Deals with the Practices, regulations and the issues related to proper waste management in the Hospitals and other similar facilities

1. Disposal of
Hospital & Bio-Medical Wastes
[Bio-Medical Waste Management]
Dr. Gunwant Joshi
Chief Chemist
Madhya Pradesh Pollution Control Board

2. What Causes wastes from Hospital premises
HAZARDOUS?
1. Waste Chemical-medications, Solutions, or
2. Infectious microbes,
3. Chemicals such as formaldehyde,
waste anesthetic gases, etc.,
4. Used disposables, Wasted equipments and
Chemotherapeutic agents,
5. Laser Smoke and aerosolized medications

3. Apart from Hospitals
Infectious wastes are also generated at
 Dental Chambers
 Nursing homes
 Path. Laboratories
 Blood Banks
 Veterinary institutions
 Bio-Medical & Biotech Research centers
The work environments similar to
Hospital environment.

4. Recurrence of
Older infectious deceases
& Advent of Newer infections
Prompted improvements
in Medical technology and
Centralized Medicare,
Brought huge volumes of
Toxic & Hazardous Waste
Situation forced a serious
rethinking & necessited
an appropriate Legislation
4

5. Who’s at Risk ?
• Doctors and nurses
• Patients
• Hospital support staff
• Waste collection and disposal staff
• General public and
• the Environment
5

6.  The Biomedical Waste
(Management & Handling) Rules,
1998
 The Municipal Solid Waste
(Management & Handling) Rules,
2000
6

7.  To minimize the potential for spread of disease
from a medical settings to the general public;
 To reduce the overall amount of infectious
medical waste produced.
 Infectious agents may become toyes of terrorists,
as Bioweapons of Mass Destruction

8. Prospective Bioweapons
Biological Agents
 Q Fever
 Anthrax
 Glanders
 Smallpox
 Cholera
 Botulism  E.Coli O157:H7
 Plague
Chemical Agents
 Tularemia  Nerve Agents
 Hemorrhagic Fevers  Vesicants or Blister Agents

9. Basic Concepts of
Hospital waste management
 Never mix Infectious Bio waste in to
Municipal wastes
[The entire waste lot shall become infectious]
 Segregation and safe containment
(packing) of waste at health facility level
 Processing and storage for
terminal disposal 9

10. Hospital Wastes are dangerous and
require more careful attention
These are heterogeneous waste,
both solid & liquid, primarily
from Health Care Facilities
The available techno-economic
options for the disposal are
largely determined by Nature
of activity of HCF and volume
of the various waste
components

11. Liquid wastes
Approx. Quantity : 4 to 250 liters / bed / day
1. Domestic Effluents and sewage
2. Sewage from isolation wards, ICU’s
toilets & urinals, Bed-bath, bathrooms
and hospital’s laundry
3. Wash waters from laboratories,OPD,
Dressing rooms & Operation theaters.

12. Solid wastes
Approximate Quantity : 0.3 to 3.5 kg/bed/day
1.Garbage 55%
(Bulk Density :330 kg/m3,Cal.Value:1000 K.cal / kg, Moisture :40%)
2.Bio-medical waste (sensu stricto) 13%
A. Wasted body remains 05%
(Blood,Cultures,Anotomicals)
B. Pharmaceutical & Chemical Wastes. 02%
C. Pathological wastes (may be infectious). 06%
3.Sharp Objects 20%
4.Pressurized Containers & Discarded Instruments 02%
5.Radioactive Wastes 0.3%

13. Key to proper Bio - Medical Waste
Management is the segregation
as individual categories of waste
are to be treated & disposed off
in different specific ways

14. 1. Out rightly send Domestic Effluents
to ..the municipal sewers
2. Isolate & Collect the infectious liquid
wastes(streams 2 & 3), Disinfect completely
and then send to municipal sewers

