Bio-medical waste

Bio-medical waste means ldquoany solid andor liquid waste including its container and any intermediate product which is generated during the diagnosis treatment or immunization of human beings or animals

Biomedical waste poses hazard due to two principal reasons ndash the first is infectivity and other toxicity

Bio Medical waste consists of

Human anatomical waste like tissues organs and body parts Animal wastes generated during research from veterinary hospitals Microbiology and biotechnology wastes Waste sharps like hypodermic needles syringes scalpels and broken glass Discarded medicines and cytotoxic drugs Soiled waste such as dressing bandages plaster casts material contaminated with

blood tubes and catheters Liquid waste from any of the infected areas Incineration ash and other chemical wastes

Legal aspect

The Central Government to perform its functions effectively as contemplated under sections 6 8 and 25 of the Environment Protection Act 1986 has made various Rules Notifications and Orders including the Bio-medical wastes (Management amp Handling) Rules 1998

A brief summary of the provisions in Bio-medical wastes (Management amp Handling) Rules 1998 is given below

Section 3 establishes the authority of the government to undertake various steps for protection and improvement of the environment

Section 5 provides for issuance of directions in writing Section 6 empowers the government to make rules Section 8 permits the education of individuals dealing with hazardous wastes

regarding various safety measures Section 10 bestows authority to enter the premises and inspect Section 15 allows the government to take punitive steps against defaulters This

involves imprisonment up to five years or penalty of upto rupees one lakh or both In case the default continues it would then attract a penalty of rupees five thousand per day up to one year and thereafter imprisonment up to seven years

Section 17 provides for punishment in case of violations by government departments

Even after the June 2000 deadline most of the large hospitals have not complied with these Rules as there is no specified authority to monitor the implementation of these Rules But the fact is that in most of the states the pollution control boards that are connected with waste in general do not have adequate powers or commitment to enforce the Rules

Biomedical waste is generated from biological and medical sources and activities such as the diagnosis prevention or treatment of diseases Common generators (or producers) of

biomedical waste include hospitals health clinics nursing homes medical research laboratories offices of physicians dentists and veterinarians home health care and funeral homes In healthcare facilities (ie hospitals clinics doctors offices veterinary hospitals and clinical laboratories) waste with these characteristics may alternatively be called medical or clinical waste

Applicability of BMW Rules 1998

The BMW Rules are applicable to every occupier of an institution generating biomedical waste which includes a hospital nursing homes clinic dispensary veterinary institutions animal houses pathological lab blood bank by whatever name called the rules are applicable to even handlers

CATEGORIES OF BIOMEDICAL WASTE SCHEDULE ndash I

WASTE CATEGORY TYPE OF WASTE TREATMENT AND

DISPOSAL OPTIONCategory No 1 Human Anatomical Waste (Human tissues organs body parts) Incineration deep burial

Category No 2

Animal Waste(Animal tissues organs body parts carcasses bleeding parts fluid blood and experimental animals used in research waste generated by veterinary hospitals and colleges discharge from hospitals animal houses)

Incineration deep burial

Category No 3

Microbiology amp Biotechnology Waste (Wastes from laboratory cultures stocks or specimen of live micro organisms or attenuated vaccines human and animal cell cultures used in research and infectious agents from research and industrial laboratories wastes from production of biologicals toxins and devices used for transfer of cultures)

Local autoclaving microwaving incineration

Category No 4Waste Sharps (Needles syringes scalpels blades glass etc that may cause puncture and cuts This includes both used and unused sharps)

Disinfecting (chemical treatment autoclaving microwaving and mutilation shredding

Category No 5 Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated contaminated and discarded medicines)

Incineration destruction and drugs disposal in secured landfills

Category No 6Soiled Waste (Items contaminated with body fluids including cotton dressings soiled plaster casts lines bedding and other materials contaminated with blood)

Incineration autoclaving microwaving

Category No 7 Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing catheters intravenous sets etc)

Disinfecting by chemical treatment autoclaving microwaving and mutilation shredding

Category No 8 Liquid Waste (Waste generated from the laboratory and washing cleaning house keeping and disinfecting activities)

Disinfecting by chemical treatment and discharge into drains

Category No 9 Incineration Ash (Ash from incineration of any biomedical waste)

Disposal in municipal landfill

Category No10 Chemical Waste (Chemicals used in production of biologicals chemicals used in disinfecting as insecticides etc)

Chemical treatment and discharge into drains for liquids and secured landfill for solids

Composition of BMW

The typical Hospital solid waste composition is as follows (based on CPCB report)

Segregation

Segregation refers to the basic separation of different categories of waste generated at source and thereby reducing the risks as well as cost of handling and disposal Segregation is the most crucial step in bio-medical waste management Effective segregation alone can ensure effective bio-medical waste management The BMWs must be segregated in accordance to guidelines laid down under schedule 1 of BMW Rules 1998

Proper labelling of bins

The bins and bags should carry the biohazard symbol indicating the nature of waste to the patients and public

Schedule III (Rule 6) of Bio-medical Waste (Management and Handling) Rules 1998 specifies the Label for Bio-Medical Waste Containers Bags as

Label shall be non-washable and prominently visibleCollection

The collection of biomedical waste involves use of different types of container from various sources of biomedical wastes like Operation Theatre laboratory wards kitchen corridor etc The containers bins should be placed in such a way that 100 collection is achieved Sharps must always be kept in puncture-proof containers to avoid injuries and infection to the workers handling them

Storage

Once collection occurs then biomedical waste is stored in a proper place Segregated wastes of different categories need to be collected in identifiable containers The duration of storage should not exceed for 8-10 hrs in big hospitals (more than 250 bedded) and 24 hrs in nursing homes Each container may be clearly labelled to show the ward or room where it is kept The reason for this labelling is that it may be necessary to trace the waste back to its source Besides this storage area should be marked with a caution sign

Transportation

The waste should be transported for treatment either in trolleys or in covered wheelbarrow Manual loading should be avoided as far as for as possible The bags Container containing BMWs should be tied lidded before transportation Before transporting

the bag containing BMWs it should be accompanied with a signed document by Nurse Doctor mentioning date shift quantity and destination

Special vehicles must be used so as to prevent access to and direct contact with the waste by the transportation operators the scavengers and the public The transport containers should be properly enclosed The effects of traffic accidents should be considered in the design and the driver must be trained in the procedures he must follow in case of an accidental spillage It should also be possible to wash the interior of the containers thoroughly

Personnel safety devices

The use of protective gears should be made mandatory for all the personnel handling waste

Gloves Heavy-duty rubber gloves should be used for waste handling by the waste retrievers This should be bright yellow in colour After handling the waste the gloves should be washed twice The gloves should be washed after every use with carbolic soap and a disinfectant The size should fit the operator

Aprons gowns suits or other apparels Apparel is worn to prevent contamination of clothing and protect skin It could be made of cloth or impermeable material such as plastic People working in incinerator chambers should have gowns or suits made of non-inflammable material

Masks Various types of masks goggles and face shields are worn alone or in combination to provide a protective barrier It is mandatory for personnel working in the incinerator chamber to wear a mask covering both nose and mouth preferably a gas mask with filters

Boots Leg coverings boots or shoe-covers provide greater protection to the skin when splashes or large quantities of infected waste have to be handled The boots should be rubber-soled and anti-skid type They should cover the leg up to the ankle

Cleaning devices

Brooms The broom shall be a minimum of 12 m long such that the worker need not stoop to sweep The diameter of the broom should be convenient to handle The brush of the broom shall be soft or hard depending on the type of flooring

Dustpans The dustpans should be used to collect the dust from the sweeping operations They may be either of plastic or enamelled metal They should be free of ribs and should have smooth contours to prevent dust from sticking to the surface They should be washed with disinfectants and dried before every use

Mops Mops with long handles must be used for swabbing the floor They shall be of either the cloth or the rubber variety The mop has to be replaced depending on the wear and tear The mechanical-screw type of mop is convenient for squeezing out the water

Vacuum cleaners Domestic vacuum cleaners or industrial vacuum cleaners can be used depending on the size of the roomsStorage devices

Dustbins

It is very important to assess the quantity of waste generated at each point Dustbins should be of such capacity that they do not overflow between each cycle of waste collection Dustbins should be cleaned after every cycle of clearance of waste with disinfectants Dustbins can be lined with plastic bags which are chlorine-free and colour coded as per the law

Handling devices

Trolleys

The use of trolleys will facilitate the removal of infectious waste at the source itself instead of adding a new category of waste

