See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/48347119

Biomedical waste management for health care industry: A review

Article
Source: OAI

CITATIONS READS

13 10,814

4 authors, including:

Palanisamy Pasupathi
KG Hospital
51 PUBLICATIONS 752 CITATIONS

SEE PROFILE

All content following this page was uploaded by Palanisamy Pasupathi on 26 May 2015.

The user has requested enhancement of the downloaded file.

 Int J Biol Med Res. 2011; 2(1): 472-486
Int J Biol Med Res www.biomedscidirect.com
Volume 2, Issue 1, Jan 2011 ISSN: 0976:6685

Contents lists available at BioMedSciDirect Publications

International Journal of Biological & Medical Research

BioMedSciDirect Journal homepage: www.biomedscidirect.com International Journal of
Publications BIOLOGICAL AND MEDICAL RESEARCH

Review article

Biomedical waste management for health care industry

Palanisamy Pasupathi*a, Sivaraman Sindhu b, Babu Shankar Ponnusha a, Athimoolam Ambika a
*a
Department of clinical Biochemistry & b Department of Microbiology, Institute Of Laboratory Medicine,
KG Hospital and Post Graduate Medical Institute, Coimbatore, Tamil Nadu, INDIA

ARTICLE INFO ABSTRACT

Keywords: Proper handling, treatment and disposal of biomedical waste play a vital role in hospital
BMW Management, infection control programme. Objectives of BMW (Biomedical waste) management mainly
Healthcare,
Treatment,disposal
involves preventing transmission of disease from patient to patient, from patient to health
worker and vice versa, to prevent injury to the health care worker and workers in support
services, while handling biomedical waste, to prevent general exposure to the harmful effects
of the cytotoxic, genotoxic and chemical biomedical waste generated in hospitals. If properly
designed and applied, waste management can be a relatively effective and an efficient
compliance-related practice. This review article discusses about the collection, segregation,
treatment and disposal of biomedical waste and its various types.
c Copyright 2011 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685. All rights reserved.

1. Introduction A. Present status

Biomedical waste, also known as infectious waste or medical above the normal inhabitants of hospital i.e patients and staff. All
waste is defined as waste generated during the diagnosis, testing, of them produce waste, which is increasing in its amount and type
treatment, research or production of biological products for due to advances in scientific knowledge and is creating its impact.
humans or animals. Biomedical waste includes syringes, live The hospital waste, in addition to the risk for patients and
vaccines, laboratory samples, body parts, bodily fluids and waste, personnel who handle these wastes poses a threat to public health
sharp needles, cultures and lancets. The main sources of and environment. Keeping in view inappropriate biomedical
biomedical waste are hospitals, medical clinics and laboratories. waste management, The Ministry of Environment and Forests
Because biomedical waste can be detrimental to human health, the notified the” Biomedical Waste (management and handling) Rules,
law requires such facilities to follow procedures that protect the 1998” in July 1998. In accordance with these Rules (Rule4), it is the
public from coming into contact with it. Agencies that regulate duty of every “occupier” i.e a person who has the control over the
different aspects of biomedical waste include Occupational Safety institution and or its premises, to take all steps to ensure that waste
and Health Administration (OSHA), Food and Drug Administration generated is handled without any adverse effect to human health
(FDA) and Nuclear Regulatory Commission. and environment. The hospitals, nursing homes, clinic, dispensary,
Hospital is one of the complex institutions, which is frequented animal house, pathological lab etc., are therefore required to set in
by people from every walk of life in the society without any place the biological waste treatment facilities. It is however not
distinction between age, sex, race and religion. This is over and incumbent that very institution has to have its own waste treatmen
facility. The rules also envisage that common facility or any other
facilities can be used for waste treatment. However it is incumbent
* Corresponding Author : Dr. Palanisamy Pasupathi
Head- Institute of Laboratory Medicine on the occupier to ensure that the waste is treated within a period
K.G. Hospital and Post Graduate Medical Institute of 48 hours [1].
Coimbatore-641 018 Tamil Nadu, INDIA
Mobile: +91 9787572244 Medical care is vital for our life, health and well-being. But the
E-mail: [email protected]
c
Copyright 2011 BioMedSciDirect Publications. All rights reserved. waste generated from medical activities can be hazardous, toxic
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
473

and even lethal because of their high potential for diseases associated biomedical research. Biomedical waste (BMW) is
transmission. The hazardous and toxic parts of waste from health generated in hospitals, research institutions, health care teaching
care establishments comprising infectious, bio-medical and institutes, clinics, laboratories, blood banks, animal houses and
radioactive material as well as sharps (hypodermic needles, veterinary institutes. Although very little disease transmission
knives, scalpels etc.) constitute a grave risk, if these are not from medical waste has been documented, both the American
properly treated/disposed or is allowed to be mixed with other Dental Association (ADA) and Center for Disease Control
municipal waste. Its propensity to encourage growth of various recommend that medical waste disposal must be carried out in
pathogen and vectors and its ability to contaminate other accordance with regulation.
nonhazardous/non-toxic municipal waste jeopardises the efforts
Most medical waste is incinerated, a practice that is short-lived
undertaken for overall municipal waste management. The rag
because of environmental considerations. The burning of solid and
pickers and waste workers are often worst affected, because
regulated medical waste generated by health care creates many
unknowingly or unwittingly, they rummage through all kinds of
problems. Medical waste incinerators emit toxic air pollutants and
poisonous material while trying to salvage items, which they can
toxic ash residues that are the major source of dioxins in the
sell for reuse. At the same time, this kind of illegal and unethical
environment. The toxic ash residues sent to landfills for disposal
reuse can be extremely dangerous and even fatal. Diseases like
have the potential to leach into groundwater. Medical waste has
cholera, plague, tuberculosis, hepatitis (especially HBV), AIDS
been identified by US Environmental Agency as the third largest
(HIV), diphtheria etc. in either epidemic or even endemic form,
known source of dioxin air emission and contributor of about 10%
pose grave public health risks. Unfortunately, in the absence of
of mercury emissions to the environment from human activities.
reliable and extensive data, it is difficult to quantify the dimension
The air emissions affect the local environment and may affect
of the problem or even the extent and variety of the risk involved.
communities hundreds or thousands of miles away. Dioxin is one
With a judicious planning and management, however, the risk can
of the most toxic chemicals known to humankind. Dioxins have
be considerably reduced. Studies have shown that about three
been linked to cancer, immune system disorders, diabetes, birth
fourth of the total waste generated in health care establishments is
defects and disrupted sexual development. International Agency
non-hazardous and non-toxic. Some estimates put the infectious
for Research on Cancer (IARC), an arm of WHO, acknowledged
waste at 15% and other hazardous waste at 5%.Therefore with a
dioxins cancer causing potential and classified it as human
rigorous regime of segregation at source, the problem can be
carcinogen. To avoid dioxin production, no chlorinated plastic bags
reduced proportionately. Similarly, with better planning and
(and preferably no other chlorinated compounds) should be
management, not the waste generation is reduced, but overall
introduced into the incinerator. Red bags must not be incinerated
expenditure on waste management can be controlled.
as red colour contains cadmium, which causes toxic emissions. If
Institutional/Organisational set up, training and motivation are
mercury-containing items are put into a red bag for infectious
given great importance these days. Proper training of health care
waste and sent to an incinerator or other waste treatment
establishment personnel at all levels coupled with sustained
technology, mercury will contaminate the environment. Airborne
motivation can improve the situation considerably.
mercury then enters a global distribution cycle in the
Since majority of the health care establishments are located environment, contaminating fish and wildlife. Mercury is a potent
within the municipal area, their waste management naturally has a neurotoxin that can cross the blood-brain barrier as well as the
close linkage with the municipal system. At the same time, the civic placenta [3].
authority is responsible for public health in the whole of the
municipal area. Therefore, the health care establishments must 3. Classification of biomedical waste
have a clear understanding with the municipality regarding
Approximately 75-90% of the biomedical waste is non-
sharing of responsibilities associated with this issue.
hazardous and as harmless as any other municipal waste. The
Studies have shown that about three fourth of the total hospital remaining 10-25% is hazardous and can be injurious to humans or
waste is not hazardous / infected (provided strict segregation is animals and deleterious to environment. It is important to realise
practised) and can even be taken care of by the municipal waste that if both these types are mixed together then the whole waste
management system, e.g., waste generated at the hospital kitchen becomes harmful.
or garden, the office or packaging material from the store etc. Such
practices of strict and careful segregation would reduce the load 3.1. Non-hazardous waste
and the cost of management of the actually hazardous and infected This constitutes about 85% of the waste generated in most
bio-medical waste (collection, transportation, treatment and healthcare set-ups. This includes waste comprising of food
disposal). Each establishment has to chalkout a programme for remnants, fruit peels, wash water, paper cartons, packaging
qualitative as well as quantitative survey of the waste generated material etc.
depending on the medical activities and procedures followed by it 3.2. Hazardous waste
[2].
Biohazard: Biological hazards, also known as biohazards, refer to
2.Sources of biomedical waste biological substances that pose a threat to the health of living
Hospital waste refers to all waste, biologic or non biologic that is organisms, primarily that of humans. This can include medical
discarded and not intended for further use. Medical waste is a waste or samples of a microorganism, virus or toxin (from a
subset of hospital waste; it refers to the material generated as a biological source) that can impact human health. It can also
result of diagnosis, treatment or immunization of patients and include substances harmful to animals. The term and its associated
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
474

