Chemical Safety Bio-Medical Waste Management Self Learning Document For Doctors, Superintendents and Administrators

BIO-MEDICAL WASTE MANAGEMENT-
SELF LEARNING DOCUMENT FOR

DOCTORS, SUPERINTENDENTS AND
ADMINISTRATORS
Supported By
World Health Organization (WHO),
India Country Office, New Delhi
Prepared By
ENVIRONMENT PROTECTION TRAINING AND RESEARCH

INSTITUTE Gachibowli, Hyderabad, Andhra Pradesh.
www.eptri.com
Environment Protection Training & Research Institute, (EPTRI)
Acknowledgment
Bio- Medical Waste Management is an essential, fundamental and important activity of all
hospital. This document on Bio-Medical Waste Management - Self Learning Document
for Doctors, Medical Superintendents and Administrators, is an attempt to refresh and
enhance the knowledge on bio-medical waste management.
Our sincere thanks to Mr. A.K. Sengupta, National Professional Officer, Sustainable
Development and Environmental Health, World Health Organization (WHO), India Country
Office, New Delhi for supporting this project and providing guidance at every level.
We are grateful to Mr. Indrajit Pal, IAS, Director General, for his encouragement in
developing this document.
We wish to express our thanks and gratitude to everyone who contributed to this document.
Dr. Razia Sultana

Project Coordinator,
Director (Programs) i/c,
EPTRI, Hyderabad, Andhra Pradesh
i
Environment Protection Training & Research Institute, (EPTRI)
Content Page No.
1. Introduction………………………………………………………………………….. 2
1.1 Definition of Bio-Medical Waste……………………………………………... 3
1.2 Risk to Personnel Due to Bio –Medical Waste………………………………. 3
1.3 Dangers of Improper Management of Bio-Medical Waste…………………… 4
2. Regulations on Bio- Medical Waste Management………………………………… 6
2.1 National Legislations Governing Waste Management……………………. ….7
2.2 Excerpts from Bio-Medical Waste (Management and Handling) Rules,1998
and as Amended............................................................................................. …8
3. Role of Doctors, Medical Superintendent and Administrators of Hospitals
In Bio-Medical Waste Management……………………………………………….. 13
3.1 Planning and Designing of Bio- Medical Waste Management…….......... 14
3.1.1 Unit Wise Generation of Bio-Medical Waste……………………………..15
3.1.2 Waste Audit and Waste Minimization……………………………… …....16
3.1.3 Items and Equipments Required for Bio- Medical Waste Management…20
3. 1.4 Placement of Required Items……………………………………………..24
3.1.5 Designing the Movement of Bio-Medical Waste…………………………24
3.1.6 Formation of Committee for Bio-Medical Waste Management…………..24
3.2 Reducing Risk of Disease Transmission and Response to Accidents…….26
3.3 Financial Management…………………………………………………...30
3.3.1 Cost of Bio-Medical Waste Management System Where common
Bio-Medical Waste Treatment Facility is Not Available………….31
3.3.2 Cost of Bio-Medical Waste Management System Where Common
Bio-Medical Waste Treatment Facility is Not Available………….31
4. Implementation of Bio- Medical Waste Management Plan……………………....33
4.1 Bio-Medical Waste Management in Hospitals Where Common Bio-
Medical Waste Treatment Facility is Not Available………………………...34
4.2 Bio-Medical Waste Management in Hospitals Where Common Bio-
Medical Waste Treatment Facility is Available……………………………..57
4.3 Bio-Medical Waste Management in PHCs and Small Units………………...69
5. Do’s and Don’ts ……………………………………………………………………...73
Annex 1 Bio-Medical waste (Management and Handling) Rules and Amendment…77
ii
Environment Protection Training and Research Institute (EPTRI)
Bio-Medical Waste Management- Self Learning Document For

Doctors, Medical Superintendents and Administrators
About the Manual:

The concern for bio-medical waste management has been felt globally with the rise in
infectious diseases and indiscriminate disposal of waste. This manual is useful for
refreshing and or up gradation of knowledge of doctors, superintendents and
administrators on bio-medical waste management. This will sensitize the reader about
the impacts of improper waste management and acquaint them with laws and
practices in India. The main bottleneck to sound bio-medical waste management is
lack of training and appropriate skills, insufficient resource allocation and lack of
adequate equipment. This document has been developed to create basic awareness
about bio-medical waste management practices, equip the readers with enough skills
for effectively managing bio-medical waste, safe guard themselves and the
community against adverse health impact.
It is to be understood that management of bio medical waste is an integral part of

health care. This manual on “Bio-Medical Waste Management - Self Learning
Document for Doctors, Medical Superintendents and Administrators” contains five
chapters describing introduction, legal provision, role of doctors and other cadres of
staff in bio-medical waste management. Waste auditing, requirement of items and
equipments, financial management, planning, designing and implementation of bio-
medical waste management with dos and don’ts has been provided. It covers safe,
efficient and environmental friendly waste management options. It also contains
safety procedures while handling waste. This will serve as a useful guide in planning,
implementation and monitoring of bio-medical waste management program in
hospitals.
1
Bio-Medical Waste Management - Self Learning Document

for
Doctors, Medical Superintendents and Administrators
1. Introduction
About this Module -
This module focuses upon the importance and the purpose of Bio-medical waste
management, definition of bio-medical waste, risks associated and dangers of improper
management of bio-medical waste.
Learning Objectives:
• To define the bio-medical waste.

• To understand the importance and purpose of bio- medical waste management.
• To get familiarized with the risks involved and dangers of improper management
of bio-medical waste.
Output:
• The reader will be able to define bio-medical waste, understand the risks if not
managed properly and importance of bio-medical waste management.
Hospitals and other healthcare establishments have a “duty of care” for the
environment, public health and have particular responsibilities in relation to
the waste they produce (i.e., bio-medical waste). Negligence in terms of bio-
medical waste management significantly contributes to polluting the environment and
affects the health of human beings. The waste generated by any hospital / health care
facilities consists of general waste like packaging material, eatables, paper, wrapper
etc., hazardous and infectious waste like out dated medicines, cytotoxic drugs, soiled
dressing, swabs, cotton with blood and body fluid, dissected body organs and tissues,
disposable syringes, intravenous fluid bottles, catheters, gloves, injection vials,
needles, blades, scalpels etc. Quantity wise around 70 % - 80% is general waste and
20% - 30% is hazardous and infectious waste which poses risk to human health and
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environment. These two basic category of wastes (hazardous and infectious) should
be segregated other wise the whole waste, the entire volume of waste will become
infectious.
1.1 Definition of Bio-Medical Waste:
As per Bio-Medical Waste (Management and Handling) Rules, 1998 and

amendments, any waste, which is generated during the diagnosis, treatment or
immunization of human beings or animals or in research activities pertaining there to
or in the production of testing of biological and including categories mentioned in
schedule 1 of the Rule, is the bio-medical waste.
As per WHO norms the health-care waste includes all the waste generated by health-
care establishments, research facilities, and laboratories. In addition, it includes the
waste originating from minor or scattered sources such as that produced in the course
of health care undertaken in the home (dialysis, insulin injections, etc.).
1.2 Risks to Personnel Due to Bio-Medical Waste:
Poor bio-medical waste management exposes hospital and other health care facility
workers, waste handlers and community to infection, toxic effects and injuries.
Doctors, nurses, paramedical staff, sanitary staff, hospital maintenance personnel,
patients receiving treatment, visitors to the hospital, support service personnel
,workers in waste disposal facilities, scavengers, general public and more specifically
the children playing with the items they can find in the waste outside the hospital
when it is directly accessible to them are potentially at risk of being injured or
infected when they are exposed to bio- medical waste.
Risk to all those who generate, collect, segregate, handle, package, store, transport,
treat and dispose waste ( an occupational hazard). Occupational exposure to blood can
result from percutaneous injury (needle stick or other sharps injury), mucocutaneous
injury (splash of blood or other body fluids into the eyes, nose or mouth) or blood
contact with non-intact skin. Over 20 blood born diseases can be transmitted but
particular concern is the threat of spread of infectious and communicable diseases like
AIDS, Hepatitis B & C, Cholera, Tuberculosis, Diphtheria etc. Waste chemicals,
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radioactive waste and heavy metals also finds its way in waste stream which are also
hazardous to health.
1.3 Dangers of improper Management of Bio-Medical Waste:
There is public health hazard due to poor management of bio-medical waste which
can cause a number of disease. Serious situations are very likely to happen when bio-
medical waste is dumped on uncontrolled sites where it can be easily accessed by
public. Children and rag pickers are particularly at risk to come in contact with
infectious waste. Inappropriate treatment and disposal contributes to environmental
pollution (uncontrolled incineration causes air pollution, dumping in drains, tanks and
along the river bed causes water pollution and unscientific land filling causes soil
pollution).
In many parts of the country bio-medical waste is neither segregated nor disinfected.
It is being indiscriminately dumped into municipal bins, along the roadsides, into
water bodies or is being burnt in the open air. All this is leading to rapid proliferation
and spreading of infectious, dangerous and fatal communicable diseases. The
improper handling and mismanagement of bio- medical waste is posing serious
problems, few of the problems due to improper disposal are as follows.
• The infectious waste which is only 20% – 25% of the entire waste from
hospitals is not segregated and is mixed with general waste by doing so the
whole of waste may turn up to infectious waste. If the same is dumped into the
municipal bin then there are fair chances of the waste in municipal bin to
become infectious.
• The disposal of sharps will lead to needle stick injuries, cuts, and infections
among hospital staff, municipal workers, rag pickers and the general public.
This will lead to transmission of diseases like Hepatitis B, C, E and HIV etc.
• The needles and syringes which are not mutilated or destroyed are being
circulated back through traders who employ the poor and the destitute to
collect such waste for repackaging and selling in the market.
• One of the reasons for spreading of infection is reuse of disposable items like
syringes, needles, catheters, IV and dialysis sets etc.
• The dumping of untreated bio-medical waste in municipal bins may increase
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the possibility of survival, proliferation and mutation of pathogenic microbial

population in the municipal waste. This leads to epidemics and increased
incidence and prevalence of communicable diseases in the community.
• Chances of vectors are high, like cats, rats, mosquitoes, flies and stray dogs
getting infected or becoming carriers which also spread diseases among the
public.
WHO has estimated that, in 2000, injections with

It is estimated that approximately 3
contaminated syringes caused:
million HCWs experience
• 21 million hepatitis B virus (HBV)
percutaneous exposure to blood
infections (32% of all new infections);
borne viruses (BBVs) each year.
• Two million hepatitis C virus (HCV)
This results in an estimated 16,000
infections (40% of all new infections);
hepatitis C, 66,000 hepatitis B and
• 260 000 HIV infections (5% of all new
200-5000 HIV infections annually.
infections).
( Source: Needle stick injuries in a
Epidemiological studies indicate that a person who
tertiary care hospital by S T
experiences one needle-stick injury from a needle
Jayanth et al , Indian Journal of
used on an infected source patient has risks of
Medical Microbiology, year 2009 ,
30%, 1.8%, and 0.3% respectively to become
Vol. 27, Issue 1, page 44-47)
infected with HBV, HCV and HIV. In 2002, the
results of a WHO assessment conducted in 22
developing countries showed that the proportion of
healthcare facilities that do not use proper waste
disposal methods ranges from 18% to 64%.
(Source: AIDE-MEMOIRE by World Health
Organization (WHO) Courtesy: Dept. of Protection of
the Human Environment Water, Sanitation and Health)
Questions
1. Define bio-medical waste?

2. Who are at risk if bio-medical waste is not managed properly?
3. What are the effects of improper management of bio-medical waste?
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2. Regulations on Bio-medical Waste Management
About this Module -
In this module the attention of reader is drawn on various legal provisions governed on
waste management. The salient features of Bio-Medical Waste (Management and
Handling) Rules, 1998 and amendments has been provided.
• To know various rules governing waste management.

