1. Presented by – Dr.DharmendraGahwai
(PG Student)
Guided by-
Dr.Y.D. Badgaiyan
Prof. and Head
Deptt. of Community Medicine
CIMS, Bilaspur (C.G.)
BIO-MEDICAL WASTE MANAGEMENT
ISSUES AND CHALLENGES

2. Let the waste of the “sick”
not contaminate the lives
of “The Healthy”

3. Medical care is vital for our life, health
and well being.
But the waste generated from medical
activities can be hazardous, toxic and
even lethal.

4. Indiscriminate disposal of waste has
resulted in a rise in deadly infections
such as –
- HIV
- Hepatitis B.

5. Its ability to contaminate other
nonhazardous municipal waste
jeopardise the efforts undertaken for
overall municipal waste management.
At the same time, illegal and unethical
reuse can be extremely dangerous and
even fatal.

6. Unfortunately, in the absence of reliable
and extensive data, it is difficult to
quantify the dimension of the problem.
With a judicious planning and
management, however, the risk can be
considerably reduced.

7. DEFINITION
According to Bio-medicalWaste(Management and
Handling ) Rules, 1998 of India, Bio-medicalWaste
means –
“Any waste, which is generated
during the diagnosis , treatment or
immunization of human being or animal, or
in research activity pertaining thereto or in
the production or testing of biologicals, and
including categories as mentioned in
schedule I.”

8. Sources of health care waste
 Government/private hospitals
 Nursing homes
 Physician/dentist office or clinic
 Dispensaries
 Primary health care centers
 Medical research and training centers
 animal./slaughter houses
 labs/research organizations
 Vaccinating centers
 Bio tech institutions/production units

9.  According to aWHO report-
- 85% of the hospital wastes are non-
hazardous.
- 10% are infective (hence, hazardous), and
- 5% are non-infectious but hazardous
(chemical, pharmaceutical and radioactive).

11. • 1.To minimize the potential for spread of disease
from a medical settings to the general public.
 2.To reduce the overall amount of infectious medical
waste produced.
 3. Prevention of Environment pollution.
 4. Infectious agents may become toys of terrorists, as
Bio-weapons of Mass Destruction

12. MAGNITUDE OF PROBLEM

13. GLOBALY
 The quantity of Bio-MedicalWaste
generated will vary depending on the
hospital policies and practices and the type
of care being provided.
 The data available from developed countries
indicate a range from 1-5 Kg/bed/day,
with substantial inter country and inter
speciallity differences.

14. Meager data from developing countries
but the figures are lower.
 i.e. 1-2 Kg/bed/day.

15. INDIA
- No national level study.
- Local or regional level study shows
hospitals generate roughly 1-2
kg/bed/day.

16.  A survey done in Banglore revealed that the quantity of
BMW generated in hospitals are –
 1. Govt. Hospitals – ½ to 4 kg/ bed / day.
 2. Private Hospitals – ½ to 2 kg / bed / day.
 3.Nursing Homes – ½ to 4 kg / bed / day.

17. CLASSIFICATION OF BIO-MEDICAL WASTE

18.  1. Infectious waste-
 2. Pathological waste-
 3. Pharmaceutical waste
 Lab cultures, tissues, swabs,
equipments and excreta.
 Human tissue or fluids e.g. body
parts, blood, other body fluids.
 Expired and contaminated
medicines.

19.  4.Genotoxic waste-
 5.Chemical waste-
 6.Waste with high
content of heavy
metals-
 Cytotoxic drugs, genotoxic
chemicals.
 Expired Lab reagents, film
developer, disinfectants.
 Batteries, broken thermometers.

20.  8. Pressurized containers-
 9. Radioactive waste-
 Gas cylinders, gas cartridges.
 Unused liquid in radiotherapy
or lab research.

21. Pathological waste

22. Pharmaceutical waste

23. Genotoxic waste

24. Waste containing heavy metals

25. Pressurized containers

26. Radioactive waste

27. HAZARDS OF BIOMEDICAL WASTE

28. Hazards of BMW
• 1. Infectious wastes and sharps cause
transmission of infections like HIV
Hepatitis B and C.
2. Chemical and Pharma waste toxic,
corrosive, flammable, reactive and
shock sensitive.