Wheelbarrows

Wheelbarrows are used to transfer the waste from the point source to the collection centres There are two types of wheelbarrow ndash covered and open Wheelbarrows are made of steel and provided with two wheels and a handle Care should be taken not to directly dump waste into it Only packed waste (in plastic bags) should be carried Care should also be taken not to allow liquid waste from spilling into the wheelbarrow as it will corrode These are ideal for transferring debris within the institution Wheelbarrows also come in various sizes depending on the utility

Chutes

Chutes are vertical conduits provided for easy transportation of refuse vertically in case of institutions with more than two floors Chutes should be fabricated from stainless steel It should have a self-closing lid These chutes should be fumigated everyday with formaldehyde vapours The contaminated linen (contaminated with blood and or other body fluids) from each floor should be bundled in soiled linen or in plastic bags before ejecting into the chute

Alternately elevators with mechanical winches or electrical winches can be provided to bring down waste containers from each floor Chutes are necessary to avoid horizontal transport of waste thereby minimizing the routing of the waste within the premises and hence reducing the risk of secondary contaminationTreatment

Technology options for lsquotreatmentrsquo

There are mainly five technology options available for the treatment of Bio-Medical Waste or still under research can be grouped as

1 Chemical processes2 Thermal processes3 Mechanical processes4 Irradiation processes5 Biological processes1 Chemical processes

These processes use chemical that act as disinfectants Sodium hypochlorit dissolved chlorine dioxide peracetic acid hydrogen peroxide dry inorganic chemical and ozone are examples of such chemical Most chemical processes are water-intensive and require neutralising agents

2 Thermal processes

These processes utilise heat to disinfect Depending on the temperature they operate it is been grouped into two categories which are Low-heat systems and High-heat systemsLow-heat systems (operates between 93-177degC) use steam hot water or electromagnetic radiation to heat and decontaminate the waste

Autoclave amp Microwave are low heat systems

Autoclaving is a low heat thermal process and it uses steam for disinfection of waste Autoclaves are of two types depending on the method they use for removal of air pockets are gravity flow autoclave and vacuum autoclave

Microwaving is a process which disinfect the waste by moist heat and steam generated by microwaveenergy

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

biomedical waste include hospitals health clinics nursing homes medical research laboratories offices of physicians dentists and veterinarians home health care and funeral homes In healthcare facilities (ie hospitals clinics doctors offices veterinary hospitals and clinical laboratories) waste with these characteristics may alternatively be called medical or clinical waste

Applicability of BMW Rules 1998

The BMW Rules are applicable to every occupier of an institution generating biomedical waste which includes a hospital nursing homes clinic dispensary veterinary institutions animal houses pathological lab blood bank by whatever name called the rules are applicable to even handlers

CATEGORIES OF BIOMEDICAL WASTE SCHEDULE ndash I

WASTE CATEGORY TYPE OF WASTE TREATMENT AND

DISPOSAL OPTIONCategory No 1 Human Anatomical Waste (Human tissues organs body parts) Incineration deep burial

Category No 2

Animal Waste(Animal tissues organs body parts carcasses bleeding parts fluid blood and experimental animals used in research waste generated by veterinary hospitals and colleges discharge from hospitals animal houses)

Incineration deep burial

Category No 3

Microbiology amp Biotechnology Waste (Wastes from laboratory cultures stocks or specimen of live micro organisms or attenuated vaccines human and animal cell cultures used in research and infectious agents from research and industrial laboratories wastes from production of biologicals toxins and devices used for transfer of cultures)

Local autoclaving microwaving incineration

Category No 4Waste Sharps (Needles syringes scalpels blades glass etc that may cause puncture and cuts This includes both used and unused sharps)

Disinfecting (chemical treatment autoclaving microwaving and mutilation shredding

Category No 5 Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated contaminated and discarded medicines)

Incineration destruction and drugs disposal in secured landfills

Category No 6Soiled Waste (Items contaminated with body fluids including cotton dressings soiled plaster casts lines bedding and other materials contaminated with blood)

Incineration autoclaving microwaving

Category No 7 Solid Waste (Waste generated from disposable items other than the waste sharps such as tubing catheters intravenous sets etc)

Disinfecting by chemical treatment autoclaving microwaving and mutilation shredding

Category No 8 Liquid Waste (Waste generated from the laboratory and washing cleaning house keeping and disinfecting activities)

Disinfecting by chemical treatment and discharge into drains

Category No 9 Incineration Ash (Ash from incineration of any biomedical waste)

Disposal in municipal landfill

Category No10 Chemical Waste (Chemicals used in production of biologicals chemicals used in disinfecting as insecticides etc)

Chemical treatment and discharge into drains for liquids and secured landfill for solids

Composition of BMW

The typical Hospital solid waste composition is as follows (based on CPCB report)

Segregation

Segregation refers to the basic separation of different categories of waste generated at source and thereby reducing the risks as well as cost of handling and disposal Segregation is the most crucial step in bio-medical waste management Effective segregation alone can ensure effective bio-medical waste management The BMWs must be segregated in accordance to guidelines laid down under schedule 1 of BMW Rules 1998

Proper labelling of bins

The bins and bags should carry the biohazard symbol indicating the nature of waste to the patients and public

Schedule III (Rule 6) of Bio-medical Waste (Management and Handling) Rules 1998 specifies the Label for Bio-Medical Waste Containers Bags as

Label shall be non-washable and prominently visibleCollection

The collection of biomedical waste involves use of different types of container from various sources of biomedical wastes like Operation Theatre laboratory wards kitchen corridor etc The containers bins should be placed in such a way that 100 collection is achieved Sharps must always be kept in puncture-proof containers to avoid injuries and infection to the workers handling them

Storage

Once collection occurs then biomedical waste is stored in a proper place Segregated wastes of different categories need to be collected in identifiable containers The duration of storage should not exceed for 8-10 hrs in big hospitals (more than 250 bedded) and 24 hrs in nursing homes Each container may be clearly labelled to show the ward or room where it is kept The reason for this labelling is that it may be necessary to trace the waste back to its source Besides this storage area should be marked with a caution sign

Transportation

The waste should be transported for treatment either in trolleys or in covered wheelbarrow Manual loading should be avoided as far as for as possible The bags Container containing BMWs should be tied lidded before transportation Before transporting

the bag containing BMWs it should be accompanied with a signed document by Nurse Doctor mentioning date shift quantity and destination

Special vehicles must be used so as to prevent access to and direct contact with the waste by the transportation operators the scavengers and the public The transport containers should be properly enclosed The effects of traffic accidents should be considered in the design and the driver must be trained in the procedures he must follow in case of an accidental spillage It should also be possible to wash the interior of the containers thoroughly

Personnel safety devices

The use of protective gears should be made mandatory for all the personnel handling waste

Gloves Heavy-duty rubber gloves should be used for waste handling by the waste retrievers This should be bright yellow in colour After handling the waste the gloves should be washed twice The gloves should be washed after every use with carbolic soap and a disinfectant The size should fit the operator

Aprons gowns suits or other apparels Apparel is worn to prevent contamination of clothing and protect skin It could be made of cloth or impermeable material such as plastic People working in incinerator chambers should have gowns or suits made of non-inflammable material

Masks Various types of masks goggles and face shields are worn alone or in combination to provide a protective barrier It is mandatory for personnel working in the incinerator chamber to wear a mask covering both nose and mouth preferably a gas mask with filters

Boots Leg coverings boots or shoe-covers provide greater protection to the skin when splashes or large quantities of infected waste have to be handled The boots should be rubber-soled and anti-skid type They should cover the leg up to the ankle

Cleaning devices

Brooms The broom shall be a minimum of 12 m long such that the worker need not stoop to sweep The diameter of the broom should be convenient to handle The brush of the broom shall be soft or hard depending on the type of flooring

Dustpans The dustpans should be used to collect the dust from the sweeping operations They may be either of plastic or enamelled metal They should be free of ribs and should have smooth contours to prevent dust from sticking to the surface They should be washed with disinfectants and dried before every use

Mops Mops with long handles must be used for swabbing the floor They shall be of either the cloth or the rubber variety The mop has to be replaced depending on the wear and tear The mechanical-screw type of mop is convenient for squeezing out the water

Vacuum cleaners Domestic vacuum cleaners or industrial vacuum cleaners can be used depending on the size of the roomsStorage devices