symbol is generally used as a warning, so that those potentially Level 4 (P4) lab will undergo similar decontamination procedures
exposed to the substances will know to take precautions. to eliminate the possibility of an accidental release [4].
3.2.1. Levels of biohazard 3.2.1.1. Potentially infectious waste
Immediate disposal of used needles into a sharps container is Over the years different terms for infectious waste have been
standard procedure. The United States' Centers for Disease used in the scientific literature, in regulation and in the guidance
Control and Prevention (CDC) categorizes various diseases in manuals and standards. These include infectious, infective,
levels of biohazard, Level 1 being minimum risk and Level 4 being medical, biomedical, hazardous, red bag, and contaminated,
extreme risk. Laboratories and other facilities are categorized as medical infectious, regulated and regulated medical waste. All
BSL (Biosafety Level) 1-4 or as P1 through P4 for short (Pathogen these terms indicate basically the same type of waste, although the
or Protection Level). terms used in regulations are usually defined more specifically. It
Biohazard Level 1: Bacteria and viruses including Bacillus constitutes 10% of the total waste which includes:
subtilis, canine hepatitis, Escherichia coli, varicella (chicken pox), Dressings and swabs contaminated with blood, pus and body
as well as some cell cultures and non-infectious bacteria. At this fluids.
level precautions against the bio hazardous materials in question Laboratory waste including laboratory culture stocks of
are minimal, most likely involving gloves and some sort of facial infectious agents
protection. Usually, contaminated materials are left in open (but Potentially infected material: Excised tumours and organs,
separately indicated) waste receptacles. Decontamination placenta removed during surgery, extracted teeth etc.
procedures for this level are similar in most respects to modern Potentially infected animals used in diagnostic and research
precautions against everyday viruses (i.e.: washing one's hands studies.
with anti-bacterial soap, washing all exposed surfaces of the lab Sharps, which include needle, syringes, blades etc.
with disinfectants, etc). In a lab environment, all materials used for Blood and blood products.
cell and/or bacteria cultures are decontaminated via autoclave. 3.2.1.2. Potentially toxic waste
Biohazard Level 2: Bacteria and viruses that cause only 1. Radioactive waste: It includes waste contaminated with
mild disease to humans, or are difficult to contract via aerosol in a radionuclide; it may be solid, liquid or gaseous waste. These are
lab setting, such as hepatitis A, B, and C, influenza A,Lyme disease, generated from in vitro analysis of body fluids and tissue, in vitro
salmonella, mumps, measles, scrapie, dengue fever, and HIV. imaging and therapeutic procedures.
"Routine diagnostic work with clinical specimens can be done
2. Chemical waste: It includes disinfectants (hypochlorite,
safely at Biosafety Level 2, using Biosafety Level 2 practices and
gluteraldehyde, iodophors, phenolic derivatives and alcohol based
procedures. Research work (including co-cultivation, virus
preparations), X-ray processing solutions, monomers and
replication studies, or manipulations involving concentrated
associated reagents, base metal debris (dental amalgam in
virus) can be done in a BSL-2 (P2) facility, using BSL-3 practices
extracted teeth).
and procedures. Virus production activities, including virus
concentrations, require a BSL-3 (P3) facility and use of BSL-3 3. Pharmaceutical waste: It includes anesthetics, sedatives,
practices and procedures", see Recommended Biosafety Levels for antibiotics, analgesics etc.
Infectious Agents. Biohazard Level 3: Bacteria and viruses that can
3.2.1.3 Microorganisms
cause severe to fatal disease in humans, but for which vaccines or
other treatments exist, such as anthrax, West Nile virus, The concerned medical establishment should constitute a
Venezuelan equine encephalitis, SARS virus, variola virus team of its experts, concerned personnel and workers (doctors,
(smallpox), tuberculosis, typhus, Rift Valley fever, Rocky Mountain chemists, laboratory technicians, hospital engineers, nurses,
spotted fever, yellow fever, and malaria. Among parasites cleaning supervisors/inspectors, cleaning staff etc.). If such
Plasmodium falciparum, which causes Malaria, and Trypanosoma expertise is not available, it may take the help of external experts in
cruzi, which causes trypanosomiasis, also come under this level. the field who can help them carry out the survey work. A third
alternative is possible if expert agencies are available who carry
Biohazard Level 4: Viruses and bacteria that cause severe to out the whole work on contract as a package.
fatal disease in humans, and for which vaccines or other
treatments are not available, such as Bolivian and Argentine In either case, the medical establishment has to earmark a
hemorrhagic fevers, H5N1(bird flu), Dengue hemorrhagic fever, suitable place where the qualitative and quantitative tests can be
Marburg virus, Ebola virus, hantaviruses, Lassa fever, Crimean- carried out. This place should be an enclosed space. Depending
Congo hemorrhagic fever, and other hemorrhagic diseases. When upon the requirement, it can be a large room or a hall or at least a
dealing with biological hazards at this level the use of a Hazmat suit covered shade with proper fencing. Unauthorized entry to this
and a self-contained oxygen supply is mandatory. The entrance space should be strictly restricted. It should be well lighted. The
and exit of a Level Four biolab will contain multiple showers, a place should be washed and disinfected daily and preferably dry
vacuum room, an ultraviolet light room, autonomous detection and clean.
system, and other safety precautions designed to destroy all traces The waste generated by all the departments has to be
of the biohazard. Multiple airlocks are employed and are collected according to the prevailing practices of collection but due
electronically secured to prevent both doors opening at the same care has to be taken to see that no portion of the total waste
time. All air and water service going to and coming from a Biosafety generated is missed out from this survey. The waste so collected
(except the liquid waste and incineration ash) has to be sorted out
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
475

