BIOMEDICAL WASTE MANAGEMENT

Biomedical waste: Biomedical wastes are defined as waste that is generated during the
diagnosis, treatment or immunization of human beings or animals, or in research activities
pertaining thereto, or in the production of biological.

Major sources of biomedical waste:

Broadly, biomedical waste is generated in the hospitals, nursing homes, clinics,
pathology/microbiology laboratories, blood banks, animal house and veterinary institutes.
Such a waste can also be generated at home if the health care is being provided there to the
patient (e.g. dialysis, insulin, injections, dressing materials etc)

Biomedical waste management:

Bio medical waste management refers to the classification, identification, segregation and
scientific disposal of bio medical waste management

Hospital wastes have always been considered as potentially hazardous in view of the inherent
potential for dissemination of infection. In recent years, a wider variety of potentially
hazardous ingredients including antibiotics, cytotoxic drugs, corrosive chemicals and
radioactive substance have become a part of the hospital waste.

Hospital waste management is an area, which has come to the limelight recently as a result of
the notification of the bio medical waste (management in handling) rules 1998. This fulfills a
long felt need of hospital administrators, nursing administrators, hospital engineers, sanitation
supervisors, laboratory personnel and student of hospital and health administration.
It is the waste generated by the health care establishments, research facilities and laboratories.
Waste may be generated during:
Diagnosis, treatment of disease and immunization of diseases associated bio medical
research, and production and testing of biological.

Biohazard means any of the following:

Laboratories waste, including but not limited to, specimen cultures from medical and
pathological laboratories, culture and stock of infectious agent from research and industrial
laboratories, wastes from the production of biological agents, discarded live and attenuated
vaccines, and culture dishes and devices used to transfer, inoculate and mix cultures or
materials which may contain infectious agents and may pose a substantial threat to health. All
non-sterilized cultures shall be presumed to be bio hazardous.
Any specimens sent to a laboratory for micro biological analysis shall be presumed to be bio
hazardous.
Surgical specimens include human or animal parts or tissues removed surgically or by
autopsy shall be presumed to bio hazardous.

CLASSIFICATION AND CATEGORIES OF HOSPITAL WASTES.

Approximately 75-90% of biomedical waste is innocuous and a harmless as any other
municipal wastes. The remaining 10-25% however differs from other waste in that it can be
injurious to human or animal health and deleterious to environment. It must be remembered
that if both these types are mixed together then the whole lot becomes harmful.
Categorization and classification of waste is very important. There are different types of
classification depending upon how a particular kind of waste is to be handled, treated and
finally disposed.

Classification According to the Ministry of Environment and Forest Rules

1998:

CATEGORIES OF BIO MEDICAL WASTE (as per rules)

S.No Waste category Treatment and disposal
Category Human anatomical Incineration and deep burial
No.1 waste
(Human body parts)
Category Animal wastes (Animal Incineration and deep burial
No.2 tissue organs , Body
parts ,carcasses,
bleeding parts, fluid,
blood and experimental
animal used in
research, waste
generate by vetenary
hospitals)
Category Microbiology and Local Autoclaving/ microwaving/
No.3 Biotechnology Incineration
wastes(Wastes from
laboratory cultures,
stock or specimens of
micro organism, live or
attenuated vaccines ,
human and animal cell
culture used in research
and infectious agent
from research and
industrial
laboratories ,waste
from production of
biological toxins,
dishes, and devices
used in transfer of
cultures.)
Category Waste sharps (Needles, Disinfection (chemical/ autoclaving/
No.4 Syringes. scalpels, microwaving and mutilation/ shredding)
blades, glass, etc.that
are capable of causing
puncture and cuts. this
includes both used and
unused sharps.)
Category Discarded medicines Incineration/destruction and disposal in
No.5 and cytotoxic drugs land fills
(Waste comprising of
outdated, contaminated
and discarded drugs
and medicines.)
Category Solid Waste (Items Incineration/autoclaving/microwaving
No.6 contaminated with
blood and body fluids
including cotton,
dressing, soiled plaster
casts, linens, beddings,
other materials
contaminated with
blood)
Category Solid waste (Waste Disinfection by chemical
No.7 generated from treatment/autoclaving/microwaving and
disposable items other multilation/shreding
than the waste sharp
such as tubing,
catheters, Iv sets, etc.)
Category Liquid waste (Wastes Disinfection by chemical treatment and
No.8 generated from discharge into drains
laboratories and
washing, cleaning,
housekeeping and
disinfection activities.)
Category Incineration Ash (Ash Disposal into municipal land fill
No.9 from incineration of
any Biomedical waste)
Category Chemical wastes Chemical treatment and discharge in drain
No.10 (Chemicals used in for liquids and or secured land fill for
production of solids.
biological, chemicals
used in disinfection, as
insecticides, etc.)