• To know Bio-Medical Waste (Management and Handling) Rules, 1998 and
Amendments.
Output:
• The reader will be able to understand various regulations which governs the
waste management and the salient features of Bio-Medical Waste
(Management and Handling) Rules, 1998 and amendments.
Establishment of a sustainable bio-medical waste management system

gets benefit from a national legal framework that regulates and organizes
the different elements of a waste management system. Legislation usually
places obligations and controls on what is permitted and prescribes sanctions on those
that deviate from accepted practice. In reality, a law will remain ineffective if sources
(finance, material and knowledge) are not available in the hospitals or health care
sectors to implement it and or if enforcement is weak.
The five guiding principles governing in waste-related laws are the “polluter pays”
principle, this requires any waste producer to be made legally and financially
responsible for the safe and environmentally sound disposal of their waste. The
responsibility to ensure that the disposal of waste causes no environmental damage is
placed upon each waste generator, the “precautionary” principle, the rationale of
the principle is that if the outcome of a potential risk is suspected to be serious, but
may not be accurately known, it should be assumed that this risk is high. This has the
effect of obliging health care waste generators to operate a good standard of
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waste collection and disposal, as well as provide health and safety training, protective
equipment and clothing for their staff , the “duty of care” principle, this recognizes
that any person managing or handling health care waste, or waste-related equipment,
is morally responsible to take good care of the waste while it is under their
responsibility, the “proximity” principle, the philosophy behind this principle is that
treatment and disposal of hazardous waste (including health care waste) should take
place at the nearest convenient location to its place of generation, in order to minimize
the risks to the general population. This does not necessarily mean treatment or
disposal has to take place at each health care establishment; instead it could be done at
a facility shared locally or at a regional or national location. An extension to this
principle is the expectation that every country should make arrangements to dispose
of all wastes in an acceptable manner inside its own national borders and prior
informed consent principle / also known as ‘cradle to grave’ control, this principle
introduces the concept that all parties involved in the generation, storage, transport,
treatment and disposal of hazardous wastes (including health care waste) should be
licensed or registered to receive and handle named categories of waste. In addition,
only licensed organizations and sites are allowed to receive and handle these wastes.
No hazardous wastes (including health care waste) should leave a place of waste
generation until the subsequent parties (e.g. transport, treatment and disposal
operators and regulators) are informed that a waste consignment is ready to be moved.
2.1 National Legislations Governing Waste Management:
National legislation is the basis for bio-medical waste management practices in the
country. It establishes control and permits for the disposal. The regulatory frame work
which governs the management of waste is as follows.
• The Water (Prevention and Control of Pollution) Act, 1974 (for liquid waste)
• The Air (Prevention and Control of Pollution) Act, 1981( for air quality)
• The Environment (Protection) Act, 1986
• Hazardous Wastes (Management, Handling and Transboundary Movement)
Rules, 2008 (for hazardous waste).
• The Bio- Medical Wastes (Management and Handling) Rules 1998 (for
hospital waste)
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• The Municipal Solid Wastes (Management and Handling) Rules, 2000 (for
domestic municipal waste)
• Battery (Management and Handling) Rules, 2001 (for used batteries waste).
2.2 Excerpts from Bio- Medical Waste (Management and Handling)

Rules 1998 and as Amended:
The Bio-Medical Waste Management and Handling Rules regulate bio-medical waste
management at local, regional and national level. The rules provides a general
foundation for improving bio- medical waste management systems by indicating in
broad terms what is regarded as good and acceptable practice in the hospitals or health
care institutions. The main benefit of a national law covering hospital waste is that it
can give a uniform basis for a country to develop good practices by providing the
definition of waste, its categories , defined legal obligations of waste producers,
requirements for record-keeping and reporting to regulatory agencies, authority for an
inspection system, establishment of procedures to permit or prohibit some waste
handling, treatment and disposal practices and the courts with powers to settle
disputes and impose penalties on offenders.
This rule has 14 sections, 6 schedules and 5 forms and is applied to all persons who
generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste
in any form. As per the rule "Occupier" means in relation to any institution
generating bio-medical waste, which includes a hospital, nursing home, clinic
dispensary, veterinary institution, animal house, pathological laboratory, blood bank
by whatever name called, means a person who has control over that institution and /
or its premises. The duty of every occupier of an institution generating bio-medical
waste is to take all steps to ensure that such waste is handled without any adverse
effect to human health and the environment.
No untreated bio-medical waste shall be kept stored beyond a period of 48 hours,

provided that if for any reason it becomes necessary to store the waste beyond such
period, the authorized person must take permission from the prescribed authority and
take measures to ensure that the waste does not adversely affect human health and the
environment. "Authorized Person" means an occupier or operator authorized by the
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prescribed authority to generate, collect, receive, store, transport, treat, dispose and or
handle bio-medical waste in accordance with these rules and any guidelines issued by
the Central Government. The “Prescribed Authority” for the enforcement of
provisions of these rules shall be the State Pollution Control Boards in respect of
states and the Pollution Control Committees in respect of the Union territories. The
“Prescribed Authority” for the health care establishments of Armed Forces under
the Ministry of Defence shall be the Director General, Armed Forces Medical
Services.
Every occupier of an institution generating, collecting, receiving, storing,

transporting, treating, disposing and / or handling bio-medical waste in any other
manner, shall make an application in form 1 to the prescribed authority for grant of
authorization. Occupier of clinics, dispensaries, pathological labs, blood banks
providing treatment / services to less than 1000 patients per month are exempted for
taking authorization. Every authorized person shall maintain records related to the
generation, collection, reception, storage, transportation, treatment, disposal and or
any form of handling of bio-medical waste in accordance with these rules and any
guidelines issued. All these records can be subjected to inspection and verification by
the prescribed authority at any time. When any accident occurs at any institution or
facility or any other site where bio-medical waste is handled or during transportation
of such waste, the authorized person shall report the accident to the prescribed
authority. The Segregation, Packaging, Transportation and Storage is as follows.
• Bio-medical waste shall not be mixed with other wastes.

• Bio-medical waste shall be segregated into containers / bags at the point of
generation in accordance with Schedule II prior to its storage,
transportation, treatment and disposal.
• The containers shall be duly labeled as per schedule III.
• If a container is transported from the premises where bio-medical waste is
generated to any waste treatment facility outside the premises, the
container shall, apart from the label prescribed in Schedule III, also carry
information prescribed in Schedule IV. The schedule IV describes the type
of waste where it is generated and to where it is being transferred.
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The Treatment and Disposal of bio-medical waste shall be in accordance with

Schedule I and in compliance with Schedule V. The schedule 1 describes category
wise treatment and disposal methodology and schedule V presents the standards for
incinerators, autoclave, liquid waste, microwave and deep burial. The schedule I, II
and III are as follows.
Schedule 1: Categories of Bio-Medical Waste
Waste Waste Category Type Treatment and
Category Disposal Option+
Category No. 1 Human Anatomical Waste (body parts, organs, Incineration @ /
human tissues etc.). deep burial*
Category No. 2 Animal Waste (animal tissues, organs, body parts Incineration @ /
carcasses, bleeding parts, fluid, blood and deep burial*
experimental animals used in research, waste
generated by veterinary hospitals, colleges,
discharge from hospitals, animal houses).
Category No. 3 Microbiology & Biotechnology Waste (Wastes Local autoclaving /
from laboratory cultures, stocks or micro-organisms micro waving /
live or vaccines, human and animal cell culture used incineration @
in research and infectious agents from research and
industrial laboratories, wastes from production of
biologicals, toxins, dishes and devices used for
transfer of cultures).
Category No. 4 Waste Sharps (needles, syringes, scalpels, blade, Disinfection
glass, etc. that may cause puncture and cuts. This (chemical treatment
includes both used and unused sharps). @ @ / autoclaving /
micro waving and
mutilation /
shredding ##
Category No. 5 Discarded Medicines and Cytotoxic drugs (Waste Incineration @ /
comprising of outdated, contaminated and discarded destruction and
medicines). drugs disposal in
secured landfills
Category No. 6 Soiled Waste (items contaminated with blood, and Local autoclaving /
body fluids including cotton, dressings, soiled micro waving /
plaster casts, lines, bedding, other material incineration @
contaminated with blood).
Category No. 7 Solid Waste (Waste generated from disposal items Disinfection by
other than the sharps such a tubings, catheters, chemical treatment
intravenous sets etc.). @ @ autoclaving /
micro waving and
mutilation/
shredding ##
Category No. 8 Liquid Waste (Waste generated from laboratory Disinfection by
and washing, cleaning, housekeeping and chemical treatment
disinfecting activities). @ @ and discharge
into drains
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Category No. 9 Incineration Ash (Ash from incineration of any Disposal in

bio-medical waste). municipal landfill
CategoryNo.10 Chemical Waste (Chemicals used in production of Disinfection by
biologicals, chemicals used in disinfection, as chemical treatment
insecticides, etc.). @ @ and discharge
into drains for
liquids and secured
land fill for solids
Note
@ There will be no chemical pretreatment before incineration. Chlorinated plastics shall not
be incinerated.
*Deep burial shall be an option available only in towns with population less than five lakhs
and in rural areas.
@@ Chemicals treatment using at least 1% hypochlorite solution or any other equivalent
chemical reagent. It must be ensured that chemical treatment ensures disinfection.
## Mutilation / shredding must be such so as to prevent un authorized reuse.
+ Options given above are based on available technologies. Occupier / operator wishing to
use other state of the art technologies shall approach the Central Pollution Control Board to
get the standards laid down to enable the prescribed authority to consider grant of
authorization.
Schedule II: Color Coding and Type of Container for sposal of Bio-Medical Waste
Color Type of Waste Category Treatment options as per
Coding Container Schedule I
Yellow Plastic bag. Cat. 1, Cat. 2, and Incineration/deep burial
Cat. 3, Cat. 6
Red Disinfected Cat. 3, Cat.6, Autoclaving / Micro waving /
container / plastic Cat.7. Chemical Treatment
bag
Blue / White Plastic bag / Cat. 4, Cat. 7. Autoclaving / Micro waving /
Translucent puncture proof Chemical Treatment and
Container Destruction / shredding
Black Plastic bag Cat. 5 and Cat. 9 Disposal in secured landfill
and Cat. 10.
(Solid)
Notes:
1.Colour coding of waste categories with multiple treatment options as defined in Schedule I,
shall be selected depending on treatment option chosen, which shall be as specified in
Schedule I.
2.Waste collection bags for waste types needing incineration shall not be made of chlorinated
plastics.
3.Categories 8 and 10 (liquid) do not require containers / bags.
4.Category 3 if disinfected locally need not be put in containers / bags.
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Schedule III
Label for Bio-Medical Waste Containers/ Bags
BIOHAZARD CYTOTOXIC
C
CYTOTOXIC
CYTOTOXIQUE
HANDLE WITH CARE

Note: Label shall be non-washable and prominently visible.
Questions
1. Name Acts and Rules which governs waste management.
2. Categorize the bio-medical waste as per Bio-Medical Waste (Management and
Handling) Rules, 1998 and amendments.
3. How many colors of waste bags or bins have been mentioned in the Rule and
for what purpose?
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3. Role of Doctors, Medical Superintendent and Administrators

In Bio- Medical Waste Management
About this Module -
This module deals with the role of Doctors, Medical Superintendents and
Administrators of hospitals in panning and designing of Bio- Medical Waste
Management. Unit wise generation of waste, its audit and minimization techniques,
items and equipments required to manage the waste and their placement has been
mentioned. Financial management as per methodology adopted for disposal is
explained.
• To enhance knowledge and skills on waste audit, waste minimization,

financial management.
• To understand unit wise generation of waste.
• To know items required to manage waste and their placement in each unit.
Output:
• The reader will be able to understand unit wise generation of waste, perform
waste audit and waste minimization techniques and will be able to do financial
management in bio-medical waste disposal.
Dealing bio-medical waste in safe manner is the responsibility of all

medical staff. Every person including Doctors and Medical
Superintendents producing waste
items are responsible for ensuring its
safe segregation at the point of generation itself.
Bio-medical waste is poorly managed in many
hospitals not only in India, worldwide. Identifying
the causes and then supporting improvements in the
system are key skills that doctors, medical
superintendents and administrators of hospitals need to develop. Assess the waste
handling and treatment system of bio-medical waste and its mandatory compliance
13
with regulatory notifications. Estimate the amount of non-infectious and infectious

waste, preferably category wise, generated in different wards or sections. Analyze the
bio-medical waste management system, including policy, practice, storage, collection,
transportation, treatment, disposal and compliance with the standards prescribed
under the regulatory framework. In order to develop a model bio-medical waste
management system in the hospital, create awareness among all the stakeholders
about the importance of bio-medical waste management, related regulations and how
to dispose off the waste. The doctors, Medical Superintendents and the Administrators
should have ‘will’ to improve waste management from a poor standard of
performance to a better one. To improve the performance, develop policy, plan, look
for waste minimization options, provide the required materials for waste management
and implement sustainable waste management system. Arrange for regular training
for all the staff and organize refresher courses, monitor and over see bio-medical
waste management system regularly. While monitoring care should be taken that it is
necessary to ensure that each type of segregated waste are kept intact in separate
specific containers and disposed off in separate specific ways, other wise medical
staff will loose confidence in the benefit of waste segregation if all wastes are remixed
in subsequent handling and disposal. Doctors, Superintendents and Administrators
are responsible, have to play a vital role in planning, designing and implementing bio-
medical waste management system, reducing risk of disease transmission by taking
appropriate measures, response to accidental spillage and financial management.
3.1 Planning and Designing of Bio- Medical Waste Management:
All the medical staff should realize that it is part of their duty to tackle bio-medical
waste management problems. To plan and design bio-medical waste management one
should know how much and what type of waste is generated and from which unit. Is
waste minimization possible if so in which unit and for what type of waste. What all
items and equipments and their quantities are required for managing the waste. What
type of disposal methodology is to be adopted to suit to their facility. Ascertain
whether common bio-medical waste facility is available in the area or not. Forming a
waste management committee will enhance the waste management practice. For
planning and designing of bio-medical waste management, unit wise generation of
waste, its audit and minimization, items and equipments required for managing the
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waste and its appropriate placement , defining route of movement of waste and
finance management needs to be taken into consideration.
3.1.1 Unit Wise Generation of Bio- Medical Waste:
Depending on the services offered by hospitals or health care establishments, there

exist the type of facilities or units in the hospitals. Activities in each unit and number
of units should be identified along with the generation of type of bio-medical waste
expected. A preliminary study should be taken up before attempting to waste audit
and its minimization. In general various types of units available in any hospitals are
out patient, injection room, general ward, labour room, operation theater, intensive
care unit, casualty or emergency , laboratory and pharmacy etc. Observe waste
generation in each unit, segregate the waste as per rule at its generation place, weigh it
daily for one week, aggregate it and then predict for monthly waste generation. If the
segregation is not good then take the total weight of waste unit wise and 10 % to 25%
will be the infectious waste. Depending on the activities performed in each unit,
different types of waste is generated. The expected type of waste generated unit wise
is as follows.
Unit Waste Generation