into the different categories according to the Schedule I of the spread of diseases and putting the people to great risk from certain
Biomedical Waste( Management and Handling) Rules, 1998 (as highly contagious and transmission prone disease vectors. This
applicable). hasgiven rise to considerable environmental concern. The first
standard on the subject to be brought out in India was by the
If an incinerator is operating within the hospital campus,
Bureau of Indian Standards (BIS), IS 12625 : 1989, entitled 'Solid
then the incinerator ash produced every day has to be weighed.
Wastes-Hospitals-Guidelines for Management' (Annexure 7.1) but
This can be done once a day. At the same time the total waste
it was unable to bring any improvement in the situation. In this
incinerated every day has also to be recorded.
scenario, the notification of the 'Biomedicalwaste (Management &
The liquid waste may be divided into two components : (a) Handling) Rules, 1998' assumes great significance [5].
liquid reagents/chemicals discarded and (b) the cleaning and
8. Hospitalization, surgical procedures, and prolonged or
washing water channeled into the drain. A measuring cylinder or
broad-spectrum antibiotic therapy may predispose patients to
other suitable measuring device can easily measure the first
colonization and infection with antibiotic-resistant organisms
component before discarding each time and keeping suitable
(e.g., MRSA or Vancomycin-resistant enterococci [VRE].[40]
records. The second component can be derived from the total
Vancomycin
water used in the hospital or by using appropriate flow metres.
The administrative head of the health care establishment 4. Biomedical Waste Management Rule
should carry out an exercise of documenting the current allocation
The rules framed by the Ministry of Environment and Forests
of responsibilities with relation to waste management within its
(MoEF),Govt. of India, known as 'Bio-medical Waste (Management
premises. In large establishments, specialized services of
and Handling)Rules, 1998,' notified on 20th July 1998, provides
consultants/experts should be sought. Each departmental head
uniform guidelines and code of practice for the whole nation. It is
should be involved in the exercise. Organisational chart indicating
clearly mentioned in this rule that the 'occupier' (a person who has
specific account ability of staff at each level in each department
control over the concerned institution / premises) of an institution
needs to be prepared.
generating bio-medical waste (e.g., hospital, nursing home,
Health care waste is a heterogeneous mixture, which is very clinic,dispensary, veterinary institution, animal house,
difficult to manage as such. But the problem can be simplified and pathological laboratory, blood bank etc.) shall be responsible for
its dimension reduced considerably if a proper management taking necessary steps to ensure that such waste is handled
system is planned. without any adverse effect to human health and the environment.
The management principles are based on the following Bio-Medical Waste Management Rules are published on
aspects :Reduction/control of waste (by controlling inventory, 20/07/1998 under Environment Protection Act, 1986. As per this
wa s t a g e o f c o n s u m a b l e i t e m s , re a g e n t s , b re a k a g e rule every occupier of an institution generating bio-medical waste
etc.),Segregation of the different types of wastes into different which includes hospitals, nursing home, clinic, dispensary,
categories according to their treatment/disposal options given in veterinary institutions, animal house, pathological laboratories,
Schedule I of the Rules mentioned above, Segregated collection blood banks to take all steps to ensure that such a waste is handled
and transportation to final treatment/disposal facility so that they without any adverse effect to human health and environment.
do not get mixed, Proper treatment and final disposal as indicated
Every occupier of an institution generating, collecting,
in the rules, Safety of handling, full care/protection against
receiving, storing, transporting, treating, disposing and/or
operational hazard for personnel at each level, Proper
handling bio-medical waste in any other manner, except such
organization and management.
occupier of clinics, dispensaries, pathological laboratories, blood
There are two main issues at present: the recent legislation banks providing treatment/service to less than 1000 (one
by the Govt. of India and implementation of the same at individual thousand) patient per month, shall make an application in Form 1
health care establishments level as well as whole town / city level. to the prescribed authority for grant of authorization.
The recent legislation has fulfilled a long-standing necessity. Now
Every operator of a bio-medical waste facility shall make an
this sector has got clear-cut guidelines, which should be able to
application in Form 1 to the prescribed authority for grant of
initiate a uniform standard of practice throughout the country.
authorization. A fee as may be prescribed by the Government of the
It would be necessary to implement proper bio-medical State or Union Territory shall accompany every application in
waste management system for each and every hospital, nursing Form 1 for grant of authorisation. Bio-medical waste shall be
home, pathological laboratory etc. Comprehensive management treated and disposed of in accordance with Schedule I, and in
system for each and every health care establishment has to be compliance with the standards prescribed in Schedule V.Every
planned for optimal techno-economic viability. At the same time occupier, where required, shall set up in accordance with the time-
the final disposal for the whole town must not be lost sight of. Since schedule in Schedule VI, requisite bio-medical waste treatment
there are a large number of small and medium health care facilities like incinerator, autoclave, microwave system for the
establishments, common treatment and disposal facilities are treatment of waste, or, ensure requisite treat.
essential.
Each State and Union Territory (UT) Government shall be
Indiscriminate disposal of infected and hazardous waste required to establish a prescribed authority for this purpose. The
from hospitals, nursing homes and pathological laboratories has respective governments would also constitute advisory
led to significant degradation of the environment, leading to committees to advise the Govts with respect to implementation of
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
476

these rules. The occupier or operator can also appeal against any The Biomedical waste management rule, 1998 mainly
order of the authority if they feel aggrieved to such other authority comprise of:
as the Govt. of the State/UT may think fit to constitute. Prescribed 1) Schedule I
Authorities, so far established by various State Governments are 2) Schedule II
listed at Annexure 7.3 and the time limit as per schedule VI of the 3) Schedule III
'Bio-Medical (Management & Handling) Rules, 1998.ent of waste
4) Schedule IV
at a common waste treatment facility or any other waste treatment
5) Schedule V
facility.
6) Schedule VI

4.1.Schedule I

Schedule I includes Categories of biomedical waste. The physico-chemical and biological nature of these components, theirtoxicity and
potential hazard are different, necessitating different methods /options for their treatment / disposal. In Schedule I of the Bio-medical
Waste(Management and Handling) Rules, 1998 (Annexure II), therefore, the wasteoriginating from different kinds of such establishments,
has been categorised into10 different categories (as mentioned in the box below) and their treatment anddisposal options have been
indicated [6].

Table 1: Categories of biomedical waste [6].

Option Treatment & Disposal Waste Category

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

Cat. No. 9 Chemical treatment Chemical Waste (chemicals used in production of biological,
discharge into drain for liquid & chemicals, used in disinfect ion, as insecticides, etc)
secured landfill for solids
Note:
a. There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated.
b. Deep burial shall be an option available only in towns with population less than half a million and in rural areas.
c. Chemical treatment using at least one per cent hypochlorite solution or any other equivalent chemical regent. It must be ensured
that chemical treatment ensures disinfection.
d. Multilation / shredding must be such that it prevents unauthorized reuse.
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
477

4.2. Schedule II
Table2: Color coding & type of container for disposal of bio-medical waste [6].
Color Coding Type of Container -I Waste Category Treatment options as 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, Cat. Autoclaving/Microwaving/
6, Cat.7. Chemical Treatment
Blue/White Plastic bag/puncture proof Cat. 4, Cat. 7. Autoclaving/Microwaving/
translucent Container Chemical Treatment and
destruction/shredding
Black Plastic bag Cat. 5 and Cat. 9 and Disposal in secured landfill
Cat. 10. (solid)

Notes:
Color coding of waste categories with treatment options as defined in Schedule 1, shall be selected depending on treatment option
chosen, which shall be as specified in Schedule 1.
Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics.
Category 8 do not require containers/bags.
Category 3 if disinfected locally need not be put in Containers/bags.

4.3. Schedule III 4.5. Schedule V

Table 3:Different labels for bio-medical waste containers Standards for treatment and disposal of bio-medical wastes
and bags shall be required for identification and safe Table 5:Disposal of treated biomedical waste [11].
handling Waste [6].
Waste Category Disposal Method
Plastic wastes after Recycling or municipal landfill
disinfection and shredding
Disinfected Sharps
(except syringes)

(I) If encapsulated Municipal landfill

(ii) If non-encapsulated Municipal landfill/ Possibility of

recycling shall be explored

4.4. Schedule IV Incineration ash Secured landfill

Table 4: Label for transport of bio-medical waste containers Other treated solid wastes Municipal landfill
/bags [6].
Oil & grease Incineration
Day:_______________ Month _________
Year ______________ Treated waste water Sewer/drain or recycling
Waste Category No. _________ Date of generation__________
Waste Class 4.6. Schedule VI
Waste Description Day:_______________ Month _________ Schedule for waste treatment facilities like incinerator/ autoclave
Sender's Name & Address Receiver's Name & Address / microwave system
5. Waste identification and waste control programme for
Phone No.:_________________ Phone No.:_________________ health care establishments
Telex No. _________________ Telex No. _________________
In fact waste identification is an important tool of waste
Fax No. ___________________ Fax No. ___________________ control programme. The necessity of segregation has already been
Contact Person _____________ Contact Person _____________ mentioned. The use of colour coding and labelling of hazardous
In case of emergency please Contact: waste containers provides great assistance in waste separation.
Name & Address Without opening a container one can easily know about the
contents. Therefore, in addition to segregation, separate
Phone No transportation and storage is also facilitated.
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
478

