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Supported By
World Health Organization (WHO),
India Country Office, New Delhi
Prepared By
Acknowledgment
Bio- Medical Waste Management is an essential, fundamental and important activity of all
hospital. This document on Bio-Medical Waste Management - Self Learning Document
for Doctors, Medical Superintendents and Administrators, is an attempt to refresh and
enhance the knowledge on bio-medical waste management.
Our sincere thanks to Mr. A.K. Sengupta, National Professional Officer, Sustainable
Development and Environmental Health, World Health Organization (WHO), India Country
Office, New Delhi for supporting this project and providing guidance at every level.
We are grateful to Mr. Indrajit Pal, IAS, Director General, for his encouragement in
developing this document.
We wish to express our thanks and gratitude to everyone who contributed to this document.
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1. Introduction………………………………………………………………………….. 2
1.1 Definition of Bio-Medical Waste……………………………………………... 3
1.2 Risk to Personnel Due to Bio –Medical Waste………………………………. 3
1.3 Dangers of Improper Management of Bio-Medical Waste…………………… 4
2. Regulations on Bio- Medical Waste Management………………………………… 6
2.1 National Legislations Governing Waste Management……………………. ….7
2.2 Excerpts from Bio-Medical Waste (Management and Handling) Rules,1998
and as Amended............................................................................................. …8
3. Role of Doctors, Medical Superintendent and Administrators of Hospitals
In Bio-Medical Waste Management……………………………………………….. 13
3.1 Planning and Designing of Bio- Medical Waste Management…….......... 14
3.1.1 Unit Wise Generation of Bio-Medical Waste……………………………..15
3.1.2 Waste Audit and Waste Minimization……………………………… …....16
3.1.3 Items and Equipments Required for Bio- Medical Waste Management…20
3. 1.4 Placement of Required Items……………………………………………..24
3.1.5 Designing the Movement of Bio-Medical Waste…………………………24
3.1.6 Formation of Committee for Bio-Medical Waste Management…………..24
3.2 Reducing Risk of Disease Transmission and Response to Accidents…….26
3.3 Financial Management…………………………………………………...30
3.3.1 Cost of Bio-Medical Waste Management System Where common
Bio-Medical Waste Treatment Facility is Not Available………….31
3.3.2 Cost of Bio-Medical Waste Management System Where Common
Bio-Medical Waste Treatment Facility is Not Available………….31
4. Implementation of Bio- Medical Waste Management Plan……………………....33
4.1 Bio-Medical Waste Management in Hospitals Where Common Bio-
Medical Waste Treatment Facility is Not Available………………………...34
4.2 Bio-Medical Waste Management in Hospitals Where Common Bio-
Medical Waste Treatment Facility is Available……………………………..57
4.3 Bio-Medical Waste Management in PHCs and Small Units………………...69
5. Do’s and Don’ts ……………………………………………………………………...73
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1. Introduction
This module focuses upon the importance and the purpose of Bio-medical waste
management, definition of bio-medical waste, risks associated and dangers of improper
management of bio-medical waste.
Learning Objectives:
Output:
• The reader will be able to define bio-medical waste, understand the risks if not
managed properly and importance of bio-medical waste management.
Hospitals and other healthcare establishments have a “duty of care” for the
environment, public health and have particular responsibilities in relation to
the waste they produce (i.e., bio-medical waste). Negligence in terms of bio-
medical waste management significantly contributes to polluting the environment and
affects the health of human beings. The waste generated by any hospital / health care
facilities consists of general waste like packaging material, eatables, paper, wrapper
etc., hazardous and infectious waste like out dated medicines, cytotoxic drugs, soiled
dressing, swabs, cotton with blood and body fluid, dissected body organs and tissues,
disposable syringes, intravenous fluid bottles, catheters, gloves, injection vials,
needles, blades, scalpels etc. Quantity wise around 70 % - 80% is general waste and
20% - 30% is hazardous and infectious waste which poses risk to human health and
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environment. These two basic category of wastes (hazardous and infectious) should
be segregated other wise the whole waste, the entire volume of waste will become
infectious.
As per WHO norms the health-care waste includes all the waste generated by health-
care establishments, research facilities, and laboratories. In addition, it includes the
waste originating from minor or scattered sources such as that produced in the course
of health care undertaken in the home (dialysis, insulin injections, etc.).
Poor bio-medical waste management exposes hospital and other health care facility
workers, waste handlers and community to infection, toxic effects and injuries.
Doctors, nurses, paramedical staff, sanitary staff, hospital maintenance personnel,
patients receiving treatment, visitors to the hospital, support service personnel
,workers in waste disposal facilities, scavengers, general public and more specifically
the children playing with the items they can find in the waste outside the hospital
when it is directly accessible to them are potentially at risk of being injured or
infected when they are exposed to bio- medical waste.
Risk to all those who generate, collect, segregate, handle, package, store, transport,
treat and dispose waste ( an occupational hazard). Occupational exposure to blood can
result from percutaneous injury (needle stick or other sharps injury), mucocutaneous
injury (splash of blood or other body fluids into the eyes, nose or mouth) or blood
contact with non-intact skin. Over 20 blood born diseases can be transmitted but
particular concern is the threat of spread of infectious and communicable diseases like
AIDS, Hepatitis B & C, Cholera, Tuberculosis, Diphtheria etc. Waste chemicals,
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radioactive waste and heavy metals also finds its way in waste stream which are also
hazardous to health.
There is public health hazard due to poor management of bio-medical waste which
can cause a number of disease. Serious situations are very likely to happen when bio-
medical waste is dumped on uncontrolled sites where it can be easily accessed by
public. Children and rag pickers are particularly at risk to come in contact with
infectious waste. Inappropriate treatment and disposal contributes to environmental
pollution (uncontrolled incineration causes air pollution, dumping in drains, tanks and
along the river bed causes water pollution and unscientific land filling causes soil
pollution).
In many parts of the country bio-medical waste is neither segregated nor disinfected.
It is being indiscriminately dumped into municipal bins, along the roadsides, into
water bodies or is being burnt in the open air. All this is leading to rapid proliferation
and spreading of infectious, dangerous and fatal communicable diseases. The
improper handling and mismanagement of bio- medical waste is posing serious
problems, few of the problems due to improper disposal are as follows.