15. 3. Pack the Segregated Solid Waste
according to prescribed mode
and

16. May be
Where,
The BMW shall be treated using
Standard methods such as Incineration,
Autoclaving, Micro- waving, and Chemical
& Mechanical techniques
and the treated waste residue shall be
finally disposed off in a secured

17. Hospital Waste classification

18. Hazardous waste:
Only 10-25% of Hospital waste is actually
hazardous and can be injurious to humans or
animals and deleterious to environment.
This may be either
A. Infectious Bio-hazard
Infectious in nature
B. Sharps that may lead to
secondary infections
C. Toxic Bio-hazard
Cytotoxic in nature
D. Radiation Bio-hazard
Radioactive in nature

19. Other Potentially Infectious Material
 Any body fluid with visible blood
 Amniotic fluid
 Cerebrospinal fluid
 Pericardial fluid
 Peritoneal fluid
 Pleural fluid
 Saliva in dental procedures
 Semen/vaginal secretions
 Synovial fluid
 Anywhere body fluids that are indistinguishable

20. Blood and Fluid Borne Pathogen
Exposures may typically occur
by one of the following ways:
 Puncture from contaminated needles, broken glass,
or other sharps
 Contact between non-intact (cut, abraded, acne, or
sunburned) skin and infectious body fluids
 Direct contact between mucous membranes and
infectious body fluids
Example: A splash in the eyes, nose, or mouth

21. Under Environment Protection Act,1998
BIO-MEDICAL WASTE (Management & handling) RULES 1998
1st Amendment Rules vide S.O.201(E) Dated 06/03/2000
2ndAmendment Rules vide S.O.1069(E) Dated 17/09/2003
The Authorization is required for
 Generation/Collection/Reception/Storage
 Transportation
 Treatment/Disposal
 or any other form of handling.

22. Classification and management
Schedule-I
Category Waste Type Treatment and Disposal Method
Human Wastes
Category 1 (Tissues, organs, body Incineration / deep burial
parts
Category 2 Animal Waste Incineration / deep burial
Microbiology and
Category 3 Autoclave/microwave/incineration
Biotechnology waste
Disinfection (chemical treatment)
Category 4 Sharps +/autoclaving/microwaving and
mutilation shredding
Discarded Medicines Incineration/ destruction and drugs
Category 5
and Cytotoxic Drugs disposal in secured landfills

23. Schedule-I. contd…
Classification and management
Category Waste Type Treatment and Disposal Method
Contaminated solid Incineration/autoclaving /
Category 6
waste microwaving
Solid waste (disposable Disinfection by chemical treatment+
Category 7 items other than microwaving/autoclaving &
sharps) mutilation shredding
Liquid waste
(generated from
laboratory washing, Disinfection by chemical treatment+
Category 8
cleaning, housekeeping and discharge into the drains
and disinfecting
activity)
Category 9 Incineration ash Disposal in municipal landfill
Chemical Treatment + and
Category10 Chemical Wastes discharge in to drain for liquids and
secured landfill for solids

24. Schedule-II
Colour coding and Type of Containers for
Different Biomedical Wastes
Colour Type of Waste Treatment /
coding container category Disposal
Incineration/
Plastic Deep Burrial
Bags
Disinfected Autoclaving,
Container / Microwaving and
Plastic Chemical Treatment
Bags
Plastic Autoclaving,
Bags Microwaving and
/Puncture Chemical Treatment
Proof Destruction/ shredding
Containers

25. MANAGEMENT OF HOSPITAL WASTE
Yellow Dustbin & Bags
From OT: Amputated Limbs,
Placenta, Intestine, Uterus
Ovary etc.
From Labs: Live or Attenuated
vaccines, Infected Samples
and cultures, Culture Plates,
Wastes from production of
Biologicals,Toxins.

26. MANAGEMENT OF HOSPITAL WASTE
Red Dustbin & Bags
Cotton pads, Swabs, Gauge
Pieces, Dressings,
Bandages, Cloths, Bedsheets
and Plaster castes
Soiled with blood, Pus,
Vomits, Sputum and other
Body Fluids.

