BIOMEDICAL WASTE MANAGEMENT- HOSPITAL PERSPECTIVE- USEFUL FOR HOSPITAL ADMINISTRATION STUDENTS, DOCTORS, NURSES AND MANAGERS

1. Biomedical Waste
Management
Presenting by…..
Dayana Jose & Divya George.
2nd MHA, JMC

2. Definition
Biomedical waste means any waste materials which is
generated during diagnosis, treatment, surgery or
immunization of human beings or animals or research
activities pertaining there to or in production of biologicals.
-WHO

3. Aims of biomedical waste management
• To prevent transmission of diseases
• To prevent injuries
• To prevent general exposure to harmful effects of
biomedical wastes
• To ensure environmental hygiene

4. Classification of health care wastes
Hazardous wastes
10-20%
Non-hazardous
wastes
75-90%
Infectious
15-18%
• Sharps
• Non-sharps
• Plastic
disposables
• Liquid
wastes
Healthcare wastes
• Radioactive
wastes
• Chemical
wastes
• Cytotoxic
wastes
• Pressurized
containers

5. Proportion of different wastes in hospitals
80%
15%
1%3%1%
General wastes
Patho&infectious wastes
Sharp Wastes
Chemical wastes
Radio&Cytotoxic

6. Sources of Biomedical wastes
• Government hospitals
• Private hospitals
• Nursing homes
• Dentist / physicians clinics
• Dispensaries
• PHC
• R&D establishments
• Training centers
• Mortuaries
• Blood bank, collection centers, laboratories
• Animal houses, slaughter houses

7. Persons at risk
• Medical doctors
• Nurses
• Nursing assistances
• Dressers
• Compounders
• OT assistances
• Ward boys
• Sweepers
• Patients
• Visitors
• Workers in support services
• Rag pickers

8. Biomedical waste statistics
Developed Countries-
 1-5 kg/bed/day, with variations among countries.
In India-
1-2 kg/bed/day with variation among
Govt. and Private establishments.
Approximately 506.74 tons/ day wastes generated
Out of which only 57% waste undergoes proper
disposal

10. Need of BMW Management in
Hospitals???

11. Hazardous health care
waste can result in
1. Infection
2. Genotoxicity and Cytotoxicity
3. Chemical toxicity
4. Radioactivity hazards.
5. Physical injuries
6. Public sensitivity.

12. Infection routes
oPuncture
oAbrasion
oCut in the skin
oThrough mucous membranes
o By inhalation and ingestion.

13. Most Common Infections
 1. Gastro enteric through faeces and/or vomit
e.g. Salmonella, Vibrio Cholera, Helminthes ,Hepatitis A
 2. Respiratory through inhaled secretions
e.g. Mycobacterium tuberculosis; Measles virus; Streptococcus pneumoniae
 3.Ocular infections through eye secretions
e.g. Herpes virus,
 4. Skin infection through pus
e.g. Streptococcus spp ,
 5. Meningitis through Cerebrospinal fluid
e.g. Neisseria meningitides
 6. Blood borne diseases
AIDS , Septicaemia and bacteraemia ,Viral Hepatitis B & C
 7. Hemorrhagic fevers through body fluids
Lassa, Ebola and Marburg viruses

14. Genotoxicity and Cytotoxicity
• Irritant to skin and eyes
e.g. alkylating agent, intercalating agent
• Carcinogenic and Mutagenic
e.g. Secondary neoplasia due to chemotherapy

15. Chemical Toxicity
• Many drugs are hazardous
• May cause intoxication , burns, poisoning on
exposure

16. Radioactivity Hazards
• Radioactive waste exposure may cause headache,
dizziness, vomiting, genotoxicity and tissue damage

17. Physical injuries
• Sharps
• Chemicals
• Explosive agents

18. Waste with high content of heavy metals

19. Pressurized containers
GAS CARTRIDGES
GAS CYLINDERS
19
AIROSOL

20. Waste Sharps eg: Needles
Human anatomical waste
Discarded medicines
Solid waste eg: cotton swabs

21. How did BMW come into Existence
• In the late 1980’s
• Items such as used syringes washed up on several
East Coast beaches USA
• Concern about HIV and HBV virus infection
• Lead to development of Biomedical Waste
Management Law in USA.
• However in India the seriousness about the
management came into lime light only after 1990’s

22. Legislation
• Recognizing the deadliest nature of the Bio-Medical Waste, the
Government and Pollution Control Boards under the guidelines
of Ministry of Environment and Forests(MOEF).
• MOEF have promptly designed and issued guidelines to the
hospitals to ensure a proper and safe disposal of bio-medical
waste
• BIO-MEDICAL WASTE Management & Handling Rule came into
effect in 1998.
• Provides uniform guidelines and code of practice for Bio-
medical waste management.

