Dr.

PRAVEEN KUMAR
DODDAMANI
ASST. PROFESSOR
DEPT. OF MICROBIOLOGY
MEDICITI INSTITUTE OF MEDICAL
SCIENCES, Medchal , R.R.dist
 Contents
Introduction
Definition
WHO statistics
Components
Hazards
Rules and penalties BMW 1998
Management
conclusion
 INTRODUCTION
• Medical care – vital in our life and health.

• BMW -emerged as issue of concern world over.

• BMW real problem for

MAN, COMMUNITY,& ENVIRONMENT

• Safe scientific cost effective methods BMW

management – need of hour.
 WASTES

Wastes

Liquid Gaseous
Solid waste
Waste Waste

• Household waste
• Industrial waste
• Biomedical waste or hospital waste
 What is Bio-medical waste ??
Definition
Waste generated during the
diagnosis, testing, treatment, research or
production of biological products for
humans or animals (WHO)
• WHO estimates

85% of hospital waste is non-hazardous

10% is infectious

5% is non-infectious.
Bio-Medical Wastes
Non-Infectious
waste, 80%

Pathological
and Infectious
waste, 15%

Radioactive,
Cytotoxic and Chemical and
heavy Sharps, 1% Pharmaceutical
metals, 1% waste, 3%
 WHO has estimated that
In year 2000
• injections with contaminated syringes caused:
• 21 million hepatitis B virus (HBV)
infections (32% of all new infections);
• Two million hepatitis C virus (HCV)
infections (40% of all new infections);
• 260 000 HIV infections (5% of all new)
 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

 Sources of Bio-Medical Waste
Major Sources Minor sources

Hospitals  Clinics
Labs  Dental clinics

Research centers  Home care

Animal research  Cosmetic clinics

Blood banks  Paramedics

 Funeral services
Nursing homes
 Institutions
Mortuaries
Autopsy centers
 WHO IS AT RISK??

Public
Patients &
Medical & attenders
Paramedical
staff
Sanitation
workers

7/28/2013 Biomedical Waste (BMW) Management 13

Need of BMW Management in Hospitals???
Small amount of infectious waste generated during patient care
can make non-infectious to infectious
 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.
 Infection
The infectious agents enter into the body
through

 Puncture
 Abrasion
 Cut in the skin
 Through mucous membranes
 By inhalation and ingestion.
 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
 Most Common Infection Cont.
6. Blood borne diseases
• AIDS
• Septicaemia and bacteraemia
• Viral Hepatitis B & C

7. Hemorrhagic fevers through body fluids

• Lassa, Ebola and Marburg viruses
 PROBLEM ASSOCIATED WITH BMW
ORGANISM DISEASES CAUSED RELATED WASTE ITEM
VIRUSES AIDS, Infectious Hepatitis, Infected needles, body
HIV, Hepatitis B, Hepatitis A,C, Infectious Hepatitis, Fluids, Human excreta, soiled
Arboviruses, Enteroviruses Dengue, Japanese linen, Blood, body fluids.
encephalitis, tick-borne
fevers, etc.

BACTERIA Typhoid, Cholera, Tetanus Human excreta and

Salmonella typhi, Wound infections, body fluid in landfills and
Vibrio cholerae, septicemia, rheumatic hospital wards, Sharps such as
Clostridium Tetani, fever, endocarditis, skin needles, surgical blades in
Pseudomonas, Streptococcus and soft tissue infections hospital waste.

PARASITES Cutaneous leishmaniasis, Human excreta, blood and

Wucheraria Bancrofti, Kala Azar, Malaria body fluids in poorly
Plasmodium managed sewage system of
hospitals.
 Genotoxicity and Cytotoxicity
• Irritant to skin and eyes
E.g. alkylating agent, intercalating agent

• Carcinogenic and Mutagenic

e.g. Secondary neoplasia due to chemotherapy
 Chemical Toxicity

• Many drugs are hazardous

• May cause intoxication , burns, poisoning on
exposure
 Radioactivity Hazards
Radioactive waste exposure may cause
headache, dizziness, vomiting, genotoxicity and tissue damage