27. MANAGEMENT OF HOSPITAL WASTE
Black Dustbin & Bags
Wastes comprising of out dated,
contaminated and discarded
medicines, solid chemicals used
for disinfection in Lab &
Hospitals as insecticides

28. MANAGEMENT OF HOSPITAL WASTE
Blue Dustbins & Bags
Needles, Scalples,
Blades, Glass ampoules
and Syringes etc. that
may cause puncture and
cuts. This includes both
used and unused sharps

29. A separate Blue Dustbins & Bags
May also be put for
All disposable items like
I.V.Sets, S.V.Sets, Venflon,
Catheter, I.V.Fluid Bottles
Uro-bags, Ryles tube,
Drainage Tube and Bags,
Empty blood bags and Dialysis
and other plastic disposable.

30. Containers Colour
Tells other staff what is in the container
 Tells the contractor what to do with the waste
 Can apply to both sacks and rigid containers
Safe for Disposal to
Sharps
General Waste
Carcass, anatomical Cytotoxic

31. Colour-Coded Bins for Segregation
of Bio Medical Waste

32. Schedule-III
Label for Containers of Bio-Medical Waste
Bio Hazard Cyto-Toxic Substance

33. Schedule-IV
Label for Transportation of
Bio-Medical Waste Containers / Bags
 Waste category No. Day -------- Month --------
 Waste class Year --------
 Waste description Date of generation-----------
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.

34. Schedule -V
a - STANDARD FOR LIQUID WASTE
pH 6.5 to 9.0
Suspended Solids 100 mg/l.
Oil & grease 10 mg/l.
BOD 30 mg/l.
COD 250 mg/l.
Bio assay 90 % Survival of fish after
96 hours in 100% effluent
Send Domestic Effluents to municipal sewers
Disinfect the infectious liquid waste and then
send it to municipal sewers

35. Bio Medical Liquid Wastes Disinfection
by Sodium Hypochlorite

36. Bio Medical Liquid Wastes Treatment by
an Effluent Treatment Plant

37. Garbage Wastes Collection &Transport

38. Sharp Management
Always
Remember
Not to recap
the Needle
and cut it
Immediately
after the use
Sharp Sign

39. Sharps Issues
 Must be collected at the point of generation, in a
leak-proof and puncture-resistant container
 Containers must bear the international biohazard
symbol and appropriate wording
 Containers should never be completely filled, nor
filled above the full line indicated on box.
Unauthorised Unsafe collection Unsafe disposal
Use/Reuse

40. Sharp Encapsulation : Sharp Pit
• MUTILATE & DISTROY
•DISINFECT:-
Chemically/Autoclave/Microwave
•DISPOSE IN SHARP PIT
•SEAL PIT WHEN 2/3 FULL
•START DISPOSAL IN NEW PIT.
•Alternatively, after Destruction/
Mutilation and Disinfection the
Stored Sharps can be sold as
Scrap

41. Waste Sharp & Syringe Destruction
 The Shredded Needles,
Sharps and Plastics may
be kept in the secured
containers and
could be sent to
Plastic / Metal
Recycling Plants

42. Bio Medical Wastes:
Segregate and
Pack it right at the
point of Generation

43. Bio Medical Wastes Collection &Transport

44. Bio Medical Wastes Collection &Transport

45. Bio Medical Wastes
BMW
Collection &Transport CTDF
by at Bhopal
Common
Treatment
& Disposal
Facility
Govindpura Industrial Area

46. Inspection & Re-Segregation
It requires to segregate again to ensure the final
disposal of BMW as per BMW Rules 1998 (M & H)

47. Autoclave
Validation test :
Spot testing by
Bacillus stearo-
thermophilus spores
on a spores strip
with at least 1 x
104 Spores/ml.
Routine test :
Chemical indicator
strip/tape