Dustbins

It is very important to assess the quantity of waste generated at each point Dustbins should be of such capacity that they do not overflow between each cycle of waste collection Dustbins should be cleaned after every cycle of clearance of waste with disinfectants Dustbins can be lined with plastic bags which are chlorine-free and colour coded as per the law

Handling devices

Trolleys

The use of trolleys will facilitate the removal of infectious waste at the source itself instead of adding a new category of waste

Wheelbarrows

Wheelbarrows are used to transfer the waste from the point source to the collection centres There are two types of wheelbarrow ndash covered and open Wheelbarrows are made of steel and provided with two wheels and a handle Care should be taken not to directly dump waste into it Only packed waste (in plastic bags) should be carried Care should also be taken not to allow liquid waste from spilling into the wheelbarrow as it will corrode These are ideal for transferring debris within the institution Wheelbarrows also come in various sizes depending on the utility

Chutes

Chutes are vertical conduits provided for easy transportation of refuse vertically in case of institutions with more than two floors Chutes should be fabricated from stainless steel It should have a self-closing lid These chutes should be fumigated everyday with formaldehyde vapours The contaminated linen (contaminated with blood and or other body fluids) from each floor should be bundled in soiled linen or in plastic bags before ejecting into the chute

Alternately elevators with mechanical winches or electrical winches can be provided to bring down waste containers from each floor Chutes are necessary to avoid horizontal transport of waste thereby minimizing the routing of the waste within the premises and hence reducing the risk of secondary contaminationTreatment

Technology options for lsquotreatmentrsquo

There are mainly five technology options available for the treatment of Bio-Medical Waste or still under research can be grouped as

1 Chemical processes2 Thermal processes3 Mechanical processes4 Irradiation processes5 Biological processes1 Chemical processes

These processes use chemical that act as disinfectants Sodium hypochlorit dissolved chlorine dioxide peracetic acid hydrogen peroxide dry inorganic chemical and ozone are examples of such chemical Most chemical processes are water-intensive and require neutralising agents

2 Thermal processes

These processes utilise heat to disinfect Depending on the temperature they operate it is been grouped into two categories which are Low-heat systems and High-heat systemsLow-heat systems (operates between 93-177degC) use steam hot water or electromagnetic radiation to heat and decontaminate the waste

Autoclave amp Microwave are low heat systems

Autoclaving is a low heat thermal process and it uses steam for disinfection of waste Autoclaves are of two types depending on the method they use for removal of air pockets are gravity flow autoclave and vacuum autoclave

Microwaving is a process which disinfect the waste by moist heat and steam generated by microwaveenergy

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Category No 9 Incineration Ash (Ash from incineration of any biomedical waste)

Disposal in municipal landfill

Category No10 Chemical Waste (Chemicals used in production of biologicals chemicals used in disinfecting as insecticides etc)

Chemical treatment and discharge into drains for liquids and secured landfill for solids

Composition of BMW

The typical Hospital solid waste composition is as follows (based on CPCB report)

Segregation

Segregation refers to the basic separation of different categories of waste generated at source and thereby reducing the risks as well as cost of handling and disposal Segregation is the most crucial step in bio-medical waste management Effective segregation alone can ensure effective bio-medical waste management The BMWs must be segregated in accordance to guidelines laid down under schedule 1 of BMW Rules 1998

Proper labelling of bins

The bins and bags should carry the biohazard symbol indicating the nature of waste to the patients and public

Schedule III (Rule 6) of Bio-medical Waste (Management and Handling) Rules 1998 specifies the Label for Bio-Medical Waste Containers Bags as

Label shall be non-washable and prominently visibleCollection

The collection of biomedical waste involves use of different types of container from various sources of biomedical wastes like Operation Theatre laboratory wards kitchen corridor etc The containers bins should be placed in such a way that 100 collection is achieved Sharps must always be kept in puncture-proof containers to avoid injuries and infection to the workers handling them

Storage

Once collection occurs then biomedical waste is stored in a proper place Segregated wastes of different categories need to be collected in identifiable containers The duration of storage should not exceed for 8-10 hrs in big hospitals (more than 250 bedded) and 24 hrs in nursing homes Each container may be clearly labelled to show the ward or room where it is kept The reason for this labelling is that it may be necessary to trace the waste back to its source Besides this storage area should be marked with a caution sign

Transportation

The waste should be transported for treatment either in trolleys or in covered wheelbarrow Manual loading should be avoided as far as for as possible The bags Container containing BMWs should be tied lidded before transportation Before transporting

the bag containing BMWs it should be accompanied with a signed document by Nurse Doctor mentioning date shift quantity and destination

Special vehicles must be used so as to prevent access to and direct contact with the waste by the transportation operators the scavengers and the public The transport containers should be properly enclosed The effects of traffic accidents should be considered in the design and the driver must be trained in the procedures he must follow in case of an accidental spillage It should also be possible to wash the interior of the containers thoroughly

Personnel safety devices

The use of protective gears should be made mandatory for all the personnel handling waste

Gloves Heavy-duty rubber gloves should be used for waste handling by the waste retrievers This should be bright yellow in colour After handling the waste the gloves should be washed twice The gloves should be washed after every use with carbolic soap and a disinfectant The size should fit the operator

Aprons gowns suits or other apparels Apparel is worn to prevent contamination of clothing and protect skin It could be made of cloth or impermeable material such as plastic People working in incinerator chambers should have gowns or suits made of non-inflammable material

Masks Various types of masks goggles and face shields are worn alone or in combination to provide a protective barrier It is mandatory for personnel working in the incinerator chamber to wear a mask covering both nose and mouth preferably a gas mask with filters

Boots Leg coverings boots or shoe-covers provide greater protection to the skin when splashes or large quantities of infected waste have to be handled The boots should be rubber-soled and anti-skid type They should cover the leg up to the ankle

Cleaning devices

Brooms The broom shall be a minimum of 12 m long such that the worker need not stoop to sweep The diameter of the broom should be convenient to handle The brush of the broom shall be soft or hard depending on the type of flooring

Dustpans The dustpans should be used to collect the dust from the sweeping operations They may be either of plastic or enamelled metal They should be free of ribs and should have smooth contours to prevent dust from sticking to the surface They should be washed with disinfectants and dried before every use

Mops Mops with long handles must be used for swabbing the floor They shall be of either the cloth or the rubber variety The mop has to be replaced depending on the wear and tear The mechanical-screw type of mop is convenient for squeezing out the water

Vacuum cleaners Domestic vacuum cleaners or industrial vacuum cleaners can be used depending on the size of the roomsStorage devices

Dustbins

It is very important to assess the quantity of waste generated at each point Dustbins should be of such capacity that they do not overflow between each cycle of waste collection Dustbins should be cleaned after every cycle of clearance of waste with disinfectants Dustbins can be lined with plastic bags which are chlorine-free and colour coded as per the law

Handling devices

Trolleys

The use of trolleys will facilitate the removal of infectious waste at the source itself instead of adding a new category of waste

Wheelbarrows

Wheelbarrows are used to transfer the waste from the point source to the collection centres There are two types of wheelbarrow ndash covered and open Wheelbarrows are made of steel and provided with two wheels and a handle Care should be taken not to directly dump waste into it Only packed waste (in plastic bags) should be carried Care should also be taken not to allow liquid waste from spilling into the wheelbarrow as it will corrode These are ideal for transferring debris within the institution Wheelbarrows also come in various sizes depending on the utility

Chutes

Chutes are vertical conduits provided for easy transportation of refuse vertically in case of institutions with more than two floors Chutes should be fabricated from stainless steel It should have a self-closing lid These chutes should be fumigated everyday with formaldehyde vapours The contaminated linen (contaminated with blood and or other body fluids) from each floor should be bundled in soiled linen or in plastic bags before ejecting into the chute

Alternately elevators with mechanical winches or electrical winches can be provided to bring down waste containers from each floor Chutes are necessary to avoid horizontal transport of waste thereby minimizing the routing of the waste within the premises and hence reducing the risk of secondary contaminationTreatment

Technology options for lsquotreatmentrsquo

There are mainly five technology options available for the treatment of Bio-Medical Waste or still under research can be grouped as

1 Chemical processes2 Thermal processes3 Mechanical processes4 Irradiation processes5 Biological processes1 Chemical processes

These processes use chemical that act as disinfectants Sodium hypochlorit dissolved chlorine dioxide peracetic acid hydrogen peroxide dry inorganic chemical and ozone are examples of such chemical Most chemical processes are water-intensive and require neutralising agents