• The infectious waste which is only 20% – 25% of the entire waste from
hospitals is not segregated and is mixed with general waste by doing so the
whole of waste may turn up to infectious waste. If the same is dumped into the
municipal bin then there are fair chances of the waste in municipal bin to
become infectious.
• The disposal of sharps will lead to needle stick injuries, cuts, and infections
among hospital staff, municipal workers, rag pickers and the general public.
This will lead to transmission of diseases like Hepatitis B, C, E and HIV etc.
• The needles and syringes which are not mutilated or destroyed are being
circulated back through traders who employ the poor and the destitute to
collect such waste for repackaging and selling in the market.
• One of the reasons for spreading of infection is reuse of disposable items like
syringes, needles, catheters, IV and dialysis sets etc.
• The dumping of untreated bio-medical waste in municipal bins may increase
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Questions
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In this module the attention of reader is drawn on various legal provisions governed on
waste management. The salient features of Bio-Medical Waste (Management and
Handling) Rules, 1998 and amendments has been provided.
Learning Objectives:
Output:
• The reader will be able to understand various regulations which governs the
waste management and the salient features of Bio-Medical Waste
(Management and Handling) Rules, 1998 and amendments.
The five guiding principles governing in waste-related laws are the “polluter pays”
principle, this requires any waste producer to be made legally and financially
responsible for the safe and environmentally sound disposal of their waste. The
responsibility to ensure that the disposal of waste causes no environmental damage is
placed upon each waste generator, the “precautionary” principle, the rationale of
the principle is that if the outcome of a potential risk is suspected to be serious, but
may not be accurately known, it should be assumed that this risk is high. This has the
effect of obliging health care waste generators to operate a good standard of
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waste collection and disposal, as well as provide health and safety training, protective
equipment and clothing for their staff , the “duty of care” principle, this recognizes
that any person managing or handling health care waste, or waste-related equipment,
is morally responsible to take good care of the waste while it is under their
responsibility, the “proximity” principle, the philosophy behind this principle is that
treatment and disposal of hazardous waste (including health care waste) should take
place at the nearest convenient location to its place of generation, in order to minimize
the risks to the general population. This does not necessarily mean treatment or
disposal has to take place at each health care establishment; instead it could be done at
a facility shared locally or at a regional or national location. An extension to this
principle is the expectation that every country should make arrangements to dispose
of all wastes in an acceptable manner inside its own national borders and prior
informed consent principle / also known as ‘cradle to grave’ control, this principle
introduces the concept that all parties involved in the generation, storage, transport,
treatment and disposal of hazardous wastes (including health care waste) should be
licensed or registered to receive and handle named categories of waste. In addition,
only licensed organizations and sites are allowed to receive and handle these wastes.
No hazardous wastes (including health care waste) should leave a place of waste
generation until the subsequent parties (e.g. transport, treatment and disposal
operators and regulators) are informed that a waste consignment is ready to be moved.
National legislation is the basis for bio-medical waste management practices in the
country. It establishes control and permits for the disposal. The regulatory frame work
which governs the management of waste is as follows.
• The Water (Prevention and Control of Pollution) Act, 1974 (for liquid waste)
• The Air (Prevention and Control of Pollution) Act, 1981( for air quality)
• The Environment (Protection) Act, 1986
• Hazardous Wastes (Management, Handling and Transboundary Movement)
Rules, 2008 (for hazardous waste).
• The Bio- Medical Wastes (Management and Handling) Rules 1998 (for
hospital waste)
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• The Municipal Solid Wastes (Management and Handling) Rules, 2000 (for
domestic municipal waste)
• Battery (Management and Handling) Rules, 2001 (for used batteries waste).
The Bio-Medical Waste Management and Handling Rules regulate bio-medical waste
management at local, regional and national level. The rules provides a general
foundation for improving bio- medical waste management systems by indicating in
broad terms what is regarded as good and acceptable practice in the hospitals or health
care institutions. The main benefit of a national law covering hospital waste is that it
can give a uniform basis for a country to develop good practices by providing the
definition of waste, its categories , defined legal obligations of waste producers,
requirements for record-keeping and reporting to regulatory agencies, authority for an
inspection system, establishment of procedures to permit or prohibit some waste
handling, treatment and disposal practices and the courts with powers to settle
disputes and impose penalties on offenders.
This rule has 14 sections, 6 schedules and 5 forms and is applied to all persons who
generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste
in any form. As per the rule "Occupier" means 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. The duty of every occupier of an institution generating bio-medical
waste is to take all steps to ensure that such waste is handled without any adverse
effect to human health and the environment.
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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. The “Prescribed Authority” for the enforcement of
provisions of these rules shall be the State Pollution Control Boards in respect of
states and the Pollution Control Committees in respect of the Union territories. The
“Prescribed Authority” for the health care establishments of Armed Forces under
the Ministry of Defence shall be the Director General, Armed Forces Medical
Services.
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Schedule II: Color Coding and Type of Container for sposal of Bio-Medical Waste
Color Type of Waste Category Treatment options as per
Coding Container Schedule I
Yellow Plastic bag. Cat. 1, Cat. 2, and Incineration/deep burial
Cat. 3, Cat. 6
Red Disinfected Cat. 3, Cat.6, Autoclaving / Micro waving /
container / plastic Cat.7. Chemical Treatment
bag
Blue / White Plastic bag / Cat. 4, Cat. 7. Autoclaving / Micro waving /
Translucent puncture proof Chemical Treatment and
Container Destruction / shredding
Black Plastic bag Cat. 5 and Cat. 9 Disposal in secured landfill
and 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.
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Schedule III
Label for Bio-Medical Waste Containers/ Bags
BIOHAZARD CYTOTOXIC
C
CYTOTOXIC
CYTOTOXIQUE
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This module deals with the role of Doctors, Medical Superintendents and
Administrators of hospitals in panning and designing of Bio- Medical Waste
Management. Unit wise generation of waste, its audit and minimization techniques,
items and equipments required to manage the waste and their placement has been
mentioned. Financial management as per methodology adopted for disposal is
explained.
Learning Objectives:
• The reader will be able to understand unit wise generation of waste, perform
waste audit and waste minimization techniques and will be able to do financial
management in bio-medical waste disposal.