HOSPITAL WASTE MANAGEMENT

General hospital hygiene is a pre-requisite for good medical waste management; it will be
useless in terms of prevention of nosocomial infection to start improving hospital waste
management if the hospital doesn’t have a reliable supply of safe water and basic sanitation
facilities accessible to hospital personnel, patients and visitors. Most hospitals in India lack
these basic amenities. It is vital that the whole hospital be kept clean and in a satisfactory
state of hygiene to prevent spread of infection from patient to patient, patient to health care
providers and vice-versa. In terms of prevention of spread of infections outside the hospital
careful management of waste from the point of generation to safe disposal is of paramount
importance.

Waste survey is an important component of the waste management scheme. A survey helps in
evaluating both the type and quantity of waste generated in the hospital.
A survey aims to:
Differentiate the type of waste
Quantify the waste generated
Determine the point of generation and the type of waste generated at each point
Determine the level of generation and disinfect ion within the hospital
To find out the type of disposal carried out and
Get familiar with the personnel at all levels

SEGREGATION AND SAFE STORAGE:

Segregation at source and safe storage is the key to whole hospital waste management
process because it is at this stage that wastes are segregated into different streams. Incorrect
classification of waste can lead to many problems at a later stage. Segregation should be
carried out at the point of generation, to keep general waste from becoming infectious. If the
infectious wastes, which forms a small part of hospital waste, is fixed with the other hospital
waste the entire waste will have to be treated as the infectious waste. To treat entire waste as
infectious is an expensive option and is also dangerous practice specially if the waste is
dumped without any prior treatment.

Thus, by segregation, a hospital can:

Reduce total treatment cost
Reduce the impacts of this waste on the community, and
Reduce the changes of infecting healthcare workers.
It is essential that all sharps (whether infected or not), infected waste not containing sharps,
chemicals and pharmaceuticals other than cytotoxic drugs, other hazardous waste are
segregated by medical and paramedical personnel users and are kept separately in readily
identifiable, preferably color coded container. Radioactive wastes, cytotoxic drugs and high-
pressure containers require a special handling and disposable channels. Ministry of
environment and forest has notified the type of container and their color codes for storage of
different categories of hospital wastes as appended below.
Color Code Type of Waste Category Treatment Options
Container
Yellow Plastic Human and animal wastes, Incineration/ deep burial
bags microbial and biotechnological
wastes and solid wastes.
(Cat.1, 2,3,6)
Red Disinfected Microbiological and Autoclaving /
container / biotechnological wastes, solid Microwaving/Chemical
plastic waste (Cat. 3,6,7) Treatment
bags
Blue/White Plastic bag/ Waste sharp and solid wastes Autoclaving/microwavin
transparent puncture (Cat.4, 7) g/Chemical treatment,
proof destruction and
containers shredding
Black Plastic bag Discarded medicines, Disposal in secured
cytotoxic drug, incineration landfills
ash and chemical waste
(Cat.5,8,9)
According to NABH guidelines
Statutory provisions with regard to Bio-medical Waste (BMW) management are
complied with

Objective elements
 a) The hospital is authorised by prescribed authority for the management and handling of
Bio-medical Waste.
b) Proper segregation and collection of Bio-medical Waste from all patient care areas of
the hospital is implemented and monitored.
c) The organization ensures that Bio-medical Waste is stored and transported to the site
of treatment and disposal in proper covered vehicles within stipulated time limits in a
secure manner.
d) Bio-medical Waste treatment facility is managed as per statutory provisions (if in-
house) or outsourced to authorised contractor(s).
e) Requisite fees, documents and reports are submitted to competent authorities on
stipulated dates.
f) Appropriate personal protective measures are used by all categories of staff handling
Bio-medical Waste

THE SCHEDULES

The Biomedical Waste (Management and Handling) Rules have six schedules.

Schedule I: classification of biomedical waste in various categories.

Schedule II: Color coding and type of containers to be used for each category of biomedical
waste
Schedule III: Proforma of label to be used on container / bag
Schedule IV: Proforma of label for transport of waste container / bag
Schedule V: standards for treatment and disposal of waste
Schedule VI: deadlines for creation of waste treatment facilities
Form VII: format of application for authorization
Form II: format of annual report
Form III: format of accident reporting