2 Thermal processes

These processes utilise heat to disinfect Depending on the temperature they operate it is been grouped into two categories which are Low-heat systems and High-heat systemsLow-heat systems (operates between 93-177degC) use steam hot water or electromagnetic radiation to heat and decontaminate the waste

Autoclave amp Microwave are low heat systems

Autoclaving is a low heat thermal process and it uses steam for disinfection of waste Autoclaves are of two types depending on the method they use for removal of air pockets are gravity flow autoclave and vacuum autoclave

Microwaving is a process which disinfect the waste by moist heat and steam generated by microwaveenergy

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Label shall be non-washable and prominently visibleCollection

The collection of biomedical waste involves use of different types of container from various sources of biomedical wastes like Operation Theatre laboratory wards kitchen corridor etc The containers bins should be placed in such a way that 100 collection is achieved Sharps must always be kept in puncture-proof containers to avoid injuries and infection to the workers handling them

Storage

Once collection occurs then biomedical waste is stored in a proper place Segregated wastes of different categories need to be collected in identifiable containers The duration of storage should not exceed for 8-10 hrs in big hospitals (more than 250 bedded) and 24 hrs in nursing homes Each container may be clearly labelled to show the ward or room where it is kept The reason for this labelling is that it may be necessary to trace the waste back to its source Besides this storage area should be marked with a caution sign

Transportation

The waste should be transported for treatment either in trolleys or in covered wheelbarrow Manual loading should be avoided as far as for as possible The bags Container containing BMWs should be tied lidded before transportation Before transporting

the bag containing BMWs it should be accompanied with a signed document by Nurse Doctor mentioning date shift quantity and destination

Special vehicles must be used so as to prevent access to and direct contact with the waste by the transportation operators the scavengers and the public The transport containers should be properly enclosed The effects of traffic accidents should be considered in the design and the driver must be trained in the procedures he must follow in case of an accidental spillage It should also be possible to wash the interior of the containers thoroughly

Personnel safety devices

The use of protective gears should be made mandatory for all the personnel handling waste

Gloves Heavy-duty rubber gloves should be used for waste handling by the waste retrievers This should be bright yellow in colour After handling the waste the gloves should be washed twice The gloves should be washed after every use with carbolic soap and a disinfectant The size should fit the operator

Aprons gowns suits or other apparels Apparel is worn to prevent contamination of clothing and protect skin It could be made of cloth or impermeable material such as plastic People working in incinerator chambers should have gowns or suits made of non-inflammable material

Masks Various types of masks goggles and face shields are worn alone or in combination to provide a protective barrier It is mandatory for personnel working in the incinerator chamber to wear a mask covering both nose and mouth preferably a gas mask with filters

Boots Leg coverings boots or shoe-covers provide greater protection to the skin when splashes or large quantities of infected waste have to be handled The boots should be rubber-soled and anti-skid type They should cover the leg up to the ankle

Cleaning devices

Brooms The broom shall be a minimum of 12 m long such that the worker need not stoop to sweep The diameter of the broom should be convenient to handle The brush of the broom shall be soft or hard depending on the type of flooring

Dustpans The dustpans should be used to collect the dust from the sweeping operations They may be either of plastic or enamelled metal They should be free of ribs and should have smooth contours to prevent dust from sticking to the surface They should be washed with disinfectants and dried before every use

Mops Mops with long handles must be used for swabbing the floor They shall be of either the cloth or the rubber variety The mop has to be replaced depending on the wear and tear The mechanical-screw type of mop is convenient for squeezing out the water

Vacuum cleaners Domestic vacuum cleaners or industrial vacuum cleaners can be used depending on the size of the roomsStorage devices

Dustbins

It is very important to assess the quantity of waste generated at each point Dustbins should be of such capacity that they do not overflow between each cycle of waste collection Dustbins should be cleaned after every cycle of clearance of waste with disinfectants Dustbins can be lined with plastic bags which are chlorine-free and colour coded as per the law

Handling devices

Trolleys

The use of trolleys will facilitate the removal of infectious waste at the source itself instead of adding a new category of waste

Wheelbarrows

Wheelbarrows are used to transfer the waste from the point source to the collection centres There are two types of wheelbarrow ndash covered and open Wheelbarrows are made of steel and provided with two wheels and a handle Care should be taken not to directly dump waste into it Only packed waste (in plastic bags) should be carried Care should also be taken not to allow liquid waste from spilling into the wheelbarrow as it will corrode These are ideal for transferring debris within the institution Wheelbarrows also come in various sizes depending on the utility

Chutes

Chutes are vertical conduits provided for easy transportation of refuse vertically in case of institutions with more than two floors Chutes should be fabricated from stainless steel It should have a self-closing lid These chutes should be fumigated everyday with formaldehyde vapours The contaminated linen (contaminated with blood and or other body fluids) from each floor should be bundled in soiled linen or in plastic bags before ejecting into the chute

Alternately elevators with mechanical winches or electrical winches can be provided to bring down waste containers from each floor Chutes are necessary to avoid horizontal transport of waste thereby minimizing the routing of the waste within the premises and hence reducing the risk of secondary contaminationTreatment

Technology options for lsquotreatmentrsquo

There are mainly five technology options available for the treatment of Bio-Medical Waste or still under research can be grouped as

1 Chemical processes2 Thermal processes3 Mechanical processes4 Irradiation processes5 Biological processes1 Chemical processes

These processes use chemical that act as disinfectants Sodium hypochlorit dissolved chlorine dioxide peracetic acid hydrogen peroxide dry inorganic chemical and ozone are examples of such chemical Most chemical processes are water-intensive and require neutralising agents

2 Thermal processes

These processes utilise heat to disinfect Depending on the temperature they operate it is been grouped into two categories which are Low-heat systems and High-heat systemsLow-heat systems (operates between 93-177degC) use steam hot water or electromagnetic radiation to heat and decontaminate the waste

Autoclave amp Microwave are low heat systems

Autoclaving is a low heat thermal process and it uses steam for disinfection of waste Autoclaves are of two types depending on the method they use for removal of air pockets are gravity flow autoclave and vacuum autoclave

Microwaving is a process which disinfect the waste by moist heat and steam generated by microwaveenergy

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

the bag containing BMWs it should be accompanied with a signed document by Nurse Doctor mentioning date shift quantity and destination

Special vehicles must be used so as to prevent access to and direct contact with the waste by the transportation operators the scavengers and the public The transport containers should be properly enclosed The effects of traffic accidents should be considered in the design and the driver must be trained in the procedures he must follow in case of an accidental spillage It should also be possible to wash the interior of the containers thoroughly

Personnel safety devices

The use of protective gears should be made mandatory for all the personnel handling waste

Gloves Heavy-duty rubber gloves should be used for waste handling by the waste retrievers This should be bright yellow in colour After handling the waste the gloves should be washed twice The gloves should be washed after every use with carbolic soap and a disinfectant The size should fit the operator

Aprons gowns suits or other apparels Apparel is worn to prevent contamination of clothing and protect skin It could be made of cloth or impermeable material such as plastic People working in incinerator chambers should have gowns or suits made of non-inflammable material

Masks Various types of masks goggles and face shields are worn alone or in combination to provide a protective barrier It is mandatory for personnel working in the incinerator chamber to wear a mask covering both nose and mouth preferably a gas mask with filters

Boots Leg coverings boots or shoe-covers provide greater protection to the skin when splashes or large quantities of infected waste have to be handled The boots should be rubber-soled and anti-skid type They should cover the leg up to the ankle

Cleaning devices

Brooms The broom shall be a minimum of 12 m long such that the worker need not stoop to sweep The diameter of the broom should be convenient to handle The brush of the broom shall be soft or hard depending on the type of flooring

Dustpans The dustpans should be used to collect the dust from the sweeping operations They may be either of plastic or enamelled metal They should be free of ribs and should have smooth contours to prevent dust from sticking to the surface They should be washed with disinfectants and dried before every use

Mops Mops with long handles must be used for swabbing the floor They shall be of either the cloth or the rubber variety The mop has to be replaced depending on the wear and tear The mechanical-screw type of mop is convenient for squeezing out the water

Vacuum cleaners Domestic vacuum cleaners or industrial vacuum cleaners can be used depending on the size of the roomsStorage devices

Dustbins

It is very important to assess the quantity of waste generated at each point Dustbins should be of such capacity that they do not overflow between each cycle of waste collection Dustbins should be cleaned after every cycle of clearance of waste with disinfectants Dustbins can be lined with plastic bags which are chlorine-free and colour coded as per the law

