1. Biomedical Waste Management (BMW)
Let the waste of the sick not contaminate
the lives of healthy
For MBBS IV Semester
26th April 2017
By: Dr Puneet Kumar Gupta
Assistant Professor, Microbiology

2. Layout Definition What’s need of BMW?
Contribution of different waste type
Various things required in management
Rule governing
Categories, Segregation, Transportation
Modality of treatment
Do & Don’t

3. Definition
Waste generated during laboratory diagnosis, treatment or immunization of human being or animals, or in research activity pertaining thereto, or in production of biologicals

4. What’s Need for BMW? Attracts flies, insects, birds and animals
Filthy and unhygienic conditions
Injury(NSI) and infection
Reuse of disposables
Harmful chemicals and radioactive materials( contaminate wells and tanks)
Animals & insects may get inf./ become carriers.
Survival & mutation of pathogenic microbes→ epidemics, increase in communicable diseases in the community

5. Contribution of different waste type
Waste generation in
Developing countries Kg/bed/day
Developed 1-5 Kg/bed/day
Hospital Waste
15-20%
80-85%
Hazardous
Non- hazardous
Bio degradable
Non-bio degradable
Potentially Toxic 5%
Potentially Infectious
15%
15%
Chemical
Radioactive
Organic
Lab
Sharps
Pharmaceutical

9. Rule governing Biomedical Waste Management & Handling Rule 1998
Amended
2000
2003
2011
Biomedical Waste Management Rule 2016

11. Bio-Medical Waste Management Rules, 2016

12. Following Waste Not covered under BMW Management Rule 2016
Solid waste
Solid Waste Management Rules, 2016
E waste
E-Waste (Management) Rules, 2016
Radioactive wastes
Atomic Energy Act, 1962(33 of 1962) and the rules made there under
Hazardous chemicals
Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989 made under the Act
Construction and demolition waste
Construction and Demolition Waste Management Rules, 2016
Lead acid batteries
Batteries (Management and Handling) Rules, 2001
Hazardous wastes
Hazardous and Other Wastes (Management and Transboundary Movement) Rules, 2016
Hazardous microorganisms, genetically engineered microorganisms and cells
Manufacture, Use, Import, Export and Storage of Hazardous Microorganisms, Genetically Engineered Microorganisms or Cells Rules, 1989 made under the Act

13. Biomedical Waste Management Rule 2016
Segregation
Biomedical Waste Management Rule 2016

14. Yellow Red Blue White (Translucent)
4 category of waste:
Yellow
Red
Blue
White (Translucent)

15. Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options (Schedule 1)
Category
Type of waste
Container to be used
Yellow
Soiled Waste (Items contaminated with blood, body fluids):
Dressings, Bandage, Gauze, Linen
Plaster casts,
Cotton swabs
Bed Protection pads
Bags containing residual or discarded blood and blood components including blood set tubing’s
Diapers, Napkins
Discarded linen, mattresses, beddings
Yellow coloured non-chlorinated plastic bags
common Bio-medical Waste treatment facility

16. Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options (Schedule 1)
Category
Type of waste
Container to be used
Yellow
Human Anatomical Waste:Human tissues, organs, body parts and fetus below the viability period (as per MTP act)
[copy of official MTP certificate from Obstetrician or the MS of hospital or healthcare establishment must be given]
Yellow coloured non-chlorinated plastic bags
common Bio-medical Waste treatment facility

17. Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options (Schedule 1)
Category
Type of waste
Container to be used
Yellow
Animal Anatomical Waste:
Experimental animal carcasses, body parts, organs, tissues, including the waste generated from animals used in experiments or testing in animal houses
Yellow coloured non-chlorinated plastic bags
common Bio-medical Waste treatment facility
Expired or Discarded Medicines (Except cytotoxic drugs)
Pharmaceutical waste like antibiotics

18. Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options (Schedule 1)
Category
Type of waste
Container to be used
Yellow
Cytotoxic drugs including all items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc
Yellow coloured non-chlorinated plastic bags with cytotoxic label
common Bio-medical Waste treatment facility

20. Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options (Schedule 1)
Category
Type of waste
Container to be used
Yellow
Chemical Liquid Waste:
Liquid waste generated due to use of chemicals in production of biological and used or discarded disinfectants,
Silver X-ray film developing liquid,
Discarded Formalin,
Infected secretions,
Aspirated body fluids,
Liquid from laboratories and floor washings, cleaning, house-keeping and disinfecting activities etc.
Separate collection
system leading to effluent
treatment system

