Project Report # 1:

Introduction to Bio-Medical Waste (BMW):

All human activities produce waste. We all know that such waste may
be dangerous and needs safe disposal. Industrial waste, sewage and
agricultural waste, polluted water, soil and air. It can also be dangerous to
human beings and environment.

Similarly, hospitals and other health care facilities generate lot of

waste which can transmit infections, particularly HIV, Hepatitis B & C and
Tetanus, to the people who handle it or come in contact with it.

Biomedical waste management has recently emerged as an issue of

major concern not only to hospitals, nursing home authorities but also to the
environment. The proper management of biomedical waste has become a
worldwide humanitarian topic today.

Although hazards of poor management of biomedical waste have

aroused the concern world over, especially in the light of its far-reaching
effects on human health and the environment. Hospital waste is a potential
health hazard to the health care workers, the public and flora and fauna of
the area.

The problems of the waste disposal in the hospitals and other health-
care institutions have become issues of increasing concern. Most countries
of the world especially the developing nations, are facing the grim situation
arising out of environmental pollution due to pathological waste arising from
increasing population and the consequent rapid growth in the number of
health care centers.
 India is no exception to this and it is estimated that there are more
than 15,000 small and private hospitals and nursing homes in the country.
This is apart from clinics and pathological labs, which also generate sizeable
amounts of medical waste.

India generates around three million tonnes of medical waste every

year and the amount is expected to grow at eight per cent annually. Creating
large dumping grounds and incinerators is the first step and some
progressive states such as Maharashtra, Karnataka and Tamil Nadu are
making efforts despite opposition.

Barring a few large private hospitals in metros, none of the other smaller
hospitals and nursing homes have any effective system to safely dispose off
their wastes. With no care or caution, these health establishments have been
dumping waste in local municipal bins or even worse, out in the open. Such
irresponsible dumping has been promoting unauthorized reuse of medical
waste by the rag pickers for some years back.
 Surveys carried out by various agencies show that the health care
establishments in India are not giving due attention to their waste
management. After the notification of the Bio-medical Waste (Handling and
Management) Rules, 1998, these establishments are slowly streamlining the
process of waste segregation, collection, treatment, and disposal. Many of
the larger hospitals have either installed the treatment facilities or are in the
process of doing so.

Who generates BMW? A “generator” of BMW is any person who owns

or operates a facility that produces BMW in any quantity. This includes, but
is not limited to, the following: hospitals, skilled nursing facilities,
laboratories, physicians, offices, veterinarians, dental offices, funeral homes,
industry, etc.

In the case where more than one generator of BMW is located in the
same building, each individual business entity is considered a separate
generator. Note: waste generated by an individual at home is specifically not
regulated as BMW.
Project Report # 2:

Definition of Bio-Medical Waste:

According to Biomedical Waste (Management and Handling) Rules,

1998 of India – Any 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 biological.

The Government of India 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.

World Health Organization states that 85% of hospital wastes are

actually non-hazardous, whereas 10% are’ infectious and 5% are non-
infectious but they are included in hazardous wastes. About 15% to 35% of
Hospital waste is regulated as infectious waste.
Bio-Medical Waste consists of:

i. Human anatomical waste like tissues, organs and body parts

ii. Animal wastes generated during research from veterinary hospitals

iii. Microbiology and biotechnology wastes

iv. Waste sharps like hypodermic needles, syringes, scalpels and broken
glass

v. Discarded medicines and cytotoxic drugs

vi. Soiled waste such as dressing, bandages, plaster casts, material

contaminated with blood, tubes and catheters

vii. Liquid waste from any of the infected areas and

viii. Incineration ash and other chemical wastes.

Project Report # 3:

Classification of Bio-Medical Waste:

The World Health Organization (WHO) has classified medical waste

into eight categories:

i. General Waste

ii. Pathological

iii. Radioactive

iv. Chemical

v. Infectious to potentially infectious waste

vi. Sharps

vii. Pharmaceuticals and

viii. Pressurized containers.

