Bio-medical waste management

1. Generation to Disposal
Dr M Veera Prasad, MD (Hosp Admn); DNB
VEERAA Health Care Consultancy

2. Bio Medical Waste Rules 2016 - an over view

3. [Published in the Gazette of India, Extraordinary, Part II,
Section 3, Sub-section (i)]
GOVERNMENT OF INDIA
MINISTRY OF ENVIRONMENT, FOREST AND CLIMATE CHANGE
NOTIFICATION
New Delhi, the 28th March, 2016
Recent guidelines …

4. DEFINITION:
Health Care Waste includes all the waste generated
by health care establishments, research facilities,
and laboratories.

5. General Waste

6. General Waste
Although there is so much hazard from hospital
waste, 80-85% of the waste generated in a
hospital is non-infectious or general and can
easily be managed, if segregated properly at
source.
General waste includes items like, paper,
cardboard boxes, plastic packaging, metal boxes
etc.
Kitchen waste (left-over food, vegetable peels,
meat, fish, teabags etc) is another kind of general
waste.

7. The present picture of BMW in
many Health Care Establishments
Is it the way???????

8. BMW is generated…D I R T
• Diagnostics
• Immunization
• Research
• Treatment

9. Horrifying But
Real Facts

10. Horrifying But
Real Facts

11. Horrifying But
Real Facts

12. Horrifying But
Real Facts

13. Horrifying But
Real Facts

14. Horrifying But
Real Facts

15. Horrifying But
Real Facts

16. Horrifying But
Real Facts

17. Horrifying But
Real Facts

20. New Biomedical Waste Management Rules
2016
Published on 28th March, 2016
 To implement these rules more effectively and to improve
• Collection
• Segregation
• Processing
• Treatment
• Disposal
 Of bio-medical wastes in an environmentally sound
management.
 Reducing the bio-medical waste generation and its impact
on the environment.

21. These Rules shall apply to all persons who
generate, collect, store, transport, treat, dispose
or handle BMW in any form including Hospitals,
Nursing homes, Clinics, Dispensaries, Veterinary
institutions, Pathological labs, Blood Banks,
AYUSH Hospitals, health camps, Medical or
surgical camps, Vaccination camps, blood
donation camps, forensic labs and research labs
BMW Management Rules 2016

22. Salient features of the BMW Rules
• To be complied with irrespective of their system of
medicine.
• No occupier shall establish onsite disposal if CTF is
available at a distance of 75 kms.
• In case CTF is not available, occupier may setup requisite
equipment as per the authorization given by PCB.
• The plastic bags used will be in compliance with bureau
of Indian standards and should be > 40 microns.
• Recyclable waste - plastic and glass shall be handed over
to a recycler having valid authorization.
• No storage of waste beyond 48 hrs
• No chemical pre-treatment before incineration except for
microbiological lab and highly infectious waste.
• Labeling with the symbol of (Biohazard) as per Part "A" of
Schedule IV.

23. These Rules shall NOT apply to
 Radio active wastes covered under Atomic energy Act.
1962.
 Hazardous Chemicals covered under manufacture
storage and import of hazardous chemicals rules 1989.
 Solid Waste covered under Municipal Waste
Management & Handling Rules 2000.
 Lead Acid batteries covered under batteries
Management & Handling Rules 2001.
 Hazardous waste covered under Hazardous waste
Management, Handling and Transboundary Rules 2008
 Waste covered under e-waste Management & Handling
Rules 2011.
 Hazardous micro organisms genetically engineered
microbes covered under manufacture , use, import,
export, storage of Hazardous micro organisms 1989.

24. Different phases in BMW Mgt
• Production----is generation at source of
operations/procedures
• Collection & Segregation- simultaneously in to
color bins
• Internal transportation
• Transit halt (at dumping area)
• External transportation to CTF

25. Types of Containers
1. Yellow bin.
2. Red bin.
3. White translucent.
4. Blue – cardboard boxes with blue colored
marking.

27. Category … yellow…
. Human anatomical waste . Body parts and tissues . Non chlorinated
plastic bags
• Animal anatomical waste ; experimental animals . Parts
• solid waste ; Contaminated with blood , body fluids ,dressings , cotton
swabs , bags with residual or discarded blood or blood components …
• Expired or discarded medicines ; along with glass or plastic ampoules
• Chemical waste : discarded disinfectants or biological chemicals
• Chemical liquid waste : silver x ray film developer discarded formalin ,
liquid from labs, etc .. Separate collection leading to ETP.
• Discarded linen, mattresses. Beddings contaminated with blood and
body fluids
• Microbiology biotechnology and other clinical lab : blood bags , lab
cultures , dishes and devices of cultures .. Autoclave ..safe plastic bags

28. Category .. RED ….
• contaminated waste ( Recyclable )…
• Tubings , bottles, IV tubes , sets, catheters,
urine bags, gloves,
• vacutainers with their needles cut ..
• Syringes without needles …
• Fixed needle syringes …
• Treatment : Autoclaving .. Shredding ..
Mutilation

30. White category …( Translucent )
• Needles , needles from needle tip cutter or
burner , scalpels, blades, any sharp that may
cause puncture or cut …
• Used and discarded metal sharps ..
• Treatment; autoclaving or dry heat
sterilization followed by shredding or
mutilation or .encapsulation

31. BLUE category …..
• Glass ware … unbroken or discarded and
contaminated glass including medicine vials
and ampoules except those contaminated
with cyto toxic wastes .
• .. Metallic body implants ..
• Type of bag ; CARD BOARD boxes with BLUE colored marking
….
• .Disinfection: by soaking in detergent and hypo .. Autoclaving
or microwaving ..