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All the medical staff should realize that it is part of their duty to tackle bio-medical
waste management problems. To plan and design bio-medical waste management one
should know how much and what type of waste is generated and from which unit. Is
waste minimization possible if so in which unit and for what type of waste. What all
items and equipments and their quantities are required for managing the waste. What
type of disposal methodology is to be adopted to suit to their facility. Ascertain
whether common bio-medical waste facility is available in the area or not. Forming a
waste management committee will enhance the waste management practice. For
planning and designing of bio-medical waste management, unit wise generation of
waste, its audit and minimization, items and equipments required for managing the
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waste and its appropriate placement , defining route of movement of waste and
finance management needs to be taken into consideration.
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After knowing the waste generation in all units in a hospital, perform waste audit and
then minimize the generation of waste. This is one of the main step in planning and
designing of bio-medical waste management. The audit will give the clear picture of
what type of waste, how much and from where it is generated. This information will
be helpful to opt for waste minimization, items and equipments required for
segregation and treatment of waste and their placement in different units. To know
how much and what type of waste is generated in each medical area, segregate the
waste at the point of generation category wise in specific color codes as per Bio-
Medical Waste (Management and Handling) Rules. The following steps will help in
finding the waste generated quantity wise/ category wise and unit wise.
• Ascertain how many medical areas produce bio-medical waste. List all the
departments and study on its activities,
production of waste and quantity.
• Find the composition of the waste in each
place. Segregate waste category wise, weigh
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it daily at least for one week and then average to monthly. The waste
generated is not same in all the areas producing waste.
• Keenly look for waste minimization options in all the departments.
• Along with the solid waste generation assessment, liquid waste assessment is
also necessary.
Waste minimization benefits the waste producers. The costs for the purchase of
goods, waste treatment and disposal are reduced and the liabilities associated with the
disposal of waste are lessened. By implementing policies and practices such as
purchasing restrictions to ensure the selection of methods or supplies that are less
wasteful or generate less hazardous waste can lead to source reduction. Use such
materials which can be recycled either on-site or off-site. Careful segregation
(separation) of waste into the ten categories (solid and liquid) as per rule helps to
minimize the quantities of hazardous / harmful waste. Careful management of stores
will prevent the accumulation of large quantities of outdated chemicals or
pharmaceuticals and limit the waste to the packaging (boxes, bottles, etc.) plus
residues of the products remaining in the containers. These small amounts of chemical
or pharmaceutical waste can be disposed of easily and relatively cheaply, whereas
disposing of larger amounts requires costly and specialized treatment, which
underlines the importance of waste minimization. Suppliers of chemicals and
pharmaceuticals can also become responsible partners in waste minimization. The
health service can encourage this by ordering only from suppliers who provide rapid
delivery of small orders, who accept the return of unopened stock, and who offer off-
site waste management facilities for hazardous wastes.
Medical and other equipment used in a hospital may be reused provided that it is
designed for the purpose and will withstand the sterilization process. Reusable items
may include certain sharps, such as scalpels and hypodermic needles, syringes, glass
bottles and containers, etc. After use, these should be collected separately from non
reusable items, carefully washed (particularly in the case of hypodermic needles, in
which infectious droplets could be trapped), and may then be sterilized. Although
reuse of hypodermic needles is not recommended, it may be necessary in
establishments that cannot afford disposable syringes and needles. Plastic syringes
and catheters should not be thermally or chemically sterilized, they should be
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Care should be taken while opting for recycle or reuse of materials, medical and other
equipments. Ensure that effective sterilization is attained. Sterilization can be
achieved by thermal sterilization and chemical sterilization. Dry sterilization is an
exposure to 160 °C for 120 minutes or 170 °C for 60 minutes in an oven. Wet
sterilization is an exposure to saturated steam at 121°C for 30 minutes in an autoclave.
Sterilization by ethylene oxide is done by exposing to an atmosphere saturated with it
for 3–8 hours, at 50°– 60°C, in a reactor tank “gas-sterilizer”, the tank should be dry
before injection of the ethylene oxide. Ethylene oxide is a very hazardous chemical,
this process should therefore be undertaken only by highly trained and adequately
protected technical personnel. Exposure to a glutaraldehyde solution for 30 minutes
will sterilize the material and this process is safer for the operators than the use of
ethylene oxide but is microbiologically less efficient. The effectiveness of thermal
sterilization may be checked by the Bacillus stearothermophilus test and for chemical
sterilization by the Bacillus subtilis test.
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The items and facilities required for managing the bio-medical waste are as follows.
• Protective aids like gloves, boots, over garment/ apron etc (for self protection
against infection / injury).
• Colored bins and bags (yellow, red / blue & white puncture proof translucent,
black and green). The Bio Hazard Label should be on all bins and bags except
on black and green. The Cytotoxic Label should be on black bin and bag. The
green color bin should be used for general waste which is like domestic waste
( for segregation of waste).
• Big blue or red container (for storing mutilated and disinfected plastic waste).
• Temporary central storage room (to keep all categories of waste after
segregation before disposal).
• Trolley (to carry the waste to temporary central storage place).
• Needle cutter or Needle burner (for destroying injection needle).
• Scissors or knife (for destroying plastic waste).
• Incinerator where Common Bio-Medical waste Treatment Facility is not
available (for incinerating waste, but having individual incinerator is
discouraged).
• Deep burial pit where population is less than 5,00,000 and in rural areas where
Common Bio- Medical Waste Treatment Facility is not available (for burial
of waste category 1 and 2 ).
• Sharp pit where Common Bio-Medical waste Treatment Facility is not
available (for encapsulating disinfected mutilated sharps).
• Autoclave / Microwave (for disinfection).
• Sodium hypo Chlorite solution (for disinfection).
• Soap (to wash hands).
• Secured landfill
• Waste water treatment plant [ for chemical (liquid) and liquid (lab and
washing etc.) waste]
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Mask Cap
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Weighing Machine
Needle Cutter
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Sharp Pit
Autoclave Shredder
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Waste will be generated depending on the activity of each individual unit. After
ensuring the category and quantity of waste generation, required items to manage the
bio-medical waste should be placed appropriately. In general the requirement of bio-
medical waste management items and its placement in each unit is as follows.