5.1. Identification of Various Components of the Waste Generated the disposables, recyclables etc. All associated materials (e.g.
The Bio-medical waste (Management and Handling) Rules, gloves, boots, brushes, disinfectants etc.), cost of fuel (for
1998 says that such waste shall be segregated into incinerator, vehicles), electricity etc. as well as many hours should
containers/bags at the point of generation in accordance with be accounted for.
Schedule II of the rules prior to its treatment and disposal. Based on these results, a comprehensive policy has to be
Thisstorage,transportation, would help in easy identification of framed inconsonance with the govt. rules so that compliance is
the various components of health care waste. All containers achieved. An official statement incorporating all practices from the
bearing hazardous material must be adequately labelled according segregated storage throughtransportation, treatment and final
to Schedule IV of the Rules General waste like garbage, garden disposal should be prepared and widely circulated after due
refuse etc. should join the stream of domestic refuse. Sharps approval.
should be collected in puncture proof containers. Bags and
containers for infectious waste should be marked with Biohazard 5.2. Waste storage
symbol. Highly infectious waste should be sterilised by
Storage of waste is necessary at two points:
autoclaving. Cytotoxic wastes are to be collected in leak proof
(I) at the point of generation and
containers clearly labelled as cytotoxic waste . Needles and (ii) Common storage for the total waste inside a health care
syringes should be destroyed with the help of needle destroyer and organisation.
syringe cutters provided at the point of generation. Infusion For smaller units, however, the common storage area may not
sets,bottles and gloves should be cut with curved scissors. be possible. Systematic segregated storage is the most important
step in the waste control programme of the health care
Disinfection of sharps soiled linen, plastic and rubber goods establishment. For ease of identification and handling it is
are to be achieved at point of generation by usage of sodium necessary to use colour coding, i.e., use of specific
hypochlorite with minimum contact of 1 hour. Fresh solution colouredcontainer with liner / sealed container (for sharps) for
should be made in each shift. On site collection requires staff to particular wastes. It must be remembered that according to the
close the waste bags when they are three quarters full either by Rules, untreated waste should not be stored beyond a period of 48
tying the neck or by sealing the bag. Kerb side storage area needs to hours.
be impermeable and hard standing with good drainage. It should
provide an easy access to waste collection vehicle [7] 5.3. Recommended Labelling and Colour Coding
Biomedical waste should be transported within the hospital These have to be in accordance with Schedule II of the notified
by means of wheeled trolleys, containers or carts that are not used rules A simple and clear notice, describing which waste should go
for any other purpose. The trolleys have to be cleaned daily. Off site to which container and how frequently it has to be routinely
transportation vehicle should be marked with the name and removed and to where,is to be pasted on the wall or at a
address of carrier. Biohazard symbol should be painted. Suitable conspicuous place nearest to the container. The notice should be in
system for securing the load during transport should be ensured. English, Hindi and the predominant local language. Preferably, it
Such a vehicle should be easily cleanable with rounded corners. should have drawings correlating the container in appropriate
All disposable plastic should be subjected to shredding colour with the kind of waste it should contain [9].
before disposing off to vendor. Final treatment of biomedical waste 5.4. Segregated Storage in Separate Containers
can be done by technologies like incineration, autoclave, (at the Point of Generation)
hydroclave or microwave.[8]
The segregation of Bio-Medical waste is the key to successful
For larger health care establishments such as hospitals, a
Bio- Medical waste management. This aspect is taken care in the
comprehensive exercise needs to be carried out for evolving its
BMWM by capturing information regarding the waste material like
own waste management plan/programme, consisting of the
solid waste, sharp waste, chemical waste etc, collected from
following steps:
various locations in the hospital at the waste generation point
1. Documenting the medical/bio-medical practice/procedures itself. Weighing machines are made available to the staff to weigh
carried out by the particular health care establishment by enlisting the waste bags properly for correctness of data.. A digital weighing
categories of waste generated as per schedule I of the rules. machine with direct interface to the system is also used for this.
2. Assessing current practices and responsibilities (as mentioned A trend analysis of the waste generation based on the reports
earlier). generated by the BMWM module helps the hospitals in arriving at
an approximate amount of waste, category wise at various points.
3. Assessing current costs for hazardous waste management.
This approximation is then used to ascertain the correctness of the
4. Developing an effective bio-medical waste management quantity of actual waste collected (category wise) in different
policy/plan according to the Rules and areas and entering it into the online BMWM system.

5. Implementation of the plan. The weight approximation trends also help in gradually
developing the judgement of the hospital staff and guides them to
It is important to identify the current costs associated with tie the bags once they are filled ¾ of its capacity.
waste management. Purchasing and inventory practices, for
example, must be closely examined to identify the costs related to The system ensures the segregation of waste bags at the point
of generation in accordance with Schedule I of Bio-Medical Waste
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
479

rules. Each category of waste (according to treatment options A shed with fencing should be provided for the carts, trolleys,
mentioned in Schedule I of the rules) has to be kept segregated in covered vehicles etc. used for collecting or moving the waste
a proper container or bag as the case may be. Such container / bag material. Care has to be taken to provide separate sheds for the
should have the following property hazardous and non-hazardous waste so that there is no chance of
cross contamination. Both the sheds should have a wash area
1. It must be sturdy enough to contain the designed maximum
provided with adequate water jets, drains, raised platform,
volume and weight of the waste without any damage. It should be
protection walls to contain splash of water and proper drainage
without any puncture/leakage.
system.
2. The container should have a cover, preferably operated by foot.
5.8. Handling and Transportation
If plastic bags are to be used, they have to be securely fitted within
a container in such a manner that they stay in place during This activity has three components: collection of different
opening and closing of the lid and can also be removed without kinds of waste(from waste storage bags/containers) inside the
difficulty. hospital, transportation and intermediate storage of segregated
waste inside the premises and transportation ofthe waste outside
3. The sharps must be stored in puncture proof sharps containers.
the premises (to the treatment/disposal facility).
But before putting them in the containers, they must be mutilated
by a needle cutter, placed in the department/ward itself. 5.8.1. Transportation of Segregated Waste Inside the Premises
4. The bags/containers should not be filled more than 3/4th All attempts should be made to provide separate service
capacity. Attempts should be made to designate fixed places for corridors for taking waste matter from the storage area to the
each container so that it becomes a part of regular scenario and collection room. Preferably these corridors should not cross the
practice for the concerned medical as well as nursing staff. paths used by patients and visitors. The waste has to be taken to
the common storage area first, from where it is to be taken to the
5.5. Certification treatment/disposal facility, either within or outside the premises
When a bag or container is sealed, appropriate label (s) as the case maybe.
clearly indicating the following information (as per Schedule IV of 5.8.2. Collection and Transportation of Waste for Small Units
the Rules) has to be attached. A water-proof marker pen should be
used for writing. Smaller units, such as, nursing homes, pathological
laboratories etc. do not have many departments/divisions and the
They should be labelled with the 'Biohazard' or 'cyto-toxic' generation of waste is small and normally they do not have
symbol as the case may be according to Schedule III of the rules. treatment facility for the bio-medical waste. In their case,
The containers should bear the name of the intermediate storage area is not required. They should install a
department/laboratory from where the waste has been generated needle cutter and a small device for cutting plastic tubing, gloves
so that in case of a problem or accident, the nature of the waste can etc. In case, highly infectious bio-medical waste is expected to be
be traced back quickly and correctly for proper remediation and if generated, they may consider installing a separate steam autoclave
necessary, the responsibility can be fixed. The containers should of suitable size exclusively for this purpose.
also be labelled with the date, name and signature of the person Adequate precaution must be taken to ward off any
responsible. This would generate greater accountability. The label occupational hazard or environmental problem. This particular
should contain the name, address, phone/fax nos. of the sender as autoclave should never be used for sterilising medical supplies or
well as the receiver. It should also contain name, address and surgical equipment. Such establishments require provision for
phone/fax nos. of the person who is to be contacted in case of an segregated storage (according to the rules), which can be packed in
emergency. sealed containers/sturdy bags and handed over to the agency
carrying them to the common treatment/disposal facility.
5.6. Common/Intermediate Storage Area
Collection room(s)/intermediate storage area where the 5.8.3. Transportation of Waste Outside
waste packets/bags are collected before they are finally For monitoring malpractice of waste, BMWM modules cross-
taken/transported to the treatment/disposal site are necessary checks the waste information gathered from each point and
for large hospitals having a number of departments, ensures total handover of the waste at the storage area. The system
laboratories,OTs, wards etc. This is all the more important when has the provision to implement at least two checking-barriers
the waste is to be taken outside the premises. Two rooms - one for between sources of waste to its destination. Here bags are weighed
the general and the other for the hazardous waste are preferable. and checked to ensure that the waste is not re-circulated nor
In case of shortage of rooms, the general waste (non-hazardous) deviates from its designated path of movement .
can be directly stored outside in dumper containers with lids of
The BMWM module also contains a mechanism to define and
suitable size. Arrangement for separate receptacles in the storage
area with prominent display of colour code on the wall nearest enforce the trolley schedule and route. Each trolley can be
tothe receptacles has to be made. When waste carrying dedicated to collect only a particular type of waste from the bins.
carts/containers arrive at this area, they have to be systematically Bins are located at a stationery location where as trolley is moving
put in the relevant receptacle/designated area [10]. from department to department for collection of waste.