32. BLUE CARDBOARD BOX

33. Category … yellow…
. Human anatomical waste . Body parts and tissues . Non chlorinated
plastic bags
• Animal anatomical waste ; experimental animals . Parts
• solid waste ; Contaminated with blood , body fluids ,dressings , cotton
swabs , bags with residual or discarded blood or blood components …
• Expired or discarded medicines ; along with glass or plastic ampoules
• Chemical waste : discarded disinfectants or biological chemicals
• Chemical liquid waste : silver x ray film developer discarded formalin ,
liquid from labs, etc .. Separate collection leading to ETP.
• Discarded linen, mattresses. Beddings contaminated with blood and
body fluids
• Microbiology biotechnology and other clinical lab : blood bags , lab
cultures , dishes and devices of cultures .. Autoclave ..safe plastic bags

34. Labels .. Bio hazard .. Cytotoxic

35. Label for transport ..
• Day, Month and year
• Waste category …
• Waste quantity …
• Senders name and address..
• Receiver s name and address ..

37. Proper packing with bio hazard symbol..

38. Always collect mercury droplets together by using two
cardboard pieces

39. Drop the collected mercury into a bottle having some
water. Tightly cover the bottle’s lid

40. Don’t transport the waste in open containers or bags through patient areas,
as it may spill and lead to spread infections.

41. Never burn the syringes and plastics

42. Never throw the needles and the syringes without
mutilation and disinfection into the waste bin

43. Never dispose the anatomical waste in un-secure open areas or
in water bodies

44. Schedule I - Part 2
Quality of Plastic Bags / Liners
• All plastic bags shall be as per BIS standards
• Till then the prevailing Plastic Waste Management Rules
shall be applicable
• Every occupier shall phase out use of non-chlorinated
plastic bags within two years from the date of
publication of these rules

45. Chemical Treatment
• Chemical treatment using at least 10% Sodium
Hypochlorite having 30% residual chlorine
• Contact time - twenty minutes

46. No Chemical Pre - treatment
There will be no chemical pre - treatment before
incineration, except for microbiological, lab and
highly infectious waste.

47. Mutilation & Shredding
Mutilation or shredding must be to an extent to
prevent unauthorized reuse.

48. Syringes should be either mutilated or needles
should be cut and or stored in tamper proof,
leak proof and puncture proof containers for
sharps storage.

50. Wearing masks and gloves …

51. Dead Fetus
• Dead Fetus below the viability period (as per the
MTP Act 1971) can be considered as human
anatomical waste.
• Disposed in yellow bag
• With a copy of the official MTP certificate from
the Obstetrician or the MS.
• Such waste should be handed over to CTF

52. Cytotoxic Drug Vials
• Shall not be handed over to unauthorized
person under any circumstances.
• Shall be sent back to the manufactures for
necessary disposal at a single point.
• As a second option, these may be sent for
incineration (plasma pyrolysis) at CTF

53. Residual or Discarded Chemical
Wastes & Chemical Sludge
• Hazardous waste should be sent to hazardous
waste treatment, storage and disposal facility
through CTF

54. On-site Pre-treatment of
Laboratory Waste
Microbiological Waste
Blood Samples
Blood Bags ----after autoclave in to yellow
bags
And then given to the common bio-medical
waste treatment and disposal facility.

55. Disposal of Liquid Waste
• Liquid Waste (OTs, Labs, Labour Rooms etc)
are to be collected in to a separate tank---
store for 24 hrs with bleaching powder---
should be released to drains/STP

56. Horrifying But
Real Facts

57. Blood/ Body fluid spill
• 5 ml blood spill over floor—
• 5 ml of 10% Hypo
• 20 minutes contact
• Cover with a cloth
• Disposal in to yellow bag

58. Installation of In-house incinerator is not
allowed. However in case there is no common
biomedical facility nearby, the same may be
installed by the occupier after taking
authorization from the State Pollution Control
Board.

59. Bmw transport

65. Bad BMW Transport

66. Disposal by deep burial is permitted only in
rural or remote areas where there is no access
to common bio-medical waste treatment
facility. This will be carried out with prior
approval from the prescribed authority and as
per the Standards specified in Schedule-III.
The deep burial facility shall be located as per
the provisions and guidelines issued by
Central Pollution Control Board from time to
time.

67. Reporting System
• Annual Report - Form IV before June 30th every year to
State Pollution Control Board and made available online
on the web site of Department.
• Accident Reporting - Form I within 24 hours. any major
accident at the facility while handling BMW as to be
reported to the prescribed authority and the remedial
actions taken in writing.
Maintenance of Records
• Register for handing over the weighed waste to the CTF.
• Stock Register of disinfectants, liners.
• Payment Register.
• Proceeding book for BMW Committee and Infection
Control Committee meetings.

68. To conclude
• To strictly follow BMW rules 2016 in all Health
Care Establishments
• PCB is very strict
• Meticulous management of BMW right from
Generation-collection & segregation-internal
transportation- storage- external
transportation to CTF
• If not properly mainteained-- risk to HCW,
public & environment