IMAGE- CBWTDF

Manthuruthy,Kanjikode,Pkd

IMAGE is a prestigious scheme of Indian Medical

Association, Kerala State Branch (IMAKSB). IMAGE has
been developed for the scientific handling and
management of biomedical waste generated from health
care facilities in Kerala.

IMAGE commenced operations in 2004 and is presently the

largest CBMTDF (Common Biomedical Waste Treatment and
Disposal facility) in India and the only one managed by IMA.
 Kerala is having 27% of the total Hospitals in
India, which is the highest among all states.

 Total registered Bed strength in Kerala 135000.

 Two third of the total waste is being disposed

through IMAGE.
 PRESENT SCENARIO
(SOME PARTS OF INDIA)
 Incorrect disposal of health care waste
creates other health risks
WHO estimated that, in 2000, contaminated injections with
contaminated syringes caused:
 21 million hepatitis B virus (HBV) infections (32% of all new
infections);
 two million hepatitis C virus (HCV) infections (40% of all new
infections); and
 at least 260 000 HIV infections (5% of all new infections).
Disposable items are often recycled and have the risk of being used
illegally. Mutilation before disposal should be the policy adopted
for such items.
 HEALTH RISKS IN IMPROPER
BIO-MEDICAL WASTE MANAGEMENT
 Solution
Effective Management and Scientific Disposal of Biomedical Waste
 HOSPITAL WASTE

NON INFECTIOUS WASTE INFECTIOUS WASTE

NON BIO DEGRADABLE BIO MEDICAL

LIQUID WASTE
WASTE WASTE

Hazardous
BIO DEGRADABLE Infectious
Waste Waste
Composition of SolidWaste
0%
WASTE 5% 10%

General
Waste
85% Total Solids - 2kg/bed/day

Biomedical - 300 gm/bed/day

Why Hospital Waste Segregation is
more Important ?
80% of Hospital Waste is non infectious (kitchen waste, paper)

15% of Hospital Waste is infectious (dressings, anatomical wastes, blood

bags)

5% is non infectious but hazardous (chemicals, drugs and mercury)

When this 20% of the hospital infectious material is mixed with

80%, then all the 100% waste becomes hazardous and infectious,
hence segregation should be done at source
 BIO-MEDICAL WASTE &
BMW(M) RULES – 2016
G.O.I, Ministry Of Environment, Forest And Climate Change Notification
G.S.R. 343(E) dated 28.03.2016
 Definition
“bio-medical waste" means any waste, which is generated
during the diagnosis, treatment or immunisation of human
beings or animals or research activities pertaining thereto or
in the production or testing of biological or in health camps

 Application
These rules shall apply to all persons who generate, collect,
receive, store, transport, treat, dispose, or handle bio
medical waste in any form.
BIO-MEDICAL WASTE MANAGEMENT RULES, 2016
BMW M (Amendment) Rules - 2018
Duties of Occupier
 Safe handling of BMW
 Segregation & Safe Storage in Colour coded containers/
Bags
 Make provision for a secured storage of Segregated
Biomedical waste
 Pre-treat Laboratory, Microbiological wastes, Blood samples
& Blood bags
 Phase out Chlorinated Plastic Bags & Gloves
 Training, Safety & Immunisation of staff (Hepatitis B,
Tetanus)
 Treatment & Disposal of Liquid waste
 Maintain records of BMW Management
 BMW M Rules 2016
Duties of Operator (CBMWTF)
 Timely Collection & Safe transportation, handling, storage, treatment &
disposal of BMW
 Establish Barcoding for handling BMW
 Establish GPS for Vehicles handling BMW

 Inform authority on HCEs not handing over segregated BMW

 Recyclables from treated BMW given to recyclers authorised by PCB

 Supply non-chlorinated bags to HCEs on chargeable basis

 Training, Safety & Immunisation of staff (Hepatitis B, Tetanus)

