Biomedical Waste Management

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2nd INTERNSHIP REPORT

XYZ Hospital, Mumbai .
BIOMEDICAL WASTE MANAGEMENT IN

XYZ HOSPITAL – A STUDY .
Dr. Rajesh Kamath

MHA-3rd semester (T.I.S.S.)(2009HO026)
BIOMEDICAL WASTE MANAGEMENT – A STUDY .

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Objectives of the study: To study the Biomedical waste management procedures

in the hospital and assess the deviation from the standard .
Methodology :
Have the standards in hand .
Make an assessment of what is actually happening in the hospital .
Compare with the standards .
Assess the gap in standards and ground realities .
Data collection methods : Observation
Unstructured Interviewing of the Microbiologist,

Nurses , Ward boys , Housemen .

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Introduction :
Proper handling, treatment and disposal of biomedical wastes are important

elements of a Hospital infection control programme.
The correct procedures will help protect health care workers, patients and the local
community.
If properly designed and applied, waste management can be a relatively effective

and an efficient compliance-related practice.
Until fairly recently, medical waste management was not generally considered an
issue.
In the 1980s and 1990s, concerns about exposure to human immunodeficiency

virus (HIV) and hepatitis B virus (HBV) led to questions about potential risks
inherent in medical waste.
Thus hospital waste generation has become a prime concern due to its
multidimensional ramifications as a risk factor to the health of patients, hospital
staff and extending beyond the boundaries of the medical establishment to the
general population.
Hospital waste refers to all waste, biologic or non biologic that is discarded and not
intended for further use.
Medical waste is a subset of hospital waste; it refers to the material generated as a

result of diagnosis, treatment or immunization of patients and associated
biomedical research.
Biomedical waste (BMW) is generated in hospitals, research institutions,

health care teaching institutes, clinics, laboratories, blood banks, animal
houses and veterinary institutes.
Although very little disease transmission from medical waste has been
documented, Experts recommend that medical waste disposal must be carried out

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in accordance with regulation.
Hospital waste management has been brought into focus in India recently,
particularly with the notification of the BMW (Management and Handling)
Rules, 1998. This rule makes it mandatory for the health care establishments to
segregate, disinfect and dispose their waste in an eco-friendly manner.
Potential implications of Biomedical waste
Risk to healthcare workers and waste handlers:
Improperly contained contaminated sharps pose the greatest infectious risk

associated with hospital waste. There is also a theoretical health risk to medical
waste handlers from pathogens that may be aerosolized during the compacting,
grinding or shredding process that is associated with certain medical waste
management or treatment practices. Physical (injury) and health hazards are also
associated with the high operating temperatures of incinerators and steam
sterilizers and with toxic gases vented into the atmosphere after waste treatment.
Risk to the public :
The Public impact is confined to the aesthetic degradation of the environment from
careless disposal and the environmental impact of improperly operated incinerators
or other medical waste treatment equipment.
There may be an increased risk of nosocomial infections in patients due to poor

waste management. Improper waste management can lead to change in microbial
ecology and the spread of antibiotic resistance.

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Classification
Non-hazardous waste
This constitutes about 85% of the waste generated in most healthcare set-ups. This
includes waste comprising of food remnants, fruit peels, wash water, paper cartons,
packaging material etc.
Hazardous waste
A) Potentially infectious waste
Over the years different terms for infectious waste have been used in scientific
literature, in regulation and in the guidance manuals and standards. These include
infectious, infective, medical, biomedical, hazardous, red bag, contaminated,
medical infectious, and regulated medical waste. All these terms indicate
basically the same type of waste, although the terms used in regulations are usually
defined more specifically. It constitutes 10 to 15 %of the total waste and includes:
1. Dressings and swabs contaminated with blood, pus and body fluids.
2. Laboratory waste including laboratory culture stocks of infectious agents
3. Potentially infected material: Excised tumours and organs, placenta removed
during surgery, extracted teeth etc.
4. Potentially infected animals used in diagnostic and research studies.
5. Sharps, which include needle, syringes, blades etc.
6. Blood and blood products.
B) Potentially toxic waste
1. Radioactive waste: It includes waste contaminated with radionuclide; it may

be solid, liquid or gaseous waste. These are generated from in vitro analysis
of body fluids and tissue, in vitro imaging and therapeutic procedures.
2. Chemical waste: It includes disinfectants (hypochlorite, gluteraldehyde,
iodophors, phenolic derivatives and alcohol based preparations), X-ray
processing solutions, monomers and associated reagents, base metal debris
(dental amalgam in extracted teeth).

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Pharmaceutical waste: It includes anesthetics, sedatives, antibiotics, analgesics etc.
Steps in Waste management
Medical waste should be managed according to its type and characteristics. For
waste management to be effective, the waste should be managed at every step,
from acquisition to disposal. The following are the elements of a comprehensive
waste management system:
 Waste survey,
 Segregation,
 Accumulation and Storage,
 Transportation,
 Treatment,
 Disposal and also
 Waste minimization.
Waste survey
The survey should differentiate and quantify the waste generated. It should
determine the points of generation, the type of waste at each point and the level of
generation and disinfection within the hospital. This helps to determine the method
of disposal.
Waste segregation
This consists of placing different kinds of wastes in different containers or coded

bags at the point of generation . It helps to reduce the bulk of infectious waste as
well as treatment costs. Segregation also helps to contain the spread of infection
and reduces the chances of infecting other health care workers.
Waste accumulation and storage
Waste accumulation and storage occurs between the point of waste generation and
site of waste treatment and disposal. While accumulation refers to the temporary
holding of small quantities of waste near the point of generation, storage of waste
is characterized by longer holding periods and large waste quantity. Storage areas
are usually located near where the waste is treated. Any offsite holding of waste is
also considered storage.