48. Sharp Storage & Disposal

49. Bio Medical Plastic Wastes Disinfection
by Sodium Hypochlorite

50. Bio Medical Wastes Destruction by
Double Chambered Incinerator

51. Details of Double Chambered Incinerator

52. Incinerator Ash Disposal

53. Schedule -V
DEEP BURIAL PIT for BMW

54. Schedule -V
D - STANDARD FOR DEEP BURIAL
Entry of scavengers to the burial site be
prevented may be by using covers of
galvanized iron/wire mash.
After every burial in the same secured
pit a layer of 10 cm. soil be added .
Burial must be performed under close and dedicated supervision.
Deep burial site should be relatively impermeable and
distant from habitat.
There should be no well, lake, river etc. close to the site to
avoid contamination of surface water or ground water.
Location of the deep burial site to be authorized by the
Prescribed Authority.
The occupier shall maintain record for all the pits

55. Land Disposal Facility for Cities & Towns
with population less than 5 lacs

56. Other Bio Medical Wastes Treatment Options

57. Other Bio Medical Wastes Treatment Options
Microwaveing

58. Other Bio Medical Wastes Treatment Options
Plasma Pyrolysis

59. Duties of the Occupier
Occupier / institution generating, collecting,
receiving, storing, transporting, treating,
disposing and/or handling Bio-medical waste
To apply for Grant of Authorization in form –I
to MPPCB which is the Prescribed Authority.
Operator of the Bio - medical Waste Treatment
Facility to apply for Grant of Authorization in
form –I to MPPCB (The Prescribed Authority).

60. Duties of the Occupier
Bio-medical Waste shall be treated and disposed
of in accordance with the Schedule -I and in
compliance with the standards prescribed in
Schedule –V.
Every Occupier, shall set- up the requisite Bio-medical
Waste Treatment Facilities like incinerator, Autoclave,
Microwave system for treatment of waste,
or, ensure requisite treatment of waste at common or any
other waste treatment facility

61. Duties of the Occupier
To submit an annual report to in form –I I by 31st
June Every year about the categories and
quantities of Bio-medical Waste handling
during the preceding year
To maintain records related to Generation,
collection,reception, storage, transportation,
treatment,disposal and/or handling of Bio-
medical waste according the rules & guidelines.

62. Duties of the Occupier
All records subject to the inspection &
verification by the MPPCB
Accident during handling & Transportation
of BMW needs to be reported by the
authorized person in Form – III to
MPPCB forthwith.

63. Please Remember!
The Primary
responsibility of
the disposal of the
Bio-Medical Waste
lies with the
Generator

64. And also do not forget that
 Bio-medical waste shall not be mixed with other
Wastes such as Municipal Waste
 Segregate the Bio-medical Waste in separate
containers at point of generation (schedule-II)
and label as prescribed (schedule-III)

65. And also do not forget that
 Biomedical waste that are to be transported,
must be securely packed, and Labeled as per
(schedule-IV).
 Transportation of BM Waste is allowed only in
vehicles authorized by the prescribed Authority
 A day -to -day record of the Quantity under
different categories of the Bio – Medical Waste
generated in premises must be maintained

66. And also do not forget that
 No untreated Bio-medical Waste shall be kept
stored beyond 48 Hrs.
 if for any reason, the Bio-Medical Waste is
required to be stored beyond this time limit, the
Authorized person must seek a permission from
Prescribed Authority and take adequate measures
to ensure that waste does not affect the human
life & environment adversely.

67. The contravention of the Act ,
Rules, Orders & directions
may lead to legal action
The punishment may lead to the
imprisonment up to 5 years with fine
up to Rs. 1 lakh.
For failure or continued contravention a
fine @ Rs.5000 /Day may be charged.
If the failure or the contravention
continues beyond one year, the
imprisonment may be extended up
to 7 years.