Out Patient Soiled Waste,(gauze, bandages etc.), Solid waste (Plastic) and
Sharps
Injection Room Soiled Waste, Sharps and Solid waste
General Ward Sharps waste, Solid waste and Soiled waste
Labour Room Body part (placenta etc.) ,Sharps waste, Solid waste and
Soiled waste
Operation Theater Body parts, Sharps waste, Solid waste and Soiled waste
Intensive Care Unit Sharps waste, Solid waste, Soiled waste
Casualty/ Emergency Sharps waste, Solid waste and Soiled waste
Laboratory Sharps waste, Solid waste, Soiled waste, Biologicals (culture /
media)
Pharmacy Discarded medicines
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General Units in Hospitals
3.1.2 Waste Audit and Waste Minimization:
After knowing the waste generation in all units in a hospital, perform waste audit and
then minimize the generation of waste. This is one of the main step in planning and
designing of bio-medical waste management. The audit will give the clear picture of
what type of waste, how much and from where it is generated. This information will
be helpful to opt for waste minimization, items and equipments required for
segregation and treatment of waste and their placement in different units. To know
how much and what type of waste is generated in each medical area, segregate the
waste at the point of generation category wise in specific color codes as per Bio-
Medical Waste (Management and Handling) Rules. The following steps will help in
finding the waste generated quantity wise/ category wise and unit wise.
• Ascertain how many medical areas produce bio-medical waste. List all the
departments and study on its activities,
production of waste and quantity.
• Find the composition of the waste in each
place. Segregate waste category wise, weigh
16
it daily at least for one week and then average to monthly. The waste
generated is not same in all the areas producing waste.
• Keenly look for waste minimization options in all the departments.
• Along with the solid waste generation assessment, liquid waste assessment is
also necessary.
Waste minimization benefits the waste producers. The costs for the purchase of
goods, waste treatment and disposal are reduced and the liabilities associated with the
disposal of waste are lessened. By implementing policies and practices such as
purchasing restrictions to ensure the selection of methods or supplies that are less
wasteful or generate less hazardous waste can lead to source reduction. Use such
materials which can be recycled either on-site or off-site. Careful segregation
(separation) of waste into the ten categories (solid and liquid) as per rule helps to
minimize the quantities of hazardous / harmful waste. Careful management of stores
will prevent the accumulation of large quantities of outdated chemicals or
pharmaceuticals and limit the waste to the packaging (boxes, bottles, etc.) plus
residues of the products remaining in the containers. These small amounts of chemical
or pharmaceutical waste can be disposed of easily and relatively cheaply, whereas
disposing of larger amounts requires costly and specialized treatment, which
underlines the importance of waste minimization. Suppliers of chemicals and
pharmaceuticals can also become responsible partners in waste minimization. The
health service can encourage this by ordering only from suppliers who provide rapid
delivery of small orders, who accept the return of unopened stock, and who offer off-
site waste management facilities for hazardous wastes.
Medical and other equipment used in a hospital may be reused provided that it is
designed for the purpose and will withstand the sterilization process. Reusable items
may include certain sharps, such as scalpels and hypodermic needles, syringes, glass
bottles and containers, etc. After use, these should be collected separately from non
reusable items, carefully washed (particularly in the case of hypodermic needles, in
which infectious droplets could be trapped), and may then be sterilized. Although
reuse of hypodermic needles is not recommended, it may be necessary in
establishments that cannot afford disposable syringes and needles. Plastic syringes
and catheters should not be thermally or chemically sterilized, they should be
17
discarded for recycling industries. Long-term radionuclides conditioned as pins,

needles, or seeds and used for radiotherapy may be reused after sterilization. Special
measures must be applied in the case of potential or proven contamination with the
causative agents of transmissible diseases.
Care should be taken while opting for recycle or reuse of materials, medical and other
equipments. Ensure that effective sterilization is attained. Sterilization can be
achieved by thermal sterilization and chemical sterilization. Dry sterilization is an
exposure to 160 °C for 120 minutes or 170 °C for 60 minutes in an oven. Wet
sterilization is an exposure to saturated steam at 121°C for 30 minutes in an autoclave.
Sterilization by ethylene oxide is done by exposing to an atmosphere saturated with it
for 3–8 hours, at 50°– 60°C, in a reactor tank “gas-sterilizer”, the tank should be dry
before injection of the ethylene oxide. Ethylene oxide is a very hazardous chemical,
this process should therefore be undertaken only by highly trained and adequately
protected technical personnel. Exposure to a glutaraldehyde solution for 30 minutes
will sterilize the material and this process is safer for the operators than the use of
ethylene oxide but is microbiologically less efficient. The effectiveness of thermal
sterilization may be checked by the Bacillus stearothermophilus test and for chemical
sterilization by the Bacillus subtilis test.
18
Units in Hospitals - Assessment of Waste Generation and Waste Audit
19
3.1.3 Items and Equipments Required for Bio- Medical Waste

Management:
The items and facilities required for managing the bio-medical waste are as follows.
• Protective aids like gloves, boots, over garment/ apron etc (for self protection
against infection / injury).
• Colored bins and bags (yellow, red / blue & white puncture proof translucent,
black and green). The Bio Hazard Label should be on all bins and bags except
on black and green. The Cytotoxic Label should be on black bin and bag. The
green color bin should be used for general waste which is like domestic waste
( for segregation of waste).
• Big blue or red container (for storing mutilated and disinfected plastic waste).
• Temporary central storage room (to keep all categories of waste after
segregation before disposal).
• Trolley (to carry the waste to temporary central storage place).
• Needle cutter or Needle burner (for destroying injection needle).
• Scissors or knife (for destroying plastic waste).
• Incinerator where Common Bio-Medical waste Treatment Facility is not
available (for incinerating waste, but having individual incinerator is
discouraged).
• Deep burial pit where population is less than 5,00,000 and in rural areas where
Common Bio- Medical Waste Treatment Facility is not available (for burial
of waste category 1 and 2 ).
• Sharp pit where Common Bio-Medical waste Treatment Facility is not
available (for encapsulating disinfected mutilated sharps).
• Autoclave / Microwave (for disinfection).
• Sodium hypo Chlorite solution (for disinfection).
• Soap (to wash hands).
• Secured landfill
• Waste water treatment plant [ for chemical (liquid) and liquid (lab and
washing etc.) waste]
20
Items And Equipments Required For Bio-Medical Waste Management

.
Mask Cap
Gloves Boots or closed-toe Shoes Over garment / Apron
Waste Segregation Bags and Bins
21
Weighing Machine
Needle Cutter
Dedicated Trolley Scissors and Disinfection Solution
Temporary Central Storage Room
22
Deep Burial Incinerator
Sharp Pit
Autoclave Shredder
Waste Water Treatment Plant
23
3.1.4 Placement of Required Items:
Waste will be generated depending on the activity of each individual unit. After
ensuring the category and quantity of waste generation, required items to manage the
bio-medical waste should be placed appropriately. In general the requirement of bio-
medical waste management items and its placement in each unit is as follows.
Unit Requirement and Placement in Units

Out Patient Yellow / red , blue and white puncture proof translucent bag & bin /
container, needle cutter, scissor and disinfection chemical.
Injection Room Yellow / red , blue and white puncture proof translucent bag & bin /
General Ward Yellow / red , blue and white puncture proof translucent bag & bin /
Labor Room Yellow / red , blue and white puncture proof translucent bag & bin /
Operation Yellow / red , blue and white puncture proof translucent bag & bin /
Theater container, needle cutter, scissor and disinfection chemical.
Intensive Care Yellow / red , blue and white puncture proof translucent bag & bin /
Unit container, needle cutter, scissor and disinfection chemical.
Casualty/ Yellow / red , blue and white puncture proof translucent bag & bin /
Emergency container, needle cutter, scissor and disinfection chemical.
Laboratory Yellow / red , blue and white puncture proof translucent bag & bin /
Pharmacy Black bin or bag.
3.1.5 Designing the Movement of Bio- Medical Waste:

The movement of waste should be such that after segregating the
waste in specific color coded bags from individual units, it should
be placed in dedicated trolleys to transport the waste to temporary
storage place for onward transmission to final disposal place. The
route should be pre defined, that is it should neither be through
inter units nor from crowded places. Care should be taken that there
should not be any spillages from bins / bags/ trolleys while
movement or transporting the bio-medical waste. Dedicated Trolley
3.1.6 Formation of Committee for Bio- Medical Waste Management:

A committee to be constituted with representative members drawn from all the
departments of hospital ( doctor/ specialist doctor, nurse, paramedical staff etc.)
24
representative from each cadre and one from Common Bio-Medical Waste Treatment
Facility if available. The committee should meet once in a week to discuss on
continual improvement of bio-medical waste management and its minimization. The
coordinator will be on turn wise basis for a period of one month from each
department who will be in charge for bio-medical waste management and allocates
resources to support the system and ensures arrangements are in place to deal with
emergencies and investigates any waste-related accidents. Heads of medical
departments ensure that all their staff are aware of the waste segregation and local
storage procedures, encourage good practices and enforce compliance. Matron or
head nurse will be responsible for a continual training and also to new nurses and new
recruits on good bio-medical waste handling practices. They should over see the
handling of bio-medical waste by class IV employees, like there should not be any
spillage along the way, should carry the waste through predefined routes etc., and
ensures that supplies of consumable items are available (e.g. waste bags, etc.).
The committee should ensure technically feasible, environmentally sound,

economically viable and socially acceptable system for management of bio-medical
25
waste. The committee members should guide the staff in assessing the waste
generation in hospital with frequent intervals of time, details of assessment should
include minimum weight of bio-medical waste in each unit of hospital and
composition of which to be determined by segregating the waste at the point of
generation itself. A person to be designated to assess the level of scavenging if any or
recycling taking place inside the hospital, along transportation routes and at final
disposal sites , also determine social issues in relation to scavenging taking place.
The committee to meet once in fortnight and review and analyze existing bio-medical
waste generation, storage, collection and its frequency and disposal system with due
regards to level of segregation. Review existing awareness on bio-medical waste
management among all cadres of staff and prepare training need analysis (TNA) and
organize programs. Committee should also over see the whether consent of operation
has been obtained or not and other regulatory parameters.
3.2 Reducing Risk of Disease Transmission and Response to Accidents:
Diseases can be transmitted from Doctors and Nurses to patient (due to unwashed
hands, contaminated sharps, or improperly cleaned reusable equipment). Patient to
Health Worker (due to being accidentally needle stick or sharps that have been used
on patients. Also due to blood or body fluids accidentally splashing onto or coming in
contact with broken skin). Health Worker to Family and Community (health
workers with unclean hands or contaminated clothing or shoes can carry infection
home to family members). Health Facility to Community (improper disposal of bio-
medical waste can lead to transmission of disease to community members due to
needle stick injury or needle reuse, droplet infection, respiratory route, skin contacts
etc). The risk can be reduced by following the guidelines mentioned below.
• Handle all sharps with care to minimize needle stick injury.
• Instruct the staff that while handling waste they should wear appropriate
protective clothing, including a water resistant apron, thick gloves, boots or
closed-toe shoes, and eye protection.
• Do not allow to sort waste or open waste containers to sort waste.
• Educate the staff to wash hands after working with waste or infected material.
• Before and after examining patient or in between two patients wash hands.
26
• Be aware of procedures for treatment of injuries, cleaning of contaminated

areas and reporting sharps injuries or accidents.
• Report sharps injuries to the appropriate personnel.
• Injuries should be followed up by post-exposure prevention treatment.
• Head nurse should maintain a log of all accidents.
• A full course of hepatitis B and tetanus vaccination will protect from the
hepatitis -B virus and tetanus.
Health workers are at risk of accidental needle stick or other injuries from sharps.
World health Organization (WHO) recommends the following steps after a needle
stick injury.
• Wounds and skin sites exposed to blood or body fluids should be washed with
soap and water; and mucous membranes flushed with water.
• If blood or body fluids have gotten into eyes, splash eyes with clean water.
• Immediately report the incident to a designated person or head nurse.
• Retain, if possible, the item involved in the incident, get details of its source
for identification of possible infection.
• Seek additional medical attention in an emergency health department as soon
as infection identified (based on body substance and severity of exposure).
• Get blood tests or other tests and counseling, if indicated.
• Record the incident.
• Investigate the incident and identify and implement remedial action to prevent
similar incidents in the future.
Health workers need to protect themselves by establishing a barrier between
themselves and the infective agent. The type of protection needed depends on the
worker’s activities. Protective clothing must be worn at all times when handling bio-
medical waste. It must be properly maintained and kept clean. The clothing should not
be taken home, must remain at the health facility to avoid possible contamination of
the community. Protective clothing includes:
• Gloves-always wear gloves when contaminated items are handled. Puncture-

Resistant gloves should be used when handling sharps containers or bags with
unknown contents.
27
• Boots or closed-toe shoes- rubber boots or leather shoes provide extra

protection to the feet from injury by sharps or heavy items that may
accidentally fall. They must be kept clean. When possible, avoid wearing
sandals or shoes made of soft materials.
• Aprons- rubber or plastic aprons provide a protective, waterproof barrier to
the body.
• Goggles- plastic goggles can protect the eyes from accidental splashes.
• Hand washing- Wash with soap and antiseptic detergent.
Protective Aids
The measures that could / should be taken in case of accidental spillages in hospitals
is as follows.
1. Evacuate the contaminated area.
2. Decontaminate the eyes and skin of exposed personnel immediately.
3. Inform the designated person who should coordinate the necessary actions.
4. Determine the nature of the spill.
5. Evacuate all the people not involved in cleaning up.
Spillage 28
6. Provide first aid and medical care to injured individuals.