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To contain spills, storage areas should not have floor drains and should be recessed
to hold liquids. Floor and walls should be impervious to liquid and easy to clean.
They should be disinfected regularly. Refrigeration may be required for prolonged
storage of putrifiable and other wastes. Storage area should be posted with
'EXPLICIT' signs.
Waste transportation
When medical waste is not treated on site, untreated waste must be transported
from the generation facility to another site for treatment and disposal.
Waste treatment
The term 'treatment' refers to the process that modifies the waste in some way
before it is taken to its final resting place. Treatment is mainly required to disinfect
or decontaminate the waste, right at source so that it is no longer the source of
pathogenic organisms. After such treatment, the residue can be handled safely,
transported and stored.
 Needles and syringe nozzle - shredded in needle destroyer and syringe

cutters
 Scalpel blades/ Lancet/ Broken glass should be put in separate containers
with bleach, transferred to plastic/ cardboard boxes; sealed to prevent
spillage and transported to incubators
 Glassware should be disinfected, cleaned and sterilized
 Culture plates with viable culture should be autoclaved; media are placed in
appropriate bags and disposed off. The plates can be reused after
sterilization
 Gloves should be shredded / cut / mutilated before disposal.
 Swabs should be chemically disinfected followed by incineration. If they
contain only a small amount of blood that does not drip, they can be placed
in the garbage.
 Disposable items are often recycled and have the risk of being used illegally.
Dipping in freshly prepared 1% sodium hypochlorite for 30 min. - one hour,
followed by mutilation before disposal should be the policy adopted for such
items.
 Liquid waste generated by the laboratory is either pathological or chemical
in nature. Non-infectious waste should be neutralized with reagents.

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 Liquid infectious waste should be treated with a chemical disinfectant for

contamination and then neutralized.
Waste disposal
The waste disposal methods vary in their
 Capabilities,
 Cost,
 Availability and
 Impacts on the environment.
The various disposal methods include
 Incineration,
 Autoclaving,
 Chemical methods,
 Thermal methods (low and high),
 Ionizing radiation process,
 Deep burial and
 Microwaving
Incineration and autoclaving are considered traditional methods.
Untreated medical waste can be disposed off in sanitary landfills. Disposal

without treatment is not recommended for human tissues, sharps and
culture from clinical laboratories.
Waste minimization
Whereas ordinary solid or liquid waste requires no treatment before disposal,

practically all infectious waste must first be treated. The cost for disposal of
infectious waste may be ten times the cost for disposal of ordinary solid
waste. Any measures that decrease the amount of infectious waste generated
will simultaneously decrease the cost of infectious waste disposal.
Cost of biomedical waste management

…..
The cost of construction, operation and maintenance of a system for
managing waste represents a significant part of the overall budget of a
hospital if the BMW handling rules have to be implemented in their true
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spirit. Self-contained on-site treatment methods may be desirable and

feasible for large healthcare facilities. They will not be practical or
economical for smaller institutes.
An acceptable common system should be in place which will provide A

regular supply of color coded bags,
Daily collection of infectious waste,
Safe transportation of waste to off site treatment facility and
Final disposal with suitable technology.
The Bio-Medical Waste (Management and Handling) Rules, 1998.
APPLICATION:
These rules apply to all persons who generate, collect, receive, store, transport,
treat, dispose, or handle bio medical waste in any form.
DEFINITIONS: In these rules unless the context otherwise requires
(1) "Act" means the Environment (Protection) Act, 1986 (29 of 1986);
(2) "Animal House" means a place where animals are reared/kept for

experiments or testing purposes;
(3) "Authorisation" means permission granted by the prescribed authority

for the generation, collection, reception, storage, transportation, treatment,
disposal and/or any other form of handling of bio-medical waste in
accordance with these rules and any guidelines issued by the Central
Government.
(4) "Authorised person" means an occupier or operator authorised by the

prescribed authority to generate, collect, receive, store, transport, treat,
dispose and/or handle bio-medical waste in accordance with these rules and
any guidelines issued by the Central Government;
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(5) "Bio-medical waste" means 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, and including categories mentioned in Schedule I;
(6) "Biologicals" means any preparation made from organisms or micro-

organisms or product of metabolism and biochemical reactions intended for
use in the diagnosis, immunisation or the treatment of human beings or
animals or in research activities pertaining thereto;
(7) "Bio-medical waste treatment facility" means any facility wherein

treatment. disposal of bio-medical waste or processes incidental to such
treatment or disposal is carried out;
(8) "Occupier" in relation to any institution generating bio-medical waste,

which includes a hospital, nursing home, clinic dispensary, veterinary
institution, animal house, pathological laboratory, blood bank by whatever
name called, means a person who has control over that institution and/or its
premises;
(9) "Operator of a bio-medical waste facility" means a person who owns

or controls or operates a facility for the collection, reception, storage,
transport, treatment, disposal or any other form of handling of bio-medical
waste;
(10) "Schedule" means schedule appended to these rules .