23. Biomedical Waste
Management and Handling Rules, 1998
[Amended in 2000]
• These rules apply to all persons who generate, collect,
receive, store, transport, treat, dispose or handle bio-
medical waste in any form. All Institutions generating
BMW must take all steps to ensure that such waste is
handled without any adverse effect to human health and
the environment

24. Penalties as per rules
• The PENALTIES are as specified in Environment
(Protection) Act 1986.
• Imprisonment for upto five years with fine upto one lakh
rupees, or both.
• In case the failure additional fine upto five thousand
rupees for every day.

25. Bio-Medical Waste Flow Chart
)

26. Categories of Biomedical Waste Schedule as per WHO Standard
WASTE
CATEGO
RY
TYPE OF WASTE TREATMENT AND
DISPOSAL OPTION
Category
No. 1
Human Anatomical Waste (Human tissues, organs,
body parts)
Incineration/ deep
burial
Category
No. 2
Animal Waste
(Animal tissues, organs, body parts, carcasses, bleeding
parts, fluid, blood and experimental animals used in
research, waste generated by veterinary hospitals and
colleges, discharge from hospitals, animal houses)
Incineration / deep
burial
Category
No. 3
Microbiology & Biotechnology Waste (Wastes
from laboratory cultures, stocks or specimen of live
micro organisms or attenuated vaccines, human and
animal cell cultures used in research and infectious
agents from research and industrial laboratories,
wastes from production of biologicals, toxins and
devices used for transfer of cultures)
Local autoclaving/
microwaving /
incineration

27. Category No. 4 Waste Sharps (Needles, syringes,
scalpels, blades, glass, etc. that may
cause puncture and cuts. This includes
both used and unused sharps)
Disinfecting (chemical
treatment@@ /
autoclaving /
microwaving and
mutilation / shredding
Category No. 5 Discarded Medicine and Cytotoxic
drugs (Wastes) comprising of
outdated, contaminated and discarded
medicines
Incineration@ /
destruction and drugs
disposal in secured
landfills
Category No. 6 Soiled Waste (Items contaminated with
body fluids including cotton, dressings,
soiled plaster casts, lines, bedding and
other materials contaminated with
blood.)
Incineration@ /
autoclaving /
microwaving
Category No. 7 Solid Waste (Waste generated from
disposable items other than the waste
sharps such as tubing, catheters,
intravenous sets, etc.)
Disinfecting by chemical
treatment@@ /
autoclaving /
microwaving and
mutilation / shredding#

28. Category No. 8 Liquid Waste (Waste
generated from the
laboratory and washing,
cleaning, house keeping
and disinfecting
activities)
Disinfecting by chemical
treatment@@ and
discharge into drains
Category No. 9 Incineration Ash (Ash
from incineration of any
biomedical waste)
Disposal in municipal
landfill
Category No. 10 Chemical Waste
(Chemicals used in
production of biologicals,
chemicals used in
disinfecting, as
insecticides, etc.)
Chemical treatment and
discharge into drains for
liquids and secured
landfill for solids.

29. Colour Waste Treatment
Yellow Human & Animal anatomical waste /
Micro-biology waste and soiled
cotton/dressings/linen/beddings etc.
Incineration/DB
Red Tubings, Catheters, IV sets. Autocl/microwav/
chemical
treatment
Blue /
White
Waste sharps
( Needles, Syringes, Scalpels, blades
etc. )
Autocl/microwav/
chemical
treatment/destru
ction/shredding
Black Discarded medicines/ cytotoxic
drugs, Incineration ash, Chemical
waste.
Disposal in land
fields

30. 1. Survey of waste generated
2. Reduction at source .
3. Segregation of hospital waste.
4. Collection & Categorization of waste.
5. Storage of waste.
6. Transportation of waste.
7. Treatment of waste.

31. Source Reduction
• Source Reduction - ways to lessen the amount of
material
• Segregation - keeping noninfectious waste out of
the infectious waste stream
• Minimization - reduce or eliminate waste at the
source
• Engineering controls - methods to reduce quantity
of waste(smaller containers)

32. Steps to Manage Hazardous Wastes
before Disposal
1. Know what hazards you have.
2. Purchase smallest quantity needed, and don’t purchase
hazardous materials if safe alternative exists
3. Limit use and access to trained persons with personal
protective gear
4. Use Engineering Controls such as Ventilation, Hoods
etc.
5. Get Rid of Unnecessary Stuff

33. 6. Label of Hazard Warnings
toxic
biohazard
inflammable
corrosiveRadiation
Gas bottle explosive
Health danger