 Maintain records of BMW Treatment & Disposal
BIOMEDICAL WASTE MANAGEMENT
PROCESS
1. Segregation at Source
2. Collection in Uniform Color coding
3. Transportation to the Final storage area
4. Storage in a Exclusive Storage Room
5. Transportation to CBWTDF
6. Scientific Treatment
7. Final Disposal
BMW – SEGREGATION & PACKAGING
4 CATEGORIES
BMW CATEGORIES
(Segregation)
 Category 1 - YELLOW

 Category 2 - RED

 Category 3 - WHITE

 Category 4 - BLUE
 BMW – SEGREGATION & PACKAGING
4 CATEGORIES

YELLOW RED WHITE BLUE

(Incinerable) (Autoclavable) (Sharps) (Glass & Metals)
 BMW RULES – SCHEDULE I
Biomedical wastes categories and their segregation, collection,
treatment, processing and disposal options

Type of Bag or Treatment and

Category Type of Waste Container to be Disposal options
Used
1 2 3 4
Yellow (a) Human Anatomical Yellow coloured Incineration or
Waste: non-chlorinated Plasma Pyrolysis or
Human tissues, organs, plastic bags deep burial*
body parts and fetus
below the viability
period (as per the
Medical Termination of
Pregnancy Act 1971,
amended from time to
time).
Category Type of Waste
used
Yellow (b)Animal Anatomical Waste:
Experimental animal
carcasses,body
parts,organs,tissues,including
the waste generated from
animals used in experiments or
testing in veterinary hospitals or
colleges or animal housesanimals
used in
(c) Soiled Waste:
Items contaminated with blood,
body fluids like dressings, plaster
casts, cotton swabs and bags
containing residual or discarded
blood and blood components
generated from
animals used in
experiments or testing
in veterinary hospitals
or colleges or animal
houses.
Container to be options
Yellow coloured Incineration or Plasma
non-chlorinated Pyrolysis or
plastic bags Deep burial*
Incineration or
Plasma Pyrolysis or
deep burial*. In absence of
above facilities, autoclaving
or micro-waving/
hydroclaving followed by
shredding or mutilation or
combination of sterilization
and shredding. Treated
waste to be sent for energy
recovery.
Category Type of Waste Type of Bag or Treatment and Disposal options
Container to be
used

Yellow (d) Expired or Yellow coloured Expired `cytotoxic drugs and

Discarded Medicines: non-chlorinated items contaminated with
Pharmaceutical waste plastic bags or cytotoxic drugs to be returned
like antibiotics, containers back to the manufacturer or
cytotoxic drugs supplier for incineration at
including all items temperature
contaminated with >1200 0’C or to common bio-
cytotoxic drugs along medical waste treatment facility
with glass or plastic or hazardous waste treatment,
ampoules, vials etc storage and disposal facility for
incineration at >1200 0’C Or
Encapsulation or Plasma Pyrolysis
at >1200 0C.
All other discarded medicines
shall be either sent back to
manufacturer or disposed by
incineration.
Category Type of Waste Type of Bag or Treatment and Disposal
Container to be options
used
Yellow (e) Chemical Waste: Yellow coloured Disposed of by
Chemicals used in containers or incineration or Plasma
production of biological non-chlorinated Pyrolysis or
and used or discarded plastic bags Encapsulation in
disinfectants. hazardous waste
treatment, storage and
disposal facility.
(f) Chemical Liquid Waste : Separate collection After resource recovery,
Liquid waste generated due to system leading the chemical liquid
use of chemicals in production of to effluent waste shall be pre-
biological and used or discarded treatment system treated before
disinfectants, Silver X-ray film mixing with other
developing liquid, discarded wastewater. The
Formalin, infected secretions, combined discharge shall
aspirated body fluids, liquid from conform to the discharge
laboratories and floor washings, norms given in Schedule-
cleaning, house-keeping and III.
disinfecting activities etc
 Container to options
be used
ellow (g) Discarded linen, mattresses, Non Non- chlorinated chemical
beddings contaminated with blood or chlorinated disinfection followed by
body fluid yellow plastic incineration or Plazma
bags or Pyrolysis or for energy
suitable recovery.
packing In absence of above facilities,
material shredding or mutilation or
combination of sterilization
and shredding. Treated waste
to be sent for energy recovery
or incineration or Plazma
Pyrolysis
h) Microbiology, Biotechnology and Autoclave safe Pre-treat to sterilize with non
other clinical laboratory waste: plastic bags or chlorinated
Blood bags, Laboratory cultures, containers chemicals on-site as per
stocks or specimens of National AIDS Control
microorganisms, live or attenuated Organisation or
vaccines, human and animal cell World Health Organisation
cultures used in research, industrial guidelines there after for
laboratories, production of biological, Incineration
residual toxins, dishes and devices
used for cultures
YELLOW BUCKETS
(With Yellow Colour Coded Bags Inside)

