Government Medical Collage

What is Biomedical Waste?
In a layman’s language - “Bio-Medical Waste” is any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals. These wastes are also generated during research activities or in the production or testing of biological material. Redefining it scientifically, Biomedical waste is defined as “any solid, fluid or liquid waste, including its container and any intermediate product, which is generated during its diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biological and the animal wastes from slaughter houses or any other like establishments.”

What is Health Care Waste or Medical Waste?
“Any waste that is generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals.”

Who comes under the purview of the BMW Rules?
Every occupier of an institution generating, handling, collecting, receiving, storing, treating and disposing biomedical waste, is compelled under law to comply with the Biomedical Waste (Management and Handling) Rules 1998, within the stipulated time. This includes all hospitals, clinics, dispensaries, laboratories, blood banks, veterinary and research institutions anywhere in the country.

Is Biomedical Waste Management a serious issue? Does improper biomedical waste management cause hazards to health care personnel? Why is there so much hue and cry about hospital waste?
All over the country, unsegregated and untreated biomedical waste is being indiscriminately discarded into municipal bins, dump sites, on roadsides, in water bodies or is being incompletely and improperly burnt in the open. All this is leading to rapid proliferation and spreading of infectious, dangerous and fatal communicable diseases like hepatitis, AIDS and several types of cancers. In urban and rural areas alike, incidence and prevalence of several such human diseases has increased and the per capita medical expenditure has also gone high several folds. Although, yet to be proven, morbidity or illness amongst both urban and rural dwellers has increased albeit for different reasons.
The Ministry of Environment and Forests, Govt. of India has notified the Biomedical Waste (Management and Handling) rules 1998 with subsequent amendments (June 2nd 2000 and September 2003). However, only 5-10% of institutions in the country have implemented the Rules or are following them at present.
Unfortunately, some western countries, in the garb of managing their biomedical wastes, are adding to our problems by exporting their wastes to poorer countries.
The improper handling, treatment, storage, transport and disposal of waste can lead to serious problems like:
- The entire waste from a healthcare establishment, which includes non-infectious as well as infectious waste, if unsegregated and untreated is mixed with the rest of the waste in a healthcare establishment, will convert the entire non infectious general waste (75-80%) also into infectious waste.
- The indiscriminate disposal of sharps within and outside institutions leading to occupational hazards like needle stick injuries, cuts, and infections among hospital employees, municipal workers and ragpickers.
- Injuries due to the sharp especially among ragpickers and hospital / municipal workers increases the incidence of Hepatitis B, C, E and HIV among these groups who transmit these diseases to others in the community and also succumb to such fatal diseases.
- Undestroyed needles and syringes being circulated back to us (Recycling), through unscrupulous traders who employ the poor and the destitute to collect such waste for repackaging and selling in the market.
- Reuse of disposable like syringes, needles, catheters, IV and dialysis sets are causing spread of infection from healthcare establishments to the general community.
- Disposal of hospital waste and veterinary hospital waste in municipal dumpsite resulting in animals especially cows feeding on the blood soaked cotton and plastics, and this in turn leading to diseases like bovine tuberculosis which through milk can infect humans.
- The indiscriminate dumping of untreated hospital waste in municipal bins increasing the possibility of survival, proliferation and mutation of pathogenic microbial population in the municipal waste. This leads to epidemics and increased incidence and prevalence of communicable diseases in the community.
- Incidence and prevalence of diseases like AIDS, Hepatitis B&C tuberculosis and other infectious diseases increasing due to inappropriate use, storage, treatment, transport and disposal of biomedical waste.
- Chances of vectors like cats, rats, mosquitoes, files and stray dogs getting infected or becoming carriers which also spread diseases in the community.

What are the benefits of proper biomedical waste management?
Scientific Waste management leads to
- cleaner and healthier surroundings.
- reduction in the incidence of hospital acquired and general infections.
- reduction in the cost of infection control within the hospital.
- reduction in the possibility of disease and death due to reuse and repackaging of infectious disposables.
- low incidence of community and occupational health hazards.
- reduction in the cost of waste management and generation of revenue through appropriate treatment and disposal of waste.
- improved image of the healthcare establishment and increase the quality of life.