34. 7. Communicate about Work -place
Hazards
• Job description
• Posters on doors
• Labels on hazards
• Give feedback on use of
PPE and disposal in
evaluation
• Role model safe use and
disposal
• Contact point who is
responsible

35. 8.Label for bio-medical waste containers/bags

36. Segregation of waste
At the point of generation
In a color coded leak-proof container
Container should bear 'Biohazard' symbol and
appropriate wording
Container should never be completely filled

39. Wastes requiring pretreatment before
disposal
 Microbiological waste
 Method: Autoclaving
 Final disposal as a general waste- Black Bag

40. Pretreatment before disposal Cont…
Tubes used for serum separation,
centrifugation of samples, preparation of
dilutions etc.
Any other contaminated plastic wares
Method: Chemical Disinfection using Sodium hypochloride
Final Disposal- Blue bag

41. Waste disposed without pretreatment
Yellow bag
 Contaminated gloves; latex & plastic(Uncontaminated –
general waste)
 Contaminated tissue /blotting papers
 Contaminated cotton
 Human tissue/organs
White sharp disposal container
 Broken glass, pipettes, broken test
tubes,
 Needles, razor blade, scalpel

42. Attention !!
Do not allow the containers to overfill
Arrange containers near the operation area
at accessible distance
Ensure that the disposed item is inside the
container and not hanging at the edge

43. PACKAGING & LABELING
• Bags 3/4th filled should be tied
• Be supervised Name of Ward
• Date of Packaging
• Destination (Treatment Site)
• Bio Hazard/Cytotoxic Symbol
• Weighing & Recording
• Separate Register and Weighing Machine
• Daily recording is mandatory

45. Bad Practice -Storage:

46. Collection, transportation, storage
(within the hospital)
Waste collected and stored in thick non-corrosive
disposable plastic bags or containers of specific
colour code.
The waste in bags or containers should be stored
in a separate area, room, or building of a size
appropriate to the quantities of waste produced
and the frequency of collection.
Health care waste should be transported within
the hospital or other facility by means of hand
cart wheeled trolley

47. Label for transport of bio-medical waste
containers/bags
• Date of generation ...................
• Waste category No .......
• Waste class……………
• Waste description………….
• Sender's Name & Address………..
Contact Person…………..
• Receiver's Name & Address………
Contact Person…………..
• In case of emergency please contact,
Name & address……….
Label shall be non-washable and prominently
visible.

48. Transportation
Transportation of BMW can be divided into
internal and external transportation.
.

50. Safe Transportation
REGISTERED, AUTHORIZED, BMW
TRANSPORTERS

51. Do you have a bio-spill kit?
Container of undiluted household bleach
Several pairs of gloves
Safety glasses
Absorbent material
Biohazardous waste (autoclave) bags
Dust pan & scoop or tongs for broken glass
Place in a labeled bag or bucket and keep in areas
where biohazards are used

52. Disposal methods of bio-medical wastes
• Incineration
• Chemical disinfection
• Autoclave
• Encapsulation
• Microwave
• Shredder
• Plasma pyrolysis
• Deep burial
In kerala, IMAGE ( Indian Medical Association Goes Eco-
Friendly) is the external agency managing final disposal
of hospital wastes…

53. Indian medical association goes eco-friendly
Indian Medical Association, Kerala State Branch,
established IMAGE, Biomedical Waste Treatment
and Disposal Facility at Palakkad and it was
commissioned on the 14th December 2003. IMAGE
was conceived and launched to support healthcare
providers to overcome the challenges posed by the
responsibilities laid down in the Biomedical Waste
(Management and Handling).

54. Office Bearers:
• IMAGE is guided by a team of professional doctors,
elected from among the members of I.M.A Kerala State
Branch, dedicating their knowledge in the field of
medicine and the hazards posed by bio medical waste.
• The Supreme Court judgment in December 2002 to
dispose the medical waste within 48 hours of generation
forced doctors engaged with IMA in Kerala chapter to
find out a solution.

57. Accident reporting
1. Date and time of accident:
2. Sequence of events leading to accident
3. The waste involved in accident :
4. Assessment of the effects of the
accidents on human health and the
environment,.
5. Emergency measures taken
6. Steps taken to alleviate the effects of accidents
7. Steps taken to prevent the recurrence of such an accident

58. Annual report
 To be submitted to the prescribed authority
by 31 January every year
 Name of the occupier with Address
 Categories of waste generated and Quantity
[monthly average] basis:
 Name of treatment facility with Address
 Category-wise quantity of waste treated
 Mode of treatment with details:
 Any other information

59. Staff safety
• Proper training
• Personal protective clothing and
equipment
• Immunization
• Post-exposure prophylaxis
• Medical surveillance
• Personal hygiene

60. Responsibility
Infection control is everyone's business.
You are not only protecting yourself, but
also those around you……