Handling devices

Trolleys

The use of trolleys will facilitate the removal of infectious waste at the source itself instead of adding a new category of waste

Wheelbarrows

Wheelbarrows are used to transfer the waste from the point source to the collection centres There are two types of wheelbarrow ndash covered and open Wheelbarrows are made of steel and provided with two wheels and a handle Care should be taken not to directly dump waste into it Only packed waste (in plastic bags) should be carried Care should also be taken not to allow liquid waste from spilling into the wheelbarrow as it will corrode These are ideal for transferring debris within the institution Wheelbarrows also come in various sizes depending on the utility

Chutes

Chutes are vertical conduits provided for easy transportation of refuse vertically in case of institutions with more than two floors Chutes should be fabricated from stainless steel It should have a self-closing lid These chutes should be fumigated everyday with formaldehyde vapours The contaminated linen (contaminated with blood and or other body fluids) from each floor should be bundled in soiled linen or in plastic bags before ejecting into the chute

Alternately elevators with mechanical winches or electrical winches can be provided to bring down waste containers from each floor Chutes are necessary to avoid horizontal transport of waste thereby minimizing the routing of the waste within the premises and hence reducing the risk of secondary contaminationTreatment

Technology options for lsquotreatmentrsquo

There are mainly five technology options available for the treatment of Bio-Medical Waste or still under research can be grouped as

1 Chemical processes2 Thermal processes3 Mechanical processes4 Irradiation processes5 Biological processes1 Chemical processes

These processes use chemical that act as disinfectants Sodium hypochlorit dissolved chlorine dioxide peracetic acid hydrogen peroxide dry inorganic chemical and ozone are examples of such chemical Most chemical processes are water-intensive and require neutralising agents

2 Thermal processes

These processes utilise heat to disinfect Depending on the temperature they operate it is been grouped into two categories which are Low-heat systems and High-heat systemsLow-heat systems (operates between 93-177degC) use steam hot water or electromagnetic radiation to heat and decontaminate the waste

Autoclave amp Microwave are low heat systems

Autoclaving is a low heat thermal process and it uses steam for disinfection of waste Autoclaves are of two types depending on the method they use for removal of air pockets are gravity flow autoclave and vacuum autoclave

Microwaving is a process which disinfect the waste by moist heat and steam generated by microwaveenergy

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Cleaning devices

Brooms The broom shall be a minimum of 12 m long such that the worker need not stoop to sweep The diameter of the broom should be convenient to handle The brush of the broom shall be soft or hard depending on the type of flooring

Dustpans The dustpans should be used to collect the dust from the sweeping operations They may be either of plastic or enamelled metal They should be free of ribs and should have smooth contours to prevent dust from sticking to the surface They should be washed with disinfectants and dried before every use

Mops Mops with long handles must be used for swabbing the floor They shall be of either the cloth or the rubber variety The mop has to be replaced depending on the wear and tear The mechanical-screw type of mop is convenient for squeezing out the water

Vacuum cleaners Domestic vacuum cleaners or industrial vacuum cleaners can be used depending on the size of the roomsStorage devices

Dustbins

It is very important to assess the quantity of waste generated at each point Dustbins should be of such capacity that they do not overflow between each cycle of waste collection Dustbins should be cleaned after every cycle of clearance of waste with disinfectants Dustbins can be lined with plastic bags which are chlorine-free and colour coded as per the law

Handling devices

Trolleys

The use of trolleys will facilitate the removal of infectious waste at the source itself instead of adding a new category of waste

Wheelbarrows

Wheelbarrows are used to transfer the waste from the point source to the collection centres There are two types of wheelbarrow ndash covered and open Wheelbarrows are made of steel and provided with two wheels and a handle Care should be taken not to directly dump waste into it Only packed waste (in plastic bags) should be carried Care should also be taken not to allow liquid waste from spilling into the wheelbarrow as it will corrode These are ideal for transferring debris within the institution Wheelbarrows also come in various sizes depending on the utility

Chutes

Chutes are vertical conduits provided for easy transportation of refuse vertically in case of institutions with more than two floors Chutes should be fabricated from stainless steel It should have a self-closing lid These chutes should be fumigated everyday with formaldehyde vapours The contaminated linen (contaminated with blood and or other body fluids) from each floor should be bundled in soiled linen or in plastic bags before ejecting into the chute

Alternately elevators with mechanical winches or electrical winches can be provided to bring down waste containers from each floor Chutes are necessary to avoid horizontal transport of waste thereby minimizing the routing of the waste within the premises and hence reducing the risk of secondary contaminationTreatment

Technology options for lsquotreatmentrsquo

There are mainly five technology options available for the treatment of Bio-Medical Waste or still under research can be grouped as

1 Chemical processes2 Thermal processes3 Mechanical processes4 Irradiation processes5 Biological processes1 Chemical processes

These processes use chemical that act as disinfectants Sodium hypochlorit dissolved chlorine dioxide peracetic acid hydrogen peroxide dry inorganic chemical and ozone are examples of such chemical Most chemical processes are water-intensive and require neutralising agents

2 Thermal processes

These processes utilise heat to disinfect Depending on the temperature they operate it is been grouped into two categories which are Low-heat systems and High-heat systemsLow-heat systems (operates between 93-177degC) use steam hot water or electromagnetic radiation to heat and decontaminate the waste

Autoclave amp Microwave are low heat systems

Autoclaving is a low heat thermal process and it uses steam for disinfection of waste Autoclaves are of two types depending on the method they use for removal of air pockets are gravity flow autoclave and vacuum autoclave

Microwaving is a process which disinfect the waste by moist heat and steam generated by microwaveenergy

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Handling devices

Trolleys

The use of trolleys will facilitate the removal of infectious waste at the source itself instead of adding a new category of waste

Wheelbarrows

Wheelbarrows are used to transfer the waste from the point source to the collection centres There are two types of wheelbarrow ndash covered and open Wheelbarrows are made of steel and provided with two wheels and a handle Care should be taken not to directly dump waste into it Only packed waste (in plastic bags) should be carried Care should also be taken not to allow liquid waste from spilling into the wheelbarrow as it will corrode These are ideal for transferring debris within the institution Wheelbarrows also come in various sizes depending on the utility

Chutes

Chutes are vertical conduits provided for easy transportation of refuse vertically in case of institutions with more than two floors Chutes should be fabricated from stainless steel It should have a self-closing lid These chutes should be fumigated everyday with formaldehyde vapours The contaminated linen (contaminated with blood and or other body fluids) from each floor should be bundled in soiled linen or in plastic bags before ejecting into the chute

Alternately elevators with mechanical winches or electrical winches can be provided to bring down waste containers from each floor Chutes are necessary to avoid horizontal transport of waste thereby minimizing the routing of the waste within the premises and hence reducing the risk of secondary contaminationTreatment

Technology options for lsquotreatmentrsquo

There are mainly five technology options available for the treatment of Bio-Medical Waste or still under research can be grouped as

1 Chemical processes2 Thermal processes3 Mechanical processes4 Irradiation processes5 Biological processes1 Chemical processes

These processes use chemical that act as disinfectants Sodium hypochlorit dissolved chlorine dioxide peracetic acid hydrogen peroxide dry inorganic chemical and ozone are examples of such chemical Most chemical processes are water-intensive and require neutralising agents

2 Thermal processes

These processes utilise heat to disinfect Depending on the temperature they operate it is been grouped into two categories which are Low-heat systems and High-heat systemsLow-heat systems (operates between 93-177degC) use steam hot water or electromagnetic radiation to heat and decontaminate the waste

Autoclave amp Microwave are low heat systems

Autoclaving is a low heat thermal process and it uses steam for disinfection of waste Autoclaves are of two types depending on the method they use for removal of air pockets are gravity flow autoclave and vacuum autoclave

Microwaving is a process which disinfect the waste by moist heat and steam generated by microwaveenergy

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Technology options for lsquotreatmentrsquo

There are mainly five technology options available for the treatment of Bio-Medical Waste or still under research can be grouped as

1 Chemical processes2 Thermal processes3 Mechanical processes4 Irradiation processes5 Biological processes1 Chemical processes

These processes use chemical that act as disinfectants Sodium hypochlorit dissolved chlorine dioxide peracetic acid hydrogen peroxide dry inorganic chemical and ozone are examples of such chemical Most chemical processes are water-intensive and require neutralising agents