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Standard prescribed Status in the hospital
1. DUTY OF OCCUPIER:
It shall be the duty of every occupier of The hospital takes all steps to ensure
an institution generating bio-medical that the waste it produces is handled
waste which includes a hospital, nursing without any adverse effect to human
home, clinic, dispensary, veterinary health and environment .
institution, animal house, pathological
laboratory, blood bank by whatever name
called to take all steps to ensure that such
waste is handled without any adverse
effect to human health and the
environment.
2. TREATMENT AND DISPOSAL:

(1) Bio-medical waste shall be treated The hospital has ensured requisite
and disposed of in accordance with treatment of waste at a common waste
Schedule I, and in compliance with the treatment facility .
standards prescribed in Schedule V.
(2) Every occupier, where required, shall 1) The waste in the hospital is
set up in accordance with the time- categorized into 5 types :
schedule in Schedule VI, requisite bio- 1. Uninfected waste , such as food
medical waste treatment facilities like waste , paper and plastic waste not
incinerator, autoclave, microwave system significant for recycling and
for the treatment of waste, or, ensure medication wrapping .
requisite treatment of waste at a common 2 . Infected waste , such as dressings ,
waste treatment facility or any other syringes and gloves .
waste treatment facility. 3 . Recyclable waste like i.v. bottles
and large plastic covers ,paper and
plastic.
4. Sharps - Needles , blades , scalpels .
The needle tips are burnt in a flame ,
then cut in a needle cutter . The needle
tips and the other sharps are put into a
3. SEGREGATION, PACKAGING, yellow , plastic , puncture proof
TRANSPORTATION AND container .
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STORAGE: 5. The used ampoules are put into a

(1) Bio-medical waste shall not be mixed plastic , puncture proof can .
with other wastes. 6. Tissue specimens sent for
(2) Bio-medical waste shall be segregated Histopathology and Human tissue
into containers/bags at the point of waste such as the placenta .
generation in accordance with Schedule
II prior to its storage, transportation, This classification is used universally
treatment and disposal. The containers in the hospital in the Segregation and
shall be labeled according to Schedule Packaging of Waste .
III.
(3) If a container is transported from the The uninfected waste , such as food
premises where bio-medical waste is waste , paper and plastic waste not
generated to any waste treatment facility significant for recycling and
outside the premises, the container shall, medication wrapping go into the
apart from the label prescribed in BLACK BAGS.
Schedule III, also carry information
prescribed in Schedule IV. The Infected waste , such as dressings ,
(4) Notwithstanding anything contained syringes and gloves go into the RED
in the Motor Vehicles Act, 1988, or rules BAGS.
thereunder, untreated biomedical waste Recyclable waste like i.v. bottles and
shall be transported only in such vehicle large plastic covers ,paper and plastic
as may be authorised for the purpose by go into the GREEN BAG.
the competent authority as specified by The needle tips and the other sharps
the government. are put into a YELLOW , plastic ,
(5) No untreated bio-medical waste shall puncture proof container .
be kept stored beyond a period of 48 The used ampoules are put into a
hours WHITE , plastic , puncture proof can .
Provided that if for any reason it becomes The tissue specimens sent for
necessary to store the waste beyond such Histopathology and Human tissue
period, the authorised person must take waste such as the placenta also go into
permission of the prescribed authority a YELLOW BAG .
and take measures to ensure that the
waste does not adversely affect human The bags or containers which get filled
health and the environment. are taken down to the Waste
Temporary storage area .
This happens according to the shifts of
the Maiters / Maitarnis . The shifts
are : 7 a.m. to 3 p.m. , 3 p.m. to 11
p.m. , and 11 p.m. to 7 a.m.
Just before the shifts end , the Maiter
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seals the bags with a cord and takes

them down .This waste is picked up by
the BMC ( BLACK BAGS ) and SMS
Envoclean ( RED and YELLOW
BAGS )
The hospital has a Waste Temporary

storage area.
This is behind the path linking the old
building to the new one .
This area has storage facilities for both
the infected and the non infected
waste.
These two types of waste are stored
separately .
The infected waste which is in the red
bags is stored in large Green plastic
containers .
There are 5 such containers in the area.
Adjacent to the place where the Green

containers are kept , is the storage
space for the Black bags , which
contain the uninfected waste or general
garbage . This is housed in a shed , and
not in closed containers like the red
bags , because the black bags contain
garbage , which after some time
produces a foul smell . Hence an open
room is more suited for the temporary
storage of this kind of waste .
Adjacent to that is the Shed which
houses the space for the temporary
storage of the green bags.
The green bags contain recyclable
material .
In this hospital , the YELLOW BAG

is supposed to be used in the O.T. ,
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Histopathology and Laboratory . In the