21. Lab & highly infectious BMW generated shall be pre-treated by equipment like autoclave or microwave
Microbiology waste and all other clinical laboratory waste shall be pre-treated by sterilisation to Log 6 or disinfection to Log 4, as per the WHO & NACO guidelines before packing & sending to CBMWTF
Use of Non-chlorinated chemicals
No chemical pretreatment before incineration, except for microbiological, lab & highly infectious waste

22. Autoclave conditions for BMW handling
Should not be less than
1210C x 15psi x 60 minutes
1350C x 31psi x 45 minutes
1490C x 52psi x 30 minutes
Biological Indicator: (Maintain record)
First Validate with 4 biological indicator
Then Daily testing with chemical indicator (>1 strips per bag of discard at different locations
Once a Week biological indicator testing

23. Biomedical wastes categories and their segregation, collection, treatment, processing and disposal options (Schedule 1)
Category
Type of waste
Container to be used
Yellow
Microbiology, Biotechnology and other clinical
laboratory waste:
Blood bags,
Vacutainers containing blood
Dishes and devices used for cultures
Laboratory cultures, stocks or specimens of microorganisms,
Live or attenuated vaccines,
human and animal cell cultures used in research, production of biological,
Residual toxins
Autoclave safe plastic bags or containers
Autoclave/ Microwave
common Bio-medical Waste treatment facility

24. Red Category Type of waste Container to be used
Contaminated Waste (Recyclable) Wastes generated from disposable items such as
All plastic tubings (Ryle’s, ICD, ET, drains)
Intravenous tubes and sets,
Catheters (Foley’s, suction etc)
Cardiac cannulas
Plastic iv Bottles
Uro bags,
syringes (without needles and fixed needle syringes)
vacutainers with their needles cut
Red coloured non-chlorinated plastic bags or containers
common Bio-medical Waste treatment facility

25. Red Category Type of waste Container to be used Gloves
Nebulization masks
Surgical disposable face mask, caps, gown, Shoe cover
Needle caps (If infected)
Plastic Test tubes
Pipettes
Disposable tips
Plastic Trough
Red coloured non-chlorinated plastic bags or containers
common Bio-medical Waste treatment facility

26. White (Translucent) Category Type of waste Container to be used
Waste sharps including Metals:
Needles (including Hypodermic needles, I/v set needles, suture needles, LP needles etc.)
Stylets of IV cannula
syringes with fixed needles,
Needles from needle tip cutter or burner,
scalpels,
blades,
Lancets
Saws
Any other contaminated sharp object that may cause puncture and cuts includes used, discarded and contaminated metal sharps
Puncture proof, Leak proof, tamper proof containers
common Bio-medical Waste treatment facility

28. Alternative Heavy duty plastic containers But, they should be Examples
leak resistant,
Remain upright during use without sharp able to come out
Tight fitting, puncture resistant lid
Translucent which has to be marked
Examples
Plastic laundry detergent container,
Plastic bottles
Empty detergent metal cans
Disinfectants empty plastic container
Empty dry media containers
A tin or a plastic box with a small opening at top with a lid for closure of the Box

29. Alternative
Clearly labelled “Sharp Metallic waste” with “biohazard symbol”
A line should be drawn on the box to mark ¾ of the volume
Needles should be filled only till this line

30. Locally made Sharp Waste containers

34. Syringes should be either mutilated or needles should be cut and or stored in tamper proof, leak proof and puncture proof containers for sharps storage

35. Blue Category Type of waste Container to be used Glassware:
Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic wastes
Broken petri dishes,
Slides and cover slips,
Broken pipettes and other glass material
Metallic Body Implants
Cardboard boxes with blue colored marking
(If soiled with infectious waste: treat by disinfectants or autoclaving)
common Bio-medical Waste treatment facility

36. Methods of disposal of microbiological samples & cultures
Sputum, LJ media, container soaked in 5% phenol overnight
The container is autoclaved
The phenol solution poured of in to drain and the container is sent to the final disposal site in red bag/blue bag
Disposal of sputum container with specimen and LJ culture:

37. Disposal of blood samples
Blood samples and container
10%sodium hypochlorite
Container sent to disposal site and the disinfectant to the drain
Clotted blood samples along with the container
Autoclave
Container sent to the common disposal site in appropriate bag

38. Other infectious samples
5% phenol
Urine
pus
Stool
Sputum

39. Disposal of Microbiological cultures
10%sodium hypochlorite overnight
Discharge into the drain
Petri dishes
1.Autoclave if reusable or
2. Disposal site for recycling
Autoclavable bags
Autoclave and reuse the petri dishes and the culture medias can be disposed off into the drain