Why should I segregate waste?
There is an urgent need to keep the infectious waste separate from non-infectious waste. This is because the infectious waste which is only 10-15%, if mixed with non-infectious waste which is 80-85% can render the entire waste infectious. Segregation of waste at the source of generation also helps in minimizing the amount of waste to be treated besides enabling more efficient treatment of each category of waste. For example, the anatomical waste and animal carcasses, if segregated, are the only types of waste which need to be incinerated according to the Biomedical Waste Rules. Similarly, biomedical plastics can be autoclaved if separated at source just like biomedical glass and metal sharps. The last three categories, in fact, can be sold to recyclers if properly sterilized, shredded and washed. Such a management is possible only if biomedical waste is segregated at source. General waste too can be managed effectively within healthcare establishments if separated into dry, non-infectious waste for recycling and wet waste for composting.

Are there colour codes for segregation?
Yes, the waste has to be segregated in colour coded liners placed in bins of appropriate size.
- Yellow for infectious waste, like anatomical, pathological, soiled dressings like gauze, cotton, linen, etc. contaminated with blood or other body fluids.
- Red for infected plastics like IV sets, tubings, catheters micro-biological waste etc. Stainless steel or Translucent puncture proof container for metal sharps.
- Blue for Glass
- Black for cytototoxic drugs, incinerator ash, chemical waste and expired medicines.
- White for all sorts of non-infected general waste which are dry and recyclable.
- Green for collecting and transporting of food waste from wards, canteens and dining halls.

What are Sharps?
Sharps consist of Needles, Scalpels, Blades, Broken Glass, etc., which have the capability to injure by piercing and cutting through the skin.

What is Needle Stick Injury?
Injuries caused by used or unused needles while treating patients or performing related activities which can lead to infection, are generally known as Needle Stick Injuries (NSI).

What are Infectious waste?
Infectious wastes are those biomedical wastes which contain sufficient population of infectious agents that are capable of causing and spreading infections among people, livestock and vectors. Infectious wastes include human tissues, anatomical waste, organs, body parts, placenta, animal waste (tissue / cell cultures), any pathological / surgical waste, microbiology and biotechnology waste (cultures, stocks, specimens of micro-organism, live or attenuated vaccines, etc.), cytological, pathological wastes, solid waste (swabs, bandages, mops, any item contaminated with blood or body fluids), infected syringes, needles, other sharps, glass, rubber, metal, plastic disposables and other such wastes.

What are Infected / Infectious plastics?
Infected plastics are those biomedical plastics which have been used for administering patient care or for performing related activities and may contain blood or body fluids or are suspected to contain infectious agents in sufficient number which may lead to infections among other humans or animals. These generally include IV tubes / bottles, tubings, gloves, aprons, blood bags / urine bags, disposable drains, disposable plastic containers, endo-tracheal tubes, microbiology and biotechnology waste and other laboratory waste.

What is cytotoxic waste?
Cytotoxic substances, as the word suggests are toxic to cells and are often anti-neoplastic which inhibit cell growth and multiplication. These drugs when come in contact with normal cells can damage them and cause severe disability or even death of those affected. These drugs could be present in the waste generated from the treatment of cancer patients or from other work related to testing and control of cancerous cells.

How do I dispose sharps?
Sharps should not be recapped or bent. The best way to treat sharps is to first clean them, aspirate the syringe and needle with 1% bleach solution, then keep them horizontally in a tray containing 1% bleach for 2 hours. Thereafter, the syringe with the needle can be expunged of liquid and the needle cut or cauterized in a mechanical / electrical needle cum syringe cutter / destroyer wherein the nozzle of the disposable syringe is also cut. Thereafter, the cut needles or sharps can be disposed in a sharp pit, or could be encapsulated in Plaster of Paris, concrete etc. The disposable syringes can be sent for recycling while the glass syringes can be sterilized and reused.

Which is the ideal dustbin to dispose waste?
The bin should essentially have a lid preferably the one which closes automatically, should be coloured coded or wherein a coloured liner can be placed, non-perforated and of a proper size.

Should I use plastic liners for separate collection of source segregated wastes in my healthcare establishment?
Yes, you could, especially if the waste being collected is infectious waste and you want to prevent leakage. The bag or liner should be made of non-chlorinated plastics especially if it is to be incinerated. Alternatively, sturdy boxes with inner lining could be used such, for example, cardboard boxes and latex lining or sturdy paper or draw sheet bags which are leak proof or having a lining of degradable wax, latex, etc. which may also prevent leakage effectively. General waste could be disposed off in ordinary cardboard boxes and kitchen wastes can be collected in sturdy containers without liners and later composted.