Project Report # 4:

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:

i. Govt. hospitals / private hospitals / nursing homes / dispensaries.

ii. Primary health centers.

iii. Medical colleges and research centers/ paramedical services.

iv. Veterinary colleges and animal research centers.

v. Blood banks/mortuaries/autopsy centers.

vi. Biotechnology institutions.

vii. Production units.

Minor Sources:

i. Physicians/ dentists’ clinics.

ii. Animal houses/slaughter houses.

iii. Blood donation camps.

iv. Vaccination centers.

v. Acupuncturists/psychiatric clinics/cosmetic piercing.

vi. Funeral services.

vii. Institutions for disabled persons.

Project Report # 5:

Categories of Bio-Medical Waste:

Chemicals treatment is using at least 1% hypochlorite solution or any

other equivalent chemical reagent. It must be ensured that chemical
treatment ensures disinfections.

 Mutilation / shredding must be such as to prevent unauthorized reuse.

 There will be no chemical pretreatment before incineration.

Chlorinated plastics shall not be incinerated.

 Deep burial shall be an option available only in towns with population

less than five lakhs and in rural areas.

Option Treatment & Disposal Waste Category

Cat. No. 1 Incineration  / deep Human anatomical Waste (human tissues,
burial organs, body parts)
Cat. No. 2 Incineration  / deep Animal Waste, Animal tissues, organs, body
burial parts carcasses, bleeding parts, fluid blood
and experimental animals used in research,
waste generated by veterinary hospitals /
colleges, discharge from hospitals, animal
houses.
Cat. No. 3 Local autoclaving / Micro Microbiology & Biotechnology waste (wastes
Waving / incineration  from laboratory cultures, stocks or specimens
of micro-organisms live or attenuated
vaccines human and animal cell culture used
in research and infectious agents from
research and industrial laboratories, waste
from production of biological, toxins, dishes
and devices used for transfer of cultures).
Cat. No. 4 Disinfections (Chemical Waste Sharps (needles, syringes, scalpels,
treatment / autoclaving / blades, glass etc., that may cause puncture
Micro waving and and cuts. This includes both used & unused
mutilation shredding  sharps.
Cat. No. 5 Incineration  / Discarded Medicines and Cytotoxic drugs
destruction & drugs (wastes comprising of outdated, contaminated
disposal in secured landfills and discarded Medicines.
Cat. No. 6 Incineration  / Solid waste (Items contaminated with blood
autoclaving / Micro waving and body fluids including cotton, dressings,
soiled plaster casts, line beddings, other
material contaminated with blood)
Cat. No. 7 Disinfections by chemical Solid waste (waste generated from disposable
treatment autoclaving / items other than the waste sharps such as
Micro waving & Mutilation rubing, catheters, intravenous sets etc.,)
shredding 
Cat. No. 8 Disinfections by chemical Liquid waste (waste generated from
treatment and discharge laboratory & Washing, cleaning, house-
into drain keeping and disinfecting activities)
Cat. No. 9 Disposal in municipal Incineration Ash (ash from incineration of any
landfill bio-medical waste)
Cat. No. 10 Chemical treatment & Chemical Waste (chemicals used in production
discharge into drain for of biological, chemicals, used in disinfect ion,
liquid & secured landfill for as insecticides, etc.
solids

The most essential part of hospital waste management is the

segregation of Bio-medical waste. The segregation of the waste should be
performed within the premises of the hospital/nursing homes.
 The colour coding, type of container to be used for different
waste categories and suggested treatment options are listed below:

Color coding & type of container for disposal of bio-medical waste

Color Coding Type of Containers Waste Treatment Options as per

Category Schedule 1
Yellow Plastic bag 1,2,3,6 Incinerations / deep burial
Disinfected
Red Disinfected container 3,6,7 Auto Claving / Mirco Waving /
/ Plastic bag Chemical Treatment
Blue / White Plastic bag / puncture 4,7 Auto Claving / Micro Waving /
Translucent proof container Chemical treatment and
destruction / shredding
Black Plastic bag 5,9,10 (Solid) Disposal in second landfill
Project Report # 6:

Legal Aspect of Bio-Medical Waste:

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 & Handling) Rules, 1998.