5.7. Parking Lot for Collection Vehicles

 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
480

The trolleys are attached with Radio Frequency /disposal facility followed by disposal in sanitary and secured
Identification (RFID) tags for monitoring the trolley movement. landfills [11].
Complete Trolley routes as well as Zero Tolerance Area routes are
6.1 Disposal of treated biomedical waste
installed with RFID readers. This is to ensure that the
transportation of waste is as per its defined path and also enforce 6.1.1 Incineration
the transportation of waste away from patient care: This is a high temperature thermal process employing
1. Separate cabins shall be provided for driver/staff and the combustion of the waste under controlled condition for converting
bio- medical waste containers. them into inert material and gases. Incinerators can be oil fired or
electrically powered or a combination thereof. Broadly, three types
2. The base of the waste cabin shall be leak proof to avoid of incinerators are used for hospital waste: multiple hearth type,
pilferage of liquid rotary kiln and controlled air types. All the types can have primary
3. The waste cabin may be designed for storing waste and secondary combustion chambers to ensure optimal
containers in tiers. combustion. These are refractory lined.The treated bio-medical
waste shall be disposed as per the following table [11]
4. The waste cabin shall be so designed that it is easy to wash
and disinfectunits. The vehicle should possess: In the multiple hearth incinerators, solid phase combustion
takes place in the primary chamber whereas the secondary
5. It should be covered and secured against accidental opening
chamber is for gas phase combustion. These are referred to as
of door, leakage/spillage etc.
excess air incinerators because excess air is present in both the
6. The interior of the container should be lined with smooth chambers. The rotary kiln is a cylindrical refractory lined shell that
finish of aluminium or stainless steel,without sharp edges/corners is mounted at a slight tilt to facilitate mixing and movement of the
or dead spaces, which can be conveniently washed and disinfected. waste inside. It has provision of air circulation. The kiln acts as the
7. There should be adequate arrangement for drainage and primary solid phase chamber, which is followed by the secondary
collection of anyrun off/leachate, which may accidentally come out chamber for the gaseous combustion. In the third type, the first
of the waste bags/containers. The floor should have suitable chamber is operated at low air levels followed by an excess air
gradient, flow trap and collection container. chamber. Due to low oxygen levels in the primary chamber, there is
better control of particulate matter in the flue gas.In a nutshell, the
8. The size of the van would depend on the waste to be carried primary chamber has pyrolytic conditions with at temperature
per In case, the waste quantity per trip is small, covered container range of about 800 (+/-) 50 deg. C. The secondary chamber
of 1-2 cu.m.,mounted on 3 wheeled chassis and fitted with a operates under excess air conditions at about 1050 (+/-)50 deg. C
tipping arrangement can beused. (Schedule V of theRules). The volatiles are liberated in the first
chamber where as they are destroyed in the second one. Some
6. Waste treatment and disposal: Rules and available options models are fitted with Eductor mechanism, which maintains the
Every hospital generating Bio-Medical waste needs to set up system under negative pressure and helps control the flue gases
requisite Bio-Medical waste treatment facilities to ensure proper more effectively. The chimney height should be minimum 30
treatment of waste. As per the guidelines no untreated Bio-Medical meters above ground level. Installation of incinerators in
waste is to be kept stored beyond a period of 48 hours. The BMWM congested area is not desirable.
module handles all aspects related to fuel filling, complaints In the Bio-medical Waste (Management and Handling)
lodging, etc of the Waste disposal equipments for ensuring smooth Rules, Incineration has been recommended for human anatomical
functioning of the Bio-Medical waste treatment facilities. The waste, animal waste, cyto-toxicdrugs, discarded medicines and
module is also able to generate alerts under exceptional conditions soiled waste [12].
such as waste not treated with in stipulated time. Additionally
online help will be available that gives exact references to the 6.1.2. Autoclave Treatment
guidelines from “Bio-Medical Waste (management and handling) This is a process of steam sterilisation under pressure. It is a
Rules, 1998”. This will help the users in proper waste generation, low heat process in which steam is brought into direct contact with
segregation, transportation, handling, disposal, etc. Different the waste material for duration sufficient to disinfect the material.
methods have been developed for rendering bio-medical waste These are also of three types : Gravitytype, Pre-vacuum type and
environmentally innocuous and aesthetically acceptable but all of Retort type.
them are not suitable for our condition. The 'Bio-Medical Waste
In the first type (Gravity type), air is evacuated with the help
(Management & Handling) Rules, 1998' has elaborately
of gravity alone. The system operates with temperature of 121 deg.
mentioned the recommended treatment and disposal options
C. and steam pressure of15 psi. for 60-90 minutes. Vacuum pumps
according to the 10 different categories of waste generated in
are used to evacuate air from the Prevacuum autoclave system so
health care establishments in Schedule I of the rules.
that the time cycle is reduced to 30-60 minutes. It operates at about
A review of the above schedule would show that there is no 132 deg. C. Retort type autoclaves are designed to handle much
single technology, which can take care of all categories of bio- larger volumes and operate at much higher steam temperature
medical waste. A judicious package has to be evolved for this and pressure. Autoclave treatment has been recommended for
purpose. For example, small and medium hospitals can opt for microbiology and biotechnology waste, waste sharps, soiled and
local (in house) disinfection, mutilation / shredding and dedicated solid wastes. This technology renders certain categories
autoclaving plus off-site incineration at a common treatment (mentioned in the rules) of bio-medical waste innocuous and
unrecognizable so that the treated residue can be landfilled [13].
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
481

6.1.3. Hydroclave Treatment contact period of 30 minutes or other equivalent chemical

Hydroclave is an innovative equipment for steam reagents such as phenolic compounds, iodine,hexachlorophene,
sterilisation process (likeautoclave). It is a double walled iodine-alcohol or formaldehyde-alcohol combination etc.
container, in which the steam is injected into the outer jacket to Preshredding of the waste is desirable for better contact with the
heat the inner chamber containing the waste. Moisture contained waste material.
in the waste evaporates as steam and builds up the requisite steam In the USA, chemical treatment facility is also available in
pressure (35-36psi). Sturdy paddles slowly rotated by a strong mobile vans. In one version, the waste is shredded, passed through
shaft inside the chamber tumble the waste continuously against 10% hypochlorite solution (dixichlor) followed by a finer
the hot wall thus mixing as well as fragmenting the same. In the shredding and drying. The treated material is landfilled [15].
absence of enough moisture, additional steam is injected. The
system operates at 132 deg.C. and 36 psi steam pressure for 6.1.6. Sanitary and Secured Landfilling
sterilisation time of 20minutes. The total time for a cycle is about
Sanitary and secured landfilling is necessary under the following
50 minutes, which includes start-up,heat-up, sterilisation, venting
circumstances :
and depressurisation and dehydration. The treated material can 1· Deep burial of human anatomical waste when the facility
further be shredded before disposal. The expected volume and of properincineration is not available (for towns having less than 5
weight reductions are upto 85% and 70% respectively. The lakh populationand rural areas, according to Schedule I of the
hydroclave can treat the same waste as the autoclave plus the MoEF rules - Securedlandfill). · Animal waste (under similar
waste sharps. The sharps are also fragmented. This technology has conditions as mentioned above) - Securedlandfill.
certain benefits, such as, absence of harmful air emissions,
absence of liquid discharges, non requirementof chemicals, 2· Disposal of autoclaved/hydroclaved/microwaved waste
reduced volume and weight of waste etc.Tata Memorial Hospital in (unrecognisable) -Sanitary landfill.
Mumbai has installed the first hydroclave in India in September 3· Disposal of incineration ash - Sanitary landfill.
1999.
4· Disposal of bio-medical waste till such time when proper
6.1.4. Microwave Treatment treatment anddisposal facility is in place - Secured landfill.
This again is a wet thermal disinfection technology but 5· Disposal of sharps - Secured landfill. This can also be done
unlike other thermal treatment systems, which heat the waste within a hospital premises .
externally, microwave heats the targeted material from inside out,
providing a high level of disinfection. In case disposal facility for sharps is not readily available in a
town, healthcare establishments, especially hospitals having
The input material is first put through a shredder. The suitable land, can construct a concrete lined pit of about 1m length,
shredded material ispushed to a treatment chamber where it is breadth and depth and cover the same with a heavy concrete slab
moistened with high temperature steam. The material is then having a 1 - 1.5 m high steel pipe of about 50 mm
carried by a screw conveyor beneath a series (normally 4-6nos.) of diameter.Disinfected sharps can be put through this pipe. When
conventional microwave generators, which heat the material to the pit is full, the pipe should be sawed off and the hole sealed with
95-100deg. C. and uniformly disinfect the material during a cement concrete. This site should not be water logged or near a
minimum residence time of30 minutes and total cycle is of 50 borewell.
minutes. A second shredder fragments the material further into
unrecognizable particles before it is automatically discharged into 7. Management Issues of Bio-medical Waste Management
a conventional / general waste container. This treated material can
be landfilled provided adequate care is taken to complete the Handling, segregation, mutilation, disinfection, storage,
microwave treatment. In the modern versions, the process control transportation and final disposal are vital steps for safe and
is computerised for smooth and effective control. scientific management of biomedical waste in anyestablishment
[3]. The key to minimisation and effective management of
Microwave technology has certain benefits, such as, absence biomedical waste is segregation(separation) and identification of
of harmful air emissions (when adequate provision of the waste.
containment and filters is made), absence of liquid discharges, non
requirement of chemicals, reduced volume of waste (due to The management principles are based on the following aspects:
shredding and moisture loss) and operator safety (due to Reduction/control of waste (by controlling inventory,
automatic hoisting arrangement for the waste bins into the hopper wastage of consumable items, reagents, breakage etc.).
so that manual contact with the waste bags is not necessary).
Segregation of the different types of wastes into different
However, the investment cost is high at present. According to the
categories according to their treatment/disposal options given in
rules, category nos, 3 (microbiology and biotechnology waste), 4
Schedule I of the Rules mentioned above.
(waste sharps), 6 (soiled waste) and 7 (solid waste) are permitted
to be microwaved [14]. Segregated collection and transportation to final
treatment/disposal facility so that they do not get mixed.
6.1.5. Chemical Disinfecting
Proper treatment and final disposal as indicated in the rules.
This treatment is recommended for waste sharps, solid and
liquid wastes as well as chemical wastes. Chemical treatment Safety of handling, full care/protection against operational
involves use of at least 1%hypochlorite solution with a minimum hazard forPersonnel at each level.
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
482