Visual impact of the anatomical waste, recognizable body parts

 Physical injuries

• Sharps

• Chemicals

• Explosive agents
Waste with high content
of heavy metals

Blood pressure guages 26

 Aerosol

PRESSURISED
CONTAINERS

Gas cartridges

Gas cylinders

27
Waste Sharps eg: Needles Discarded medicines

Human anatomical waste Solid waste eg: cotton swabs

 Hospital waste disposal

Blood bags found in the municipal waste stream in violation of rules for
such waste. 29
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.
 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 1998 came into effect.
• Provides uniform guidelines and code of practice for
Bio-medical waste management.
 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
 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.
 Bio-Medical Waste Disposal Cycle
Legislation
(BMW Rule)

Common Facility Implement ting Authority

(Transportation, Treatment
And Disposal)

Waste Generator
(Hospitals)
 Bio-Medical Waste Flow Chart
Generator In House Segregation Common Storage Point
(HOSPITALS) (Collection, Segregation Packing At
in Color Coded Poly Bags) Hospitals

Waste Water Transportation

(Approved Special Vehicle)
to ETP

Unloading and Temp

Storage at CBWTF
Re Use

Treatment
Disposal (Incineration, Autoclaving
( Recycling & Landfill) and Shredding)
Categories of Biomedical Waste Schedule
as per WHO Standard
WASTE TREATMENT AND
TYPE OF WASTE
CATEGORY DISPOSAL OPTION
Incineration@ / deep
Category No. 1 Human Anatomical Waste (Human tissues, organs, body parts)
burial*

Animal Waste
(Animal tissues, organs, body parts, carcasses, bleeding parts,
Incineration@ / deep
Category No. 2 fluid, blood and experimental animals used in research, waste
burial*
generated by veterinary hospitals and colleges, discharge from
hospitals, animal houses)

Microbiology & Biotechnology Waste (Wastes from laboratory

cultures, stocks or specimen of live micro organisms or
Local autoclaving/
attenuated vaccines, human and animal cell cultures used in
Category No. 3 microwaving /
research and infectious agents from research and industrial
incineration@
laboratories, wastes from production of biologicals, toxins and
devices used for transfer of cultures) 36
 Categories of Biomedical Waste Schedule
as per WHO standards Cont….
Waste Sharps (Needles, syringes, scalpels, Disinfecting (chemical
blades, glass, etc. that may cause puncture and treatment@@ / autoclaving /
Category No. 4
cuts. This includes both used and unused microwaving and mutilation /
sharps) shredding

Discarded Medicine and Cytotoxic drugs Incineration@ / destruction and

Category No. 5 (Wastes comprising of outdated, contaminated drugs disposal in secured
and discarded medicines) landfills

Soiled Waste (Items contaminated with body

fluids including cotton, dressings, soiled plaster Incineration@ / autoclaving /
Category No. 6
casts, lines, bedding and other materials microwaving
contaminated with blood.)

Disinfecting by chemical
Solid Waste (Waste generated from disposable
treatment@@ / autoclaving /
Category No. 7 items other than the waste sharps such as
microwaving and mutilation /
tubing, catheters, intravenous sets, etc.) 37
shredding# #
 Categories of Biomedical Waste Schedule
as per WHO standards cont….

Liquid Waste (Waste generated from the Disinfecting by chemical

Category No. 8 laboratory and washing, cleaning, house treatment@@ and discharge
keeping and disinfecting activities) into drains

Incineration Ash (Ash from incineration of

Category No. 9 Disposal in municipal landfill
any biomedical waste)

Chemical Waste (Chemicals used in Chemical treatment @@ and

Category No.10 production of biologicals, chemicals used discharge into drains for liquids
in disinfecting, as insecticides, etc.) and secured landfill for solids.

38
COLOR WASTE TREAT

Yellow Human & Animal anatomical waste / Micro- Incineration/DB/

biology waste and soiled
cotton/dressings/linen/beddings etc.
Red Tubings, Catheters, IV sets. Autocl/microwav
/chemical
treatment
Blue / Waste sharps Autocl/microwav
White ( Needles, Syringes, Scalpels, blades etc. ) /chemical
treatment/destr
uction/shredding

Black Discarded medicines/cytotoxic drugs, Disposal in land

Incineration ash, Chemical waste. fields
2011
Awareness of BMW Management and treatment among HCW

Study subjects Total Aware (%)

Doctors 56 43 (76.8)

Interns 65 25(38.5)

Nurses 83 68(81.9)

Technicians 44 12(27.3)

Attenders 78 23(29.5)

House keeping staff 57 11(19.3)

Source:International Journal for Basic Medical Science

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.
If you are not measuring
it, you are not
managing it.
 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)
 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
**Use mercury-free thermometers
Steps to Manage Hazardous Wastes (cont..)