O.T. , the yellow bags are kept in
prescribed places , such that they are
not easily amenable to misuse . The
yellow bags are used for the Placenta
and amputated parts .
The amputated parts are sometimes
claimed by the family members for
rituals / cremation / burial.
In the case of usage of the yellow bag
for the amputated parts , a procedure
has to be followed . A form has to be
filled in triplicate .
The form is named “Requisition for
Disposal of body parts”.
It has the following information :
Patient’s name
Reg number
Ward/Cot
Surgeon’s name
Anaesthetist’s name
Diagnosis (with brief history )
Type of procedure
Specimen to be disposed
Remarks
The signature of the Surgeon
In case the body part is claimed by the

patient’s relatives , then the following
information is added, handwritten , on
the Requisition form .
The body part handed over .
The name of the patient’s relative .
The Patient’s relative’s signature .
The relative’s relation to the patient .
It is forwarded to the A.M.D.
One copy of the form goes with the

O.T. procedure form .
One copy goes to the patient’s file .
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One copy goes with the yellow bag for

the records of the occupier involved in
the disposal of the part ( Incineration
and burial ) .
This form is needed for Medicolegal

purposes . If tomorrow a patient or an
allegedly aggrieved party alleges that a
body part was amputated without
consent / needlessly / against sound
medical advice / unethically , and that
it was disposed off clandestinely , then
the Hospital as well as the Occupier
concerned with the disposal of the
body part have the duly filled
Requisition form in their defence .
For the disposal of placentas , no form

is required.
The most common contents of the

yellow bags are , apart from placentas ,
gangrenous toes , fingers and limbs .
It was seen that some mixing of the

Biomedical waste with other waste
happens from time to time. In one
instance , there was blood stained
cotton in the black bin . The sister
asked the maiterni , the maiterni
blamed the trainee sister / patients .
4. PRESCRIBED AUTHORITY
(1) The Government of every State and The prescribed authority for Mumbai
Union Territory shall establish a and Maharashtra is the Maharashtra
prescribed authority with such members Pollution Control Board ( MPCB )
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as may be specified for granting

authorisation and implementing these
rules. If the prescribed authority
comprises of more than one member, a
chairperson for the authority shall be
designated.
(2) The prescribed authority for the State
or Union Territory shall be appointed
within one month of the coming into
force of these rules.
(3) The prescribed authority shall
function under the supervision and
control of the respective Government of
the State or Union Territory.
(4) The prescribed authority shall on
receipt of Form 1 make such enquiry as it
deems fit and if it is satisfied that the
applicant possesses the necessary
capacity to handle bio-medical waste in
accordance with these rules, grant or
renew an authorisation as the case may
be.
(5) An authorisation shall be granted for a
period of three years, including an initial
trial period of one year from the date of
issue. Thereafter, an application shall be
made by the occupier/operator for
renewal. All such subsequent
authorisation shall be for a period of three
years. A provisional authorisation will be
granted for the trial period, to enable the
occupier/operator to demonstrate the
capacity of the facility.
(6) The prescribed authority may after
giving reasonable opportunity of being
heard to the applicant and for reasons
thereof to be recorded in writing, refuse
to grant or renew authorisation.
(7) Every application for authorisation
shall be disposed of by the prescribed
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authority within ninety days from the

date of receipt of the application.
(8) The prescribed authority may cancel
or suspend an authorisation, if for
reasons, to be recorded in writing, the
occupier/operator has failed to comply
with any provision of the Act or these
rules :
Provided that no authorisation shall be
cancelled or suspended without giving a
reasonable opportunity to the
occupier/operator of being heard.
5. AUTHORISATION
(1) Every occupier of an institution
generating, collecting, receiving, storing, The hospital has received the requisite
transporting, treating, disposing and/or authorization .
handling bio-medical waste in any other The Hospital pays the Maharashtra
manner, except such occupier of clinics, Pollution Control Board ( MPCB ) a
dispensaries, pathological laboratories, license fee of Rs.30,000 for 3 years .
blood banks providing treatment/service
to less than 1000 (one thousand) patients
per month, shall make an application in
Form 1 to the prescribed authority for
grant of authorisation.
(2) Every operator of a bio-medical waste
facility shall make an application in Form
1 to the prescribed authority for grant of
authorisation.
(3) Every application in Form 1 for grant
of authorisation shall be accompanied by
a fee as may be prescribed by the
Government of the State or Union
Territory.
6. ADVISORY COMMITTEE
The Government of every State/Union Not applicable to the hospital .
Territory shall constitute an advisory
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committee. The committee will include

experts in the field of medical and health,
animal husbandry and veterinary
sciences, environmental management,
municipal administration, and any other
related department or organisation
including non-governmental
organisations. The State Pollution
Control Board/Pollution Control
Committee shall be represented. As and
when required, the committee shall
advise the Government of the
State/Union Territory and the prescribed
authority about matters related to the
implementation of these rules.
7. ANNUAL REPORT
Every occupier/operator shall submit an There is no Annual report written in
annual report to the prescribed authority the hospital regarding the Biomedical
in Form 11 by 31 January every year, to waste .
include information about the categories
and quantities of bio-medical wastes Earlier , registers used to be
handled during the preceding year. The maintained in the wards recording the
prescribed authority shall send this dispatch of the waste bags from the
information in a compiled form to the wards to the Waste temporary storage
Central Pollution Control Board by 31 area . According to the the I.C. nurse ,
March every year. this was possible then because all the
maiter / maiterni staff were permanent
, and they followed the procedure of
registering . But now , with the advent
of contract employees , it was more
difficult to ensure compliance , and
8. MAINTENANCE OF RECORDS hence based on the feedback from the
(1) Every authorised person shall nurses , this facility .
maintain records related to the
generation, collection, reception, storage, Up until about May 2009 , a YELLOW
transporation, treatment, disposal and/or MUSTER card , popularly called the
any form of handling of bio-medical YELLOW CARD , was in use . This
waste in accordance with these rules and was a record of all the RED BAGS ,
any guidelines issued. YELLOW BAGS and PUNCTURE
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(2) All records shall be subject to PROOF CANS that were lifted by the
inspection and verification by the occupier responsible for the waste
prescribed authority at any time. disposal .
This card contained the following
information :
The DATE on which the bags were
lifted .
The NUMBER of bags .
The WEIGHT of the bags .
The SIGNATURE of the
representative of the Occupier for
Disposal , when lifting it off the
hospital premises .
This card was used by the I.C. sister to