7. Secure the area to prevent exposure of additional individuals.
8. Provide adequate protective clothing to personnel involved in cleaning-up.
9. Limit the spread of the spill.
10. Neutralize or disinfect the spilled or contaminated material if indicated.
11. Collect all spilled and contaminated material. Sharps should never be picked
up by hand, brushes and pans or other suitable tools should be used. Spilled
material and disposable contaminated items used for cleaning should be placed
in the appropriate waste bags or containers.
12. Decontaminate or disinfect the area, wiping up with absorbent cloth. The
decontamination should be carried out by working from the least to the most
contaminated part, with a change of cloth at each stage. Dry cloths should be
used in the case of liquid spillage, for spillages of solids, cloth impregnated
with water (acidic, basic, or neutral as appropriate) should be used.
13. Rinse the area, and wipe dry with absorbent cloths.
14. Decontaminate or disinfect any tools that were used.
15. Remove protective clothing and decontaminate or disinfect it if necessary.
16. Seek medical attention if exposure to hazardous material has occurred during
the operation.
If the spillage of mercury occurs then collection of mercury spill and storage aspect
is as follows.
1. Remove everyone from the area that has been contaminated with mercury.
Keep the heat below 20°C and ventilate the area if possible.
2. Put on face mask in order to prevent breathing of mercury vapor.
3. Remove all jewelry from hands and wrists so that the mercury cannot
combine (amalgamate) with the precious metals.
4. Appropriate personal protective equipment (rubber gloves, goggles / face
shields and clothing) should be used while handling mercury. 5. Locate all
mercury beads carefully. Cardboard sheets should be used to push the spilled
beads of mercury together. Mercury should be placed carefully in a container
with some water.
6. Never use a broom or a vacuum cleaner.
29
7. It should not be swept down the drain and wherever possible, it should be disposed
off at a hazardous waste facility or given to a mercury-based equipment manufacture.
Collection of Mercury Beads
3.3 Financial Management:
According to the “polluter pays principle”, all organizations are financially liable for
the safe management of any waste it generates. The costs of separate collection,
appropriate packaging, and on-site handling are internal to the establishment and paid
as labor and supplies costs. The costs of off-site transport, treatment, and final
disposal are external and paid to the contractors who provide the service (common
bio-medical waste treatment facilitator). Where common bio- medical waste treatment
facility is not available, the costs of construction, operation, and maintenance of
systems for managing the waste can represent a significant part of the overall budget
of a hospital. They should be covered by a specific allotment from the hospital
budget. Certain basic principles should always be respected in order to minimize these
costs. Waste minimization, segregation, and recycling are recommended which can
greatly reduce disposal costs. The benefits of producing less waste are evident, and
segregation prevents the unnecessary treatment of general waste by the costly
methods necessary for waste management.
For government-owned hospitals, the government may use general revenues to pay
the cost of the waste management system. For private organizations, they need to
implement waste management system from their own resources. Since few years
30
privatization of waste management system ( common bio-medical waste treatment

facility) is gaining importance and it should be encouraged to reduce environmental
pollution in the vicinity of hospitals. For cost estimation all hospitals need to establish
accounting procedures to document the costs they incur in managing waste. Accurate
record keeping and cost analysis must be undertaken which helps to reduce
management cost. All the activities of bio-medical waste management should be
observed with out compromise in its cost involved. The requirement of items and
equipments and placement of these has been discussed in 3.4 and 3.5, hence
depending on the waste management plan budget should be allocated.
3.3.1 Costs of Waste Management System Where Common bio- Medical

Waste Treatment Facility is Not Available:
An Initial capital investment is necessary for management of bio medical waste. Cost
on the following items has to be taken into account. Plant and equipment ( sterilizer,
shredder, incinerator / deep burial where population is less than 5000 population in
rural areas), utility requirements (fuel, electricity, water, etc.), operation and
maintenance, consumables, incinerator building, waste storage room, offices, waste
collection trucks, bins/containers / bags for transporting waste from hospitals to
incinerator site, trolleys for collecting waste bags from wards, bag holders to be
located at all sources of waste in hospitals, weighing machines for weighing waste
bags, protective clothing, disinfecting solution, soap to wash hands and mutilating
agents. The indirect operating costs involves training, replacement of parts,
consumables, vehicle maintenance, uniforms and safety equipment, ash disposal,
compliance monitoring of flue-gas emissions, project management and administrative
costs for the organization responsible for the execution and long-term operation of the
project.
3.3.2 Costs of Waste Management System Where Common bio- Medical

Waste Treatment Facility is Available:
When the common bio-medical waste treatment facility is available, the cost of
colored bags / bins / containers, trolley for transporting the waste to temporary storage
place, mutilating agents, protective clothing, disinfecting solution, soap to wash hands
needs to be considered. The treatment like autoclave , shredding etc. will be taken
31
care by common bio-medical waste treatment facility along with final disposal of
waste.
Questions
1. How to perform waste audit? What is waste minimization?
2. Name protective aids.
3. What measures should be taken in case of accidental spillages in a
hospital?
4. How mercury is to be picked up when there is spillage of mercury?
32
4. Implementation of Bio- Medical Waste Management Plan
About this Module –
This module explains the implementation of bio-medical waste management plan in

hospitals where common bio-medical waste treatment facility is not available and or
available, in primary health centers and in small hospitals situated in rural areas.
• To understand the various steps involved in management of bio-medical waste in

the absence of common bio-medical waste treatment facility.
• To understand the various steps involved in management of bio-medical waste in
the presence of common bio-medical waste treatment facility.
• To get familiarized with management of bio-medical waste in primary health

centers and in small hospitals in the rural areas.
Output:
• The readers will be able to implement bio-medical waste management plan

properly in their hospitals.
The bio-medical waste management is a crucial one which starts from

point of generation and ends at point of disposal. Policy on bio-medical
waste management needs to be evolved on the feasibility option and
optimal sustainable treatment technologies. There are various options
available for managing bio-medical waste and the selection of treatment and disposal
depends on the availability and non availability of common bio-medical waste
treatment facility, nature of hospital ( large scale or small scale) place where it is
situated etc. The implementation plan for bio-medical waste management with
various options is as follows.
33
4.1 Bio- Medical Waste Management in Hospitals Where Common

Bio- Medical Waste Treatment Facility is Not Available:
The bio-medical waste management starts from the point of generation. Waste
minimization options should be considered and adopted. After the waste is generated
the immediate step is segregation followed by collection, storage, transportation,
treatment and disposal. The path between the two points (cradle to grave) can be
segmented schematically as
• Identification of areas of waste generation
• Categorization, quantification of waste and minimization
• Segregation, handling and storage
• Treatment, destruction and disposal
The detailed implementation of bio-medical waste management plan where common

bio-medical waste treatment facility is not available is as follows.
Identification of Areas of Waste Generation:

To identify areas of waste generation, list out units available in the hospital and a
survey of all the units will help to identify waste generation. In almost all the units
(out patient, wards, operation theater, labour room, laboratories, intensive care units
etc.), waste is generated, only difference will be in quantity and category.
Categorization, Quantification of Waste and Minimization:

Categorize the waste according to Bio-Medical Waste (Management and Handling)
Rules. The quantification will help in placing the bins / bags of appropriate size,
quantity and at appropriate places as close to the source of waste generation. Waste
minimization helps in reducing the burden of waste management in special way.
Waste minimization practice should be adopted at source of generation ( reuse,
recycle and reduction). Reuse of chemicals, medical equipments etc. translates into
cost saving. Recycling of specific materials like disinfected and shredded plastic helps
a secondary industry. Reduction in waste generation decreases waste disposal costs.
All the categories of bio-medical waste have been mentioned in chapter two,
quantification and waste minimization has been explained in chapter three. The ten
categories of bio-medical waste mentioned above are as follows.
34
• Category 1: Human Anatomical Waste (body parts, organs, human tissues

etc.).
• Category 2: Animal Waste (animal tissues, organs, body parts carcasses,
bleeding parts, fluid, blood and experimental animals used in research, waste
generated by veterinary hospitals, colleges, discharge from hospitals, animal
houses).
• Category 3: Microbiology & Biotechnology Waste (Wastes from
laboratory cultures, stocks or micro-organisms live or attenuated vaccines,
human and animal cell culture used in research and infectious agents from
research and industrial laboratories, wastes from production of biologicals,
toxins, dishes and devices used for transfer of cultures).
• Category 4: Waste Sharps (needles, syringes, scalpels, blade, glass, etc. that
may cause puncture and cuts. This includes both used and unused sharps).
•
• Category 5: Discarded Medicines and Cytotoxic drugs (Waste comprising

of outdated, contaminated and discarded medicines).
• Category 6: Soiled Waste (items contaminated with blood, and body fluids
including cotton, dressings, soiled plaster casts, lines, beddings, other material
• Category 7: Solid Waste (Waste generated from disposable items other than
the waste sharps such as tubings, catheters, intravenous sets etc.).
• Category 8: Liquid Waste (Waste generated from laboratory and washing,
cleaning, housekeeping and disinfecting activities).
• Category 9: Incineration Ash (Ash from incineration of any bio-medical
waste).
• Category 10: Chemical Waste (Chemicals used in production of biologicals,
chemicals used in disinfection, as insecticides, etc.).
35
Categories of Bio-medical Waste
Category 1 : Human Anatomical Waste Category 2: Animal Waste
Category 3: Micro Category 4: Waste Category 5: Discarded

& Biotech Waste Sharp Medicine & Cytotoxic
Drugs
Category 6: Soiled Waste Category 7: Solid Waste Category 8: Liquid Waste
Category 9: Category 10: Chemical

Incineration Ash Waste Solid and Liquid
36
Segregation, Handling and Storage:
Segregation is a very important factor in waste management system. Depending upon

the treatment and disposal option for various categories of wastes, specific colored
containers are required to segregate and store it at temporary central storage place till
it is disposed off. The disposal should be with in 48 hours. The waste which goes for
incinerator or deep burial, should be collected in yellow plastic bag or bin. The waste
which is planed for autoclaving or
microwaving or chemical treatment and
finally to find its way in secured landfill or
for recycling, should be collected in red or
blue bin or bag. The waste sharps such as
needles, blades etc. which is for disinfection,
destruction or shredding should be collected in
white puncture proof translucent container, which will be encapsulated or can go for
recycling as final disposal. The chemical waste (solid), out dated medicines and
cytotoxic drugs which goes for disposal in secured land fill should be collected in
black bin or bag with Cytotoxic label. All the bins and bags should have biohazard
label except on black colored bin or bag on which cytotoxic label to be inserted. The
details of segregation of waste into specific color coded bags or bins, as per treatment
and disposal option planned is presented below. Maximizing segregation is very
effective in reducing waste management costs, environmental impacts and also
complexity of management.
Handling of waste needs attention. As soon as the waste is generated it should be

segregated into specific color coded containers or bags. When these are 3/4th filled
then it should be picked up from the neck and placed so that bags can be picked up by
the neck again for further handling. While handling care should be taken to reduce the
risk of needle prick injury and infection. No other forms of waste should be mixed
with bio-medical waste. The waste should not be over loaded while transporting. The
movement of waste in the wheeled trolleys, containers or carts should be through pre
defined route within the hospital till it reaches central temporary storage place. These
trolleys should not be used for any other purpose and need to be cleaned daily.
37
Segregation of Waste in Specific Colored Bins Depending on Treatment

and Disposal Technology
Yellow Plastic Bag – Non Chlorinated
Cat -1 Human Anatomical Waste , Cat -2 Animal Waste, Cat -3

Microbiology & Biotechnology Waste, Cat-6 Soiled Waste
Treatment & Disposal- Incineration or Deep Burial

Blue Plastic Bag
Cat -7 Solid Waste
Treatment & Disposal- Autoclaving or Microwave or Chemical Treatment

and Destruction or Shredding- Recycling
White Translucent Puncture Proof Container
Cat – 4 Sharps Waste

and Destruction or Shredding- Encapsulation on Secured Landfill
Red Disinfected container / plastic bag
Cat-3 Microbiology & Biotechnology Waste, Cat – 6 Soiled Waste,