INCINERABLE WASTE

• HUMAN BODY PARTS

• ITEMS CONTAMINATED WITH BLOOD & BODY FLUIDS
(WOUND DRESSING MATERIALS, BANDAGES, COTTON SWABS, POP Casts)
• DISCARDED LINEN, BEDDINGS CONTAMINATED WITH BLOOD OR BODY
FLUID
• MICROBIOLOGY, BIOTECHNOLOGY & CLINICAL LAB WASTE (Pre-treated)
• FACE MASK & GOWN
• DISCARDED MEDICINES (TABLETS & CAPSULES ONLY) - NO BOTTLES
• CYTOTOXIC DRUGS
SEGREGATION POSTER TO BE AFFIXED ON EACH COLOUR CODED BUCKETS /
CONTAINERS
COLOUR CODED BAGS/CONTAINERS (YELLOW)

BMW Consumables supplied by IMA PEPS Authorised Suppliers

Category Type of Waste
Red Contaminated Waste
(Recyclable)
(a) Wastes generated from
disposable items such as
tubing, bottles, intravenous
tubes and sets, catheters,
urine bags, syringes
(without needles and fixed
needle syringes) and
vaccutainers with their
needles cut) and gloves.
Type of Bag or Treatment and Disposal
Container to be used options
Red coloured Autoclaving or micro-
non-chlorinated waving/ hydroclaving
plastic bags or followed by shredding or
containers mutilation or combination
of sterilization and
shredding. Treated waste
to be sent to registered or
authorized recyclers or for
energy recovery or plastics
to diesel or fuel oil or for
road making, whichever is
possible.
Plastic waste should not be
sent to landfill sites
RED BUCKETS (With Red Colour Coded Bags Inside)
AUTOCLAVABLE
WASTES
• UROBAGS & CATHETERS
• FEEDING TUBES
• GLOVES
• INFUSION SETS
• PLASTIC IV BOTTLES
• PLASTIC MEDICINE BOTTLES
• SYRINGES & NEEDLE CAPS (without Needle)
• VACUTAINERS
• DISHES AND CONTAINERS
SEGREGATION POSTER TO BE AFFIXED ON EACH COLOUR CODED BUCKETS /
CONTAINERS

Category Type of Waste
White Waste sharps
including Metals:
Needles, syringes with
fixed needles, needles
from needle tip cutter or burner,
scalpels, blades, or any other
contaminated sharp
object that may cause
puncture and cuts. This includes
both used, discarded and
contaminated metal
sharps
Type of Bag or
Treatment and Disposal
Container to be
options
Used
Puncture proof, Autoclaving or Dry Heat
Leak proof, Sterilization followed by
tamper proof shredding or mutilation or
containers encapsulation in metal
container or cement
concrete; combination of
shredding cum
autoclaving; and sent for
final disposal to iron
foundries (having consent
to operate from the State
Pollution Control Boards
or Pollution
Control Committees) or
sanitary
landfill or designated
concrete waste sharp pit
SHARP CONTAINERS (WHITE)
(Puncture Proof, Leak Proof & Tamper Proof)

 NEEDLES (Fixed Needle Syringes Also)

 BLADES

 LANCETS

 OTHER SHARPS & SMALL METALLIC ITEMS

Category Type of Waste Type of Bag or Treatment and Disposal
Container to be used options

Blue (a) Glassware: Cardboard boxes Disinfection (by soaking

Broken or discarded and
contaminated glass including
medicine vials and ampoules
except
those contaminated with
cytotoxic wastes
with blue the washed glass waste
colored marking after cleaning with
detergent and Sodium
Hypochlorite treatment)
or through autoclaving or
microwaving or
hydroclaving and then
sent for recycling.