A brief summary of the provisions in Bio-medical wastes

(Management & Handling) Rules, 1998 is given below:

i. Section 3 establishes the authority of the government to undertake

various steps for protection and improvement of the environment.

ii. Section 5 provides; for issuance of directions in writing.

iii. Section 6 empowers the government to make rules.

iv. Section 8 permits the education of individuals dealing with hazardous

wastes regarding various safety measures.

v. Section 10 bestows authority to enter the premises and inspect.

vi. Section 15 allows the government to take punitive steps against

defaulters. This involves imprisonment up to five years or penalty 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.

vii. 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.
Project Report # 7:

Treatment of Bio-Medical Waste:

i. Chemical Processes:

These processes use chemicals that act as disinfectants. Sodium

hypochlorits, dissolved chlorine dioxide, per-acetic acid, hydrogen peroxide,
dry inorganic chemicals and ozone are examples of such chemicals. Most
chemical processes are water-intensive and require neutralising agents.

ii. Thermal Processes:

These processes utilise heat to disinfect. Depending on the

temperature they operate it has been grouped into two categories, which are
Low-heat systems and High-heat systems Low-heat systems (operate
between 93-177°C) use steam, hot water, or electromagnetic radiation to
heat and decontaminate the waste.

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 disinfects the waste by moist heat and

steam generated by microwave. High-heat systems (operate between 540-
8,300°c) employ combustion and high temperature plasma to
decontaminate and destroy the waste.
 Incinerator & Hydroclaving are high heat systems. Hydroclaving – is
steam treatment with fragmentation and drying of waste.

iii. 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.

iv. Irradiation Processes:

Expose wastes to ultraviolet or ionizing radiation in an enclosed

chamber. These systems require post shredding to render the waste
unrecognizable.

v. Biological Processes:

Using biological enzymes for treating medical waste. It is claimed that

biological reactions will not only decontaminate the waste but will also cause
the destruction of all the organic constituents so that only plastics, glass,
and other inert will remain in the residues.
Points to ponder in processing the waste.

a. Incineration:

i. Incinerators should be suitably designed to achieve the emission limits.

ii. Wastes to be incinerated shall not be chemically treated with any

chlorinated disinfectant.

iii. Toxic metals in the incineration ash shall be limited within the regulatory
quantities

iv. Only low sulphur fuel like Diesel shall be used as fuel in the incinerator.

b. Autoclaving:

The autoclave should be dedicated for the purpose of disinfecting and

treating biomedical waste.

A. When operating a gravity flow autoclave, medical waste shall be

subjected to:

i. A temperature of not less than 121°C and pressure of about 15

pounds per square inch (psi) for an autoclave residence time of
not less than 60 minutes; or

ii. A temperature of not less than 135°C and a pressure of 31 psi

for an autoclave residence time of not less than 45 minutes; or

iii. A temperature of not Less than 149°C and a pressure of 52 psi

for an autoclave residence time of not less than 30 minutes.

B. 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:
 i. A temperature of not less than 121°C and a pressure of 15 psi
per an autoclave residence time of not less than 45 minutes; or

ii. Temperature of not less than 135°C 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 are achieved.

c. Microwaving:

i. Microwave treatment shall not be used for cytotoxic, hazardous

or radioactive wastes, contaminated animal carcasses, body
parts and large metal items.

ii. The microwave system shall comply with the efficacy

tests/routine tests

iii. The microwave should completely and consistently kill bacteria

and other pathogenic organisms that is ensured by the approved
biological indicator at the maximum design capacity of each
microwave unit.