cross check the weight claimed to be
lifted by the Occupier for Disposal . At
the end of the month , the figures on
the YELLOW CARD would be tallied
with the corresponding figures on the
Bill given by the Occupier for Disposal
. If there were any discrepancies , the
concerned parties would be asked to
give suitable explanations .
Around May , 2009 , the contract was

renegotiated and the payment to be
made was now going to be on a PER
BED basis . As the weight being lifted
was no longer significant to the
payments being made , the
maintenance of the
Yellow muster card was stopped .
Hence now there are no records of how
the quantity of waste in terms of
weight being generated in the hospital.
The I.C. sister does not get the Yellow
muster cards anymore .
The Black bags too are not weighed .

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There are no records as to the quantity

of waste in terms of weight being
generated in the hospital .
There is no weighing / quantification

of the waste generated .
The hospital has a contract with SMS

Envoclean Pvt. Lmtd.
The contract was signed for 256 beds .
The contract is for the Biomedical
waste in the Red and Yellow bags .
The payment for the Beds 1 to 50 was
Rupees 3.40/ bed/day .
Above 50 beds , it was Rupees 1.95
/bed/ day .
The black bags are lifted by the BMC .
In the morning , generally between 11

a.m. and 12 a.m. , BMC trucks lift the
RED BAGS .
In the evening , generally between 4.30
p.m. and 5 p.m. , the BMC trucks
( different ones ) pick up the black
bags .
According to the rates fixed in the
contract , the amount would come to :
For the first 50 beds ,
50 x Rs.3.40 x 30 = Rs.5,100
For the remaining 206 beds ,
206 x Rs.1.95 x 30 = Rs.12,051
Rs.5,100 + Rs.12,051 = Rs. 17,151/
month

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9. ACCIDENT REPORTING
When any accident occurs at any
institution or facility or any other site Accident reporting is done . The
where bio-medical waste is handled or proforma for needle stick injuries is
during transportation of such waste, the with the Infection control sister .
authorised person shall report the If there is an injury , the CMO is
accident in Form Ill to the prescribed informed .
authority forthwith. The CMO informs the IC sister .
The I.C. sister goes to the Casualty
with the Proforma for the needle stick
injury .
The Infectious diseases consultant , in
this case H.I.V. specialist Dr. Om
Srivastav is informed , who then orders
investigations and prescribes
medication . Follow up is done with
him in the OPD every Thursday at 11
o’clock .
The A.M.D.( Assistant Medical
Director ) is informed . The routing of
the payment and other procedures is
through the A.M.D.
The hospital has a Hospital Infection Control Committee (H.I.C.C.) .

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Dr. Poorva , MD , Microbiology .
2 H.I.C. Nurses . The H.I.C. sisters take rounds three times a day . The first sister
takes a round of the entire hospital at 9 in the morning . Then , the first sister takes
rounds of one half of the hospital and the second sister the other half of the hospital
at 2 p.m. The third round is at 6 p.m. in the evening
Matron
O.T. Nurses - incharge
Pathologist .
The Medical Director .- Chairperson
The Assistant Medical Director .
An Infectious Diseases Consultant .
The Heads of all Clinical Branches .
This H.I.C. meets in the hospital once in three months .
Mumbai has the Hospital Infection Society , Mumbai Forum ( H.I.S.M.F. ) .
It has about 120 members .
They meet every second Tuesday .
H.N. Hospital sends its I.C. Committee members for meetings there.
1. The Infection control ( IC )Nurse has a Hospital infection control ( H.I.C.)

file:
In this , they have a check list of all the items to be checked .
The segregation of waste is done in the following manner .
Black bag – Kitchen waste , paper etc.

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Red bag – Infected gauze pieces , body fluids , contaminated gloves , syringes ,
dressings ,blood bags etc.
Yellow bag – Only tissues .From O.T. , L.T. , Histopathology .
Green bag – Recycling of uninfected items . I.V. bottles , paper , plastic , glass
bottles .
Puncture proof jar for sharp Biomedical waste : Needles , blades ( sharps ) , slides
( from lab )
Recycling puncture proof jar ( ampoules , injection bottles )
2. Needle stick injury file :
For the O.T., the O.T. Sister in charge is responsible for H.I.C. supervision . For
the rest of the hospital , it is the H.I.C. sisters .
The Proforma for needle stick injury is with the I.C. sister .
3. Fumigation :
The IC Sister receives handwritten slips , signed by the respective ward incharges
that their respective wards have been fumigated on the given date . One copy goes
to the fumigation file and one copy is kept in the concerned ward .
The L.T. is fumigated every 15 days .
AKD , Endoscopy , Cath Lab – Every month
All these have fixed days .
The fumigation is done with Bacillocid liquid spray .
The mini O.T. is fumigated every Saturday .
After fumigation , the spaces are kept closed for 1 hour , and then open for another
hour before being used.

