BIO-MEDICAL WASTE MANAGEMENT

Abstract

The issue of biomedical waste management has assumed great significance in recent times
particularly in view of the rapid upsurge of HIV infection. Government of India has made
proper handling and disposal of this category of waste a statutory requirement with the
publication of gazette notification no 460 dated 27 July 1998. The provisions are equally
applicable to our service hospitals and hence there is a need for all the service medical,
dental, nursing officers, other paramedical staff and safaiwalas to be well aware of the
basic principles of handling, treatment and disposal of biomedical waste. The present
article deals with such basic issues as definition, categories and principles of handling and
disposal of biomedical waste.

KEY WORDS: Bio-medical waste, Hospital infections, Hospital waste disposal

Introduction

The subject of biomedical waste management and handling has been assuming increasing
significance for the past few years. The responsibility of medical administrators as regards
proper handling and disposal of this category of waste has now become a statutory
requirement with the promulgation of Government of India (Min of Environment and
Forests) gazette notification no. 460 dated 27 Jul 1998 [1]. The provisions of the gazette
are also applicable to Armed Forces hospitals. The present system of biomedical waste
disposal system in Armed Forces is far from satisfactory [2]. It is therefore highly
desirable that all service officers concerned with the administration of hospitals and other
health care echelons take all steps to adhere to the laid down directives. It is equally
important that all service medical, dental, nursing officers, other paramedical staff and
waste handlers such as safaiwalas be well oriented to the basic requirements of handling
and management of biomedical waste. It is with this objective of providing such basic
information that the present article has been composed.

Definition

Biomedical waste is defined as any waste, which is generated during the diagnosis,
treatment or immunisation of human beings or animals, or in research activities pertaining
thereto, or in the production or testing of biologicals [1].

Categories of Biomedical Waste

There are ten defined categories (category code Nos 1 to 10) as follows [1, 3].

 1.
 Human anatomical waste: (tissues, organs, body parts)

 2.

Animal waste: (including animals used in research and waste originating from
veterinary hospitals and animal houses).

 3.

Microbiological and biotechnology waste: (including waste from lab cultures,

stocks or specimens of microorganisms, live or attenuated vaccines, wastes from
production of biologicals, etc.)

 4.

Waste sharps: (used/unused needles, syringes, lancets, scalpels, blades, glass etc.)

 5.

Discarded medicines and cytotoxic drugs.

 6.

Soiled wastes: (items contaminated with blood and body fluids, including cotton
dressings, linen, plaster casts, bedding etc.)

 7.

Solid wastes: (wastes generated from disposable items other than waste sharps such
as tubing, catheters, i.v. sets, etc.)

 8.

Liquid waste: (waste generated from washing, cleaning, house keeping and
disinfection activities including these activities in labs).

 9.

Incineration ash: (from incineration of any biomedical waste)

 10.

Chemical waste: (chemicals used in production of biologicals and disinfection).

Quantum of waste

The quantity of biomedical waste generated per bed per day will vary depending upon the
type of health problems, the type of care provided and the hospital waste management
practices. It varies from 1–2 kg in developing countries to 4.5 kg in developed countries
such as USA [3, 4]. 10–15% of the waste is infectious in developed countries whereas it
varies from 45.5 to 50% in India, requiring special handling [4]. Infective waste was found
to be only 6% at Command Hospital (Air Force) Bangalore [5].

Hazards

The following properties of biomedical waste make it hazardous [6]:-

 a.

Infectious

 b.

Injurious

 c.

Cytotoxic

 d.

Chemical

Biomedical waste is hazardous since it has an inherent potential for dissemination of

infection, both nosocomial within health care settings as well as risk of infection to
persons working outside health care facilities, like waste handlers, scavenging staff and
also to the general public. It is reported that 60% of all hospital staff sustain injuries from
sharps during various procedures undertaken in health care facilities [7]. Cytotoxic and
chemical waste is mutagenic and / or teratogenic [8]. Additional hazard includes recycling
of disposables without being even washed [3].

Schedule for Waste Treatment Facilites

The schedule for complete establishment of waste treatment facilities is as follows:-[1]

 A.

Hospitals in towns with a population of 30 lakhs and above: By 30 Jun 2000 or

earlier.

 B.

Hospitals in towns with population below 30 lakhs.

o i.