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representative from each cadre and one from Common Bio-Medical Waste Treatment
Facility if available. The committee should meet once in a week to discuss on
continual improvement of bio-medical waste management and its minimization. The
coordinator will be on turn wise basis for a period of one month from each
department who will be in charge for bio-medical waste management and allocates
resources to support the system and ensures arrangements are in place to deal with
emergencies and investigates any waste-related accidents. Heads of medical
departments ensure that all their staff are aware of the waste segregation and local
storage procedures, encourage good practices and enforce compliance. Matron or
head nurse will be responsible for a continual training and also to new nurses and new
recruits on good bio-medical waste handling practices. They should over see the
handling of bio-medical waste by class IV employees, like there should not be any
spillage along the way, should carry the waste through predefined routes etc., and
ensures that supplies of consumable items are available (e.g. waste bags, etc.).
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waste. The committee members should guide the staff in assessing the waste
generation in hospital with frequent intervals of time, details of assessment should
include minimum weight of bio-medical waste in each unit of hospital and
composition of which to be determined by segregating the waste at the point of
generation itself. A person to be designated to assess the level of scavenging if any or
recycling taking place inside the hospital, along transportation routes and at final
disposal sites , also determine social issues in relation to scavenging taking place.
The committee to meet once in fortnight and review and analyze existing bio-medical
waste generation, storage, collection and its frequency and disposal system with due
regards to level of segregation. Review existing awareness on bio-medical waste
management among all cadres of staff and prepare training need analysis (TNA) and
organize programs. Committee should also over see the whether consent of operation
has been obtained or not and other regulatory parameters.
Diseases can be transmitted from Doctors and Nurses to patient (due to unwashed
hands, contaminated sharps, or improperly cleaned reusable equipment). Patient to
Health Worker (due to being accidentally needle stick or sharps that have been used
on patients. Also due to blood or body fluids accidentally splashing onto or coming in
contact with broken skin). Health Worker to Family and Community (health
workers with unclean hands or contaminated clothing or shoes can carry infection
home to family members). Health Facility to Community (improper disposal of bio-
medical waste can lead to transmission of disease to community members due to
needle stick injury or needle reuse, droplet infection, respiratory route, skin contacts
etc). The risk can be reduced by following the guidelines mentioned below.
• Handle all sharps with care to minimize needle stick injury.
• Instruct the staff that while handling waste they should wear appropriate
protective clothing, including a water resistant apron, thick gloves, boots or
closed-toe shoes, and eye protection.
• Do not allow to sort waste or open waste containers to sort waste.
• Educate the staff to wash hands after working with waste or infected material.
• Before and after examining patient or in between two patients wash hands.
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The measures that could / should be taken in case of accidental spillages in hospitals
is as follows.
1. Evacuate the contaminated area.
2. Decontaminate the eyes and skin of exposed personnel immediately.
3. Inform the designated person who should coordinate the necessary actions.
4. Determine the nature of the spill.
5. Evacuate all the people not involved in cleaning up.
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If the spillage of mercury occurs then collection of mercury spill and storage aspect
is as follows.
1. Remove everyone from the area that has been contaminated with mercury.
Keep the heat below 20°C and ventilate the area if possible.
2. Put on face mask in order to prevent breathing of mercury vapor.
3. Remove all jewelry from hands and wrists so that the mercury cannot
combine (amalgamate) with the precious metals.
4. Appropriate personal protective equipment (rubber gloves, goggles / face
shields and clothing) should be used while handling mercury. 5. Locate all
mercury beads carefully. Cardboard sheets should be used to push the spilled
beads of mercury together. Mercury should be placed carefully in a container
with some water.
6. Never use a broom or a vacuum cleaner.
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7. It should not be swept down the drain and wherever possible, it should be disposed
off at a hazardous waste facility or given to a mercury-based equipment manufacture.
According to the “polluter pays principle”, all organizations are financially liable for
the safe management of any waste it generates. The costs of separate collection,
appropriate packaging, and on-site handling are internal to the establishment and paid
as labor and supplies costs. The costs of off-site transport, treatment, and final
disposal are external and paid to the contractors who provide the service (common
bio-medical waste treatment facilitator). Where common bio- medical waste treatment
facility is not available, the costs of construction, operation, and maintenance of
systems for managing the waste can represent a significant part of the overall budget
of a hospital. They should be covered by a specific allotment from the hospital
budget. Certain basic principles should always be respected in order to minimize these
costs. Waste minimization, segregation, and recycling are recommended which can
greatly reduce disposal costs. The benefits of producing less waste are evident, and
segregation prevents the unnecessary treatment of general waste by the costly
methods necessary for waste management.
For government-owned hospitals, the government may use general revenues to pay
the cost of the waste management system. For private organizations, they need to
implement waste management system from their own resources. Since few years
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An Initial capital investment is necessary for management of bio medical waste. Cost
on the following items has to be taken into account. Plant and equipment ( sterilizer,
shredder, incinerator / deep burial where population is less than 5000 population in
rural areas), utility requirements (fuel, electricity, water, etc.), operation and
maintenance, consumables, incinerator building, waste storage room, offices, waste
collection trucks, bins/containers / bags for transporting waste from hospitals to
incinerator site, trolleys for collecting waste bags from wards, bag holders to be
located at all sources of waste in hospitals, weighing machines for weighing waste
bags, protective clothing, disinfecting solution, soap to wash hands and mutilating
agents. The indirect operating costs involves training, replacement of parts,
consumables, vehicle maintenance, uniforms and safety equipment, ash disposal,
compliance monitoring of flue-gas emissions, project management and administrative
costs for the organization responsible for the execution and long-term operation of the
project.
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care by common bio-medical waste treatment facility along with final disposal of
waste.
Questions
1. How to perform waste audit? What is waste minimization?
2. Name protective aids.
3. What measures should be taken in case of accidental spillages in a
hospital?
4. How mercury is to be picked up when there is spillage of mercury?
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Learning Objectives:
Output:
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The bio-medical waste management starts from the point of generation. Waste
minimization options should be considered and adopted. After the waste is generated
the immediate step is segregation followed by collection, storage, transportation,
treatment and disposal. The path between the two points (cradle to grave) can be
segmented schematically as
• Identification of areas of waste generation
• Categorization, quantification of waste and minimization
• Segregation, handling and storage
• Treatment, destruction and disposal
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Storage location for hospitals / health-care waste should be designated inside its
premises. The waste in the bags or containers should be stored in central storage place
in an area or room of a size appropriate to the quantities of waste produced and the
frequency of collection. Recommendation for storage facilities with in the hospitals is
as follows.