40. Transportation Always collect waste in a covered bin/bags
Dispose bags every day or whenever ¾ filled
Handover waste to dedicated waste collection team
Collection team should tie properly labelled bag, weight, record particular in waste collection register
Then collection team should keep the waste bag/container in transportation trolley/container
Transportation should be done safely without spillage & leakage

41. Transportation
Collection container should then be cleaned with soap and water/disinfectant by housekeeping staff and new suitable bag/ container will be applied and to be checked by staff nurse or technician (OT, Laboratory) of respective area
No waste to be stored >24 hours at point of segregation
Collection team then transport waste in closed container to storage area in a pre-defined path of least crowding
Waste in common storage area will be delivered to the authorised person from common biomedical treatment facility

42. Every Biomedical waste bags/container must have biohazard sign and label with details

44. What's differences b/w 1998/2011/2016 BMW Rules?

45. BMW (Management
and Handling) Rules, 1998, 2000, 2003, 2011
BMW Management Rules, 2016
Word Handling
Handling word omitted Management’ includes Handling
Not cover these
Cover healthcare activity undertaken outside the healthcare facility: vaccination camps, blood donation camps, surgical camps or any other
-----
Additional Duties of occupier Added:
Provision of safe, ventilated and secured location for storage of segregated BMW
Pre-treat the laboratory waste, microbiological waste, blood samples and blood bags through disinfection or sterilisation on-site as per WHO or NACO guidelines & then sent to CBMWFs
Phase out use of chlorinated plastic bags, gloves and blood bags within two years of notification of rule

46. BMW (Management
and Handling) Rules, 1998, 2011
BMW Management Rules, 2016
------
Additional Duties of occupier Added:
Immunise all its HCP and others involved in handling of BMW for protection against diseases including Hepatitis B & Tetanus
Establish a Bar- Code System for bags or containers
Report major accidents including accidents caused by fire hazards, blasts during handling of BMW
Operator of CBMWFs
Ensure timely collection of BMW from HCFs, assist the HCFs in conduct of training
Not to establish on-site treatment & disposal facility if a service of CBMWFs available at a distance of 75Km

47. BMW (Management
and Handling) Rules, 2011
BMW Management Rules, 2016
8 category (10 in 1998 Rule)
4 category
No storage beyond 48 hrs
Permission required to be taken
Untreated human anatomical waste, animal anatomical waste, soiled waste and, biotechnology waste shall not be stored beyond a period of 48 hrs
In case for any reason it becomes necessary to store such waste beyond such a period, the occupier shall take appropriate measures to ensure that the waste does not adversely affect human health & environment
Inform the SPCB along with reasons
Hospitals treating ≥ 1000 patients/month to obtain
authorization from SPCBs/PCCs
One time Authorisation for Non-bedded HCFs.
Validity of authorization shall be synchronised with validity of consent orders for Bedded HCFs

48. BMW (Management
and Handling) Rules, 2011
BMW Management Rules, 2016
To strengthen advisory committee of Government of every State/Union Territory- Additional members added
150 mg/nm3
1 sec
...Nil..
Emission standards Incineration
SPM in Incinerator’s Emission 50 mg/nm3
Residence Time in Secondary chamber of incinerators =2 Sec
Standards for Dioxin and furans 1%
Chemical Treatment
10% sodium Hypochlorite
Black color
Cytotoxic waste in Yellow
Blue/ white bags
Sharp 2 types

49. Final disposal Modalities: Thermal Processes
High Temperature Processes
Incineration
Pyrolysis
Plasma Technology
Gasification
Non-Burn/Low-Temperature Treatments
Autoclave
Hydroclave
Microwave
Dry heat
Steam auger (waste is shredded prior to t/t)

50. Modalities: Chemical Disinfection

51. Incinerator
Incineration is a high heat system process of burning combustible solids at very high temperature in a furnace.
Burning of waste material in 10 Chamber stages (850±500C)
Followed by combustion of gases in 20Chamber (1050±500C)
Cleaning of flue gas through a number of pollution control devices
End product is devoid of infectious organisms
Not to be done: Burning of Plastic waste & Sharp -

52. AUTOCLAVE Gravity displacement type – Operates at
Not<121°C at 15psi for not < 60 minutes
Pre vacuum type
Vacuum pumps are utilized to evacuate air in the chamber of autoclave
Steam under pressure is pushed
Operates at
Not<121°C at 15psi for not < 45 minutes
Not<135°C at 31psi for not < 30 minutes
Not Recommended for pathological Waste