Proper organization and management Since majority of the measuring device before discarding each time and keeping
health care establishments are located within the municipal area, suitable records[18].
their waste management naturally has a close linkage with the 8. Environmental Concern
municipal system. At the same time, the civic authority
isresponsible for public health in the whole of the municipal area. The following are the main environmental concerns with
Therefore, the health care establishments must have a clear respect to improper disposal of bio-medical waste management:
understanding with the municipality regarding sharing of Spread of infection and disease through vectors (fly,
responsibilities associated with this issue. mosquito, insects etc.)which affect the in -house as well as
Studies have shown that about three fourth of the total surrounding population.
hospital waste is not hazardous / infected (provided strict Spread of infection through contact/injury among
segregation is practised) and can even be taken care of by the medical/non-medical personnel and sweepers/rag pickers,
municipal waste management system, e.g., waste generated at the especially from the sharps (needles, blades etc.).
hospital kitchen or garden, the office or packaging material from
Spread of infection through unauthorised recycling of
the store etc.
disposable items such as hypodermic needles, tubes, blades,
Such practices of strict and careful segregation would reduce bottles etc.
the load and the cost of management of the actually hazardous and
Reaction due to use of discarded medicines.
infected bio-medical waste (collection, transportation, treatment
and disposal)
9. Cost of Biomedical Waste Management
Since, it would not be possible for each and every health care
The cost of construction, operation and maintenance of
establishment to have its own full fledged treatment and disposal
system for managing biomedical waste represents a significant
system for bio-medical waste, there would be need for common
part of overall budget of a hospital if the BMWhandling rules 1998
treatment and disposal facilities under the
have to be implemented in their truespirit. Govt of India in its pilot
ownership/supervision/guidance of the civic authority.
project for hospital waste management in Govt hospitals has
The concerned medical establishment should constitute a estimated Rs.85 lakhas capital cost in 1000 bedded super specialty
team of its experts, concerned personnel and workers (doctors, teaching hospital which includes on site final disposal of BMW.Two
chemists, laboratory technicians, hospital engineers, nurses, types of costs are required to be incurred by hospitals for BMW
cleaning supervisors/inspectors, cleaning staff etc.). If such mgt, internal and external. Internal cost is the cost for segregation,
expertise is not available, it may take the help of external experts in mutilation, disinfection, internal storage and transportation
the field who can help them carryout the survey work. A third including hidden cost of protective equipment. External cost
alternative is possible if expert agencies are available who carry involves off site transport of waste, treatment and final disposal
out the whole work on contract as a package. [19].
In either case, the medical establishment has to earmark a 10. Occupational hazards and safety measures
suitable place where the qualitative and quantitative tests can be
carried out. This place should be an enclosed space. Depending The staffs of the health care establishments, who are either
upon the requirement, it can be a large room or a hall or at least a in contact with the patient or the infectious waste generated, are
covered shade with proper fencing. Unauthorised entry to this continuously at risk during their working hours. Therefore it is
space should be strictly restricted. It should be well lighted. The essential that adequate protection measures are provided against
place should bewashed and disinfected daily and preferably dry occupational health hazards. The administration of the healthcare
and clean. establishment (Infection Control Officer in case of large ones)
should have a detailed deliberation on this subject.
The waste generated by all the departments has to be
collected according to the prevailing practices of collection but due 10.1. Occupational Hazards
care has to be taken to see that no portion of the total waste The following types of occupational hazards occur / can
generated is missed out from this survey. The waste so collected occur in case of medical/para-medical personnel or staff involved
(except the liquid waste and incineration ash) has to be sorted out with cleaning/collection or transportation of waste etc.:
into the different categories according to the Schedule I of the
Biomedical Waste (Management and Handling) Rules, 1998 (as 1· Accidental cut or punctures from infected sharps such as,
applicable). hypodermic needles, scalpels, knives etc.

If an incinerator is operating within the hospital campus, 2· Contact with infected material like pathological waste, used
then the incinerator ash produced every day has to be weighed. gloves, tubingetc., especially from the operation theatre.
This can be done once a day. At the same time the total waste 3· Bedding and dress material of the patient or from the doctors
incinerated every day has also to be recorded. (used during check up/ surgery etc.)
The liquid waste may be divided into two components: (a) 4· Contact with stool, urine, blood, pus etc of the patients during
liquid reagents/chemicals discarded and (b) the cleaning and cleaning job.
washing water channeled into the drain. The first component can
be easily measured by a measuring cylinder or other suitable 10.2. Safety Measures for the Medical and Para-medical Staff
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
483

The following instructions need to be notified and strictly adhered From a planner's point of view, the topic of hospital waste
to: management may be divided into two parts:
1· Clear directives in the form of a notice to be displayed in all
concerned areas. (i) Internal (planning of the hospital/nursing home, various
2· Issuance of all protective clothes such as, gloves, aprons, movement routs,service corridors, storage area for hospital waste,
masks etc. without fail. treatment site if so planned, availability of open area, buffer zone
etc.).
3· Sterilization of all equipment and issue of only properly
sterilized equipment and tool, such as, surgical tools to the medical (ii) External (for off-site treatment/disposal, common
personnel. treatment/disposal facility) - site selection for such facilities
4. Maintenance of registers for this purpose. according to land use plan, transfer route etc. of the town.