2 Thermal processes

These processes utilise heat to disinfect Depending on the temperature they operate it is been grouped into two categories which are Low-heat systems and High-heat systemsLow-heat systems (operates between 93-177degC) use steam hot water or electromagnetic radiation to heat and decontaminate the waste

Autoclave amp Microwave are low heat systems

Autoclaving is a low heat thermal process and it uses steam for disinfection of waste Autoclaves are of two types depending on the method they use for removal of air pockets are gravity flow autoclave and vacuum autoclave

Microwaving is a process which disinfect the waste by moist heat and steam generated by microwaveenergy

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

High-heat systems (operates between 540-8300degC) employ combustion and high temperature plasma to decontaminate and destroy the waste

Incinerator amp Hydroclaving are high heat systems Hydroclaving - is steam treatment with fragmentation and drying of waste

Incineration - is a burn technology

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

3 Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling or to process the waste in conjunction with other treatment steps The two primary mechanical processes are

Compaction - used to reduce the volume of the waste

Shredding - used to destroy plastic and paper waste to prevent their reuse Only the disinfected waste can be used in a shredder

4 Irradiation processes

exposes wastes to ultraviolet or ionizing radiation in an enclosed chamber These systems require post shredding to render the waste unrecognizable

5 Biological processes -

using biological enzymes for treating medical waste It is claimed that biological reactions will not only decontaminate the waste but also cause the destruction of all the organic constituents so that only plastics glass and other inert will remain in the residuesPoints to ponder in processing the waste

Incineration

Incinerators should be suitably designed to achieve the emission limits Wastes to be incinerated shall not be chemically treated with any chlorinated

disinfectants Toxic metals in the incineration ash shall be limited within the regulatory quantities Only low sulphur fuel like Diesel shall be used as fuel in the incinerator

Autoclaving

The autoclave should be dedicated for the purpose of disinfecting and treating biomedical

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

waste

1 When operating a gravity flow autoclave medical waste shall be subjected to

A temperature of not less than 121 oC and pressure of about 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes or

A temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes or

A temperature of not less than 149 oC and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes

2 When operating a vacuum autoclave medical waste shall be subjected to a minimum of one per vacuum pulse to purge the autoclave of all air The waste shall be subjected to the following

A temperature of not less than 121 oC and a pressure of 15 psi per an autoclave residence time of not less than 45 minutes or

temperature of not less than 135 oC and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes or Medical waste shall not be considered properly treated unless the time temperature and pressure indicate stipulated limits If for any reason these were not reached the entire load of medical waste must be autoclaved again until the proper temperature pressure and residence time were achieved

Microwaving

Microwave treatment shall not be used for cytotoxic hazardous or radioactive wastes contaminated animal carcasses body parts and large metal items

The microwave system shall comply with the efficacy testsroutine tests The microwave should completely and consistently kill bacteria and other pathogenic

organism that is ensured by the approved biological indicator at the maximum design capacity of each microwave unit

Deep Burial

A pit or trench should be dug about 2 m deep It should be half filled with waste and then covered with lime within 50 cm of the surface before filling the rest of the pit with soil

It must be ensured that animals do not have access to burial sites Covers of galvanised ironwire meshes may be used On each occasion when wastes are added to the pit a layer of 10cm of soil be added

to cover the wastes Burial must be performed under close and dedicated supervision The site should be relatively impermeable and no shallow well should be close to the

site The pits should be distant from habitation and sited 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 The location of the site will be authorized by the prescribed authority

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

The institution shall maintain a record of all pits for deep burial

Disposal of Sharps

Blades and needles waste after disinfection should be disposed in circular or rectangular pits

Such pits can be dug and lined with brick masonry or concrete rings The pit should be covered with a heavy concrete slab which is

penetrated by a galvanized steel pipe projecting about 15 m above the slab within internal diameter of upto 20 mm

When the pipe is full it can be sealed completely after another has been prepared

Radioactive waste from medical establishments

It may be stored under carefully controlled conditions until the level of radioactivity is so low that they may be treated as other waste

Special care is needed when old equipment containing radioactive source is being discarded

Expert advice should be taken into account

Mercury control

Wastes containing Mercury due to breakage of thermometer and other measuring equipment need to be given

Proper attention should be given to the collection of the spilled mercury its storage and sending of the same back to the manufacturers

Must take all measures to ensure that the spilled mercury does not become part of biomedical wastes ]

Waste containing equal to or more than 50 ppm of mercury is a hazardous waste and the concerned generators of the wastes including the health care units are required to dispose the waste as per the norms

Standard For Liquid Waste

The effluent generated from the hospitals must confirm to the following

Parameter Permissible limit

pH 65 ndash 90Suspended solids 100 mglOil and grease 10 mglBOD 30 mglCOD 250 mgl

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 that

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

have no terminal sewage treatment plant or not connected to public sewers that have terminal facilities In addition the general standards as notified under the Environment (Protection) Act 1986 shall be applicable

Waste minimization Waste minimization is an important first step in managing wastes safely responsibly and in a cost effective manner This management step makes use of reducing reusing and recycling principles There are many possible routes to minimize the amount of both general waste and biomedical wastes within the health care or related facility Alternative technologies for biomedical waste minimization (eg microwave treatment hammer mill) have been investigated and are not considered to be practical Some of the principles of waste minimization are listed below and will be developed further in the long-term strategy

Different Types of BMW according to WHO

The World Health Organisation (WHO) has classified medical wastes according to their weight density and constituents into different categories These are

Infectious material-containing pathogens in sufficient concentrations or quantities that if exposed can cause diseases This includes waste from surgery and autopsies on patients with infectious diseases sharps disposable needles syringes saws blades broken glasses nails or any other item that could cause a cut

Pathological tissues organs body parts human flesh foetuse blood and body fluids drugs and chemicals that are returned from wards spilled outdated contaminated or are no longer required

Radioactive solids liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter and

Others waste from the offices kitchens rooms including bed linen utensils paper etc

Health hazards

According to the WHO the global life expectancy is increasing year after year However deaths due to infectious disease are also increasing A study conducted by the WHO reveals that more than 50000 people die everyday from infectious diseases

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

One of the causes for the increase in infectious diseases is improper waste management Blood body fluids and body secretions which are constituents of bio-medical waste harbour most of the viruses bacteria and parasites that cause infection

This passes via a number of human contacts all of whom are potential lsquorecipientsrsquo of the infection Human Immunodeficiency Virus (HIV) and hepatitis viruses spearhead an extensive list of infections and diseases documented to have spread through bio-medical waste Tuberculosis pneumonia diarrhea diseases tetanus whooping cough etc are other common diseases spread due to improper waste management

Occupational health hazards

The health hazards due to improper waste management can affect

The occupants in institutions and spread in the vicinity of the institutions

People happened to be in contact with the institution like laundry workers nurses emergency medical personnel and refuse workers

Risks of infections outside hospital for waste handlers scavengers and (eventually) the general public

Risks associated with hazardous chemicals drugs being handled by persons handling wastes at all levels

Injuries from sharps and exposure to harmful chemical waste and radioactive waste also cause health hazards to employees

Hazards to the general public

The general publicrsquos health can also be adversely affected by bio-medical waste

Improper practices such as dumping of bio-medical waste in municipal dustbins open spaces water bodies etc leads to the spread of diseases

Emissions from incinerators and open burning also lead to exposure to harmful gases which can cause cancer and respiratory diseases

Exposure to radioactive waste in the waste stream can also cause serious health hazards

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

An often-ignored area is the increase of in-home healthcare activities An increase in the number of diabetics who inject themselves with insulin home nurses taking care of terminally ill patients etc all generate bio-medical waste which can cause health hazards

Bio-medical waste can cause health hazards to animals and birds too

Plastic waste can choke animals which scavenge on open dumps Injuries from sharps are common feature affecting animals Harmful chemicals such as dioxins and furans can cause serious health hazards to animals and birds Heavy metals can even affect the reproductive health of the animals Change in microbial ecology spread of antibiotic resistance

What you can do

Use only disposable syringes After use throw the syringes after breaking them Bandages cotton and other blood stained materials should not be thrown with general garbage Use black plastic bags to dispose biomedical wastes Keep trash out of reach of small children and infants Diapers Sanitary napkins etc should also be disposed separately Drugs that are past date of expiry must never be used

Dos and Donrsquots

Ensure

1 that the used product is mutilated2 that the used product is treated prior to disposal3 that the used product is segregated

Do not

1 reuse plastic equipment2 mix plastic equipment with other wastes3 burn plastic waste