With 500 beds and above: By 30 Jun 2000

 o ii.

With 200 to 499 beds: 31 Dec 2000 or earlier

o iii.

With 50 to 199 beds: 31 Dec 2001 or earlier

o iv.

With less than 50 beds: 31 Dec 2002 or earlier

 C.

All other institutions generating bio-medical waste not included in A and B above
by 31 Dec 2002 or earlier.

Principles of bio-medical waste management

The principles of biomedical waste management are as follows:-

 a.

General principles of hygiene and sanitation.

Observance of general principles of hygiene and sanitation such as cleanliness, good

house keeping, adequate supply of safe water, sanitary facilities and proper
ventilation are essential components of a good bio-medical waste management plan.

 b.

Waste minimization

It is essential that every waste generated from the hospital should be identified and
quantified. Hospitals should endeavour to reduce waste by controlling inventory,
wastage of consumable items and breakages etc. Waste can also be minimized by
recycling certain waste such as glassware, plastic material etc after proper cleaning
and disinfection.

 c.

Waste segregation

Segregation of waste at source and safe storage is the key to whole hospital waste
management process. Segregation of various types of wastes into different
categories according to their treatment/disposal options should be done at the point
of generation in colour coded plastic bags/containers as per schedule II of the
gazette notification. The needles and syringes should be disinfected and mutilated
 before segregation. The type of containers and their colour codes as stipulated in
Govt of India notification are given in Table – 1.

 d.

Waste treatment on site

Microbiological and biotechnology waste being highly infectious should be treated

on site by autoclaving/microwaving/chemical treatment. The guidelines for
chemical disinfection of different categories of biomedical wastes are shown in
Table 2,3 [3, 9].

 e.

Waste transportation

The waste should be transported to kerb collection area in covered container. All
containers should have biohazard label according to schedule III of the gazette
notification. If a container is transported from the premises where biomedical 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. The containers and the vehicles used for transportation of biomedical
waste should not be used for any other purpose. Care should be taken to avoid spills.

TABLE 3.

Chemical disinfection B. Non-chlorine releasing compounds (used for disinfection

of items which are adversely affected upon by chlorine)

Contact Required
Used for disinfection of Name of disinfectant
period concentration

Smooth metal surfaces, table

3-5 min 70% Ethanol
tops. incubators. thermometers

Ambii bags, suction

tubes/bottles, laryngoscopes, o Alkaline
30 min 2%
endotracheal tubes, catheters, o Glutaraldehyde
etc.

Furniture, rooms, walls,

30 min 3-4% Formaldehyde/formalin
blankets, beds, books, etc.

Cheatle forceps 30 min 1% Savlon

Instruments and plastic 15 min 5% Dettol (Chloroxylenol)

 Contact Required
Used for disinfection of Name of disinfectant
period concentration

equipment

All purpose disinfectant 30 min 2.5 – 5% Cresol

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 f.

Waste treatment off site.

 The various final treatment options available are:-

o i.

Incinerator

o ii.

Microwave

o iii.

Autoclave

o iv.

Hydroclave

o v.

Plasma torch technology

o vi.

Medical waste sterilization unit

All the above systems have certain limitations. Heavy metals and plastic
cannot be burnt in incinerators. Microwave cannot take up large pieces of
metals and body parts for disinfection. The autoclave does not reduce the
volume and may increase the weight of the waste due to moisture. Plasma
Torch Technology is prohibitively expensive. Hydroclaves are comparatively
cheap to run but not suitable for large body parts. Hence one has to look for
multiple options instead of basing the waste treatment system only on one
option.
  g.

Final disposal

 The various disposal options after treatment are incineration, secured landfill,
vermicomposting and public sewers. Biomedical waste should be treated and
disposed off finally in accordance with schedule 1 of the rules and the prescribed
standards given in schedule V of Govt of India gazette notification by one of the
following methods
o i.

Chemical treatment – sharps, solid, liquid and chemical wastes

o ii.

Autoclaving/Microwaving – microbiology/biotechnology, sharps, soiled and

solid wastes.

o iii.

Incineration – human, animal, microbiology/biotechnology and solid waste.

o iv.

Deep burial in secured landfills – discarded medicines, incineration ash and

chemical solid waste such as mercury.

o v.