P a g e | 24
4. Culture and Sensitivity of Aerial count dishes is done in the O.T. , and in all
the Intensive care units. This is done once a month .
The strips are taken to the testing areas and kept there for 20 minutes . A control
strip is kept in the laboratory environment where culture is going to be grown , so
that the relative difference in growth can be estimated .
Reports of this are maintained with the I.C. sister .
5. Microbiological report for drinking water .

The overhead water tank and the water from the water tanker are tested for
microbiological contamination. Reports are maintained with the I.C. sister .
6. Tanker water which is brought in during periods of shortage like in summer is

tested in the laboratory – Before chlorination and After chlorination .
Reports are maintained with the I.C. sister .
7. Patients with Infectious diseases .
The file has U.P. ( Universal Precautions ) written on the top left hand corner of
the file .
There is a green wooden tag hung on the door .
There is a red bag under the bed into which all contaminated material can be put
immediately .
For H.I.V. , HBsAg , HCV , Open Koch’s , Measles and Pseudomonas infected
patients , Universal Precautions (U.P.) have to be taken . These constitute Barrier
Nursing Care : Wearing of Gloves , Mask , Gown .
Reports are maintained with the I.C. sister .
8. P.H.C. (Public Health Centre ) File
If there is a case of a notifiable disease , then it is noted in a Public Health Centre

file and the B.M.C. ( Municipal Authorities ) are notified , who then take the
necessary steps in the area that the patient came from .

P a g e | 25
9. Nurses Vaccination Register .
A record of all the vaccination received is maintained .
HBV – 0 months , 1 month , 6 months , Booster ( after 5 years ) .
10. Educational initiatives for staff were regularly taken .
There were Dramas and skits for the level 4 staff .
An award every month , in the form of a plaque had been instituted for the best
ward in Infection control practices .
There are rounds every day in the morning and the afternoon by the two Hospital
infection control nurses.
The following things are checked :
1 . General sanitation and hygiene .
2 . Chittle forceps .
It is checked if a new one is issued every day . The date of sterilisation of the
forceps will be pasted on the forceps holder .
3 .Hand sanitiser .
Ideally every bed should have one .
Some wards and even ICUs have one for multiple beds .
They should ideally be at the bedside , for each bed , preferably on the right side ,
because that’s the side used for examining and also for most nursing activities , and
hence is the side used more than the left side . The further the Hand sanitiser is
from the point of contact with the patient , the lesser the compliance .
4 . The date on the vein flow on each patient is checked . The vein flow has to be
changed every 72 hours.
5 . The date on the I.V. tubing is checked . The I.V. tubing has to be changed every
24 hours .

P a g e | 26
6 . The waste bins with the different colour coded bags are checked .
The waste bins should not be overflowing .
The waste must be in the right bags .
PENALTY FOR CONTRAVENTION OF THE

PROVISIONS OF THE ACT AND THE RULES,
ORDERS AND DIRECTIONS.
(1) Whoever fails to comply with or contravenes any of the provisions of this Act,
or the rules made or orders or directions issued there under, shall, in respect of
each such failure or contravention, be punishable with imprisonment for a term
which may extend to five years or with fine which may extend to one lakh rupees,
or with both, and in case the failure or contravention continues, with additional fine
which may extend to five thousand rupees for every day during which such failure
or contravention continues after the conviction for the first such failure or
contravention.
(2) If the failure or contravention referred to in sub-section (1) continues beyond a

period of one year after the date of conviction, the offender shall be punishable
with imprisonment for a term which may extend to seven years.

P a g e | 27
THE FOLLOWING INFORMATION HAS BEEN

INCORPORATED IN THE REPORT AS IT IS A PART OF
AND IS REFERRED TO IN THE STANDARDS . IT IS
FOR REFERENCE PURPOSE .
SCHEDULE I
CATEGORIES OF BIO-MEDICAL WASTE
----------------------------------------------------------------------------------------------------
--------------------
Option Waste Category
----------------------------------------------------------------------------------------------------
--------------------
Category No. 1 Human Anatomical Waste
(human tissues, organs, body parts)
Treatment and disposal : incineration@/deep burial*
Category No. 2 Animal Waste

(animal tissues, organs, body parts carcasses, bleeding parts, fluid,
blood and experimental animals used in research, waste generated
by veterinary hospitals colleges, discharge from hospitals, animal
houses)
Treatment & Disposal : incineration@/deep burial*
Category No 3 Microbiology & Biotechnology Waste

(wastes from laboratory cultures, stocks or specimens of micro-
Organisms , live or attenuated vaccines , human and animal cell
cultures used in research and infectious agents from research
P a g e | 28
and industrial laboratories, wastes from production of biologicals,

toxins, dishes and devices used for transfer of cultures)
Treatment & Disposal : Local autoclaving , microwaving , incineration .
Category No 4 Waste sharps