Use protective gear when handling waste

Avoid needle stick injuries

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Collect waste whenthe bin is 34 th full

Avoid using common lift to move waste

Avoid spillage Clean spillswith disinfectant

Use trolleys amp do not drag waste bags

Conclusion

We need innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community

India[edit]

In India The Bio-medical Waste (Management and Handling) Rules 1998 and further amendments were passed for the regulation of bio-medical waste management Each states Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation[9]

In India there are a number of different disposal methods yet most are harmful rather than helpful If body fluids are present the material needs to be incinerated or put into an autoclave Although this is the proper method most medical facilities fail to follow the regulations It is often found that biomedical waste is put into the ocean where it eventually washes up on shore or in landfills due to improper sorting when in the medical facility Improper disposal can lead to many diseases in animals as well as humans For example animals such as cows in Pondicherry India are consuming the infected waste and eventually these infections can be transported to humans through eating of the meat

Many studies took place in Gujarat India regarding the knowledge of workers in facilities such as hospitals nursing homes or home health It was found that 26 of doctors and 43 of paramedical staff were unaware of

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

the risks related to biomedical wastes After extensively looking at the different facilities many were undeveloped in the area regarding biomedical waste The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998 yet a large number of health care facilities were found to be sorting the waste incorrectly Worldwide there are specific colored bags bins and labels that are recommended for each type of waste For example syringes needles and blood-soiled bandages should be all disposed of in a red colored bag or bin where it will later be incinerated

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 containersbags 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 thereunder 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

(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

DefinitionAccording to Biomedical Waste (Management and Handling) Rules 1998 of India ldquoAny waste which is generated during the diagnosis treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals 4

The Government of India (notification 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities This involves management of range of activities which are mainly engineering functions such as collection transportation operation or treatment of processing systems and disposal of wastes

Classification of Bio-Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

acute General Waste

acute Pathological

acute Radioactive

acute Chemical

acute Infectious to potentially infectious waste

acute Sharps

acute Pharmaceuticals

acute Pressurized containers

Sources of Biomedical Waste

Hospitals produce waste which is increasing over the years in its amount and type The hospital waste in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment

Major Sources Govt hospitalsprivate hospitalsnursing homes dispensaries Primary health centers Medical colleges and research centers paramedic services Veterinary colleges and animal research centers Blood banksmortuariesautopsy centers Biotechnology institutions Production units

Minor Sources Physicians dentistsrsquo clinics Animal housesslaughter houses Blood donation camps Vaccination centers Acupuncturistspsychiatric clinicscosmetic piercing Funeral services Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard improper and indiscriminate manner Lack of segregation practices results in mixing of hospital wastes with general waste making the whole waste stream hazardous Inappropriate segregation ultimately results in an incorrect method of waste disposal

Inadequate Bio-Medical waste management thus will cause environmental pollution unpleasant smell growth and multiplication of vectors like insects rodents and worms and may lead to the transmission of diseases like typhoid cholera hepatitis and AIDS through injuries from syringes and needles contaminated with humanVarious communicable diseases which spread through water sweat blood body fluids and contaminated organs are important to be prevented The Bio Medical Waste scattered in and around the hospitals invites flies insects rodents cats and dogs that are responsible for the spread of communication disease like plague and rabies Rag pickers in the hospital sorting out the garbage are at a risk of getting tetanus and HIV infections The recycling of disposable syringes needles IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis HIV and other viral diseases It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern prompting hospital administration to seek new ways of scientific safe and cost effective management of the waste and keeping their personnel informed about the advances in this area The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals

Fig 1Click here to View figure

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste such as

1 Injuries from sharps leading to infection to all categories of hospital personnel and waste handler2 nosocomial infections in patients from poor infection control practices and poor waste management

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

3 Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals

4 Risk associated with hazardous chemicals drugs to persons handling wastes at all levels5 ldquoDisposablerdquo being repacked and sold by unscrupulous elements without even being washed6 Drugs which have been disposed of being repacked and sold off to unsuspecting buyers7 Risk of air water and soil pollution directly due to waste or due to defective incineration emissions and

ash3Biomedical Waste Management Process

There is a big network of Health Care Institutions in India The hospital waste like body parts organs tissues blood and body fluids along with soiled linen cotton bandage and plaster casts from infected and contaminated areas are very essential to be properly collected segregated stored transported treated and disposed of in safe manner to prevent nosocomial or hospital acquired infection

1 Waste collection2 Segregation3 Transportation and storage4 Treatment amp Disposal5 Transport to final disposal site6 Final disposal

Biomedical Waste Treatment and Disposal

Health care waste is a heterogeneous mixture which is very difficult to manage as such But the problem can be simplified and its dimension reduced considerably if a proper management system is planned

Incineration TechnologyThis is a high temperature thermal process employing combustion of the waste under controlled condition for converting them into inert material and gases Incinerators can be oil fired or electrically powered or a combination thereof Broadly three types of incinerators are used for hospital waste multiple hearth type rotary kiln and controlled air types All the types can have primary and secondary combustion chambers to ensure optimal combustion These are refractory lined7

Non-IncinerationTechnologyNon-incineration treatment includes four basic processes thermal chemical irradiative and biological The majority of non-incineration technologies employ the thermal and chemical processes The main purpose of the treatment technology is to decontaminate waste by destroying pathogens Facilities should make certain that the technology could meet state criteria for disinfection 9

Autoclaving

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

acute The autoclave operates on the principle of the standard pressure cooker

acute The process involves using steam at high temperatures

acute The steam generated at high temperature penetrates waste material and kills all the micro organism

acute These are also of three types Gravity type Pre-vacuum type and Retort type

In the first type (Gravity type) air is evacuated with the help of gravity alone The system operates with temperature of 121 deg C and steam pressure of15 psi for 60-90 minutes Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is reduced to 30-60 minutes It operates at about 132 deg C Retort type autoclaves are designed much higher steam temperature and pressure Autoclave treatment has been recommended for microbiology and biotechnology waste waste sharps soiled and solid wastes This technology renders certain categories (mentioned in the rules) of bio-medical waste innocuous and unrecognizable so that the treated residue can be land filled 8

Microwave Irradiation

acute The microwave is based on the principle of generation of high frequency waves

acute These waves cause the particles within the waste material to vibrate generating heat

acute This heat generated from within kills all pathogens

Chemical Methods

acute 1 hypochlorite solution can be used for chemical disinfection

Plasma PyrolysisPlasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste It is an environment-friendly technology which converts organic waste into commercially useful byproducts The intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste biomedical waste and hazardous waste in a safe and reliable manner Medical waste is pyrolysed into CO H2 and hydrocarbons when it comes in contact with the plasma-arc These gases are burned and produce a high temperature (around 1200oC)9Biomedical Waste Management Rules

Safe disposal of biomedical waste is now a legal requirement in India The Biomedical Waste Management amp Handling) Rules 1998 came into force on 1998 In accordance with these rules it is the duty of every ldquooccupierrdquo ie a person who has the control over the institution or its premises to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment It consists of six schedules

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

Schedule VI

Schedule 1 Categories of Bio-Medical WasteClick here to View schedule

Schedule II Colour Coding and Type Of Container for Disposal of Bio-Medical WastesClick here to View schedule

Schedule III Label for Bio-Medical Waste ContainersBagsClick here to View schedule

Schedule IV

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Label for Transport of Bio-Medical Waste ContainersBags

Day helliphelliphelliphellip Month helliphelliphelliphelliphelliphellipYear helliphelliphelliphelliphellip

Date of generation helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Waste category No helliphellip

Waste class

Waste description

Senderrsquos Name amp Address Receiverrsquos Name amp Address

Phone No helliphelliphelliphelliphelliphellip Phone No helliphelliphelliphelliphelliphelliphellip

Telex No helliphelliphelliphelliphelliphelliphellipTelex No helliphelliphelliphelliphelliphelliphelliphellip

Fax No helliphelliphelliphelliphelliphelliphellip Fax No helliphelliphelliphelliphelliphelliphelliphellip

Contact Person helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Contact Person helliphelliphellip

In case of emergency please contact Name amp Address

Phone No

Note Label shall be non-washable and prominently visible

Schedule-V

Standards for Treatment and Disposal Of

Bio-Medical Wastes Standards For Incinerators

Schedule-VISchedule for Waste Treatment Facilities like Incinerator Autoclave Microwave System10(Source- The Bio Medical Waste (Management and Handling) Rules 1998)