• The storage area should have an impermeable, hard-standing floor with good
drainage; it should be easy to clean and disinfect.
• There should be a water supply for cleaning purposes.
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• The storage area should afford easy access for staff in charge of handling the
waste.
• It should be possible to lock the store to prevent access by unauthorized
persons.
• Easy access for waste-collection vehicles is essential.
• There should be protection from the sun.
• The storage area should be inaccessible for animals, insects, and birds.
• There should be good lighting and at least passive ventilation.
• The storage area should not be situated in the proximity of fresh food stores or
food preparation areas.
• A supply of cleaning equipment, protective clothing, and waste bags or
containers should be located conveniently close to the storage area.
Cytotoxic waste should be stored separately from other health-care waste in a
designated secure location.
The various treatment, destruction and disposal methods for each category of waste as
per bio-medical waste management and handling rules are mentioned below.
Category 1 Human Anatomical Waste (human tissues, organs, body parts):
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Category 2 Animal Waste (animal tissues, organs, body parts, bleeding parts
etc.):
Category 4 Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that may
cause puncture and cuts. This includes both used and unused sharps):
After the injection is administered the needles should be cut from the hub by a needle
cutter, both the needle and the syringe become useless and can’t be reused. The cut
needle gets segregated in the pot which is fixed to the needle cutter. The cut syringe
goes in the plastic bucket with sieve, which has 1% sodium hypochlorite solution or
any other equivalent chemical agent. Metal needle from the pot can be stored in the
puncture proof translucent container having 1% sodium hypochlorite solution or any
other equivalent chemical agent. It must be ensured that chemical treatment ensures
disinfection. The disinfected needle can be encapsulated for disposal into municipal
secured landfill or can be given to authorized metal recycler. If auto disabled
syringes are provided it prevents the reuse of non sterile syringes as it self locks after
single use. The waste syringes will follow the same route of management of sharps
waste.
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Category 6 Soiled waste (items contaminated with blood, and body fluids
including cotton, dressings, soiled plaster casts, lines, beddings, other material
contaminated with blood.):
Category 7 Solid waste (waste generated from disposable items other than waste
sharps such as tubings, catheters, intravenous sets etc.):
Destroy the plastic waste to ensure prevention of reuse and disinfect by keeping in 1%
sodium hypochlorite solution or any other equivalent chemical agent. It must be
ensured that chemical treatment ensures disinfection. If recycling of plastic waste is
planned, care should be taken to give to authorized recycler only after disinfection and
shredding.
The liquid waste generated from labs and washing, cleaning and house keeping need
to be treated to the standards prescribed and flush in the drains. The standard for
liquid waste is as follows.
The effluent generated from the hospital should conform to the following limits: PH -
63-9.0, Suspended solids - 100 mg/l, Oil and grease - 10 mg/l, BOD - 30 mg/l, COD -
250 mg/l, Bio-assay test - 90% survival of fish after 96 hours in 100% effluent.
These limits are applicable to those, hospitals which are either connected with sewers
without terminal sewage treatment plant or not connected to public sewers. For
discharge into public sewers with terminal facilities, the general standards as notified
under the Environment (Protection) Act, 1986 shall be applicable.
As per the guidelines issued by Central Pollution Control Board disposal of bio-
medical waste by individual hospitals is discouraged and common bio-medical waste
treatment facilities are encouraged. Pictorial representation of detail implementation
plan of action with various technological options category wise is presented below.
Provision of Common Bio-Medical Waste Treatment Facility (CBMWTF) if in
course of time comes up has also been considered and provided in the implementation
plan.
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CBMWTF
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CBMWTF
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AUTOCLAVE
CBMWTF
MUNICIPAL SECURED
LANDFILL 45
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CENTRAL STORAGE
METAL RECYCLER
CBMWTF
SHARP PIT
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DISCARDED DRUGS
AND MEDICINES
BLACK BIN
SEPARATE
STORAGE PLACE
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SOLIED WASTE
YELLOW BIN
CENTRAL STORAGE
CBMWTF
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SOILED WASTE
RED BIN
CENTRAL STORAGE
AUTOCLAVE CBMWTF
MUNICIPAL SECURED
LANDFILL
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PLASTIC WASTE
MUTILATE
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CENTRAL STORAGE
AUTOCLAVE
PLASTIC RECYCLER
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LIQUID WASTE
EFFLUENT
TREATMENT PLANT
DISCHARGE INTO
DRAIN
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INCINERATOR ASH
BLACK BIN
MUNICIPAL SECURED
LANDFILL
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BLACK BIN
CHEMICAL SOLID
WASTE
MUNICIPAL SECURED
CBMWTF
LANDFILL
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CHEMICAL LIQUID
WASTE
EFFLUENT
TREATMENT PLANT
DISCARGE INTO
DRAIN
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The details of category wise treatment and disposal methods are presented in the
following table.
Category Wise Treatment and Disposal
Category Treatment and Disposal
1.Human anatomical waste No treatment required, incineration@/ deep burial*
2.Animal Waste No treatment required, incineration @/ deep burial*
3.Microbiology and No treatment required, incineration @
Biotechnology Waste Autoclaving / microwaving, municipal secured
landfill
4.Waste Sharps Mutilating / shredding / disinfection and
encapsulation
municipal secured landfill
Mutilating / shredding / disinfection and non-
encapsulation, possibility of recycling shall be
explored
5.Discarded medicines and No treatment required, incineration @
Cytotoxic Destruction, municipal secured landfill
6.Soiled waste (Cotton No treatment required, incineration @
dressings etc.) Autoclaving / microwaving, municipal secured land
fill
7.Solid waste ( Tubing , Disinfection @@ / autoclaving / microwaving /
Catheters etc) mutilating / shredding##, recycling or municipal
secured land fill
8.Liquid waste Disinfection by chemical treatment @@ ,discharge
into drain
9.Incineration ash No treatment required, disposal in municipal land fill
/ Secured Landfill
10. Chemical waste Chemical treatment @@ ,discharge into drains for
(Chemicals used in production liquids and secured landfill for solids.
of biological, Chemicals used
in disinfection etc.)
