Biomedical Waste Management

Introduction to Biomedical Waste Management

• Hospitals have historically been unaware of the adverse effects of waste on human health and the environment.
• Hospital waste poses a potential health hazard to healthcare workers, the public, and local flora and fauna.

Legal Framework

• The Ministry of Environment and Forests passed an act in 1986, which led to the notification of the Bio-Medical Waste (Management and Handling) Rules in July 1998.
• The "occupier", who controls the institution, must ensure waste is handled without adverse effects on health and the environment.

Defining Medical Waste

• Hospital waste includes all discarded biological and non-biological materials not intended for further use.
• Bio-medical waste is any waste generated during diagnosis, treatment, or immunization of humans or animals, research activities, or production/testing of biologicals, as listed in Schedule I.
• Infectious waste contains pathogens in sufficient concentration or quantity to cause diseases, such as cultures, infectious agents from labs, surgical waste, or waste from infectious patients.

Sources of Bio Medical Waste

• Bio Medical Waste is commonly produced in hospitals and nursing homes
• Bio Medical Waste is also produced clinics, medical laboratories, blood banks and mortuaries
• Medical research facilities and training centers produce Bio Medical Waste
• Biotechnology institutions/production units can produce biomedical waste
• Bio Medical Waste is common in Animal houses
• Waste can be generated at home when providing healthcare, such as injections or dressing material.

Categories of Bio-Medical Waste and Treatment

• Category No. I, Human Anatomical Waste (tissues, organs, body parts) is treated by incineration or deep burial.
• Category No. 2, Animal Waste (tissues, organs, carcasses, blood, fluids, experimental animals) is also incinerated/deep buried.
• Category No. 3, Microbiology & Biotechnology Waste (laboratory cultures, live microorganisms/vaccines, cell culture, infectious agents) undergoes local autoclaving, microwaving or incineration.
• Category No. 4, Waste sharps (needles, syringes, scalpels, glass) are disinfected via chemical treatment, autoclaving/microwaving, and mutilation/shredding.
• Category No. 5, Discarded Medicines and Cytotoxic drugs are incinerated/destroyed and disposed of in secured landfills.
• Category No. 6, Soiled Waste (blood-contaminated items) is treated via incineration, autoclaving, or microwaving.
• Category No. 7, Solid Waste (disposable items, excluding sharps) is disinfected by chemical treatment, autoclaving, microwaving, mutilation, or shredding.
• Category No. 8, Liquid Waste (from labs, cleaning) is disinfected chemically and discharged into drains.
• Category No. 9, Incineration Ash is disposed of in municipal landfills.
• Category No. 10, Chemical Waste is chemically discharged into drains for liquids and secured landfills for solids.

Color Coding of Waste Containers (Rule 1998, Schedule II)

• Yellow bags are for human anatomical waste, animal waste, microbiological waste and solid waste.
• Red containers (disinfected plastic bags) are for microbiological waste and soiled dressing.
• Blue/white puncture-proof containers are for waste sharps and plastic disposables.
• Black containers are for discarded medicine, incineration ash, and chemical waste.

Transportation and Storage Protocols

• Waste is stored temporarily in a central area and sent in bulk for final disposal once or twice daily.
• Waste bags/containers must be sealed and labeled.
• Bags should not be overfilled for easy handling and only one bag lifted at a time.
• Minimize manual handling to prevent needle stick injuries.
• BMW should be stored in a designated area.
• Clean containers and lids with disinfectant after bag removal.
• Waste bags/containers should be removed daily from wards/OPDs, and transported in covered wheeled containers/trolleys.
• Untreated bio-medical waste should not be stored for more than 48 hours.

Transportation to Final Disposal

• Transportation to the final disposal site should ideally occur in a closed motor vehicle to prevent spillage.
• Vehicles transporting BMW must display the "Bio-Hazard" symbol; these vehicles should not be used for other purposes.
• Labels should be non-washable and prominently visible.

Methods of Biomedical Waste Disposal

• Deep burial is for Category 1 and 2 waste and is performed only in cities with <500,000 people and rural areas.
• Autoclave and microwave treatment must meet standards in the 1998 Management and Handling Rules; it is suitable for categories 3, 4, 6, and 7
• Shredding of plastics and sharps should be conducted only after chemical treatment/microwaving/autoclaving; needle destroyers can be used for needles directly.
• Incinerator ash, discarded medicines, cytotoxic substances, and solid chemical waste can be treated by land disposal.

Incineration Details

• Incineration is a high-temperature dry oxidation process that reduces organic and combustible waste to inorganic, incombustible matter.
• Incineration is typically used for waste that cannot be reused, recycled, or disposed of in a landfill.
• Incinerators should be installed and operated following BMW rules 1998, and certified by the CPCB/State Pollution Control Board.
• Categories 1, 2, 3, 5, and 6 can be incinerated.
• Waste suitable for incineration has low heating volume (above 2000 Kcal/Kg for single chamber, above 3500 Kcal/Kg for pyrolytic double chamber incinerators) and >60% combustible matter.
• Waste must have non-combustible matter <50%, non-combustible fines <20%, and moisture content <30% to be suitable for incineration.
• Waste not to be incinerated includes pressurized gas containers, large amounts of reactive chemical wastes, silver salts, photographic/radiographic wastes, halogenated plastics (PVC), mercury/cadmium-containing waste, and sealed ampoules containing heavy metals.
• Incinerators can be double chamber pyrolytic, single-chamber furnaces, or rotary kilns.

Safety Measures

• Biomedical waste generators take universal precautions and safety measures.
• Drivers/collectors/handlers should be aware of waste and risks.
• Written spillage/accident procedures should be provided.
• Protective gear and instructions should be given
• Vaccination against tetanus and hepatitis B for workers.

Training and Administration

• Hospitals need well-planned awareness and training programs for all personnel categories.
• Training should be in an appropriate language/medium and manner.
• All medical professionals must know the Bio-medical Waste (Management and Handling) Rules 1998.
• Each hospital forms a waste management committee chaired by the institute head with representation from all major departments.
• The committee makes a hospital-specific action plan for supervision, monitoring, and implementation of waste management.
• The annual & accident reports should be submitted as per BMW rules.

Waste Minimization Techniques

• Encouraging the purchase of reusable glass and metal items should happen whenever possible.
• Procedures and policies must properly manage waste, ensuring that waste segregation is performed to reduce the quantity of waste that is created and needs to be handled.
• An effective and sound plastic recycling policy is recommended.
• Hospitals should select non-PVC plastic items.

Coordination Between Hospitals and Outside Agencies

• For general waste (non-toxic and non-hazardous), hospitals should interact with municipal authorities for regular removal and landfill/treatment.
• Pollution Control Boards will aid with searching for better tech, provide testing facilities and approve hospital-use in conformity with standards.
• Pollution Control Boards will also contribute cost effective and environmental tech for biomedical waste and hazardous waste.
• Pollution Control Boards help search for suitable containers for bio-medical waste requiring incineration/autoclaving/microwaving.