(needles, syringes, scalpels, blades, glass, etc. that may cause
puncture and cuts. This includes both used and unused sharps)
Treatment and Disposal : Disinfection ( Chemical treatment / autoclaving /
microwaving / mutilation /shredding )
Category No 5 Discarded Medicines and Cytotoxic drugs

(wastes comprising of outdated, contaminated and discarded
medicines)
Treatment and Disposal : Disinfection (chemical treat ment@01/auto claving /
microwaving and mutilation/ shredding .
Category No 6 Solid Waste

(Items contaminated with blood, and body fluids including cotton,
dressings, soiled plaster casts, lines, beddings, other material
contaminated with blood)
Treatment and Disposal : incineration@ , autoclaving/microwaving.
Category No. 7 Solid Waste

(wastes generated from disposable items other than the waste
sharps
such as tubings, catheters, intravenous sets etc).
P a g e | 29
Treatment and Disposal : Disinfection by chemical,treatment@@ autoclaving/

microwaving and mutilation/ shredding##
Category No. 8 Liquid Waste

(waste generated from laboratory and washing, cleaning, house-
keeping and disinfecting activities)
Treatment and Disposal : disinfection by chemical treatment@@ and
discharge into drains .
Category No. 9 Incineration Ash

(ash from incineration of any bio-medical waste)
Treatment and Disposal : disposal in municipal landfill
Category No. 10 Chemical Waste

(chemicals used in production of biologicals, chemicals used in
disinfection, as insecticides, etc.)
Treatment and Disposal : chemical treatment@@ and discharge
into drains for liquids and secured landfill for solids .
----------------------------------------------------------------------------------------------------
--------------------
@@ Chemicals treatment using at least 1% hypochlorite solution or any other

equivalent chemical reagent. It must be ensured that chemical treatment ensures
disinfection.

P a g e | 30
## Multilation/shredding must be such so as to prevent unauthorised 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.
SCHEDULE II
COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF

BIO-MEDICAL WASTES
Colour Type of Container -I Waste Category Treatment options as

Conding per
Schedule I
Yellow Plastic bag Cat. 1, Cat. 2, and Cat. 3, Incineration/deep
burial
Cat. 6.

Red Disinfected container/plastic bag Cat. 3, Autoclaving/Microwav
Cat. 6, Cat.7. ing/

P a g e | 31
Chemical Treatment
Blue/White Plastic bag/puncture proof Cat. 4, Cat. 7. Autoclaving/Microwav
ing/
translucent Container
Chemical Treatment
and
destruction/shredding
Black Plastic bag Cat. 5 and Cat. 9 and Disposal in secured
landfill
Cat. 10. (solid)
Notes:
1. Colour coding of waste categories with multiple treatment options as defined in

Schedule I, shall be selected depending on treatment option chosen, which shall be
as specified in Schedule I.
2. Waste collection bags for waste types needing incineration shall not be made of
chlorinated plastics.
3. Categories 8 and 10 (liquid) do not require containers/bags.
4. Category 3 if disinfected locally need not be put in containers/bags.

P a g e | 32
SCHEDULE III
LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS
HANDLE WITH CARE
Note : Label shall be non-washable and prominently visible.

P a g e | 33
SCHEDULE IV
LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE

CONTAINERS/BAGS
Day ............ Month ..............

Year ...........
Date of generation ...................
Waste category No ........

Waste class
Waste description
Sender's Name & Address Receiver's Name & Address

Phone No ........ Phone No ...............
Telex No .... Telex No ...............
Fax No ............... Fax No .................
Contact Person ........ Contact Person .........
In case of emergency please contact
Name & Address :
Phone No.
Note :
Label shall be non-washable and prominently visible.

P a g e | 34
FORM II
ANNUALREPORT
(To be submitted to the prescribed authority by 31 January every

year).
1 . Particulars of the applicant:
(i) Name of the authorised person (occupier/operator):
(ii) Name of the institution:
Address
Tel. No
Telex No.
Fax No.
2. Categories of waste generated and quantity on a monthly average

basis:
3. Brief details of the treatment facility:
In case of off-site facility:
(i) Name of the operator
(ii) Name and address of the facility:
Tel. No., Telex No., Fax No.
4. Category-wise quantity of waste treated:
5. Mode of treatment with details:

P a g e | 35
6. Any other information:
7. Certified that the above report is for the period from
Date ............................... Signature ...........................................
Place.............................. Designation..........................................
Recommendations
1.The trainee nurses should be impressed upon the knowledge and importance of
proper segregation of the waste at the source . A spot survey must be made of ALL
ward staff , INCLUDING CLASS IV / CONTRACT EMPLOYEES and education
to bridge the gap , if any , must be an ongoing process .
2.After observation of the lifting of the BLACK BAGS by the BMC , it seems that
the BLACK BAGS are not sealed properly, because the contents spilled and it was
an unpleasant sight with an accompanying unpleasant odour . Some of the bags are
VERY HEAVY , my estimate would be 30 to 40 kilos . This becomes very heavy
for the BMC employees to lift onto the trucks . Also the sealing ( with short
lengths of rope ) comes off more easily with the heavier bags . The BMC workers
P a g e | 36
do an admirable job of cleaning up the mess that results , but a better sealing
system and load limits for bags would make the process better .
3.Labelling is not standardized and entirely random . Most of the bags don’t have
the labeling according to the prescribed format . In fact , many of them don’t have
any labeling at all . Many have only the colour of the bag written on the tag .
4. There is no weighing / quantification of the waste generated . The rationale