Category 2 Animal Waste (animal tissues, organs, body parts, bleeding parts
etc.):
After segregation the waste in yellow colored bin or bag it should be kept in
temporary central storage place from where it is to be collected by common bio-
medical waste treatment facility with in 48 hours. The waste does not need any
treatment before handing over to common bio-medical waste treatment facility.
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After segregation the waste in yellow or red colored bin or bag it should be kept in
temporary central storage place from where it is to be collected by common bio-
medical waste treatment facility with in 48 hours. The waste does not need any
treatment before handing over to common bio-medical waste treatment facility.
Category 4 Waste Sharps (needles, syringes, scalpels, blades, glass, etc. that may
cause puncture and cuts. This includes both used and unused sharps):
After mutilation keep the sharps in white translucent puncture proof bin having 1%
sodium hypochlorite solution for disinfection . When it occupies 3/4th of the bin, hand
over to the common bio medical waste treatment facility.
Keep the waste in black bag or bin having cytotoxic label on it and hand over to the
common bio medical waste treatment facility. The waste does not need any treatment
before handing over to common bio-medical waste treatment facility.
Category 6 Soiled waste (items contaminated with blood, and body fluids
including cotton, dressings, soiled plaster casts, lines, beddings, other material
contaminated with blood.):
After segregation the waste in yellow or red colored bin or bag it should be kept in
temporary central storage place to be collected by common bio-medical waste
treatment facility with in 48 hours. The waste does not need any treatment before
handing over to common bio-medical waste treatment facility.
Category 7 Solid waste (waste generated from disposable items other than waste
sharps such as tubings, catheters, intravenous sets etc.):
As soon as the solid plastic waste is generated, mutilate, disinfect, keep in red or blue
colored bin or bag and hand over to common bio-medical waste treatment facility.
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The liquid waste generated from labs and washing, cleaning and house keeping need
to be treated to the standards prescribed and flush in the drains. The standard for
liquid waste is as follows.
The effluent generated from the hospital should conform to the following limits: PH -
63-9.0, Suspended solids - 100 mg/l, Oil and grease - 10 mg/l, BOD - 30 mg/l, COD -
250 mg/l, Bio-assay test - 90% survival of fish after 96 hours in 100% effluent.
These limits are applicable to those, hospitals which are either connected with sewers
without terminal sewage treatment plant or not connected to public sewers. For
discharge into public sewers with terminal facilities, the general standards as notified
under the Environment (Protection) Act, 1986 shall be applicable.
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YELLOW BIN
BODY PART
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MICROBIOLOGY &
BIOTECHNOLOGY
WASTE
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DISCARDED MEDICINES
&CYTOTOXIC DRUGS
BLACK BIN
SEPARATE
STORAGE
PLACE
COMMON BIO-MEDICAL
WASTE TREATMENT
FACILITY
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SOILED WASTE
COMMON BIO-MEDICAL
WASTE TREATMENT
FACILITY
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SOLID WASTE
(PLASTIC)
MUTILATION
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LIQUID WASTE
EFFLUENT TREATMENT
PLANT
DISCARGE INTO
DRAIN
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In Primary Health Centers (PHCs) and in small scale hospitals the quantity of waste
generated is too small because the activities taken up in these hospitals are restricted
to certain extent. All categories of waste is not generated as the activity of medical
treatment is minimum. In general the categories of waste generated are category 1:
human anatomical waste, category 4: sharps waste, category 5: discarded medicines,
category 6: soiled waste, category 7: solid waste (plastic ), category 8: liquid waste,
category 10: chemical waste and general domestic waste. As the PHCs are scattered
small units and placed in far away from the common bio-medical waste treatment
facility, it is not feasible for the facilitator to collect waste from these places with in
48 hours. Same case with small scale hospitals in the rural areas. In absence of such
facility / arrangement, a cost effective management plan for bio-medical waste
disposal is designed. Segregation, treatment and disposal are the main steps in
managing bio-medical waste. Category wise segregation, treatment and disposal for
the above mentioned categories is as follows.
Category 7 (solid plastic waste), mutilate the plastic waste and disinfect with 1 %
sodium hypo chlorite solution or any other equivalent chemical. After ensuring
disinfection store in a big blue bin for sale to authorized recyclers.
Category 5 (discarded drugs ), put it in secured landfill or hand over to the District
Medical Health Officer (DM&HO) for onward transmission to secured landfill.
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Category 8( liquid waste), liquid waste generated from laboratory ,washing, cleaning
and house keeping need to be treated to the standards prescribed and flush in the
drains. The standard for liquid waste is as follows.
The effluent generated from the hospital should conform to the following limits: PH -
63-9.0, Suspended solids - 100 mg/l, Oil and grease - 10 mg/l, BOD - 30 mg/l, COD -
250 mg/l, Bio-assay test - 90% survival of fish after 96 hours in 100% effluent.
These limits are applicable to those, hospitals which are either connected with sewers
without terminal sewage treatment plant or not connected to public sewers. For
discharge into public sewers with terminal facilities, the general standards as notified
under the Environment (Protection) Act, 1986 shall be applicable.
The implementation plan for bio-medical waste management for Primary Health
Centers (PHCs) and small scale hospitals in rural areas is presented in the following
table.
Implementation Plan for Bio- Medical Waste Management in Primary Health
Centers and Small Scale Hospitals in Rural Areas
Cate Waste Requirement Treatment and Disposal Post
gory disposal
1 Human 1.Deep burial pit Treatment is not required. If deep
anatomical 2.Yellow bin / bag Handover the yellow bin or bag to burial then
waste transporter of CBMWTF or Deep cover it with
burial. soil and
lime.
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4 Waste Sharps 1.Needle cutter/ burner Mutilate the needle & If it is put in
2.Sharp pit disinfection. Handover the sharp pit
3.White puncture proof container to transporter of then close
translucent container CBMWTF Or Dispose mutilated the sharp pit
4. 1% Sodium Hypo needles in sharp pit and lock it.
Chlorite solution
The detail of deep burial pit and sharp pit are as follows
Deep Burial Pit:
• A pit or trench should be dug out about 2 meters deep. It should be half filled
with waste, then covered with lime within 50 cm of the surface, before filling
the rest of pit with soil.