Blue (b) Metallic Body Cardboard boxes Disinfection (by soaking

Implants with blue the washed glass waste
colored marking after cleaning with
detergent and Sodium
Hypochlorite treatment)
or through autoclaving or
microwaving or
hydroclaving and then
sent for recycling.
 GLASS SHARPS

Ampoules

Vials

Glass Slides
Container with Blue colored marking
METALIC BODY IMPLANTS

Surgical Nails

Bolts & Nuts

Any Ortho Implants

 SEGREGATION
CRUCIAL PART IN BMW MANAGEMENT
BMW Generation sources in HCE’s
 Operation Theatres
 ICU/CCU/NICU
 Labour Rooms
 Casuality
 Nursing Stations & Wards
 Laboratories
 Dental chairs
 Immunisation Area
YELLOW COLOUR BINS / BAGS
(Type a,b,c,d,e,g,h)
Type a

Post Operative Organs,

Placenta, Tooth

Type b
Animal tissues, carcasses
 Type c

Soiled Cotton, Dressing Materials

Disposable face mask

Type d
Expired or Discarded Medicines

Type e
Chemical waste
 Type g
Discarded linen, mattresses,
beddings contaminated with
blood or body fluid.

Type h
Microbiology, Biotechnology
and other clinical laboratory
waste.
Disposable Culture plates &
containers
RED COLOUR BINS / BAGS

Syringes without needle

I V Sets

Catheters
Gloves

Urine Bags

IV Bottles

Dialysis Kits
 Puncture Proof /Tamper proof Container
METAL SHARPS

Needles

Syringes with fixed needles

Scalpels

Surgical Blades
 GLASS SHARPS

Ampoules

Vials

Glass Slides
Container with Blue colored marking
METALIC BODY IMPLANTS

Surgical Nails

Bolts & Nuts

Any Ortho Implants

 Schedule III
LABEL FOR BIOMEDICAL WASTE CONTAINERS/BAGS
The bins and bags should carry the biohazard symbol indicating
the nature of waste to the patients and public.

Biohazard CYTOTOXIC
HANDLE WITH CARE
Note : Label shall be non-washable and prominently visible
TRANSPORTATION to Central Storage Room
within the HCE

 The Biomedical waste should be transported by the

trained house keeping staff in the special closed trolley
bin designated for the purpose to the common storage
point.

 Under no circumstances, the biomedical waste should

spill in the premises or surroundings
INTERNAL TRANSPORTATION
 BIOMEDICAL WASTE STORAGE
 The biomedical waste should be stored in a Central Storage Room with Lock &
Key manned by a security Person. It has to be exclusively used for this purpose
only.
 QR Code provided by IMAGE to be displayed at the final storage point of HCE.
 Storage room should be cleaned and disinfected regularly.
 The bags stored in the room should be sealed properly using zip lock tags.
 The sealed yellow and red bags should be placed in the respective containers /
barrels at the central storage room.
 The Sharps should be kept in respective Puncture Proof containers
 Glassware and Metallic Implants (if any) to be kept in respective Blue containers
FINAL STORAGE POINT
 Role of Doctors, Nurses, Lab
technicians.
 Do not dispose dressings in patients bin / Ask
for disposal bags.
 Ensure all the plastics and gloves are cut.
 Ensure all used injections are cut using
needle cutters.
 Ensure compliance of this scheme during
ward visits.
 Help patients understand the scheme.
 DONT’S
Put the waste indiscriminately.
Put wrong bags in bin. (Adhere to colour code.)
Fill the bags till neck. (To avoid spill over.)
Handle waste without protective clothing.
Drag the bags after removal. (Bags can burst
and the site could be repulsive.)
Never re-cap the needle.
Mix non infectious waste with infectious waste.
 BMW COLLECTION