29. • 3. Genotoxic and Radioactive wastes
are responsible for toxicity ranges from
the headache , nausea and vomiting to
the skin reactions and malignancies.
4. Public sensitivity for visual impact
of anatomical wastes.

30. 30
Who’s at Risk ?
• Doctors and nurses
• Patients
• Hospital support staff
•Waste collection and disposal staff
• General public and
•the Environment

31. 1. Identification of points of generation of waste.
2.Waste minimization & recycling of waste.
3.Waste segregation at source.
4.Waste treatment (disinfection etc.) at the site.
5. Waste collection and transportation, on-site and
off-site.
3
1
Principles of Waste Management

32. 6. Waste treatment , on-site & off the site
7. Final disposal of waste
8. Occupational safety
9. Continuous monitoring of the system
10.Training of the staff.

33. PROCESS OF BMW MANAGEMENT

34. Biomedical Waste Management Process
 1. Source Identification.
 2. Segregation.
 3. Collection and storage.
 4.Transport.
 5.Treatment and Disposal.

35. 1. Source Identification
 Identification of source required both at
- the macro level.
(Institutes that generates wastes)
- the micro level.
(Points and activities within the
institution).

36. 2. SEGREGATION
 “Separation of different types of
waste as per treatment and disposal
options.”
 It is the key to the active process of
scientific waste management.

37. 3. COLLECTION AND STORAGE
 Storage of waste refers to storage within
wards or collection points within the
departments.
 Collection centers are planned between 2-3
wards.
 Central collection.
 CommonTreatment Facility (CTF)

38.  No untreated biomedical waste shall
be kept stored beyond period of 48
hours.
 If any reason it is necessary then
permission of the prescribed
authority is essential.

39. 4. TRANSPORT
 Transportation system should be secured
with special containers and well defined
route with minimum patient influx.
 The containers should have non-washable
and prominently visible label showing the
type of waste it contains – Cytotoxic or
Biohazrds.

40. 5. TREATMENT AND DISPOSAL
 The main objectives of treatment are
- disinfecting and decontaminating the waste
and
- volume reduction.

41.  Broadly two categories –
 1. BURNTECHNOLOGY.
 2. NON-BURNTECHNOLOGY.

42. BURNTECHNOLOGY NON-BURNTECHNOLOGY
1. Open Burning.
2. Small Scale incinerators.
3. Single Chamber Incinerators.
4. Double Chamber Incinerator.
5. Pyrolyltic incinerators and Ratary
Kiln.
1.Chemical Disinfection.
2. Microwave Irradiation.
3. Dry andWet thermal
techniques.(AUTOCLAVING)
4. Sanitary landfill
5. Deep Burial
6. Inertization and Encapsulation.

43. INCINERATION
 Method of choice for most hazardous
health care waste.
 High temp dry oxidation process.
 Reduces organic and combustible waste to
inorganic and incombustible material.
 Significant reduction in waste volume
and weight.

44. INCINERATORS
SINGLE CHAMBER INCINERATOR DRUM/BRICK INCINERATION

45. INCINERATORS
ROTARY KILN PYROLYTIC INCINERATOR

46. AUTOCLAVING
 Autoclaving is efficient thermal disinfection process.
 Commonly used for reusable medical equipments.
 Effective inactivation of all the micro-organism and
bacterial spores at 121 degree C temperature and
30 psi pressure for 3 minutes holding time.

47. TEMPERATURE PRESSURE HOLDINGTIME
134 C 30 psi 03 minutes
126 C 20 psi 10 minutes
121 C 15 psi 15 minutes

48. CHEMICAL DISINFECTION
Most suitable for treating liquid waste
such as infected blood, urine,
stools, or hospital sewage.
Chemicals are added to waste to kill
the pathogens.

49. MICROWAVE IRRADIATION
 Microorganisms are
destroyed by the action
of microwave at -
- a frequency of about
2450 MHz and
- a wavelength of 12.24
nm.

50. LAND DISPOSAL
 Whatever may the modality of waste
treatment, final product has to be taken to
the land.
 Two types of methods –
 1. Open dump.
 2. Sanitary landfill.

51. Land Disposal Facility for Cities & Towns

52. INERTIZATION
 Mixing of waste with cement and other
substances .
 Commonly used for the pharmaceutical waste.
 A typical proportion of mixture is –
- 65 % of Pharmaceutical waste.
- 15 % lime
- 15 % cement and
- 5 % water.