How long am I allowed to store waste in my healthcare establishment?
You are allowed to store infectious waste in your HCE only for 48 hours during which period the waste should be treated and made non-infectious.

What is a Common Waste Treatment Facility?
A common Medical Waste Treatment Facility ensures safe collection, transportation, treatment and disposal of biomedical waste by either an entrepreneur, a co-operative or the government on a pay and use basis. The Common Medical Waste Treatment Facility is normally established in the outskirts of the city or town and the medical waste collected from different healthcare establishments is brought to the facility for treatment and disposal in a cold storage van.

Can waste be transported in any vehicle?
Wastes have to be transported according to the Motor Vehicle Act which prescribe standards for the transport of hazardous wastes. This specifies that the vehicle should be a covered one with proper markings to indicate that infectious bio-medical wastes are being transported in it. Besides, the vehicle may have to be refrigerated in case the ambient temperature is very high as in the summers and the wastes have to be transported over long distances for a substantial period of time. It may also be useful to have different compartments to separate infectious wastes from general wastes and to avoid contamination.

What is the service fee that I have to pay to the Common Facility provider?
The service charge collected ranges from Rs. 2.50 - 4.00/bed/day in most places in the country when the service provider caters to about 10,000 beds irrespective of the bed occupancy. In some cases, charging on kilogram basis has been tried out but this often leads to illegal burning of wastes to reduce quantity. The service provider has to be consulted for further details.

After handing over the waste to the Common Facility provider, does my responsibility end?
No, if there is any negligence in the waste collection, transport, treatment or disposal, the occupiers still have to own the responsibility for it.

Can I hand over the General Waste of the hospital to the Municipal Authorities?
Yes, you can but only if you have segregated it at source and it is not contaminated. Remember, even food waste can be contaminated. So, if you suspect that any kind of waste is contaminated and infectious, first treat it appropriately - not just routinely but make sure the waste is actually decontaminated and no longer a health hazard. Thereafter, you can hand over the same to the municipal authorities. Normally infectious waste cannot be so easily decontaminated within the healthcare establishment and that’s the reason the common facility operator picks up your infectious waste and transports it in a safe way to an offsite facility and treats and decontaminates the waste. However, if your HCE is remote and has been allowed to have onsite facility / facilities to properly decontaminate and treat the different kinds of wastes generated in your HCE, then you can hand over the ‘treated’ hospital waste to the municipal authorities for secured land filling and to recyclers for recycling.

From where do I get the list of equipment manufacturers for biomedical waste management?
The list could be available with the pollution control boards, NGOs, Regional Indian Medical Association (IMAs) and other individuals and institutions active in the field in your respective regions or States.

Who is permitted to use deep burial for infectious wastes?
According to the BMWM rules, only towns having a population of less than five lakhs are permitted to use deep burial as an option for treating their infectious wastes. The deep burial pit must be about 6.5 feet (2 meters) deep and every time wastes are put into it, it must be covered with a layer of soil. When the pit is three-fourths full, lime is added and again covered with soil. The pit should be away from aquifers and the depth of the pit is governed by the height of the water table in the particular area. The pit should be covered with a meshed door to keep it protected from animals and birds.

How do I minimize waste?
- By source reduction (avoiding wastage)
- By using sterilizable reusables wherever possible (e.g. using sterilizable glass ware, stainless steel, etc.), changing purchasing policy (purchasing non-PVC health care equipment), segregating at source (separating biomedical plastics, glass, metal at source for autoclaving and shredding each category separately before recycling), stock management (inventoring regularly and replacing IV fluids, blood and drugs so that there is no wastage due to spoilage).

How do I treat the wastes with multiple characteristics?
There are some wastes with multiple characteristics that fall into more than one category e.g. ‘Radioactive sharps’, ‘plastic IV tubes with cytotoxics’ etc. They need to be managed with caution. These wastes should be treated first for the hazardous waste component and once the hazard is removed, then it can be categorized as infectious metal sharps, glass, plastic, pathological etc., and treated accordingly.