Benefits of Biomedical Waste Management

acute Cleaner and healthier surroundings

acute Reduction in the incidence of hospital acquired and general infections

acute Reduction in the cost of infection control within the hospital

acute Reduction in the possibility of disease and death due to reuse and repackaging of infectious

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

acute Low incidence of community and occupational health hazards

acute Reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste

acute Improved image of the healthcare establishment and increase the quality of life

Recommendations1 For the use of incinerator Training should be given to some number of persons from staff2 Specific fund should be allocated for the use of incinerator3 Every hospital should have special boxes to use as dustbin for bio-medical waste4 Bio-medical waste should not be mixed with other waste of Municipal Corporation5 Private hospitals should also be allowed to use incinerator which is installed in govt hospital For this

purpose a specific fee can be charged from private hospitals6 Special vehicle ie bio-medical waste vehicle should be started to collect waste from private hospitals and

private medical clinics and carry it up to the main incinerator7 As provided by bio-medical waste rules the whole of the waste should be fragmented into colours due to

their hazardous nature8 Bio-medical waste Management Board can be established in each District9 Either judicial powers should be given to the management board or special court should be established in

the matters of environment pollution for imposing fines and awarding damages etc10 Housekeeping staff wear protective devices such as gloves face masks gowned while handling the waste11 There is biomedical waste label on waste carry bags and waste carry trolley and also poster has put on the

wall adjacent to the bins (waste) giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule Carry bags also have the biohazard symbol on them

CONCLUSIONMedical wastes should be classified according to their source typology and risk factors associated with their handling storage and ultimate disposal The segregation of waste at source is the key step and reduction reuse and recycling should be considered in proper perspectives We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society The challenge before us therefore is to scientifically manage growing quantities of biomedical waste that go beyond past practices If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community Steps of biomedical waste managementSegregation should be done as per categoriesCategory Type of Container Colour coding

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

1 Human anatomical waste Plastic bag yellow2 Animal waste Plastic bag yellow3 Microbiology and Plastic bag yellowredBiotechnology waste4 Waste sharp Puncture proof Bluewhitecontainer5 Discarded Medicines Plastic bag Blackand cytotoxic waste6 Solid soiled waste plastic bag yellowred7 Solid waste plastic bag blue(all disposableplastics)8 Liquid waste ndash ndash9 Incineration ash plastic bag black

10 Chemical waste (solid) plastic bag black

Safety MeasuresHealth Care Workers (HCW) require following Personal Protection Equipments(PPE)10486981048698Gloves10486981048698Masks10486981048698Protective glasses10486981048698Plastic aprons10486981048698Gum boots for waste handlers10486981048698Hepatitis B and Tetanus immunizationAll accidents while doing therapeutic diagnostic and handling waste should berecorded All waste handlers should be made aware of risks involved in handling

BMW

3 Health Hazards from Indiscriminate Managementof Bio-Medical WasteThere are many examples and ample evidences thatindiscriminate management of Bio-Medical Waste couldcause serious hazards to health and environment as follows-31 There are many harmhl agents in the Biomedicalwaste The most important are Biological agentswhich pollute water and food and cause alimentaryinfections like cholera typhoid dysentery infectivehepatitis polio ascariasis and hook worm diseasesetc32 Wastes breed vermin and pests Examples area Mosquitoes that transmit insect borne diseaseslike malaria and filariab Common house flies which transmit infectionsmechanicallyc Many other insects and worms that causenuisance eg cockroaches antsd Rats thriving on refuse33 Dust may harbour Tubercle Bacilli and other germs

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

which cause diseases if inhaled34 Soil polluted by night soil may be rich in Tetanusspores35 Nosocomiol infections and AIDS Hepatitis BampC etc36 Aesthek -Sullage water refuse and night soil all

create intolerable nuisance of sight and smell

7 Reasons for indiscriminate management andhandling of Bio-Medical Waste71 Lack of Priority in policy on Bio-Medical WasteManagement and funds on the issue72 Lack of Managerial skill and Training of Bio-MedicalWaste Management73 Lack of Appropriate technologies for treatment anddisposal of Bio-Medical Waste

74 Lack of Strict implementation of infection control

75 Lack of Awareness among medical personal patientsattendants and people at large76 Lack ofampordination between municipality PollutionControl Board and hospital authorities77 Lack of Accountability of persons involved in the

management of Bio-Medical Waste

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Reference

A Report by Dr Saurabh Sikka on Biomedical Waste in Indian ContextAcharya D B and Singh M (2000) The Book of Hospital Waste Management Minerva Press New Delhi 2000 15 47

Ahmed R (1997) Hospital Waste Management in Pakistan Case Study Report Special Waste Fractions Hospital WasteWaste August 1997

Akter Nasima (1998) Medical waste managementEnvironmental Engineering program school of EnvironmentResources and Development Asian Institute of Technology

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Askarian M Vakili M Kabir G (2004) Hospital waste management status in university hospitals of the Fars provinceIran Int J Environ Health Res 14 295305

Glenn McR amp Garwal R (1999) Clinical waste in Developing Countries An analysis with a Case Study of India and a Critique of the BasleTWG Guidelines

Hassan MM Ahmed SA Rahman KA Biswas TK (2008)Pattern of medical waste management existing scenario in Dhaka City Bangladesh BMC Public Health

wwwbiomedcentralcom1471-2458836 Accessed 09052013 HCWH (2001) Non-Incineration Medical Waste TreatmentTechnologies Health Care without Harm Washington DC 20009 pp01-90 Hem Chandra (1999) Hospital Waste Environmental Hazard and Its Management

Hossain MS Santhanam A Narulaini NAN Omar AKM(2011) Clinical solid waste management practices and its impact on human health and environment ndash A review Waste Management 31 754-766

httphealthdelhigovtnicinHealthfilesbiohtm

httpisebindiacom95-9999-07-2htm

httpkspcbkarnicinBMW

httpmpcbmahnici

httpwwwcpcbnici

httpwwwipaiindiaorgfiles2007pd

Brain Abel Smith A study of the costs and sources of finance in six countries Public H P WHO1963 17 32-3

Park K Healthcare of the Community 16th Edition 2000 (reprinted) MS Banarasidas Bhanot Jabalpur 482001 p637

Liewelyn DR Macaulay HMC Hospital planning and administration Monograph series WHOGeneva 1966 54

Saha JB Study of the inpatient system of a Gynaecology ward in a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social Medicine All India Institute of Hygiene and Public Health Calcutta 1984

Bhadra U K et al An analysis of in-patient system of a State Hospital in Calcutta Thesis for Doctor of Medicine in Preventive and Social MedicineAll India Institute of Hygiene and Public Health Calcutta 1984

Anand TR Hospital services and management methods background reading material for training course on Hospital Management 61982 Cohan CF Hospital expenses rise faster than overall CP1 Hospital 1980 54 (21) 59-62

Report of High Power Committee on urban Solid Waste Management Planning Commission Govt Of India 1995 Hospital Waste Management 35-47

Gravers PD Management of Hospital Wastes- An overview Proceedings of National workshop on Management of HospitalWaste 1998 Apr 16th to 18th Jaipur BRD and Shristi 1998

Management of Waste from Hospitals and other health care estabhshments Euro Reportsand Studies No 97WHO 1985 l-61

Thornton J MC tally M Orris P Wentreg J Hospitals and plastics Dioxin prevention and Medical Waste Incineration Public Health Reports V-d BI July-Aug 1996 299-3 13

Nobel J J Waste Disposal Units Paediatrics Emergency Care1995 April ll(2) 118-120

Acknowledgment

We would like to thank DrYSRINIVASA RAO professor and our project guide for his unending support thorought our project work

We express our deep gratitude toDrYSRINIVASA RAOprincipalvignan institute of pharmaceutical technology Duvvada Visakhapatnam for rendering us guidance and valuable advise always He has been a perennial source of inspiration and motivation right from the inception the completion of this project

We would like to thank Dr L RATHIAH Chairman of vignan institution for providing various facilities and equipment at collage premisesWe take the opportunity to extend our gratitude to Mr KVARAPRASAD RAO Head of the department of the collage for aiding our project regarding valuable information and guidance

We express our thanks to MrHARIKISHNA Head librarineto let us use the library books and reference articles in the collage library

We express our thanks to store in charge for providing us with the various required chemicals and equipment without hesitation

We sincerely thanks all Asst ProfessorsLab assistants for their help during our projects

• India[edit]