of the Act The contravention of the Act , ,
Rules, Orders & directions Rules, Orders & directions
may lead to legal actionmay lead to legal action
The punishment may lead to the The punishment may lead to the
imprisonment up to 5 years with fine imprisonment up to 5 years with fine
up to Rs. 1 lakh.up to Rs. 1 lakh.
For failure or continued contravention a For failure or continued contravention a
fine @ Rs.5000 /Day may be charged.fine @ Rs.5000 /Day may be charged.
If the failure or the contravention If the failure or the contravention
continues beyond one year, the continues beyond one year, the
imprisonment may be extended up imprisonment may be extended up
to 7 yearsto 7 years..

68. Liquid Infectious Medical WastesLiquid Infectious Medical Wastes
Placed directly in the Placed directly in the
Biohazardous waste, Biohazardous waste,
Autoclaved & the poured Autoclaved & the poured
down a sanitary sewer,down a sanitary sewer,
Solidified using an approved Solidified using an approved
disinfectant solidifier and disinfectant solidifier and
discarded in the solid wastediscarded in the solid waste
Liquid Infectious Medical Waste, i.e., the contents of Liquid Infectious Medical Waste, i.e., the contents of
suction canisters, may be disposed as followssuction canisters, may be disposed as follows

69. Disposal Procedure – PlasticsDisposal Procedure – Plastics
Laboratory plasticsLaboratory plastics
Render safe firstRender safe first
If non-identifiable following autoclave then non-If non-identifiable following autoclave then non-
clinical disposal [Black Bag and label “Safe for clinical disposal [Black Bag and label “Safe for
Disposal”]Disposal”]
If identifiable still then possibly “offensive” - If identifiable still then possibly “offensive” -
Orange Bag and label as for Clinical WasteOrange Bag and label as for Clinical Waste

70. Disposal ProcedureDisposal Procedure
GlasswareGlassware
Render safe firstRender safe first
Designated boxes – clearly labelled “Broken Glassware Designated boxes – clearly labelled “Broken Glassware
– Safe for Disposal”– Safe for Disposal”
Except if contains hazardous chemicals – special Except if contains hazardous chemicals – special
disposal route via Chemistrydisposal route via Chemistry
Mercury -Mercury -Collect through spill kit and send for recyclingCollect through spill kit and send for recycling

71. Comparison of Treatment TechnologiesComparison of Treatment Technologies

72. Biomedical Waste Management - IssuesBiomedical Waste Management - Issues
•Not considered importantNot considered important
–Lack of interest from senior management Lack of interest from senior management

–No ownership of the processNo ownership of the process
–Awareness of problems Awareness of problems
–Appreciate the need for constant monitoringAppreciate the need for constant monitoring

73. 73
–Segregation of waste not taken seriously at user level Segregation of waste not taken seriously at user level
–Non compliance with color codingNon compliance with color coding
–Monitoring segregation at source – low budgets allocated – Monitoring segregation at source – low budgets allocated –
costs are not always known/nor worked out properlycosts are not always known/nor worked out properly
–Cost of color coding, staff, transport and disposal is a major Cost of color coding, staff, transport and disposal is a major
deterrentdeterrent
–Quantification of waste generated is not accurately doneQuantification of waste generated is not accurately done
Biomedical Waste Management - IssuesBiomedical Waste Management - Issues

74. 74
–Protection of healthcare workers not given Protection of healthcare workers not given
adequate thoughtadequate thought
–Clinical waste dumped with non infectious waste - Clinical waste dumped with non infectious waste -
Risk for healthcare workers and publicRisk for healthcare workers and public
–Residual Waste disposal not effective, often Residual Waste disposal not effective, often
dumped in open landfillsdumped in open landfills
Biomedical Waste Management - IssuesBiomedical Waste Management - Issues

75. Over Classification makes it complexOver Classification makes it complex
The disposal of solid wastes that are not infectious The disposal of solid wastes that are not infectious
medical waste, is often done as if they were medical waste, is often done as if they were
infectiousinfectious
It is the most commonly cited violationIt is the most commonly cited violation
It increases the financial burden on patients and It increases the financial burden on patients and
taxpayers in the form of increased disposal costs taxpayers in the form of increased disposal costs
for health care facilitiesfor health care facilities

76. ProblemsProblems
When large volumes of plastics, When large volumes of plastics,
common in medical waste, are common in medical waste, are
incinerated there is an increased incinerated there is an increased
potential for atmospheric potential for atmospheric
release of reformed gaseous release of reformed gaseous
carcinogenic agents such as carcinogenic agents such as
Dioxins & FuransDioxins & Furans
Increased medical waste generation increases the Increased medical waste generation increases the
risk of costly accidents and spills due to the risk of costly accidents and spills due to the
increased number of trucks required to haul the increased number of trucks required to haul the
wastewaste

77. When infectious waste and regular solid When infectious waste and regular solid
waste mixes together, it can not be waste mixes together, it can not be
permitted to separate thempermitted to separate them
Once combined, Once combined,
the entire the entire
contents are contents are
considered considered
infectious waste!infectious waste!

78. 78
ChallengesChallenges
Establishing robust waste management policies within the Establishing robust waste management policies within the
Health Care Facility/organizationHealth Care Facility/organization
 Organization wide awareness about the health hazardsOrganization wide awareness about the health hazards
 Sufficient financial and Trained human resources neededSufficient financial and Trained human resources needed
 Monitoring and control of waste disposal Monitoring and control of waste disposal
 Clear responsibility and tracebility for appropriate handling Clear responsibility and tracebility for appropriate handling
and disposal of waste.and disposal of waste.

79. 7979
ADRESSING THE ISSUES
1.Need to build-up of a comprehensive system, address
responsibilities, resource allocation, handling and
disposal
2.This is a long-term process, sustained by gradual
improvements.
3.Specific personnel need to be assigned to monitor the
bio-medical waste management in the hospital.
4.Man power needs and other resources for the BMWM of
hospital to be addressed.
5.Quality assessment of bio-medical waste management
should be done from time to time.

80. 80
ADRESSING THE ISSUES- continued
6.Segregated collection and transportation – need for Non-
ambiguous color coding and labeling of wastes.
7.Clear directives in the form of a posters and notice to be
displayed in all concerned areas in English and local
languages.
8.Safety of handlers is a big concern that is still not addressed
adequately.
9.Raising Awareness about risks related to health-care waste;
training staff & Waste handlers on safe practices.
10.Selection of safer & environmentally friendly management
options, to protect people from hazards when collecting,
handling, storing, transporting, treating or disposing waste.

81. 8181
ADRESSING THE ISSUES
11.Issue of all protective clothing such as, gloves,
aprons, masks etc. to all HCW & Waste handlers.
12.Regular medical check-up (half-yearly) of staff
associated with BMWM.
13.Maintenance of Record registers for this purpose.
14.Containers should be robust and leak proof
15.Tracking of Bio Medical Waste up to point of Disposal.
16.Proper treatment and final disposal.