Cat-7 Solid Waste

– Secured Landfill and Cat. 7 Recycle
Black Plastic bag
Cat-5 Discarded Medicine & Cytotoxic Drugs, Cat – 9 Incineration Ash
Cat – 10 Chemical Waste (solid)
Treatment & Disposal- Disposal in Secured Landfill
Storage location for hospitals / health-care waste should be designated inside its
premises. The waste in the bags or containers should be stored in central storage place
in an area or room of a size appropriate to the quantities of waste produced and the
frequency of collection. Recommendation for storage facilities with in the hospitals is
as follows.
• The storage area should have an impermeable, hard-standing floor with good
drainage; it should be easy to clean and disinfect.
• There should be a water supply for cleaning purposes.
38
• The storage area should afford easy access for staff in charge of handling the
waste.
• It should be possible to lock the store to prevent access by unauthorized
persons.
• Easy access for waste-collection vehicles is essential.
• There should be protection from the sun.
• The storage area should be inaccessible for animals, insects, and birds.
• There should be good lighting and at least passive ventilation.
• The storage area should not be situated in the proximity of fresh food stores or
food preparation areas.
• A supply of cleaning equipment, protective clothing, and waste bags or
containers should be located conveniently close to the storage area.
Cytotoxic waste should be stored separately from other health-care waste in a
designated secure location.
Central Storage Place
Treatment, Destruction and Disposal:
The various treatment, destruction and disposal methods for each category of waste as
per bio-medical waste management and handling rules are mentioned below.
Category 1 Human Anatomical Waste (human tissues, organs, body parts):
As soon as it is segregated in yellow colored bin or bag, before 48 hours it should be

incinerated or deep burial. The deep burial option is for towns where population is
less than five lakh and in rural areas.
39
Category 2 Animal Waste (animal tissues, organs, body parts, bleeding parts
etc.):
As soon as it is segregated in yellow colored bin or bag, before 48 hours it should be

incinerated or deep burial. The deep burial option is for towns where population is
less than five lakh and in rural areas.
Category 3 Microbiology and Biotechnology Waste (waste from Lab, cultures,

stocks or specimens human and animal cells etc.):
As soon as it is segregated before 48 hours it should be incinerated or deep burial. The

deep burial option is for towns where population is less than five lakh and in rural
areas. Other option is disinfect and put it in secured landfill.
Category 4 Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that may
cause puncture and cuts. This includes both used and unused sharps):
After the injection is administered the needles should be cut from the hub by a needle
cutter, both the needle and the syringe become useless and can’t be reused. The cut
needle gets segregated in the pot which is fixed to the needle cutter. The cut syringe
goes in the plastic bucket with sieve, which has 1% sodium hypochlorite solution or
any other equivalent chemical agent. Metal needle from the pot can be stored in the
puncture proof translucent container having 1% sodium hypochlorite solution or any
other equivalent chemical agent. It must be ensured that chemical treatment ensures
disinfection. The disinfected needle can be encapsulated for disposal into municipal
secured landfill or can be given to authorized metal recycler. If auto disabled
syringes are provided it prevents the reuse of non sterile syringes as it self locks after
single use. The waste syringes will follow the same route of management of sharps
waste.
Category 5 Discarded medicines and Cytotoxic drugs (waste comprising of

outdated, contaminated and discarded medicines.):
Either directly incinerate or after destruction put it in secured landfill.
40
Category 6 Soiled waste (items contaminated with blood, and body fluids
contaminated with blood.):
Either incinerate or disinfect by autoclaving / microwaving and put it in secured

landfill.
Category 7 Solid waste (waste generated from disposable items other than waste
sharps such as tubings, catheters, intravenous sets etc.):
Destroy the plastic waste to ensure prevention of reuse and disinfect by keeping in 1%
sodium hypochlorite solution or any other equivalent chemical agent. It must be
ensured that chemical treatment ensures disinfection. If recycling of plastic waste is
planned, care should be taken to give to authorized recycler only after disinfection and
shredding.
Category 8 Liquid waste (waste generated from laboratory and washing,

cleaning, house-keeping and disinfection activities):
The liquid waste generated from labs and washing, cleaning and house keeping need
to be treated to the standards prescribed and flush in the drains. The standard for
liquid waste is as follows.
Standards for liquid waste:
The effluent generated from the hospital should conform to the following limits: PH -
63-9.0, Suspended solids - 100 mg/l, Oil and grease - 10 mg/l, BOD - 30 mg/l, COD -
250 mg/l, Bio-assay test - 90% survival of fish after 96 hours in 100% effluent.
These limits are applicable to those, hospitals which are either connected with sewers
without terminal sewage treatment plant or not connected to public sewers. For
discharge into public sewers with terminal facilities, the general standards as notified
under the Environment (Protection) Act, 1986 shall be applicable.
Category 10 Chemical waste (chemical used in production of biological,

chemicals used in disinfection, as insecticides, etc.):
Chemical waste that is chemical used in production of biological, chemicals used in

41
disinfection, as insecticides, etc. should be treated by using 1% sodium hypochlorite

solution or any other equivalent chemical agent. It must be ensured that chemical
treatment ensures disinfection. After treatment discharge into drains for liquids and
secured landfill for solid.
As per the guidelines issued by Central Pollution Control Board disposal of bio-
medical waste by individual hospitals is discouraged and common bio-medical waste
treatment facilities are encouraged. Pictorial representation of detail implementation
plan of action with various technological options category wise is presented below.
Provision of Common Bio-Medical Waste Treatment Facility (CBMWTF) if in
course of time comes up has also been considered and provided in the implementation
plan.
42
BIO-MEDICAL WASTE MANAGEMENT

CATEGORY 1: HUMAN ANATOMICAL WASTE
BODY PART YELLOW BIN
CENTRAL STORAGE PLACE
INCINERATIOR DEEP BURIAL
CBMWTF
43

CATEGORY 2: ANIMAL WASTE
EXPERIMENTAL ANIMAL YELLOW BIN
INCINERATIOR DEEP BURIAL
CBMWTF
44

CATEGORY 3: SOILED WASTE
MICROBIOLOGY AND RED BIN

BIOTECHNOLOGY WASTE
AUTOCLAVE
CBMWTF
MUNICIPAL SECURED
LANDFILL 45

CATEGORY 4: WASTE SHARP
WASTE SHARPS MUTILATION DISINFECTION
CENTRAL STORAGE
METAL RECYCLER
CBMWTF
SHARP PIT
GLASS WASTE BLUE BIN GLASS RECYCLER
46

CATEGORY 5: DISCARDED DRUGS AND MEDICINES
DISCARDED DRUGS
AND MEDICINES
BLACK BIN
SEPARATE
STORAGE PLACE
MUNICIPAL SECURED CBMWTF

LANDFILL
47

SOLIED WASTE
YELLOW BIN
CENTRAL STORAGE
INCINERATOR DEEP BURIAL
CBMWTF
48

SOILED WASTE
RED BIN
CENTRAL STORAGE
AUTOCLAVE CBMWTF
MUNICIPAL SECURED
LANDFILL
49

CATEGORY 7: SOLID WASTE ( PLASTIC)
PLASTIC WASTE
MUTILATE
CENTRAL STORAGE CBMWTF

PLACE
50

CATEGORY 7: SOLID WASTE
PLASTIC WASTE MUTILATE RED BIN
CENTRAL STORAGE
AUTOCLAVE
PLASTIC RECYCLER
51

CATEGORY 8: LIQUID WASTE )
LIQUID WASTE
EFFLUENT
TREATMENT PLANT
DISCHARGE INTO
DRAIN
52

CATEGORY 9: INCINERATOR ASH
INCINERATOR ASH
BLACK BIN
MUNICIPAL SECURED
LANDFILL
53

CATEGORY 10: CHEMICAL WASTE
BLACK BIN
CHEMICAL SOLID
WASTE
MUNICIPAL SECURED
CBMWTF
LANDFILL
54

CHEMICAL LIQUID
WASTE
EFFLUENT
TREATMENT PLANT
DISCARGE INTO
DRAIN
55
The details of category wise treatment and disposal methods are presented in the
following table.
Category Wise Treatment and Disposal
Category Treatment and Disposal
1.Human anatomical waste No treatment required, incineration@/ deep burial*
2.Animal Waste No treatment required, incineration @/ deep burial*
3.Microbiology and No treatment required, incineration @
Biotechnology Waste Autoclaving / microwaving, municipal secured
landfill
4.Waste Sharps Mutilating / shredding / disinfection and
encapsulation
municipal secured landfill
Mutilating / shredding / disinfection and non-
encapsulation, possibility of recycling shall be
explored
5.Discarded medicines and No treatment required, incineration @
Cytotoxic Destruction, municipal secured landfill
6.Soiled waste (Cotton No treatment required, incineration @
dressings etc.) Autoclaving / microwaving, municipal secured land
fill
7.Solid waste ( Tubing , Disinfection @@ / autoclaving / microwaving /
Catheters etc) mutilating / shredding##, recycling or municipal
secured land fill
8.Liquid waste Disinfection by chemical treatment @@ ,discharge
into drain
9.Incineration ash No treatment required, disposal in municipal land fill
/ Secured Landfill
10. Chemical waste Chemical treatment @@ ,discharge into drains for
(Chemicals used in production liquids and secured landfill for solids.
of biological, Chemicals used
in disinfection etc.)
@@ Chemical treatment using at least 1 % hypochlorite solution or any other

equivalent chemical reagent. It must be ensured that chemical treatment ensures
disinfection.
# # Mutilation/shredding must be such so as to prevent unauthorized re-use
@ There will be no chemical pre-treatment before incineration. Chlorinated plastic
shall not be incinerated.
* Deep burial shall not be an opinion available only in towns with population less
than five lakhs and rural areas.
Occupier / Operator wishing to use other state of the art technologies shall approach
the Central Pollution Control Board to get the standards laid down to enable the
prescribed authority to consider grant of authorization.
56
4.2 Bio- Medical Waste Management in Hospitals Where Common Bio-

Medical Waste Treatment Facility is Available:
As mentioned above at 4.1 that bio-medical waste management covers

• Identification of areas of waste generation
• Categorization, quantification of waste and minimization
• Segregation, handling and storage
• Treatment, destruction and disposal
The bio-medical waste management in hospitals where common bio-medical waste

treatment facility is available, the above first three steps should be followed exactly as
mentioned at 4.1 (identification of areas of waste generation, categorization,
quantification of waste and minimization and segregation, handling and storage).
After having kept in temporary central storage place , the waste should be collected
with in 48 hours by common bio-medical waste treatment facility for final treatment,
destruction and disposal. The detailed prerequisites for giving to common bio-
medical waste treatment facility for final treatment, destruction and disposal, category
wise is as follows.
Category 1 Human Anatomical Waste (human tissues, organs, body parts):

After segregation the waste in yellow colored bin or bag it should be kept in
temporary central storage place from where it is to be collected by common bio-
medical waste treatment facility with in 48 hours. The waste does not need any
treatment before handing over to common bio-medical waste treatment facility.
Category 2 Animal Waste (animal tissues, organs, body parts, bleeding parts
etc.):
After segregation the waste in yellow colored bin or bag it should be kept in
57
Category 3 Microbiology and Biotechnology Waste (waste from Lab, cultures,

stocks or specimens human and animal cells etc.):
After segregation the waste in yellow or red colored bin or bag it should be kept in
Category 4 Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that may
cause puncture and cuts. This includes both used and unused sharps):
After mutilation keep the sharps in white translucent puncture proof bin having 1%
sodium hypochlorite solution for disinfection . When it occupies 3/4th of the bin, hand
over to the common bio medical waste treatment facility.
Category 5 Discarded medicines and Cytotoxic drugs (waste comprising of

outdated, contaminated and discarded medicines.):
Keep the waste in black bag or bin having cytotoxic label on it and hand over to the
common bio medical waste treatment facility. The waste does not need any treatment
before handing over to common bio-medical waste treatment facility.
Category 6 Soiled waste (items contaminated with blood, and body fluids
contaminated with blood.):
After segregation the waste in yellow or red colored bin or bag it should be kept in
temporary central storage place to be collected by common bio-medical waste
treatment facility with in 48 hours. The waste does not need any treatment before
handing over to common bio-medical waste treatment facility.
Category 7 Solid waste (waste generated from disposable items other than waste
sharps such as tubings, catheters, intravenous sets etc.):
As soon as the solid plastic waste is generated, mutilate, disinfect, keep in red or blue
colored bin or bag and hand over to common bio-medical waste treatment facility.
58
Category 8 Liquid waste (waste generated from laboratory and washing,

cleaning, house-keeping and disinfection activities):
The liquid waste generated from labs and washing, cleaning and house keeping need
to be treated to the standards prescribed and flush in the drains. The standard for
liquid waste is as follows.
Category 10 Chemical waste (chemical used in production of biological,

chemicals used in disinfection, as insecticides, etc.):
Chemical waste that is chemical used in production of biological, chemicals used in

disinfection, as insecticides, etc. should be treated by using 1% sodium hypochlorite
solution or any other equivalent chemical agent. It must be ensured that chemical
treatment ensures disinfection. After treatment discharge into drains for liquids and
for solid chemical waste, hand over to common bio medical waste treatment facility.
59