3. Limit use and access

to trained persons
with personal
protective gear
 4. Use Engineering Controls such as
Ventilation, Hoods for Select Hazards
 5. Get Rid of Unnecessary Stuff

• Don’t accumulate unneeded products

• Don’t let peroxides and oxidising agents turn

into bombs

5: Managing Medical Waste Slide 48

 6. Label of Hazard Warnings

toxic Gas bottle explosive

inflammable

Radiation biohazard corrosive Health danger

 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

5: Managing Medical Waste Slide 50

LABEL FOR BIO-MEDICAL WASTE
CONTAINERS/BAGS
 8. Recycle Products When Possible

5: Managing Medical Waste

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

Segregation of waste should be
observed strictly

To avoid mixing of general (non-infectious) waste

into infectious waste. Once mixed, becomes
infectious and should not be removed.

To reduce infectious waste

To decrease expenditure on disposal of infectious

waste
COLOR WASTE

Yellow Human & Animal anatomical waste / Micro-biology

waste and soiled cotton/dressings/linen/beddings etc.

Red Tubings, Catheters, IV sets.

Blue / Waste sharps

White ( Needles, Syringes, Scalpels, blades etc. )

Black Discarded medicines/cytotoxic drugs,

Incineration ash, Chemical waste.
Wastes requiring pretreatment before disposal

Microbiological waste

Autoclaving

Final disposal as a general waste- Black Bag

 Pretreatment before disposal Cont…

WASTE
•Tubes used for serum separation, centrifugation of
samples, preparation of dilutions etc.
sample cups ,Tips , Caps.

Any other contaminated plastic wares

Method: Chemical Disinfection

Sodium hypochlorite
Final Disposal- Blue bag
-Frequency of changing of Na hypochlorite solution-Daily

Who prepares the solution?

-Technical person. A trained housekeeping person can do
preparation under observation.

Disposal of liquid and solid

-Liquid: Pour into drain with running tap

- Solid: Blue bag

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
 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
 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
Bad Practice -Storage:
 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 .
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.
 TRANSPORTATION

• Transportation of BMW can be divided into

internal and external transportation.
• INTERNAL: it is for yellow ,red ,blue and white
bags.
• EXTERNAL: it is for the general waste collected in
the black coloured plastic bags.
 Safe Transportation
REGISTERED, AUTHORIZED, BMW TRANSPORTERS
 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
 DISPOSAL METHODS OF BIO-MEDICAL WASTES

• Incineration
• Chemical disinfection
• Inertisation
• Autoclave
• Encapsulation
• Microwave
• Shredder
• Plasma pyrolysis
• Deep burial

• G.J multiclave Ltd is external agency managing final

disposal in this zone.
 BMW RULES 2011 v/s 1998
2011 1998

Every occupier generating BMW, Occupiers with more than 1000 beds
irrespective of the quantum of wastes required to obtain authorisation
comes under the BMW Rules and
requires to obtain authorisation

Duties of the operator listed Operator duties absent

Categories of Biomedical Waste Biomedical waste divided in ten

reduced to Eight categories
Treatment and disposal of BMW Rules restricted to HCEs with more
made mandatory for all the HCEs than 1000 beds

A format for annual report appended No format for Annual Report

with the Rules
 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
 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
 STAFF SAFETY
• Proper training
• Personal protective clothing and equipment
• Immunization
• Post-exposure prophylaxis
• Medical surveillance
• Personal hygiene
Responsibility

Infection control is everyone's business.

You are not only protecting yourself, but

also those around you
 Conclusion
 Thus refuse disposal cannot be solved without public
education.

 Individual participation is required.

 Municipality and government should pay importance to

disposal of waste economically.

 Thus educating and motivating oneself first is important

and then preach others about it.

 PPE does not replace proper procedures and techniques,

consider all as hazard.
 Our’s is a
Beautiful Planet…Let us save together…

Lets Make This World A Better Place to Live in.

• References:
• MOEF guidelines INDIA
• BMW(management & handling) RULES 1998
• WHO guidelines & CDC guidelines
• Current world environment journal-Need for
BMW management system vol 7,2012.

THANK YOU