The Yellow Bags, Red Bags, Sharps, Glass & Metals in

the prescribed Containers are collected daily from all
bedded HCIs

Please ensure that protective wears like Gloves,Masks

and Boots are worn by the collection Staff
 TRANSPORTATION
 The Segregated waste to be kept at the
final storage point.
 QR Code to be displayed at the final
storage point.
 Closed Vehicle authorized by PCB for
collection.
 After scanning QR Code details of
Biomedical waste collected from the
central Storage Room of HCE will be
uploaded to the IMAGE Server using
IMAGE Mobile Device by the Truck
Supervisors after scanning the barcode
on the bags/ containers
www.imageima.org
Username: Affiliation no
Password : Affiliation no
IMAGE MOBILE APP & DEVICE

Through this, the complete details of the

particular Collection Centre, from which
BMW is collected, will be automatically
registered and the data will be transmitted
immediately through clouds to the IMAGE
server.
 GPS Vehicle Monitoring System
(AVL View)
Monitor the Waste Collection Vehicles (48 Vehicles / Trucks)

IMAGE runs 48 GPS installed covered vehicles which ply a distance of 9000 km
per day.

Each vehicle crew includes a driver, a sanitary worker and a supervisor.

Each vehicle collects biomedical waste daily and are taken to district transfer stations,
from there directly to the plant at Palakkad

https://app.avlview.com/vehicle/dashboard
 IMAGE
Common Biomedical Waste Treatment & Disposal Facility

 IMAGE has set up a Common Biomedical Waste Treatment and

Disposal facility at Kanjikode in Palakkad for scientific disposal
of Biomedical waste.
 Works in accordance with the provision of Biomedical Waste
Management Rules 2016 and with the approval and guidance
of Kerala state Pollution control Board.
 Biomedical Waste Collected from more than 9000 affiliated
health care Institutions were scientifically treated and disposed
by using sophisticated technologies.
32 Surveillance Cameras installed in the IMAGE
Plant, Palakkad & online monitoring of the same is
available in Mobile Phone & Computers
BMW TREATMENT IN IMAGE
 INCINERATION

 AUTOCLAVING

 EFFLUENT TREATMENT
(GENERATED DURING TREATMENT PROCESS)
 INCINERATORS (1,500 Kg / Hr)
 Burns the incinerable waste collected in Yellow bags at prescribed
temperature.
 Has 2 chambers.
 Combustion efficiency (CE) shall be at least 99.00%.
 The temperature of the primary chamber shall be a minimum of 800°C and
the secondary chamber shall be minimum of 1050°C + or – 50°C.
 Quench Column-Flue gas-450°C
 Packed Scrubber-Flue gas-80°C
 Droplet seperator
 30 meter height Chimney (Atmospheric temperature).
INCINERATION PROCESS
 AUTOCLAVES 1000 ltr/Cycles
 The autoclave should be dedicated for the
purposes of disinfecting and treating bio-
medical waste collected in Red colour
(Recyclable)
 Sterilization temperature is 1210 C
 Pressure maintained in the autoclave is
15psi
 Microprocessor based control
 Log report is generated in print format
automatically
 Sterilization time 20 minutes as per CPCB
guidelines
AUTOCLAVING PROCESS
 SHREDDER
Autoclaved plastic items should not be disposed as it is.
Shredding is a process in which the plastic material is
shredded or cut to pieces.
Shredding avoids chances of reusing .
Shredded plastic is disposed by sending it for recycling
SHREDDING PROCESS
 COMPACTOR
SIZE REDUCTION

EASIER TRANSPORTATION

LESS STORAGE SPACE

Glass Grinding Unit
 EFFLUENT TREATMENT PLANT
Contaminated water is generated during the process of
Incineration, Autoclaving, Floor Washing and Vehicle
Washing. This contaminated water is called as Effluent.