68. Liquid Infectious Medical Wastes
Liquid Infectious Medical Waste, i.e., the contents of
suction canisters, may be disposed as follows
 Placed directly in the
Biohazardous waste,
 Autoclaved & the poured
down a sanitary sewer,
 Solidified using an approved
disinfectant solidifier and
discarded in the solid waste

69. Disposal Procedure – Plastics
 Laboratory plastics
 Render safe first
 If non-identifiable following autoclave then non-
clinical disposal [Black Bag and label “Safe for
Disposal”]
 If identifiable still then possibly “offensive” -
Orange Bag and label as for Clinical Waste

70. Disposal Procedure
 Glassware
 Render safe first
 Designated boxes – clearly labelled “Broken Glassware
– Safe for Disposal”
 Except if contains hazardous chemicals – special
disposal route via Chemistry
 Mercury -Collect through spill kit and send for recycling

71. Comparison of Treatment Technologies

72. Biomedical Waste Management - Issues
• Not considered important
– Lack of interest from senior management
– No ownership of the process
– Awareness of problems
– Appreciate the need for constant monitoring

73. Biomedical Waste Management - Issues
–Segregation of waste not taken seriously at user level
–Non compliance with color coding
–Monitoring segregation at source – low budgets allocated –
costs are not always known/nor worked out properly
–Cost of color coding, staff, transport and disposal is a major
deterrent
–Quantification of waste generated is not accurately done
73

74. Biomedical Waste Management - Issues
–Protection of healthcare workers not given
adequate thought
–Clinical waste dumped with non infectious waste -
Risk for healthcare workers and public
–Residual Waste disposal not effective, often
dumped in open landfills
74

75. Over Classification makes it complex
 The disposal of solid wastes that are not infectious
medical waste, is often done as if they were
infectious
 It is the most commonly cited violation
 It increases the financial burden on patients and
taxpayers in the form of increased disposal costs
for health care facilities

76. Problems
 When large volumes of plastics,
common in medical waste, are
incinerated there is an increased
potential for atmospheric
release of reformed gaseous
carcinogenic agents such as
Dioxins & Furans
 Increased medical waste generation increases the
risk of costly accidents and spills due to the
increased number of trucks required to haul the
waste

77.  When infectious waste and regular solid
waste mixes together, it can not be
permitted to separate them
 Once combined,
the entire
contents are
considered
infectious waste!

78. Challenges
Establishing robust waste management policies within the
Health Care Facility/organization
 Organization wide awareness about the health hazards
 Sufficient financial and Trained human resources needed
 Monitoring and control of waste disposal
 Clear responsibility and tracebility for appropriate handling
and disposal of waste.
78

79. ADRESSING THE ISSUES
1. Need to build-up of a comprehensive system, address
responsibilities, resource allocation, handling and
disposal
2. This is a long-term process, sustained by gradual
improvements.
3. Specific personnel need to be assigned to monitor the
bio-medical waste management in the hospital.
4. Man power needs and other resources for the BMWM of
hospital to be addressed.
5. Quality assessment of bio-medical waste management
should be done from time to time. 79

80. ADRESSING THE ISSUES- continued
6. Segregated collection and transportation – need for Non-
ambiguous color coding and labeling of wastes.
7. Clear directives in the form of a posters and notice to be
displayed in all concerned areas in English and local
languages.
8. Safety of handlers is a big concern that is still not addressed
adequately.
9. Raising Awareness about risks related to health-care waste;
training staff & Waste handlers on safe practices.
10.Selection of safer & environmentally friendly management
options, to protect people from hazards when collecting,
handling, storing, transporting, treating or disposing waste.
80

81. ADRESSING THE ISSUES
11.Issue of all protective clothing such as, gloves,
aprons, masks etc. to all HCW & Waste handlers.
12.Regular medical check-up (half-yearly) of staff
associated with BMWM.
13.Maintenance of Record registers for this purpose.
14.Containers should be robust and leak proof
15.Tracking of Bio Medical Waste up to point of Disposal.
16.Proper treatment and final disposal.
81