CATEGORY 1: HUMAN ANATOMICAL WASTE
YELLOW BIN
BODY PART
COMMON BIO-MEDICAL WASTE CENTRAL STORAGE PLACE

TREATMENT FACILITY
60

CATEGORY 2: ANIMAL WASTE
EXPERIMENTAL ANIMAL YELLOW BIN

COMMON BIO-MEDICAL WASTE
TREATMENT FACILITY
61

CATEGORY 3: MICROBIOLOGY & BIOTECHNOLOGY
MICROBIOLOGY &
BIOTECHNOLOGY
WASTE
YELLOW BIN RED BIN

TREATMENT FACILITY
62

CATEGORY 4: WASTE SHARPS
WASTE SHARPS MUTILATION & DISINFECTION
COMMON BIO-MEDICAL WASTE CENTRAL STORAGE PLACE

TREATMENT FACILITY
63

CATEGORY 5: DISCARDED DRUGS AND MEDICINES
DISCARDED MEDICINES
&CYTOTOXIC DRUGS
BLACK BIN
SEPARATE
STORAGE
PLACE
COMMON BIO-MEDICAL
WASTE TREATMENT
FACILITY
64

SOILED WASTE
COMMON BIO-MEDICAL
WASTE TREATMENT
FACILITY
65

CATEGORY 7: SOLID WASTE
SOLID WASTE
(PLASTIC)
MUTILATION

TREATMENT FACILITY
66
BIO-MEDICAL WASTE MANAGEMNET

CATEGORY 8: LIQUID WASTE AND
CATEGORY 10: CHEMICAL LIQUID WASTE
LIQUID WASTE
EFFLUENT TREATMENT
PLANT
DISCARGE INTO
DRAIN
67

CHEMICAL WASTE (SOLID) BLACK BIN

TREATMENT FACILITY
68
4.3 Bio- Medical Waste Management in Primary Health Centers and

Small Scale Units in Rural Areas
In Primary Health Centers (PHCs) and in small scale hospitals the quantity of waste
generated is too small because the activities taken up in these hospitals are restricted
to certain extent. All categories of waste is not generated as the activity of medical
treatment is minimum. In general the categories of waste generated are category 1:
human anatomical waste, category 4: sharps waste, category 5: discarded medicines,
category 6: soiled waste, category 7: solid waste (plastic ), category 8: liquid waste,
category 10: chemical waste and general domestic waste. As the PHCs are scattered
small units and placed in far away from the common bio-medical waste treatment
facility, it is not feasible for the facilitator to collect waste from these places with in
48 hours. Same case with small scale hospitals in the rural areas. In absence of such
facility / arrangement, a cost effective management plan for bio-medical waste
disposal is designed. Segregation, treatment and disposal are the main steps in
managing bio-medical waste. Category wise segregation, treatment and disposal for
the above mentioned categories is as follows.
Category 1 (Human anatomical waste) and Category 6 (soiled waste), should be

segregated immediately as soon as the waste is generated in yellow color bin or bag.
No treatment is required for these two types of wastes. With in 48 hours it should be
buried in deep burial pit
Category 4 (waste sharps ), as soon as the injection is administered the needle

should be mutilated and store in white puncture proof translucent container having 1
% sodium hypo chlorite solution or any other equivalent chemical. When it is 3/4th
filled the mutilated needles to be poured in sharp pit and lock the lid of the pit.
Category 7 (solid plastic waste), mutilate the plastic waste and disinfect with 1 %
sodium hypo chlorite solution or any other equivalent chemical. After ensuring
disinfection store in a big blue bin for sale to authorized recyclers.
Category 5 (discarded drugs ), put it in secured landfill or hand over to the District
Medical Health Officer (DM&HO) for onward transmission to secured landfill.
69
Category 8( liquid waste), liquid waste generated from laboratory ,washing, cleaning
and house keeping need to be treated to the standards prescribed and flush in the
drains. The standard for liquid waste is as follows.
Category 10 (chemical waste), chemical used in production of biological, chemicals

used in disinfection, as insecticides, etc. should be treated by using 1% sodium
hypochlorite solution or any other equivalent chemical agent. It must be ensured that
chemical treatment ensures disinfection. After treatment discharge into drains for
liquids and for solid chemical waste put it in secured landfill or hand over to DM &
HO for onward transmission to secured landfill.
The implementation plan for bio-medical waste management for Primary Health
Centers (PHCs) and small scale hospitals in rural areas is presented in the following
table.
Implementation Plan for Bio- Medical Waste Management in Primary Health
Centers and Small Scale Hospitals in Rural Areas
Cate Waste Requirement Treatment and Disposal Post
gory disposal
1 Human 1.Deep burial pit Treatment is not required. If deep
anatomical 2.Yellow bin / bag Handover the yellow bin or bag to burial then
waste transporter of CBMWTF or Deep cover it with
burial. soil and
lime.
6 Soiled Waste 1.Deep burial pit Treatment is not required. If deep

2.Yellow or Red bin / Handover the yellow bin or bag to burial then
bag transporter of CBMWTF or Deep cover it with
burial. soil and
lime.
70
4 Waste Sharps 1.Needle cutter/ burner Mutilate the needle & If it is put in
2.Sharp pit disinfection. Handover the sharp pit
3.White puncture proof container to transporter of then close
translucent container CBMWTF Or Dispose mutilated the sharp pit
4. 1% Sodium Hypo needles in sharp pit and lock it.
Chlorite solution
7 Solid Waste 1.Scissors / knife for Mutilate the plastics & -

(Plastic) mutilation disinfection.
2. 1% Sodium Hypo Handover the bin or bag to
Chlorite solution transporter of CBMWTF Or
3.Blue bin / bag Store in bigger container and
dispose by sale to authorized
recycling industry.
5 Discarded Secured Landfill Treatment is not required.
Medicines Secured landfill or hand over to
DM&HO
8 & Liquid Waste Disinfection Chemical Treat the waste and disinfect. For
10 & Chemical liquid waste allow it to reach the
Waste drain and for solid waste put it in
black bin and then in to secured
landfill or hand over to DM&HO
6 General Green bin No treatment required, put in -
Waste like secured land fill.
paper,
eatables etc.
The detail of deep burial pit and sharp pit are as follows
Deep Burial Pit:
• A pit or trench should be dug out about 2 meters deep. It should be half filled
with waste, then covered with lime within 50 cm of the surface, before filling
the rest of pit with soil.
• It must be ensure that animals do not have any access to burial site. Covers of
galvanized iron / wire meshes may be used.
• On each occasion, when wastes are added to pit, layer of 10 cms of soil shall
be added to cover the wastes.
• Burial must be performed under close and dedicated supervision.
• Pits should be distant from habitation so as to ensure that no contamination of
ground water occurs. The area should not be prone to flooding or erosion.
• The institution shall maintain record of all the pits for deep burial
• Fencing of the deep burial pit has to be maintained
71
• The deep burial site should be relatively impermeable and no shallow well
should be close to the site.
• The location of the deep burial site will be authorized by the prescribed
authorities.
Sharp Pit:
A pit is to be dug according to the requirement of the hospital. All the sides of the pit
should be plastered with cement. A cylindrical metal pipe of 4 inches diameter or
more is fixed at the ceiling of the pit. The opening of the metal pipe should have
locking facility. The sharps are deposited in this pit through the pipe from the
puncture proof translucent container after mutilating.
Questions
1. Name the categories of bio-medical waste and mention color coded bins or
bags for their segregation?
2. Which categories of waste should be mutilated?
3. Does the waste needs any treatment before incineration?
72
5. Do’s & Don’ts
About this Module -
This module contains specific information on Dos and Don’t s while managing bio-
medical waste. This will highlight on the activities or action to be performed or not
during bio-medical waste management.
• To understand do and not to do actions during bio-medical waste management.
Output:
• The reader will be able to understand performance of various actions during bio-
medical waste management, reason out adoption of various technologies for
segregation, store, transport, treat and dispose the bio-medical waste category
wise.
Do’s
1. Generate waste when it is essential.
2. Segregate waste as soon as it is generated into specified categories of waste.
3. Collect the waste in specific color coded covered bins having bio hazard logo.
4. Put the body parts and animal waste in yellow container.
5. Soiled waste to go into yellow or red container.
6. As soon as the solid waste (plastic waste) is generated mutilate it so that it can
not be reused again and put in blue or red container.
7. Destroy needle by using needle cutter or needle burner.
8. Keep the needles in puncture proof, translucent container having 1% sodium
hypochlorite solution and put the plastic syringe in blue or red container.
9. The cytotoxic drugs or discarded medicine to be placed in black container
having cytotoxic logo on it.
10. Clean the bins regularly with soap and water and disinfect the bins regularly.
11. Collect the domestic waste/eatables, wrappers, fruit peels, papers etc. in green
bin.
73
12. Adopt waste minimization practice.

13. Carry / transport the waste in closed containers.
14. Use dedicated waste collection bins / trolleys / wheel barrows for transporting
waste.
15. Transport waste through a predefined route within the Hospital.
16. Mutilate the needle soon after injection.
17. Mutilate plastic waste (solid waste) as soon as it is generated.
18. Disinfect needle and solid waste (plastic) after mutilation.
19. Dispose body parts in yellow bin and handover to Common Bio Medical
Waste Treatment Facility for incineration.
20. Before handing over to CBMWTF for disposal, wastes sharps should be kept
in white translucent bin filled with disinfectant solution.
21. All liquid chemical waste should be drained out in to drains only after
chemical treatment.
Don’ts
1. Do not generate waste unnecessary for e.g. avoid injection by prescribing oral
medicines.
2. Never mix infectious and non- infectious waste
3. Never mix chlorinated wastes with such wastes those which have designated for
incineration.
4. Never overfill the bins.
5. Never store waste beyond 48 hrs.
6. There should not be any spillage on the way of transport.
7. Avoid transport of waste through crowded areas. Do not throw infectious waste
into general waste without any pretreatment and mutilation.
8. Don’t dispose the body part into deep burial where population is above 5lakh.
9. Don’t dispose the solid waste (plastic) and sharp waste without mutilation and
disinfection.
Question:
1. Which photographs (1 to 27) presented below reflects right action and which is
wrong action? Give reasons?
74
1 2
3 4
5 6 7
8 9 10
11 12 13
75
15 16
14
17 18 19
20 21 22
23
24 25
26 27
76
Annexure - 1
Bio- Medical Waste (Management and Handling) Rules, 1998 and Amendments
S.O. 630 (E).-Whereas a notification in exercise of the powers conferred by Sections

6, 8 and 25 of the Environment (Protection) Act, 1986 (29 of 1986) was published in
the Gazette vide S.O. 746 (E) dated 16 October, 1997 inviting objections from the
public within 60 days from the date of the publication of the said notification on the
Bio-Medical Waste (Management and Handling) Rules, 1998 and whereas all
objections received were duly considered..
Now, therefore, in exercise of the powers conferred by section 6, 8 and 25 of the

Environment (Protection) Act, 1986 the Central Government hereby notifies the rules
for the management and handling of bio-medical waste.
1. SHORT TITLE AND COMMENCEMENT:
(1) These rules may be called the Bio-Medical Waste (Management and
Handling)(Second Amendment ) Rules, 2003.
(2) They shall come into force on the date of their publication in the
official Gazette.
2. APPLICATION:
These rules apply to all persons who generate, collect, receive, store, transport,
treat, dispose, or handle bio medical waste in any form.
3. DEFINITIONS: In these rules unless the context otherwise requires
(1) "Act" means the Environment (Protection) Act, 1986 (29 of 1986);
(2) "Animal House" means a place where animals are reared/kept for
experiments or testing purposes;
(3 "Authorisation" means permission granted by the prescribed authority
for the generation, collection, reception, storage, transportation,
treatment, disposal and/or any other form of handling of bio-medical
waste in accordance with these rules and any guidelines issued by the
Central Government.
(4) "Authorised person" means an occupier or operator authorised by the
prescribed authority to generate, collect, receive, store, transport, treat,
dispose and/or handle bio-medical waste in accordance with these rules
and any guidelines issued by the Central Government;
(5) "Bio-medical waste" means any waste, which is generated during the
diagnosis, treatment or immunisation of human beings or animals or in
research activitiescategories mentioned in Schedule I;
(6) "Biologicals" means any preparation made from organisms or micro-
organisms or product of metabolism and biochemical reactions
intended for use in the diagnosis, immunisation or the treatment of
human beings or animals or in research activities pertaining thereto;
77
(7) "Bio-medical waste treatment facility" means any facility wherein

treatment. disposal of bio-medical waste or processes incidental to
Such treatment or disposal is carried out and includes common
treatment facilities.
7 (a) “Form” means Form appended to these Rules
(8) "Occupier" in relation to any institution generating bio-medical waste,
which includes a hospital, nursing home, clinic dispensary, veterinary
institution, animal house, pathological laboratory, blood bank by
whatever name called, means a person who has control over that
institution and/or its premises;
(9) "Operator of a bio-medical waste facility" means a person who owns or
controls or operates a facility for the collection, reception, storage,
transport, treatment, disposal or any other form of handling of bio-
medical waste;
(10) "Schedule" means schedule appended to these rules;
4. DUTY OF OCCUPIER:
It shall be the duty of every occupier of an institution generating bio-medical waste

which includes a hospital, nursing home, clinic, dispensary, veterinary institution,
animal house, pathological laboratory, blood bank by whatever name called to take all
steps to ensure that such waste is handled without any adverse effect to human health
and the environment.
5. TREATMENT AND DISPOSAL
(1) Bio-medical waste shall be treated and disposed of in accordance with

Schedule I, and in compliance with the standards prescribed in
Schedule V.
(2) Every occupier, where required, shall set up in accordance with the
time- schedule in Schedule VI, requisite bio-medical waste treatment
facilities like incinerator, autoclave, microwave system for the
treatment of waste, or, ensure requisite treatment of waste at a
common waste treatment facility or any other waste treatment facility.
6. SEGREGATION, PACKAGING, TRANSPORTATION AND STORAGE
(1) Bio-medical waste shall not be mixed with other wastes.