d. Deep Burial:

i. 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.

ii. It must be ensured that animals do not have access to burial

sites.

iii. Covers of galvanised iron/wire meshes may be used.

 iv. On each occasion, when wastes are added to the pit, a layer of
10cm of soil must be added to cover the wastes.

v. Burial must be performed under close and dedicated supervision.

vi. The site should be relatively impermeable and no shallow well

should be close to the site.

vii. The pits should be distant from habitation, and sited so as to

ensure that no contamination of any surface water or ground
water occurs.

viii. The area should not be prone to flooding or erosion.

ix. The location of the site must be authorized by the prescribed

authority.

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

e. Disposal of Sharps:

Sharps are discarded needles and lancets that have been used in
animal or human patient care/treatment or in medical, research or industrial
laboratories. Sharps include items such as hypodermic needles, syringes,
dental carpules, and scalpel blades. Please note that certain exemptions
apply to farmers.

i. Blades and needles waste after disinfection should be disposed

in circular or rectangular pits.

ii. Such pits can be dug and lined with brick, masonry, or concrete
rings.

iii. The pit should be covered with a heavy concrete slab, which is
penetrated by a galvanized Steel pipe projecting about 1.5 m
above the slab, within internal diameter of upto 20 mm.
 iv. When the pipe is full it can be sealed completely after another
has been prepared.

f. Radioactive Waste from Medical Establishments:

i. It may be stored under carefully controlled conditions until the

level of radioactivity is so low that they may be treated as other
waste.

ii. Special care is needed when old equipment containing

radioactive source is being discarded.

iii. Expert advice should be taken into account.

g. Mercury Control:

Wastes containing Mercury due to breakage of thermometer and other

measuring equipment need to be given

i. Proper attention should be given to the collection of the spilt

mercury, its storage and sending of the same back to the
manufacturers

ii. Must take all measures to ensure that the spilt mercury does not
become part of biomedical wastes and

iii. 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.
h. Standard for Liquid Waste:

The effluent generated from the hospitals must conform to the following:

i. 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
waste within the health care or related facility.

Alternate technologies for biomedical waste minimization (e.g.,

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.
Project Report # 8:

Collection and Storage of Bio-Medical Waste:

The collection of biomedical waste involves use of different types of

containers from various sources of biomedical wastes like Operation
Theatres, laboratory’s, wards, kitchens, corridors 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 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.
Project Report # 9:

Health Hazards of Bio-Medical Waste:

According to the WHO, the global life expectancy is increasing year

after year. However, deaths due to infectious diseases are increasing. A
study conducted by the WHO reveals that more than 50,000 people die every
day 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
‘recipients’ of the infection. Human Immunodeficiency Virus (HIV) and
hepatitis virus spearhead an extensive list of infections and diseases
documented to have spread through bio-medical waste. Tuberculosis,
pneumonia, diarrhoea diseases, tetanus, whooping cough etc., are other
common diseases which spread due to improper waste management.

A. Occupational Health Hazards:

The health hazards due to improper waste management can affect

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

institutions

ii. People who happen to be in contact with the institution like

laundry workers, nurses, emergency medical personnel, and
refuse workers.

iii. Risk of infection outside hospital for waste handlers, scavengers

and (eventually) the general public
 iv. Risks associated with hazardous chemicals, drugs, being handled
by persons handling waste at all levels and

v. Injuries from sharps and exposure to harmful chemical waste

and radioactive waste also cause health hazards to employees.

B. Hazards to the General Public:

The general public’s health can also be adversely affected by bio-

medical waste.

i. Improper practices such as dumping of bio-medical waste in

municipal dustbins, open spaces, water bodies etc., leads to the
spread of diseases.

ii. Emissions from incinerators and open burning also lead to

exposure to harmful gases which can cause cancer and
respiratory diseases.

iii. Exposure to radioactive waste in the waste stream can also

cause serious health hazards.

iv. 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.