given is that the waste treatment charges levied are on a per bed basis . But
weighing is recommended , so as to have data regarding the amount of waste
generated . Weighing of the bags must be done on a daily basis as and when they
are being sent for disposal . Musters must be maintained and a consolidated record
must be prepared every month which should then be sent to every member on the
Infection control-Biomedical Waste management committee .
5. There is no Annual report written in the hospital regarding the Biomedical

waste . Earlier , registers used to be maintained in the wards recording the dispatch
of the waste bags from the wards to the Waste temporary storage area . According
to the I.C. nurse , this was possible then because all the maiter / maiterni staff
were permanent , and they followed the procedure of registering . But now , with
the advent of contract employees , it was more difficult to ensure compliance , and
hence based on the feedback from the nurses , this practice was terminated .
Also , the practice of maintaining Yellow Muster cards at the security post has
been done away with . This must be re-instated so that relevant data is not lost .
6. Hand sanitisers should be kept ideally at the bedside , for each bed , preferably
on the right side , because that’s the side used for examining and also for most
nursing activities , and hence is the side used more than the left side . The further
the Hand sanitiser is from the point of contact with the patient , the lesser the
compliance . Hand contact is the most common mode of spread of infection and
this needs to be emphasised over and over again to everybody who comes in
contact with patients as it was seen that sometimes even Doctors don’t always
sanitise their hands between patients , even in the ICCU .
7.The O.T. ward boys and maiternis have no idea about the the use of Yellow bags
in the O.T. This led to a lot of confusion in the course of gathering information for

P a g e | 37
this case study / report . It is recommended that they be given the required amount
of sensitization towards the goal of knowing the basics of Biomedical waste
disposal so that such situations are avoided in the future .

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Page |1

2nd INTERNSHIP REPORT

BIOMEDICAL WASTE MANAGEMENT IN

Dr. Rajesh Kamath

BIOMEDICAL WASTE MANAGEMENT – A STUDY .

Objectives of the study: To study the Biomedical waste management procedures

Have the standards in hand .

Make an assessment of what is actually happening in the hospital .

Compare with the standards .

Assess the gap in standards and ground realities .

Data collection methods : Observation

Unstructured Interviewing of the Microbiologist,

BIOMEDICAL WASTE MANAGEMENT – A STUDY .

Proper handling, treatment and disposal of biomedical wastes are important

If properly designed and applied, waste management can be a relatively effective

In the 1980s and 1990s, concerns about exposure to human immunodeficiency

Medical waste is a subset of hospital waste; it refers to the material generated as a

Biomedical waste (BMW) is generated in hospitals, research institutions,

BIOMEDICAL WASTE MANAGEMENT – A STUDY .

in accordance with regulation.

Potential implications of Biomedical waste

Risk to healthcare workers and waste handlers:

Improperly contained contaminated sharps pose the greatest infectious risk

Risk to the public :

There may be an increased risk of nosocomial infections in patients due to poor

BIOMEDICAL WASTE MANAGEMENT – A STUDY .

A) Potentially infectious waste

B) Potentially toxic waste

1. Radioactive waste: It includes waste contaminated with radionuclide; it may

BIOMEDICAL WASTE MANAGEMENT – A STUDY .

Pharmaceutical waste: It includes anesthetics, sedatives, antibiotics, analgesics etc.

Steps in Waste management

This consists of placing different kinds of wastes in different containers or coded

Waste accumulation and storage

BIOMEDICAL WASTE MANAGEMENT – A STUDY .

 Needles and syringe nozzle - shredded in needle destroyer and syringe

BIOMEDICAL WASTE MANAGEMENT – A STUDY .

 Liquid infectious waste should be treated with a chemical disinfectant for

The waste disposal methods vary in their

The various disposal methods include

Incineration and autoclaving are considered traditional methods.

Untreated medical waste can be disposed off in sanitary landfills. Disposal

Whereas ordinary solid or liquid waste requires no treatment before disposal,

Cost of biomedical waste management

spirit. Self-contained on-site treatment methods may be desirable and

An acceptable common system should be in place which will provide A

The Bio-Medical Waste (Management and Handling) Rules, 1998.

DEFINITIONS: In these rules unless the context otherwise requires

(1) "Act" means the Environment (Protection) Act, 1986 (29 of 1986);

(2) "Animal House" means a place where animals are reared/kept for

(3) "Authorisation" means permission granted by the prescribed authority

(4) "Authorised person" means an occupier or operator authorised by the

(5) "Bio-medical waste" means any waste, which is generated during the

(6) "Biologicals" means any preparation made from organisms or micro-

(7) "Bio-medical waste treatment facility" means any facility wherein

(8) "Occupier" in relation to any institution generating bio-medical waste,

(9) "Operator of a bio-medical waste facility" means a person who owns

(10) "Schedule" means schedule appended to these rules .

BIOMEDICAL WASTE MANAGEMENT – A STUDY .

Standard prescribed Status in the hospital

2. TREATMENT AND DISPOSAL:

STORAGE: 5. The used ampoules are put into a

seals the bags with a cord and takes