• It must be ensure that animals do not have any access to burial site. Covers of
galvanized iron / wire meshes may be used.
• On each occasion, when wastes are added to pit, layer of 10 cms of soil shall
be added to cover the wastes.
• Burial must be performed under close and dedicated supervision.
• Pits should be distant from habitation so as to ensure that no contamination of
ground water occurs. The area should not be prone to flooding or erosion.
• The institution shall maintain record of all the pits for deep burial
• Fencing of the deep burial pit has to be maintained
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• The deep burial site should be relatively impermeable and no shallow well
should be close to the site.
• The location of the deep burial site will be authorized by the prescribed
authorities.
Sharp Pit:
A pit is to be dug according to the requirement of the hospital. All the sides of the pit
should be plastered with cement. A cylindrical metal pipe of 4 inches diameter or
more is fixed at the ceiling of the pit. The opening of the metal pipe should have
locking facility. The sharps are deposited in this pit through the pipe from the
puncture proof translucent container after mutilating.
Questions
1. Name the categories of bio-medical waste and mention color coded bins or
bags for their segregation?
2. Which categories of waste should be mutilated?
3. Does the waste needs any treatment before incineration?
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This module contains specific information on Dos and Don’t s while managing bio-
medical waste. This will highlight on the activities or action to be performed or not
during bio-medical waste management.
Learning Objectives:
Output:
• The reader will be able to understand performance of various actions during bio-
medical waste management, reason out adoption of various technologies for
segregation, store, transport, treat and dispose the bio-medical waste category
wise.
Do’s
1. Generate waste when it is essential.
2. Segregate waste as soon as it is generated into specified categories of waste.
3. Collect the waste in specific color coded covered bins having bio hazard logo.
4. Put the body parts and animal waste in yellow container.
5. Soiled waste to go into yellow or red container.
6. As soon as the solid waste (plastic waste) is generated mutilate it so that it can
not be reused again and put in blue or red container.
7. Destroy needle by using needle cutter or needle burner.
8. Keep the needles in puncture proof, translucent container having 1% sodium
hypochlorite solution and put the plastic syringe in blue or red container.
9. The cytotoxic drugs or discarded medicine to be placed in black container
having cytotoxic logo on it.
10. Clean the bins regularly with soap and water and disinfect the bins regularly.
11. Collect the domestic waste/eatables, wrappers, fruit peels, papers etc. in green
bin.
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Question:
1. Which photographs (1 to 27) presented below reflects right action and which is
wrong action? Give reasons?
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1 2
3 4
5 6 7
8 9 10
11 12 13
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15 16
14
17 18 19
20 21 22
23
24 25
26 27
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Annexure - 1
Bio- Medical Waste (Management and Handling) Rules, 1998 and Amendments
(1) These rules may be called the Bio-Medical Waste (Management and
Handling)(Second Amendment ) Rules, 2003.
(2) They shall come into force on the date of their publication in the
official Gazette.
2. APPLICATION:
These rules apply to all persons who generate, collect, receive, store, transport,
treat, dispose, or handle bio medical waste in any form.
(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;
(5) "Bio-medical waste" means any waste, which is generated during the
diagnosis, treatment or immunisation of human beings or animals or in
research activitiescategories 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;
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4. DUTY OF OCCUPIER:
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7. PRESCRIBED AUTHORITY
(1) The prescribed authority for enforcement of the provisions of these rules
shall be the State Pollution Control Boards in respect of States and the
Pollution Control Committees in respect of the Union territories and all
pending cases with a prescribed authority appointed earlier shall stand
transferred to the concerned State Pollution Control Board, or as the case may
be, the Pollution Control Committees.
(1A). The prescribed authority for enforcement of the provisions of these rules
in respect of all health care establishments including hospitals, nursing homes,
clinics, dispensaries, veterinary institutions, Animal houses, pathological
laboratories and blood banks of the Armed Forces under the Ministry of
Defence shall be the Director General, Armed Forces Medical Services.
(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 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 living a
reasonable opportunity to the occupier/operator of being heard.
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8. AUTHORISATION
9. ADVISORY COMMITTEE
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(1) The Central Pollution Control Board shall monitor the implementation of
these rules in respect of all the Armed Forces health care establishments under
the Ministry of Defence.
(2) After giving prior notice to the Director General Armed Forces Medical
Services, the Central Pollution Control Board along with one or more
representatives of the Advisory committee constituted under sub-rule (2) of
rule 9 may, if it considers it necessary, inspect any Armed Forces health are
establishments.
When any accident occurs at any institution or facility or any other site where bio-
medical waste is handled or during transportation of such waste, the authorised person
shall report the accident in Form Ill to the prescribed authority forthwith.
13. APPEAL
(1) Any person aggrieved by an order made by the prescribed authority under
these rules may, within thirty days from the date on which the order is
communicated to him, prefer an appeal in form V to such authority as the
Government of State/Union Territory may think fit to constitute:
Provided that the authority may entertain the appeal after the expiry of the said
period of thirty days if it is satisfied that the appellant was prevented by
sufficient cause from filing the appeal in time.
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(2) Any person aggrieved by an order of the Director General, Armed Forces
Medical Services under these rules may, within thirty days from the date on
which the order is communicated to him prefer an appeal to the Central
Government in the Ministry of Environment and Forests.”.
SCHEDULE I
(See Rule 5)
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SCHEDULE-II
(See Rule 6)
COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL
OF BIOMEDICAL WASTES
Note:
SCHEDULE-III
(See Rule 6)
BIOHAZARDS
C
CYTOTOXIC
CYTOTOXIQUE
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SCHEDULE IV
(see Rule 6)
LABEL FOR TRANSPORT OF BIO-MEDICAL WASTE
CONTAINERS/BAGS
SCHEDULE V
(see Rule 5 and Schedule 1)
All incinerators shall meet the following operating and emission standards
A. Operating Standards
1. Combustion efficiency (CE) shall be at least 99.00%.
2. The Combustion efficiency is computed as follows:
%C02
C.E. = ------------ X 100
%C02 + % CO
3. The temperature of the primary chamber shall be 800 ± 50 deg. C°.
4. The secondary chamber gas residence time shall be at least I (one) second at 1050 ±
50 C°, with
minimum 3% Oxygen in the stack gas.