53. Hydroclave Expansions of Autoclave Steam sterilization technology
Steam Introduced into hollow walls of hydroclave
Steam does not come in contact with waste
Volume & Weight Reduction much more than autoclave
Cycle time 1 hr

54. Use electromagnetic waves 300-300,000 MHz
Radiation produced by microwave break molecular chemical bonds
Heat up waste material from inside, unlike the external heat given in autoclave & hydro clave
Work at temp C
Cycle time min
Not to be used with Body parts & tissue

55. Deep Burial Pit A pit or trench 2m deep
1/2 with waste, then covered with lime within 50 cm of surface, before filling the rest of pit with soil
On each occasion, when wastes are added to pit, layer of 10 cms of soil shall be added to cover the wastes
Ensure that animals do not have any access to burial site
Covers of galvanized iron / wire meshes
Should be distant from habitation
Should be relatively impermeable & no shallow well should be close to the site.
Burial must be performed under close & dedicated supervision

56. Sharp Pit Dug according to the requirement of hospital
All 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.

58. Building a protected sharp Barrel

59. Do’s FOR WASTE M/M Generate waste when essential
Segregate waste at source into specified categories of waste with biohazard logo
Mutilate waste at source if possible to prevent unauthorized reuse
Destroy needle by using needle cutter or needle burner
Keep the needles in puncture proof, translucent container
Clean the bins regularly with soap & water and disinfect the bins regularly.
All liquid chemical waste should be drained out in to ETP

60. Don’ts
Do not generate waste unnecessary (e.g. avoid injection by prescribing oral medicines)
Never mix infectious & non- infectious waste
Never mix chlorinated wastes with such wastes those which have designated for incineration.
Never overfill the bins.
Never store waste beyond 48 hrs.
There should not be any spillage on the way of transport.

61. Don’ts Avoid transport of waste through crowded areas
Do not throw infectious waste into general waste without any pre- treatment and mutilation
Don’t dispose the solid waste (plastic) and sharp waste without mutilation

62. Q1: How much percentage of waste will come under biomedical waste?5%
15-20%
25-30%
85%

63. Q2: Nursing sister finds expired chemotherapeutic drugs stored in glass ampoules in RCC ward. She tells the sister in charge to dispose those expired drugs . The sister in-charge is confused regarding the disposal . Suggest the appropriate BMW management
Chemotherapeutic drugs has to be disposed into red bag
Chemotherapeutic drugs being in a glass ampoule dispose in a puncture proof box
Chemotherapeutic drugs has to be disposed in black bag
Chemotherapeutic drugs has to be disposed in yellow bag

64. Blood sample has to be discarded in yellow bag
Q 3: There was a blood sample from a HIV pateint. The lab personnel wanted to discard the blood in a safe manner. Tell the appropriate BMW management
Blood sample has to be discarded in yellow bag
Blood sample has to be pretreated with 10% sodium hypochlorite and then disposed
Blood samples should be autoclaved and then disposed.
Both b and c are correct methods of disposal

65. Yes , as the right chemical pretreatment is 10% sodium hypochlorite
Q4: A TB patient coming to mycobacteriology lab gives a sputum sample for drug susceptibility testing. The lab personnel after processing the sputum sample discards the sample into 10 % sodium hypochlorite. Is this the appropriate method of disposal?
Yes , as the right chemical pretreatment is 10% sodium hypochlorite
No, 5% lyzol should be used.
No, 5% phenol should be used.
No pretreatment required as it has to be disposed in the sewage effluent plant .

66. Q5: According to rules 2016, the BMW management should be done
Inside the hospital campus
Outsource it if the disposal site is within 125km radius from the hospital
Outsource it if the disposal site is within 75km radius from the hospital
Can be stored and disposed after a month to the outsourcing unit

67. Q6: Which among these waste is not included under biomedical waste?
a. expired medicines
b. Laboratory cultures
c. Lead acid batteries
d. e- waste
e. Both c and d

68. Q7:Bags used for the BMW management should be
Plastic/ chlorinated
Plastic/ nonchlorinated
Plastic/ flurinated
Nonplastic/ nonchlorinated

69. So Everyone Responsibility

70. References Biomedical Waste Management Rule 2016
Safe management of wastes from health-care activities. WHO 2nd Edition
1st Edition of Essential of Medical Microbiology by Apruba Shankar Sastry & Santhiya Bhat K.
5th Edition of Texbook of Microbiology by Dr CP Bhaveja
NACO Manuals