5· Provision of disinfectant, soap etc of the right quality and These have been outlined keeping in view the requirements
cleantowels/tissue paper. at the time ofinitial planning, but some of these may be valid for
existing facilities or for thepurpose of expansion / extension.
6· Regular medical check-up (half-early).
13.1. Planning Inside the Health Care Establishment Premises
11. Steps for personal safety
The hospital buildings are broadly divided into three
The following steps are to be followed by individuals for their parts/areas: Outpatient Department (OPD), Investigative facility
personal safety. area and In-patient department.OPD deals with patients on their
1. Wash your hands with soap and warm water after first contact and those who do not need to beadmitted in the
handling biomedical waste. Also, wash all areas of your body with hospital. It also has an Emergency unit, which takes care of
soap and water that you think may have come into contact with patients under trauma, injury or other life threatening
biomedical waste, even if you are not sure your body actually emergencies. This area generates bio-medical waste. The
touched the biomedical waste. investigative area contains Operating Theatre (OT), investigating
equipment like X-ray, Ultra sound, Electro Cardio Gram (ECG),
2. Keep all sores and cuts covered. stress tests (including Thallium stress test, which uses
3. Immediately replace wet bandages with clean, dry radioactivecompound), bio-chemical/pathological laboratory etc.
bandages. and is usually sandwiched between the OPD and the In-patient
department (wards). The investigative area and the wards are the
4. Wear disposable latex gloves when handling biomedical
main generators of hazardous and bio-medical waste in the health
waste. Discard the gloves immediately after use.
care establishments. Other important utility areas in a hospital are
5. Wear an apron or another type of cover to protect your the laundry, chemist's counter etc.
clothes from contact with the waste. If your clothes become soiled,
In general, an attempt should be made to keep the areas
put on fresh clothes, and take a shower, if possible.
generating infectious and hazardous waste (OT, maternity area,
6. Launder or throw away clothes soiled with biomedical emergency area, infectious disease area, isolation area etc.)
waste. separated from those, which generate non-hazardous waste
(administration/office, kitchen, store etc.) so that there is a broad
7. Promptly clean and disinfect soiled, hard-surfaced floors
demarcation and proper management of waste becomes more
by using a germicidal or bleach solution and mopping up with
effective and more convenient.
paper towels.
8. Clean soiled carpets. First blot up as much of the spill as Each point of waste generation should have adequate
possible with paper towels and put the soiled paper towels in a storage space for storing different kinds of waste matter. This
plastic lined, leak-proof container. should include any exigencies so that the system does not fail. For
9. Never handle syringes, needles, or lancets with your areas, which have potential to generate more infectious and
hands. Use a towel, shovel, and/or broom and a dustpan to pick up hazardous waste, twice the average requirement should be taken.
these sharp objects. Dispose of them in a plastic soda pop bottle The storage area should be easily accessible from the service
with a cap. Tape down the bottle cap. Then throw the bottle in the corridors meant for this specific purpose (discussed below).
trash.
Arrangement for separate receptacles in the storage area
12. Awareness Generation with prominent display of colour code on the wall nearest to the
receptacles.
Sustained awareness generation is essential. The
management of thehospital should organise awareness Separate service corridors for taking waste matter from the
programmes, especially for the auxiliary staff.Debates, drama, storage area to the collection room must be provided. These
essay competition etc. may be considered for this purpose [20]. corridors should not cross the paths used by patients and visitors.

13.Planning elements Collection room (s) where the waste packets/bags are
collected before they are finally taken/transported to the
treatment/disposal site. This is more important when the waste is
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
484

to be taken outside the premises. Two rooms -one for the general if necessary. The facility should be well connected with special
and the other for the hazardous waste are preferable. service corridors for bringing the hazardous material and also for
The latter should be secured, cool and provided with fine removal of the treated waste.
wire mesh to prevent access of flies, mosquitoes etc. Proper Hydroclave technology, which is somewhat similar to the
gradient and drains should be provided so that this area can be autoclave, requires less steam (only for the outer jacket and
cleaned and washed daily. In the event of shortage of rooms, the occasional supplementary steam for the main vessel in case of very
general waste (non-hazardous) can be directly stored outside in dry waste) from an external source. Hence its proximity to a boiler
dumper containers (with lids) of suitable size. is not a necessity. Small dedicated steam generators may also be
A shed with fencing should be provided for the carts, trolleys, installed for small to medium size facility.
covered vehicles etc. used for collecting or moving the waste If Microwave technology is chosen, then also, the installation
material. Care has tobe taken to provide separate sheds for the can be suitably at one side of the building or a separate building.
hazardous and non-hazardouswaste so that there is no chance of Other conditions are the same as those for the hydroclave.
cross contamination. Both the sheds should have a wash area
The hospital may like to have its own secured disposal sites
provided with adequate water jets, drains, raised platform and
within the premises for sharps, incinerator ash, treated denatured
protection walls to contain splash of water.
waste etc. Such facilities should be planned after appropriate site
If treatment of the hazardous/bio-medical waste is planned qualification (at a mini scale), such as, distance from water
within the hospital premises, then its location has to be considered sources, accessibility of birds, rats, vermin etc. as well as rag
very carefully. pickers, children and visitors.
If incineration is the chosen technology, it has to be installed Separate roads and entry/exit gates should be provided for
at a place where there is least chance of contamination or taking out the hospital waste, be it general waste or treated waste
pollution, especially from the emission, either for the hospital or its or incinerator ash.
surroundings. Normally it should be away from the main building
but should have sufficient buffer zone from the outside buildings, 13.2. Planning Outside the Health Care Establishment
roads etc. so that there is no real or ethical nuisance perception.
The recommended stack height (minimum 30 metres) has to be The main concerns outside the establishment are - siting of
followed. In some hospitals in high-density areas, incinerators common treatment facility and secured engineered landfills for
have been installed on the roof top to save space and to have extra sharps, incinerator ash and similar hazardous material for their
stack / chimney height with relation to the ground. But such ultimate disposal.
practices are fraught with danger unless very careful planning is Common treatment facilities should be planned with an eye
done for fire fighting, movement of hazardous waste with separate at the future development prospects of the town/city. The sites
lifts, safe removal of ash etc. have to be properly evaluated from the environmental angle as
If autoclave technology is chosen for treatment, then a well as location of the clients(health care establishments). As
decision has to be taken whether the boiler used by the laundry mentioned earlier (7.9), the local landfill site may also be
would also be used for the autoclave or a separate boiler would be considered for installation of the common treatment facility.
installed. Accordingly, the equipment may be housed near the The ultimate disposal site for incinerator ash, sharps, toxic
boiler of the laundry. However, these areas must be separated by a matter etc. should be planned in the same way as a secured landfill
wall so that there is no chance of contamination of the laundry site is made forother toxic and hazardous waste. In fact, the local
From a planner's point of view, the topic of hospital waste body (municipality) mayconsider to have a secured landfill site for
management may be divided into two parts: all hazardous substances within its boundaries and allow its use
on payment of charges / cost sharing basis.
(i) Internal (planning of the hospital/nursing home, various
13.3. Relation to Overall Town Planning
movement routs,service corridors, storage area for hospital waste,
treatment site if so planned, availability of open area, buffer zone Proper planning, whether at the hospital (or other health
etc.). care establishment)level or at the town planning level, is of utmost
importance. Obviously, the be stand the most effective system can
(ii) External (for off-site treatment/disposal, common
evolve in an establishment, where the building itself has been
treatment/disposal facility) - site selection for such facilities designed accordingly. Similarly, it would be prudent to consider
according to land use plan, transfer route etc. of the town. thepoints involved forsiting of common treatment/disposal
These have been outlined keeping in view the requirements facility in the townplanning document. Then only optimal
at the time ofinitial planning, but some of these may be valid for solutions and results can be expected [21].
existing facilities or for thepurpose of expansion / extension. area. 14. Conclusion
Only steam pipes (properly insulated) have to pass through the
The quantity of hospital waste and proportion of infection
dividing wall. Proper drainage and outlet for spent steam / gases
waste is definitely higher than one would expect in India due to
(with adequate filter elements) have to be provided. The steam
extensive use of medical and non-medical disposals. Most of the
condensate should be put in the underground sewer, after cooling,
waste generated in hospitals, including food waste is no more
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
485