B. Emission Standards
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Environment Protection Training and Research Institute (EPTRI)
Note :
• Suitably designed pollution control devices should be installed/retrofitted with
the incinerator to achieve the above emission limits, if necessary.
• Wastes to be incinerated shall not be chemically treated with any chlorinated
disinfectants. Chlorinated plastics shall not be incinerated.
• Toxic metals in incineration ash shall be limited within the regulatory
quantities as defined under the Hazardous Waste (Management and Handling
Rules,) 1989.
• Only low sulphur fuel like L.D.0dLS.H.S.1Diesel shall be used as fuel in the
incinerator.
The autoclave should be dedicated for the purposes of disinfecting and treating bio-
medical waste,
(I) When operating a gravity flow autoclave, medical waste shall be subjected to:
(i) a temperature of not less than 121 C' and pressure of 15 pounds per square
inch (psi) for an autoclave residence time of not less than 60 minutes; or
(ii) a temperature of not less than 135 C° and a pressure of 31 psi for an
autoclave residence time of not less than 45 minutes; or
(iii) a temperature of not less than 149 C° and a pressure of 52 psi for an
autoclave residence time of not less than 30 minutes.
(i) a temperature of not less than 121 C° and pressure of 15 psi per an
autoclave residence time of not less than 45 minutes; or
(ii) a temperature of not less than 135 C° and a pressure of 31 psi for an
autoclave residence time of not less than 30 minutes;
(III) Medical waste shall not be considered properly treated unless the time,
temperature and pressure indicators indicate that the required time, temperature and
pressure were reached during the autoclave process. If for any reasons, time
temperature or pressure indicator indicates that the required temperature, pressure or
residence time was not reached, the entire load of medical waste must be autoclaved
again until the proper temperature, pressure and residence time were achieved.
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indicator at the maximum design capacity of each autoclave unit. Biological indicator
for autoclave shall be Bacillus stearothermophilus spores using vials or spore Strips;
with at least 1X104 spores per milliliter. Under no circumstances will an autoclave
have minimum operating parameters less than a residence time of 30 minutes,
regardless of temperature and pressure, a temperature less than 121 C° or a pressure
less than 15 psi.
The effluent generated from the hospital should conform to the following limits
These limits are applicable to those, hospitals, which are either connected with sewers
without terminal sewage treatment plant or not connected to public sewers. For
discharge into public sewers with terminal facilities, the general standards as notified
under the Environment (Protection) Act, 1986 shall be applicable.
STANDAR DS OF MICROWAVING
1. A pit or trench should he dug about 2 meters deep. It should be half filled with
waste, then covered with lime within 50 cm of the surface, before filling the rest of
the pit with soil.
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2. It must be ensured that animals do not have any access to burial sites. Covers of
galvanised iron/wire meshes may be used.
3. On each occasion, when wastes are added to the pit, a layer of 10 em of soil shall
be added to cover the wastes.
4. Burial must be performed under close and dedicated supervision.
5. The deep burial site should be relatively impermeable and no shallow well should
be close to the site.
6. The pits should be distant from habitation, so as to ensure that no contamination
occurs of any surface water or ground water. The area should not be prone to
flooding or erosion.
7. The location of the deep burial site will be authorised by the prescribed authority.
8. The institution shall maintain a record of all pits for deep burial.
SCHEDULE VI
(see Rule 5)
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FORM I
(see rule 8)
[APPLICATION FOR AUTHORISATION /RENEARL OF
AUTHORISATION]
(To be submitted in duplicate.)
To
The Prescribed Authority
(Name of the State Govt / UT Administration)
Address.
1. Particulars of Applicant
(i) Name of the Applicant
(In block letters & in full)
(ii) Name of the Institution:
Address:
Tele No., Fax No. Telex No.
2. Activity for which authorisation is sought:
(i) Generation
(ii) Collection
(iii) Reception
(iv) Storage
(v) Transportation
(vi) Treatment
(vii) Disposal
(viii) Any other form of handling
8. Declaration
I do hereby declare that the statements made and information given above are true to
the best of my knowledge and belief and that I have not concealed any information. I
do also hereby undertake to provide any further information sought by the prescribed
authority in relation to these rules and to fulfill any conditions stipulated by the
prescribed authority.
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FORM II
(see rule 10)
ANNUALREPORT
Place.............................. Designation.............................
FORM III
(see Rule 12)
ACCIDENT REPORTING
Place.............................. Designation..........................................
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References:
1. Bio Medical Waste (Management and Handling) Rules, 1998 and amendments
2. Guidelines for Common Bio-medical Waste Treatment Facility by Central
Pollution Control Board
3. Health Care Waste Management (HCWM) by WHO / Annette Pruess, E. Giroult,
P. Rushbrook
4. http://www.scribd.com/doc/14034406/BioMedical-Waste-
Management? autodown=doc
5. Training Manual- Training for workers in the management of sharp waste, version
1, October 2005 by USAID and PATH- www.nursingworld.org/occupational
6. Bio Medical Waste Management: An infra structural survey of hospitals
By Lt. Col. S.K.m.Rao et al
7. Shaner, H. et al. (1993) An Ounce of Prevention: Waste Reduction Strategies for
Health Care Facilities. American Society for Healthcare Environmental Services.
Chicago, IL. A Resource Kit for Pollution Prevention in Health Care.
8. www.nursingworld.org/occupational environmental American nurses association,
safe needle safe life 2008 study of nurses views on work place safety and needle
stick injury.
9. Safe Management of Waste From Health Care Activities
10. http://www.all creatures.org/wlalw/rat-01-jpg
11. British Journal of Industrial Medicine 1987- Occupational Hazards in Hospitals:
Accident, Radiation, Exposure to Noxious Chemicals, Drugs Addiction and
Psychic Problems and Assualt by J J Guestal
12. Preparation of National Health Care Waste Management Plans in Sub-Saharan
Countries- UNEP- SBC and WHO
13. National Health Care Waste Management Plan – Kingdom of Lesotho
14. Infection Prevention and Waste Management for Merrygold Health Network-
Participants Manual 2008- Supported by USAID,SIFPSA and Implemented by
HLFPPT
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