Where and how do I dispose the insulin syringes used in my home?
A small manual needle and syringe cutter could be used for cutting the needles and the nozzle of the syringe. The cut needles could be put into any used puncture proof container available in homes and the cut syringes stored in a cardboard box with preferably a red liner or a red coloured sticker outside any liner. Both the puncture proof container and the cardboard box should be handed over to the nearest clinic or nursing home for handling over to a common waste treatment facility collector

What do I do when there is spillage of mercury?
Mercury is a hazardous substance which should not be incinerated or disposed in water bodies. Hence if there is a spillage of mercury, the spill should be sucked into a syringe without needle and stored under water in a test tube or vial. Mercury being heavier will sink to the bottom. The water may be drained off and the mercury can be sent for recycling or reuse in manufacture of thermometers etc.

What happens if Plastics are dumped in an Incinerator?
Plastics, especially chlorinated plastics, when incinerated at low temperature release toxic carcinogenic gases like Dioxins and Furans which can be estimated by the amount of HCL gas in the emissions.

Are there standards of liquid wastes / effluents generated from hospitals?
Yes, the standards for liquid wastes and effluents are described in the BMWM rules and all healthcare establishments are required to follow these rules. Disinfect / decontaminate liquid wastes before discharge into sewers. Health Care Establishments are connected to ETPs or sewage treatment plants.

What if my healthcare establishment does not comply with the BMWM Rules?
In case of failure to comply with the rules, the Administrator is punishable, with an imprisonment for a term which may extend upto 5 years or with a fine which may amount to One lakh rupees, or both, and in case the failure of compliance continues, with additional fine which may amount to 5000 rupees for every day during which the failure or contravention continues, after the conviction for the first such failure or contravention. If failure or contravention continues beyond a period of one year, the Health Care Establishments shall be punishable for a (imprisonment) term, which may extend upto 7 years.

What about Government healthcare establishments?
Fixed criminal liability lies on the Heads of Department of Government hospitals where an offence is committed by the concerned department and the Head of the Department is not able to prove that the offence was committed without his/her knowledge or that he/she exercised all due diligence to prevent the commission of such offence. Also any officer, other than the Head of Department shall be liable to be prosecuted against and punished accordingly if found negligent.

Apart from the segregating and disposing aspects, do I have to maintain any records?
Yes.
1. An Annual Report has to be submitted to the State Pollution Control Board by 31st of January every year, which includes the categories of waste generated and their quantities. So this involves daily quantification of waste. The Air and Water consent forms should also be filed every year.
2. Every authorized person has to maintain records related to generation, collection, reception, storage, transportation, treatment, disposal and / or any form of handling of biomedical waste, and be subject to inspection and verification at any time.
3. If any accident occurs in any institution or the common facility site, the authorized person is required to report and maintain records in the stipulated form.
4. Payment of authorization fee should be prompt and regular. Receipt should be maintained too.

What is authorization fee?
This is for grant of authorization for generating waste, which has to be treated onsite or in a common facility. The authorization fee to the tune of Rs. 7,500/- has to been deposited alongwith form, then authorization is granted for a period of three years, or as the case may be, including an initial trial period of one year from the date of issue, by the State Pollution Control Board or Committee.

Who is a Prescribed authority?
An authority prescribed by the Central / State government for implementing the biomedical waste management rules is the designated prescribed authority in that state. The State Pollution Control Board is the Prescribed Authority in case of States and the Pollution Control Committee in case of Union Territories.

Who is responsible for Hospital Waste Management? It anyway doctors, Nurses or cleaning staff?
It is a collective initiative and shared responsibility of all viz. doctors, nurses, paramedical staff, cleaning staff, all employees and administrators.

What safety precautions one should take ?
All personnel should be made aware and trained regarding biomedical waste. Prophylactic immunization to staff against Hepatitis B and Tetanus. Accident reporting should be on the proper proforma to the authorities. Spillages should be investigated and recurrence prevented. Personal should be protected with gloves, caps, masks, gum boots and preferably aprons.

What is sharp injury and how to tackle it ?
Accidental injury or break in skin produced by any sharps. The commonest cause are improper segregation and improper local treatment. The easy ways to tackle it are stop procedure and wash with soap and water, encourage bleeding and apply antiseptic, immediately report to designated person, retain the source of tracking.