hazardous than general municipal waste. Therefore, hospital [25] Drummond L, Michael C D, Croke K . Mercury generation potential from
waste should be segregated into risk wastes and non- risk wastes dental waste amalgam, J Dentist.2003; 31: 493-501.
[26] Preben H B.Amalgam toxicity - environmental and occupational hazards, J
and disposed off accordingly. The last century witnessed the rapid
Dentist.2004;32: 359-65.
mushrooming of hospitals in the public and private sector, [27] Cocchiarella L, Scott D, Young D. Biohazardous waste management: What
dictated by the need of the expanding population, and the advent the physicians need to know, Arch Fam Med.2000; 9: 26-9.
and acceptance of “disposable” has made the generation of [28] Wilson HF, Edward Bellinger G, Mjor A . Dental practice and the
hospital waste a significant factor in present hospitals. environment, Int Dent J.1998; 48: 161-166.
[29] Seymour B S.Disinfection, sterilization and preservation, (5 th ed.),
15. References Lippincott Williams and Wilkins publication.2001.
[30] Laboratory diagnosis, biosafety and quality control. National institute of
[1] Gordon JG, Rein PA.Medical waste management. Hospital epidemiology
communicable diseases and national AIDS control organization, Delhi.
and infection control.2004; 3: 1773-85.
Pages 26-41.
[2] Rao SKM, Garg RK. A study of Hospital Waste Disposal System in Service
[31] Harrison B . States act to regulate medical waste, JADA.1999; 122: 118-20.
Hospital. Journal of Academy of Hospital Administration .1994;6:27-31.
[32] Ravikant, Chitnis V, Jaiswal SP, Vaidya K, Chitnis DS. Effluent Treatment
[3] Singh IB, Sarma RK. Hospital Waste Disposal System and Technology.
Plant: Why and How? Journal of Academy of Hospital Administration.
Journal of Academy of Hospital Administration.1996; 8:44-8.
2002; 14: 33-37.
[4] Acharya DB, Singh M. The book of Hospital Waste Management. Minerva
[33] Chitnis V, Patil S, Chitnis DS, Ravikant. Hospital Effluent: A Source of
Press, New Delhi 2000; 15:47-48.
Multidrug Resistant Bacteria. Current Sciences. 2000; 79 : 535-540.
[5] Srivastava JN. Hospital Waste Management project at Command Hospital,
[34] Chitnis V, Chitnis S, Patil S, Chitnis DS. Treatment of discarded blood units:
Air Force, Bangalore. National Seminaron Hospital waste Management: a
disinfection with hypochlorite/formalin verses steam sterilization. Indian
report. 27 May 2000.
J Med Microbiol .2003; 21: 265-267.
[6] A study of Hospital Waste Management System in CommandHospital
[35] Chitnis V, Chitnis S, Patil S, Chitnis DS. Hypochlorite (1%) Is Inefficient In
(Southern Command), Pune; a dissertation submittedto University of
Decontaminating Blood Containing Hypodermic Needles .Indian J Med
Pune. 2001.
Microbiol .2002; 20: 215-218.
[7] Investigation: source of beach wash-ups . New York State, Deptt. Of
[36] Marwick C. Medical facilities to focus on cleaner environment. JAMA. 1998
Environmental Conservation Report, Albany,New York.1998.
;280:501–502.
[8] Wadhera BL v/s Union of India and others: Judgment Today.1996; 3:38-51.
[37] Zaki AN, Campbell JR. Infectious waste management and laboratory design
[9] The Bio Medical Waste (Management and Handling) Rules, 1998.
criteria. Am Ind Hyg Assoc J. 1997; 11:800–808.
[10] Report of High Power Committee on urban Solid Waste Management,
[38] Rutala WA, Odette RL, Samsa GP. Management of infectious waste by US
Planning Commission, Govt. Of India, 1995.
hospitals. JAMA. 1989; 262:1635–1640.
[11] Gravers PD. Management of Hospital Wastes- An overview. Proceedings of
[39] Collins CH, Kennedy DA. The microbiological hazards of municipal and
National workshop on Management of Hospital Waste, 1998.
clinical wastes. J Appl Bacteriol. 1992; 73:1–6.
[12] Management of Waste from Hospitals and other health care
[40] Garcia R. Effective cost-reduction strategies in the management of
establishments. Euro Reports and Studies No. 97, WHO. 1985: l-61.
regulated medical waste. Am J Infect Control. 1999; 165–175.
[13] Thornton J, Tally MC, Orris P, Wentreg J. Hospitals and plastics Dioxin
[41] English N. Reprocessing disposables: one strategy to balance cost reduction
prevention and Medical Waste Incineration;Public Health Reports. 1996;
and quality patient care. Todays Surg Nurse. 1996;4: 23–26.
1:299- 313.
[42] Klangsin P, Harding A. Medical waste treatment and disposal methods used
[14] Nobel J J. Waste Disposal Units: Paediatrics Emergency Care.1995; 2: 118-
by hospitals in Oregon, Washington and Idaho. Journal of the Air and Waste
120.
Management Association. 1998; 48:516–526.
[15] Acharya DB . The Book of Hospital Waste Management.2000;1:92-96.
[43] Or I, Akgill M. An optimisation approach for locating a hazardous waste
[16] Basu RN. Issues involved in Hospital Waste Management; an experience
disposal facility in Istanbul province. Waste Management Research
from a large teaching institution. Journal of Academy of Hospital
Journal. 1994; 12:495–506.
Admimstration. 1995;101:79-83.
[44] Askarian M, Vakili M, Kabir G. Results of a hospital waste survey in private
[17] Baghotia KS. Study of Waste Management Practices in tertiarycare
hospitals in Fars province, Iran. Waste management. 2004; 24:347–352.
hospital. Thesis work submitted for M.D.Community Health
[45] Almuneef M, Memish ZA. Effective medical waste management: it can be
Administration at NlHFW, 1998.
done. American Journal of Infection Control. 2003; 31:188–192.
[18] Pathak S. Management of Hospital Waste: A Jaipur Scenario., Proceedings
[46] Patil GV, Pokhrel K. Biomedical solid waste management in an Indian
of National workshop on Management and Hospital Waste. 1998;1:31-33.
hospital: a case study. Waste management. 2005; 25:592–599.
[19]. Singh R, Mahajan SL. Management of Hospital Waste in Hospitals of Govt.
[47] Coronel B, Durosellet P, Behrt H, Moskovtchenko JF, Freney J. In situ
Medical College, Amritsar,Journal of Academy of Hospital Administration.
decontamination of medical wastes using oxidative agents: a 16-month
1998; 1: 33-37.
study in a polyvalent intensive care unit. The Journal of Hospital Infection.
[20] Sharma RK, Mathur SK. Management of Hospital Waste, Journal of
2002; 50:207–212.
Academy of Hospital Administration.1989; 121:55-57.
[48] Muhlich M, Scherrer M, Daschner FD. Comparison of infectious waste
[21] Waste characterisation and quantification; “Parivesh” News letter on
management in European hospitals. The Journal of Hospital Infection.
Hospital Waste;March ,CPCB. Ministry of Environment 6c Forest, Govt. of
2003; 55:260–268.
India, New Delhi.1998;2:3-4.
[49] Sigsgaard T, Malmros P, Nersting L, Petersen C. Respiratory disorders and
[22] Veda Hegde, Kulkarni RD, Ajantha GS.Biomedical waste management,
atopy in Danish refuse workers. American Journal of Respiratory and
JOMPF.2007; 11:5-9.
Critical Care Medicine. 1994; 149:1407–1412.
[23] Chitnis V, Chitnis S, Patil S, Chitnis D . Solar disinfection of infectious
[50] Massrouje HTN. Medical waste and health workers in Gaza governorates.
biomedical waste: A new approach for developing countries, Lancet.2003;
Eastern Mediterranean Health Journal. 2001; 7:1017–1024.
362: 1285-1286.
[51] Becher S, Lichtnecker H. Immunological aspects and affections of rubbish
[24] Fan PL, Bindslev DA, Schmalz G, Halbach S, Berendsen H. Environmental
collectors caused by Bioaerosols. Journal of Occupational Health. 2002;
issues in dentistry - mercury, Int Dental J.1997;47: 105-109.
44:125–130.
 Palanisamy Pasupathi et al / Int J Biol Med Res. 2011; 2(1): 472-486
486

[52] Da Silva CE, Hoppe AE, Ravanello MM, Mello N. Medical wastes [57] Karademir A. Health risk assessment of PCDD/F emissions from a
management in the south of Brazil. Waste Management. 2004; hazardous and medical waste incinerator in Turkey. Environmental
25:600–605. International. 2004; 30:1027–1038.
[53] Mukesh Y. Hospital waste – a major problem. JK-Practitioner. 2001; [58] Mohee R. Medical wastes characterisation in healthcare institutions in
8:276–202. Mauritius. Waste Management. 2005; 25:575–581.
[54] Blenkharn JI. Standards of clinical waste management in UK hospitals. [59] Maoa IF, Chena CN, Linb YC, Chena ML. Airborne particle PM2.5/PM10
The Journal of Hospital Infection. 2006; 62:300–303. mass distribution and particle-bound PAH concentrations near a
[55] Jang YC, Lee C, Yoon OS, Kim H. Medical waste management in Korea. medical waste incinerator. Atmospheric Environment. 2007;
Journal of Environmental Management. 2006; 80:107–115. 41:2467–2475.
[56] Abdulla F, Qdais HA, Rabi A. Site investigation on medical waste [60] Ponka A, Kaski A, Lahdevirta J. Recommendation for the management of
management practices in northern Jordan. Waste Management. 2008; waste from healthcare facilities in Helsinki. Waste Management
28:450–458. Research. 1996; 14:145–150.

c Copyright 2011 BioMedSciDirect Publications IJBMR -ISSN: 0976:6685. All rights reserved.

View publication stats