Sophisticated Effluent treatment plant having a capacity of

4,50,000 liters /Cycle

40% of Treated water is used for gardening and remaining

60% is reused.
E Effluent Treatment Plant
F
F Flash
L
Grit & Equalizatio
Screen Mixer &
U Oil Trap n Tank Flocculator
E
N Primary
T
MBBR Clarifier
Disinfection Secondary
Reactor Clarifier Sludge

Sand Filter

Activated Carbon Treated Water

Adsorber
EFFLUENT TREATMENT PLANT
 Treated water

Sludge drying pit

Treated water used for gardening
 DISPOSAL AT IMAGE
SHARP PIT
INCINERATION ASH PIT
 DISPOSAL AT IMAGE
 Ash is being temporarily stored in the facility and then
transported to KEIL for secured landfill.
 Flue gas generated in the Incinerator is cleaned and then
released to the atmosphere by a 100 ft chimney.
 Treated Plastics are shredded and being send to authorized
recyclers.
 Treated Glass is also being send for recycling after grinding
process
 Treated Metal sharps are being landfilled in secured pits in
the facility itself.
 Treated effluent is used for gardening and reprocessing for
Incinerators.
 Safe disposal at IMAGE avoids contamination of water, land
and air.
 SERVICES OFFERED TO IMAGE AFFILIATED HCES
 Training to appropriate staff of the institution for scientific segregation of biomedical waste.

 Supply of barcoded, colour coded bags and containers for reasonable price through PEPS IMA.

 Daily collection of appropriate segregated biomedical waste from the institutions.

 Transportation to CBWTF at Palakkad.

 Safe disposal of the BMW in the plant as per BMW M Rules 2016

 Annual statement on the quantity of BMW collected and disposed on behalf of the institution.

 Facilitate to obtain the authorization from the Pollution Control Board for functioning of HCEs.
 IMAGE PLANT
Buildings

 Incinerator Plants -3  Bottle Processing -1

 Autoclave Plant -1  Canteen -1
 Medicine Shed -1  Office Buildings -2
 Sorting Shed -2  Conference Hall -1
 Scrap Storage Shed -1  Security and Office -1
 Ash Storage Shed -1  Staff Rest Area -1
 ETP -1  Vehicles wash area -1
 Cloak Room -1
IMAGE PLANT
 INCINERATORS - 5 (1500 Kg/ Hour) 27 T / Day (23 T / Day)
Alfatherm (Old) 1 No. 250 Kg/hr

Thermax 1 No. 200 Kg/hr

Ensys 1 No. 250 Kg/hr

Rotary Kiln Alfatherm 1 No. 500 Kg/hr

Alfatherm (New) Static 1 No. 300 Kg/hr

 AUTOCLAVES - 5 (1000 Ltrs Capacity each) (13 T / Day)

Natsteel High Pressure Sterilizer
IMAGE PLANT
 Washing Cum Shredders

 Conveyer Belt System For Scrap Sorting - 150 Mtrs

 Scrap Grinders With Washing

 Hydraulic Bundling Machine

 Bottle Sorting Machines

 Tube Cutters

 Needles/ Sharps Cutting Machines

 Online Stack Emission Monitoring System (OCEMS)

IMAGE PLANT
 Surveillance Cameras - 32
125 KW Generators
380 KVA Generator
 320 KVA Transformer
 Vehicle Wash Area
 ETP (Effluent Treatment Plant) Capacity 4.5 Lakhs L per
day (450 KLD)
 Security Office
 Conference Hall with Office Complex
 Rest Room for Gents & Ladies
IMAGE PLANT
 Canteen  Rain Water Harvest System

 Toilet cum Bathrooms Complex  Fire Hydrant System

 Electrical & Mechanical Workshop  Green Belt with Garden

 Discarded Medicines Storage  Pets Shed (Birds)

Shed  Cloak Room

 Incinerator Ash Storage Shed  Bore wells and Pump

 Steel Wire Fencing of Compound

 Rain Water Collection Pond

 IMAGE – ONLINE FACILITIES

Application for Affiliation

Monthly Payments
Monthly Receipts
Application for Certificates
Statement of Accounts
Annual Reports
Application for change of Ownership/ Address

www.imageima.org
OUR RESPONSIBILITY