Drainage – liquid waste, chemical liquid waste, cytotoxic waste in addition to

being toxic are mutagenic hence should never be diluted and discharged into
the sewers [8

TABLE 1.

Category and colour code of waste disposal system

Colour code Type of container Waste category

Yellow Plastic bags 1,2,3 and 6

Red Disinfected container/plastic bag 3,6 and 7

Blue/white translucent Puncture proof container/plastic bags 4 and 7

Black Plastic bags 5.9 and 10 (solids)

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Notes:

• Colour coding of waste categories with multiple treatment options as defined in schedule
I, shall be selected depending on treatment option chosen

• Waste collection bags should not be made of chlorinated plastics

• Categories 8 and 10 (liquid) do not require container/bags

• Category 3 if disinfected locally need not be put in containers/bags

TABLE 2.

Chemical disinfection A. Chlorine releasing compounds (used for disinfection of materials

contaminated with blood and body fluids)

Amount of disinfectant to be Contact Required Available Name of

dissolved in 1 litre of water period chlorine chlorine disinfectant

Sodium
100 ml 30 minutes 0.5% 5%
hypochlorite

Calcium
7.0 g 30 minutes 0.5% 70%
hypochlorite

8.5 g 30 minutes 0.5% — NaOcl powder

(Sodium dichlorosocyanurate)

4 tablets 30 minutes 0.5% — Naocl tablets

20 g 30 minutes 0.5% 25% Chloramine

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Storage of waste pending final disposal

The following points need to be considered

 i.

Do not store waste beyond a period of 48 hours.

ii Bins can be of metal or plastic.

 iii.
 If bins are re-usable, ensure their cleaning and disinfection.

 iv.

Containers should not be too large as they may be difficult to lift and there can be
spillage.

 v.

Each receptacle should be properly marked to show the ward or section where it is
kept.

 vi.

Bins preferably should be inner lined with polythene bags and provided with lids.

 vii.

Move bins atleast once a day from all areas, twice or more from OTs, ICUs.

 viii.

Bags for wastes needing incineration should not be made of chlorinated plastic.

 ix.

Categories 8 and 10 (liquid waste) need not be put in containers.

 X.

Category 3 if disinfected locally need not be put into containers.

 xi.

Polythene bags carrying waste should be sealed/tied at the top whenever waste is
being transported within or outside the hospital.

 xii.

Disposable items should be shredded or mutilated to prevent reuse. Subsequently,

they should be disinfected/disposed off as per guidelines.

 xiii.

Bins or polythene bags placed in the containers to be changed with each shift or
when they arc 3/4 full. At this point, they should be treated with suitable chemical
disinfectant, collected in proper plastic bags from various wards and sections, and
then despatched to the final disposal site as stipulated.
Maintenance of Records

All hospitals should maintain records regarding quantity and category of all biomedical
waste, which are subject to inspection and verification by the Govt prescribed authority at
any time.

Annual Report

Every hospital is required to submit an annual report as per prescribed proforma by 31

January every year regarding the quantity and category of waste handled during the
preceding year to the prescribed authority who in turn will forward a consolidated report to
Central Pollution Control Board of the state by 31 March every year.

Accident Reporting

When any accident occurs while handling or transportation of waste, the authorised person
shall report the accident in prescribed form to the authority forthwith.

Training of personnel

The objectives of a waste management scheme should be to change a mind set through
training [10]. Standard training modules/manuals for doctors, nursing staff, lab
technicians, ward attendants, safaiwalas, patients and their attendants should be developed
to create awareness and ensure efficient handling and management of biomedical waste
[11].

Evaluation

Ongoing evaluation of the biomedical waste management programme in the hospital is

very important to identify bottlenecks and to take remedial action. It is suggested that
Hospital Infection Control Committee (HICCOM) should specifically look into this
aspect.

Consequent to the gazette notification, it is now mandatory for all health care facilities to
have sound bio-medical waste management and handling facilities as per prescribed
standards and schedules. It may not be possible to achieve all the standards in one go. An
incremental approach, which has been suggested by the WHO, is the best strategy [2]. The
aim should be to make improvements and gradually move towards a sustainable system in
order to achieve a healthier environment, mind and body. It is time that our service
hospitals, which are eminently known for their high standards of hygiene, good
maintenance and excellent administration, should take a lead in this vital area of health
care.

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