53. Bio-medical Waste (Management
and Handling) Rule 1998 of India

54. Bio-Medical Waste Management and
Handling Rule 1998, of India.
 Govt. of India, by sections 6, 8 and 25 of
Environment (Protection ) Act 1986,
notified rules to improve the environment
by prescribing norms and rules for health
care waste management under the
notification called Bio-MedicalWaste
(Management and Handling ) Rules
1998.

55. Bio-Medical Waste Management and
Handling Rule 1998, of India.
This rule is prescribed by the Ministry
of Environment and Forests,
Government of India.
Came in to force on 28 July 1998.

56. Bio-Medical Waste Management and
Handling Rule 1998 of India.
This rule applies to those who
generate, collect, receive,
store, dispose, treat or
handle bio-medical waste in
any manner.

57. Any violation of these rules is
punishable up to 5 years rigorous
imprisonment or fine of
rupees one lakh or both.

58. Bio-medical Waste (Management and
Handling) Rule 1998
Schedule- 1.
Categories of bio-medical waste in India.
Schedule- 2.
Color coding and type of container for disposal
of bio-medical waste.
Schedule- 3.
Label for bio-medical waste container/bags.

59. Categories of Bio-medical Waste
Category Waste Type Treatment and Disposal Method
Category 1
Human Anatomical
Wastes (Tissues, organs,
body parts )
Incineration / deep burial
Category 2 Animal Waste Incineration / deep burial
Category 3
Microbiology and
Biotechnology waste
Autoclave/microwave/incineration
Category 4 Sharps
Disinfection (chemical
treatment)+/autoclaving/microwaving
and mutilation shredding
Category 5
Discarded Medicines
and Cytotoxic Drugs
Incineration/ destruction and drugs
disposal in secured landfills
Schedule-I

60. Category Waste Type Treatment and Disposal Method
Category 6 Contaminated solid waste Incineration/autoclaving / microwaving
Category 7
Solid waste (disposable
items other than sharps)
Disinfection by chemical treatment+
microwaving/autoclaving & mutilation
shredding
Category 8
Liquid waste (generated
from laboratory washing,
cleaning, housekeeping
and disinfecting activity)
Disinfection by chemical treatment+ and
discharge into the drains
Category 9 Incineration ash Disposal in municipal landfill
Category10 Chemical Wastes
Chemical Treatment + and discharge in
to drain for liquids and secured landfill
for solids
Schedule-I. contd…

63. ISSUES AND CHALANGES

64. ISSUES. . . .
 1.Lack of Priority in policy on Bio-MedicalWaste
Management and funds on the issue.
 2. Lack of Managerial skill andTraining of Bio-
MedicalWaste Management.
 3. Lack of Appropriate technologies for treatment
and disposal of Bio-MedicalWaste.

65.  4. Lack of Strict implementation of infection
control measures like sterilization and
disinfection techniques.
• 5. Lack of Awareness among medical personal,
patients, attendants and people at large.

66.  6. Lack of coordination between municipality,
Pollution Control Board and hospital authorities.
 7. Lack of Accountability of persons involved in
the management of Bio-MedicalWaste.

67. 67
Challenges
1. Establishing robust waste management
policies within the Health Care Facility.
2. Organization wide awareness about the
health hazards.
3. Sufficient financial andTrained human
resources needed.

68. 4. Monitoring and control of waste
disposal .
5. Clear responsibility and traceability
for appropriate handling and disposal of
waste.

69. 69
Environmental Legislations in India
 The Air (Prevention and Control of Pollution) Act, 1981.
 The Environment (Protection)Act, 1986.
 The HazardousWaste (Management & Handling) Rules,
1989.
 The National EnvironmentalTribunal Act, 1995.
 The BiomedicalWaste (Management & Handling) Rules,
1998.
 The Municipal SolidWaste (Management & Handling) Rules,
2000.

70. CONCLUSION

71. Safe and effective management
of bio-medical waste is not only
a legal necessity but also a
Social Responsibility.

72. Bio-MedicalWaste Management
cannot successfully be implemented
without the willingness, devotion, self-
motivation, cooperation and
participation of all sections of
employees of any health care
establishment.

73. If we want to protect our environment
and health of the community we must
see ourselves to this important issue
not only in the interest of health
managers but also in the interest of
community.

74. THANK YOU