(2) Bio-medical waste shall be segregated into containers/bags at the point
of generation in accordance with Schedule II prior to its storage,
transportation, treatment and disposal. The containers shall be labeled
according to Schedule III.
(3) If a container is transported from the premises where bio-medical
waste is generated to any waste treatment facility outside the premises,
the container shall, apart from the label prescribed in Schedule III, also
carry information prescribed in Schedule IV.
(4) Notwithstanding anything contained in the Motor Vehicles Act, 1988,
or rules there under, untreated biomedical waste shall be transported
only in such vehicle as may be authorised for the purpose by the
competent authority as specified by the government.
78
(5) No untreated bio-medical waste shall be kept stored beyond a period of

48 hours Provided that if for any reason it becomes necessary to store
the waste beyond such period, the authorised person must take
permission of the prescribed authority and take measures to ensure that
the waste does not adversely affect human health and the environment.
(6) The Municipal body of the area shall continue to pick up and transport
segregated non bio-medical solid waste generated in hospitals and
nursing homes, as well as duly treated bio-medical wastes for disposal
at municipal dump site.
7. PRESCRIBED AUTHORITY
(1) The prescribed authority for enforcement of the provisions of these rules
shall be the State Pollution Control Boards in respect of States and the
Pollution Control Committees in respect of the Union territories and all
pending cases with a prescribed authority appointed earlier shall stand
transferred to the concerned State Pollution Control Board, or as the case may
be, the Pollution Control Committees.
(1A). The prescribed authority for enforcement of the provisions of these rules
in respect of all health care establishments including hospitals, nursing homes,
clinics, dispensaries, veterinary institutions, Animal houses, pathological
laboratories and blood banks of the Armed Forces under the Ministry of
Defence shall be the Director General, Armed Forces Medical Services.
(2) The prescribed authority for the State or Union Territory shall be
appointed within one month of the coming into force of these rules.
(3) The prescribed authority shall function under the supervision and
control of the respective Government of the State or Union Territory.
(4) The prescribed authority shall on receipt of Form 1 make such enquiry
as it deems fit and if it is satisfied that the applicant possesses the
necessary capacity to handle bio-medical waste in accordance with
these rules, grant or renew an authorisation as the case may be.
(5) An authorisation shall be granted for a period of three years, including
an initial trial period of one year from the date of issue. Thereafter, an
application shall be made by the occupier/operator for renewal. All
such subsequent authorisation shall be for a period of three years. A
provisional authorisation will be granted for the trial period, to enable
the occupier/operator to demonstrate the capacity of the facility.
(6) The prescribed authority may after giving reasonable opportunity of
being heard to the applicant and for reasons thereof to be recorded in
writing refuse to grant or renew authorisation.
(7) Every application for authorisation shall be disposed of by the
prescribed authority within ninety days from the date of receipt of the
application.
(8) The prescribed authority may cancel or suspend an authorisation, if for
reasons, to be recorded in writing, the occupier/operator has failed to
comply with any provision of the Act or these rules : Provided that no
authorisation shall be cancelled or suspended without living a
reasonable opportunity to the occupier/operator of being heard.
79
8. AUTHORISATION
(1) Every occupier of an institution generating, collecting, receiving,

storing, transporting, treating, disposing and/or handling bio-medical
waste in any other manner, except such occupier of clinics,
dispensaries, pathological laboratories, blood banks providing
treatment/service to less than 1000 (one thousand) patients per month,
shall make an application in Form 1 to the prescribed authority for
grant of authorisation.
(2) Every operator of a bio-medical waste facility shall make an
application in Form 1 to the prescribed authority for grant of
authorisation.
(3) Every application in Form 1 for grant of authorisation shall be
accompanied by a fee as may be prescribed by the Government of the
State or Union Territory.
(4) The authorization to operate a facility shall be issued in Form IV,
subject to conditions laid therein and such other condition, as the
prescribed authority, may consider it necessary.
9. ADVISORY COMMITTEE
(1) The Government of every State/Union Territory shall constitute an

advisory committee. The committee will include experts in the field of
medical and health, animal husbandry and veterinary sciences, environmental
management, municipal administration, and any other related department or
organisation including non-governmental organisations. As and when
required, the committee shall advise the Government of the State/Union
Territory and the prescribed authority bout matters related to the
implementation of these rules.
(2) Not with standing anything contained in sub-rule ( 1) , the Ministry of

Defence shall constitute in that Ministry, an Advisory Committee consisting of
the following in respect of all health care establishments including hospitals,
nursing homes, clinics, dispensaries, veterinary institutions, animal houses,
pathological laboratories and blood banks of the Armed Forces under the
Ministry of Defence , to advise the Director General, Armed Forces Medical
Services and the Ministry of Defence in matters relating to implementation of
these rules, namely:-
(1) Additional Director General of

Armed Forces Medical Services …….. Chairman
(2) A representative of the Ministry of

Defence not below the rank of Deputy
Secretary, to be nominated by that Ministry …….. Member
(3) A representative of the Ministry of Environment

and Forests not below the rank of Deputy Secretary
To be nominated by that Ministry ...…….. Member
80
(4) A representative of the Indian Society of

Hospitals Waste Management, Pune ….….... Member”
9A. Monitoring of implementation of the rules in Armed Forces Health Care

Establishments
(1) The Central Pollution Control Board shall monitor the implementation of
these rules in respect of all the Armed Forces health care establishments under
the Ministry of Defence.
(2) After giving prior notice to the Director General Armed Forces Medical
Services, the Central Pollution Control Board along with one or more
representatives of the Advisory committee constituted under sub-rule (2) of
rule 9 may, if it considers it necessary, inspect any Armed Forces health are
establishments.
10. ANNUAL REPORT
Every occupier/operator shall submit an annual report to the prescribed authority in

Form 11 by 31 January every year, to include information about the categories and
quantities of bio-medical wastes handled during the preceding year. The prescribed
authority shall send this information in a compiled form to the Central Pollution
Control Board by 31 March every year.
11. MAINTENANCE OF RECORDS
(1) Every authorised person shall maintain records related to the

generation, collect ' ion, reception, storage, transportation, treatment,
disposal and/or any form of handling of bio-medical waste in
accordance with these rules and any guidelines issued.
(2) All records shall be subject to inspection and verification by the
prescribedauthority at any time.
12. ACCIDENT REPORTING
When any accident occurs at any institution or facility or any other site where bio-
medical waste is handled or during transportation of such waste, the authorised person
shall report the accident in Form Ill to the prescribed authority forthwith.
13. APPEAL
(1) Any person aggrieved by an order made by the prescribed authority under
these rules may, within thirty days from the date on which the order is
communicated to him, prefer an appeal in form V to such authority as the
Government of State/Union Territory may think fit to constitute:
Provided that the authority may entertain the appeal after the expiry of the said
period of thirty days if it is satisfied that the appellant was prevented by
sufficient cause from filing the appeal in time.
81
(2) Any person aggrieved by an order of the Director General, Armed Forces
Medical Services under these rules may, within thirty days from the date on
which the order is communicated to him prefer an appeal to the Central
Government in the Ministry of Environment and Forests.”.
14. COMMON DISPOSAL/INCINERATION SITES.
Without prejudice to rule 5 of these rules, the Municipal Corporations, Municipal

Boards or Urban Local Bodies, as the case may be, shall be responsible for providing
suitable common disposal/incineration sites for the biomedical wastes generated in the
area under their jurisdiction and in areas outside the jurisdiction of any municipal
body, it shall be the responsibility of the occupier generating bio-medical
waste/operator of a bio-medical waste treatment facility to arrange for suitable sites
individually or in association, so as to comply with the provisions of these rules
SCHEDULE I
(See Rule 5)
Waste Waste Category Type Treatment and

Category Disposal Option+
Category No. 1 Human Anatomical Waste (body parts, organs, Incineration @ /
human tissues etc.). deep burial*
Category No. 2 Animal Waste (animal tissues, organs, body parts Incineration @ /
carcasses, bleeding parts, fluid, blood and deep burial*
experimental animals used in research, waste
generated by veterinary hospitals, colleges,
discharge from hospitals, animal houses).
Category No. 3 Microbiology & Biotechnology Waste (Wastes Local autoclaving /
from laboratory cultures, stocks or micro-organisms micro waving /
live or vaccines, human and animal cell culture used incineration @
in research and infectious agents from research and
industrial laboratories, wastes from production of
biologicals, toxins, dishes and devices used for
transfer of cultures).
Category No. 4 Waste Sharps (needles, syringes, scalpels, blade, Disinfection
glass, etc. that may cause puncture and cuts. This (chemical treatment
includes both used and unused sharps). @ @ / autoclaving /
micro waving and
mutilation /
shredding ##
Category No. 5 Discarded Medicines and Cytotoxic drugs (Waste Incineration @ /
comprising of outdated, contaminated and discarded destruction and
medicines). drugs disposal in
secured landfills
Category No. 6 Soiled Waste (items contaminated with blood, and Local autoclaving /
body fluids including cotton, dressings, soiled micro waving /
plaster casts, lines, bedding, other material incineration @
82

Category No. 7 Solid Waste (Waste generated from disposal items Disinfection by
other than the sharps such a tubings, catheters, chemical treatment
intravenous sets etc.). @ @ autoclaving /
micro waving and
mutilation/
shredding ##
Category No. 8 Liquid Waste (Waste generated from laboratory Disinfection by
and washing, cleaning, housekeeping and chemical treatment
disinfecting activities). @ @ and discharge
into drains
Category No. 9 Incineration Ash (Ash from incineration of any Disposal in
bio-medical waste). municipal landfill
CategoryNo.10 Chemical Waste (Chemicals used in production of Disinfection by
biologicals, chemicals used in disinfection, as chemical treatment
insecticides, etc.). @ @ and discharge
into drains for
liquids and secured
land fill for solids
Note
@ There will be no chemical pretreatment before incineration. Chlorinated plastics
shall not be incinerated.
*Deep burial shall be an option available only in towns with population less than five
lakhs and in rural areas.
@@ Chemicals treatment using at least 1% hypochlorite solution or any other
equivalent chemical reagent. It must be ensured that chemical treatment ensures
disinfection
## Mutilation / shredding must be such so as to prevent un authorized reuse.
+ Options given above are based on available technologies. Occupier / operator
wishing to use other state of the art technologies shall approach the Central Pollution
Control Board to get the standards laid down to enable the prescribed authority to
consider grant of authorization.
83
SCHEDULE-II
(See Rule 6)
COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL
OF BIOMEDICAL WASTES
Color Type of Waste Category Treatment options as per

Coding Container Schedule I
Yellow Plastic bag. Cat. 1, Cat. 2, and Incineration/deep burial
Cat. 3, Cat. 6
Red Disinfected Cat. 3, Cat.6, Cat.7. Autoclaving / Micro waving /
container / plastic Chemical Treatment
bag
Blue / White Plastic bag / Cat. 4, Cat. 7. Autoclaving / Micro waving /
Translucent puncture proof Chemical Treatment and
Container Destruction / shredding
Black Plastic bag Cat. 5 and Cat. 9 Disposal in secured landfill
and Cat. 10. (Solid)
Note:
1. Colour coding of waste categories with multiple treatment options as defined in

Schedule I, shall be selected depending on treatment option chosen, which shall be
as
specified in Schedule I
2. Waste collection bags for waste types needing incineration shall not be made of
chlorinated plastics
3. Categories 8 and 10 (liquid) do not require containers / bags.
4. Category 3 if disinfected locally need not be put in containers / bags.
SCHEDULE-III
(See Rule 6)
Label for Bio Medical Waste Containers/ Bags
BIOHAZARDS
C
CYTOTOXIC
CYTOTOXIQUE
HANDLE WITH CARE

Note : Lable shall be non-washable and prominently visible.
84
SCHEDULE IV
(see Rule 6)
LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE
CONTAINERS/BAGS
Day ............ Month ..............

Year ...........
Date of generation ...................
Waste category No ........
Waste class
Waste description
Sender's Name & Address Receiver's Name & Address
Phone No ........ Phone No ...............
Telex No .... Telex No ...............
Fax No ............... Fax No .................
Contact Person ........ Contact Person .........
In case of emergency please contact
Name & Address :
Phone No.
Note : Label shall be non-washable and prominently visible.
SCHEDULE V
(see Rule 5 and Schedule 1)
STANDARDS FOR TREATMENT AND DISPOSAL OF BIO-MEDICAL

WASTES
STANDARDS FOR INCINERATORS:
All incinerators shall meet the following operating and emission standards
A. Operating Standards
1. Combustion efficiency (CE) shall be at least 99.00%.
2. The Combustion efficiency is computed as follows:
%C02
C.E. = ------------ X 100
%C02 + % CO
3. The temperature of the primary chamber shall be 800 ± 50 deg. C°.
4. The secondary chamber gas residence time shall be at least I (one) second at 1050 ±
50 C°, with
minimum 3% Oxygen in the stack gas.
B. Emission Standards
Parameters Concentration mg/Nm3 at (12% CO2 correction)
(1) Particulate matter 150

(2) Nitrogen Oxides 450
(3) HCI 50
(4) Minimum stack height shall be 30 metres above ground
(5) Volatile organic compounds in ash shall not be more than 0.01%
85
Note :
• Suitably designed pollution control devices should be installed/retrofitted with
the incinerator to achieve the above emission limits, if necessary.
• Wastes to be incinerated shall not be chemically treated with any chlorinated
disinfectants. Chlorinated plastics shall not be incinerated.
• Toxic metals in incineration ash shall be limited within the regulatory
quantities as defined under the Hazardous Waste (Management and Handling
Rules,) 1989.
• Only low sulphur fuel like L.D.0dLS.H.S.1Diesel shall be used as fuel in the
incinerator.
STANDARDS FOR WASTE AUTOCLAVING:
The autoclave should be dedicated for the purposes of disinfecting and treating bio-
medical waste,
(I) When operating a gravity flow autoclave, medical waste shall be subjected to:
(i) a temperature of not less than 121 C' and pressure of 15 pounds per square
inch (psi) for an autoclave residence time of not less than 60 minutes; or
(ii) a temperature of not less than 135 C° and a pressure of 31 psi for an
autoclave residence time of not less than 45 minutes; or
(iii) a temperature of not less than 149 C° and a pressure of 52 psi for an
autoclave residence time of not less than 30 minutes.
(II) When operating a vacuum autoclave, medical waste shall be subjected to a

minimum of one pre-vacuum pulse to purge the autoclave of all air. The waste
shall be subjected to the following:
(i) a temperature of not less than 121 C° and pressure of 15 psi per an
autoclave residence time of not less than 45 minutes; or
(ii) a temperature of not less than 135 C° and a pressure of 31 psi for an
autoclave residence time of not less than 30 minutes;
(III) Medical waste shall not be considered properly treated unless the time,
temperature and pressure indicators indicate that the required time, temperature and
pressure were reached during the autoclave process. If for any reasons, time
temperature or pressure indicator indicates that the required temperature, pressure or
residence time was not reached, the entire load of medical waste must be autoclaved
again until the proper temperature, pressure and residence time were achieved.
(IV) Recording of operational parameters

Each autoclave shall have graphic or computer recording devices which will
automatically and continuously monitor and record dates, time of day, load
identification number and operating parameters throughout the entire length of the
autoclave cycle.
(V) Validation test

Spore testing :
The autoclave should completely and consistently kill the approved biological
86
indicator at the maximum design capacity of each autoclave unit. Biological indicator
for autoclave shall be Bacillus stearothermophilus spores using vials or spore Strips;
with at least 1X104 spores per milliliter. Under no circumstances will an autoclave
have minimum operating parameters less than a residence time of 30 minutes,
regardless of temperature and pressure, a temperature less than 121 C° or a pressure
less than 15 psi.
VI) Routine Test

A chemical indicator strip/tape the changes colour when a certain temperature is
reached can be used to verify that a specific temperature has been achieved. It may be
necessary to use more than one strip over the waste package at different location to
ensure that the inner content of the package has been adequately autoclaved
STANDARD FOR LIQUID WASTE:
The effluent generated from the hospital should conform to the following limits
PARAMETERS PERMISSIBLE LIMITS

PH 63-9.0
Susponded solids 100 mg/l
Oil and grease 10 mg/l
BOD 30 mg/l
COD 250 mg/l
Bioassay test 90% survival of fish after 96 hours in 100%
effluent.
These limits are applicable to those, hospitals, which are either connected with sewers
STANDAR DS OF MICROWAVING
1 Microwave treatment shall not be used for cytotoxic, hazardous or radioactive

wastes, contaminated animal car cases, body parts and large metal items.
2. The microwave system shall comply with the efficacy test/routine tests and a
Performance guarantee may be provided by the supplier before operation of the
limit.
3. The microwave should completely and consistently kill the bacteria and other
pathogenic organisms that is ensured by approved biological indicator at the
maximum design capacity of each microwave unit. Biological indicators for
microwave shall be Bacillus Subtilis spores using vials or spore strips with at least
1 x 101 spores per milliliter.
STANDARDS FOR DEEP BURIAL
1. A pit or trench should he dug about 2 meters deep. It should be half filled with
waste, then covered with lime within 50 cm of the surface, before filling the rest of
the pit with soil.
87
2. It must be ensured that animals do not have any access to burial sites. Covers of
galvanised iron/wire meshes may be used.
3. On each occasion, when wastes are added to the pit, a layer of 10 em of soil shall
be added to cover the wastes.
4. Burial must be performed under close and dedicated supervision.
5. The deep burial site should be relatively impermeable and no shallow well should
be close to the site.
6. The pits should be distant from habitation, so as to ensure that no contamination
occurs of any surface water or ground water. The area should not be prone to
flooding or erosion.
7. The location of the deep burial site will be authorised by the prescribed authority.
8. The institution shall maintain a record of all pits for deep burial.
SCHEDULE VI
(see Rule 5)
SCHEDULE FOR WASTE TREATMENT FACILITIES

LIKE INCINERATOR/ AUTOCLAVE / MICROWAVE SYSTEM
A. Hospitals and nursing homes in towns with by 30th June,2000 or earlier

population of 30 lakhs and above
B. Hospitals and nursing homes in towns

with population of below 30 lakhs
(a) With 500 beds and above by 30th June, 2000 or earlier
(b) With 200 beds and above but
less than 500 beds by 31st December, 2000 or earlier
(c) With 50 beds and above but
less than by 31st December, 2001 or earlier
200 beds
(d) With less than 50 beds by 31st December, 2002 or earlier
C. All other institutions generating
bio- medical waste not included in by 31st December, 2002 or earlier
A and B above
88
FORM I
(see rule 8)
[APPLICATION FOR AUTHORISATION /RENEARL OF
AUTHORISATION]
(To be submitted in duplicate.)
To
The Prescribed Authority
(Name of the State Govt / UT Administration)
Address.
1. Particulars of Applicant
(i) Name of the Applicant
(In block letters & in full)
(ii) Name of the Institution:
Address:
Tele No., Fax No. Telex No.
2. Activity for which authorisation is sought:
(i) Generation
(ii) Collection
(iii) Reception
(iv) Storage
(v) Transportation
(vi) Treatment
(vii) Disposal
(viii) Any other form of handling
3. Please state whether applying for fresh authorisation or for renewal:

(In case of renewal previous authorisation-number and date)
4. (i) Address of the institution handling bio-medical wastes:
(ii) Address of the place of the treatment facility:
(iii) Address of the place of disposal of the waste:
5. (i) Mode of transportation (in any) of bio-medical waste:

(ii) Mode(s) of treatment:
6. Brief description of method of treatment and disposal (attach details):
7. (i) Category (see Schedule 1) of waste to be handled

(ii) Quantity of waste (category-wise) to be handled per month
8. Declaration
I do hereby declare that the statements made and information given above are true to
the best of my knowledge and belief and that I have not concealed any information. I
do also hereby undertake to provide any further information sought by the prescribed
authority in relation to these rules and to fulfill any conditions stipulated by the
prescribed authority.
Date : Signature of the Applicant
Place : Designation of the Applicant
89
FORM II
(see rule 10)
ANNUALREPORT
(To be submitted to the prescribed authority by 31 January every year).
1 . Particulars of the applicant:

(i) Name of the authorised person (occupier/operator):
(ii) Name of the institution:
Address
Tel. No
Telex No.
Fax No.
2. Categories of waste generated and quantity on a monthly average basis:
3. Brief details of the treatment facility:
In case of off-site facility:
(i) Name of the operator
(ii) Name and address of the facility:
Tel. No., Telex No., Fax No.
4. Category-wise quantity of waste treated:
5. Mode of treatment with details:
6. Any other information:
7.Certified that the above report is for the period
from..……………………………….....…
Date ............................... Signature .................................
Place.............................. Designation.............................
FORM III
(see Rule 12)
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 …………………………
Date ............................... Signature ...........................................
Place.............................. Designation..........................................
90
References:
1. Bio Medical Waste (Management and Handling) Rules, 1998 and amendments
2. Guidelines for Common Bio-medical Waste Treatment Facility by Central
Pollution Control Board
3. Health Care Waste Management (HCWM) by WHO / Annette Pruess, E. Giroult,
P. Rushbrook
4. http://www.scribd.com/doc/14034406/BioMedical-Waste-
Management? autodown=doc
5. Training Manual- Training for workers in the management of sharp waste, version
1, October 2005 by USAID and PATH- www.nursingworld.org/occupational
6. Bio Medical Waste Management: An infra structural survey of hospitals
By Lt. Col. S.K.m.Rao et al
7. Shaner, H. et al. (1993) An Ounce of Prevention: Waste Reduction Strategies for
Health Care Facilities. American Society for Healthcare Environmental Services.
Chicago, IL. A Resource Kit for Pollution Prevention in Health Care.
8. www.nursingworld.org/occupational environmental American nurses association,
safe needle safe life 2008 study of nurses views on work place safety and needle
stick injury.
9. Safe Management of Waste From Health Care Activities
10. http://www.all creatures.org/wlalw/rat-01-jpg
11. British Journal of Industrial Medicine 1987- Occupational Hazards in Hospitals:
Accident, Radiation, Exposure to Noxious Chemicals, Drugs Addiction and
Psychic Problems and Assualt by J J Guestal
12. Preparation of National Health Care Waste Management Plans in Sub-Saharan
Countries- UNEP- SBC and WHO
13. National Health Care Waste Management Plan – Kingdom of Lesotho
14. Infection Prevention and Waste Management for Merrygold Health Network-
Participants Manual 2008- Supported by USAID,SIFPSA and Implemented by
HLFPPT
91

Chemical Safety Bio-Medical Waste Management Self Learning Document For Doctors, Superintendents and Administrators

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BIO-MEDICAL WASTE MANAGEMENT-

SELF LEARNING DOCUMENT FOR

ENVIRONMENT PROTECTION TRAINING AND RESEARCH

Dr. Razia Sultana

Content Page No.

Annex 1 Bio-Medical waste (Management and Handling) Rules and Amendment…77

Bio-Medical Waste Management- Self Learning Document For

About the Manual:

It is to be understood that management of bio medical waste is an integral part of

Bio-Medical Waste Management - Self Learning Document

About this Module -

• To define the bio-medical waste.

1.1 Definition of Bio-Medical Waste:

As per Bio-Medical Waste (Management and Handling) Rules, 1998 and

1.2 Risks to Personnel Due to Bio-Medical Waste:

1.3 Dangers of improper Management of Bio-Medical Waste:

the possibility of survival, proliferation and mutation of pathogenic microbial

WHO has estimated that, in 2000, injections with

1. Define bio-medical waste?

2. Regulations on Bio-medical Waste Management

About this Module -

• To know various rules governing waste management.

Establishment of a sustainable bio-medical waste management system

2.1 National Legislations Governing Waste Management:

2.2 Excerpts from Bio- Medical Waste (Management and Handling)

No untreated bio-medical waste shall be kept stored beyond a period of 48 hours,

Every occupier of an institution generating, collecting, receiving, storing,

• Bio-medical waste shall not be mixed with other wastes.

The Treatment and Disposal of bio-medical waste shall be in accordance with

Category No. 9 Incineration Ash (Ash from incineration of any Disposal in

HANDLE WITH CARE

3. Role of Doctors, Medical Superintendent and Administrators

About this Module -

• To enhance knowledge and skills on waste audit, waste minimization,

Dealing bio-medical waste in safe manner is the responsibility of all

with regulatory notifications. Estimate the amount of non-infectious and infectious

3.1 Planning and Designing of Bio- Medical Waste Management:

3.1.1 Unit Wise Generation of Bio- Medical Waste:

Depending on the services offered by hospitals or health care establishments, there

Unit Waste Generation

General Units in Hospitals

3.1.2 Waste Audit and Waste Minimization:

discarded for recycling industries. Long-term radionuclides conditioned as pins,

Units in Hospitals - Assessment of Waste Generation and Waste Audit

3.1.3 Items and Equipments Required for Bio- Medical Waste

Items And Equipments Required For Bio-Medical Waste Management

Gloves Boots or closed-toe Shoes Over garment / Apron

Waste Segregation Bags and Bins

Dedicated Trolley Scissors and Disinfection Solution

Temporary Central Storage Room

Deep Burial Incinerator

Waste Water Treatment Plant

3.1.4 Placement of Required Items:

Unit Requirement and Placement in Units

3.1.5 Designing the Movement of Bio- Medical Waste:

3.1.6 Formation of Committee for Bio- Medical Waste Management:

The committee should ensure technically feasible, environmentally sound,

3.2 Reducing Risk of Disease Transmission and Response to Accidents:

• Be aware of procedures for treatment of injuries, cleaning of contaminated

• Gloves-always wear gloves when contaminated items are handled. Puncture-

• Boots or closed-toe shoes- rubber boots or leather shoes provide extra

6. Provide first aid and medical care to injured individuals.