Bio-Medical Waste Management: An Introduction for Health Care

Facilities.
Amit Dumka
Govt Medical College, Haldwani

According to Bio Medical Waste (Management and Handling )Rules 1998 of India "Bio-
medical waste" means any waste, which is generated during the diagnosis, treatment or
immunisation of human beings or animals or in research activities pertaining thereto or in the
production or testing of biological, and including categories mentioned in Schedule I". About 75-
90% waste generated by the health care facilities (HCF) is Non-Hazardous or Non-Risk and the
remaining 10-25% are "Hazardous" or "Risk" waste and may create various healths hazardous. The
waste generated from Health Care Facilities can broadly be classified into 8 main Categories :
General Waste; Pathological waste; Infectious Waste; Sharps; Pharmaceutical waste; Chemical
Waste; Radioactive Waste and Pressurised waste. The Bio-Medical Waste (Management &
Handling) Rules 1998 of India has categorized the waste into 11 Categories as per the schedule-I of
the rules. The categorization is presented in the Table-1.
Table-11: Categorization as per bio-medical waste regulation in India
Category Type of waste
1. Human Human tissues, organs, body parts
anatomical waste
2. Animal wastes Animal tissues, organs, body parts, carcasses, fluid, blood;
experimental animals used in research, waste generated by
veterinary hospitals
3. Microbiology Waste from laboratory cultures, stocks or specimens of
and biotechnology wastes micro-organisms, live or attenuated vaccines, human and
animal cell cultures used in research, infectious agents from
research and industrial laboratories, from production of
biological wastes, toxins, dishes and devices used to transfer
of cultures
4. Waste sharps Needles, syringes, scalpels, blades, glass, etc., capable of
causing punctures and cuts. This includes both used and
unused sharps
5. Discarded Waste comprising outdated, contaminated and discarded
medicines and drugs and medicines
6. cytotoxic drugs
7. Soiled wastes Items contaminated with blood fluids including cotton,
dressings, soiled plaster casts, linens, bedding
8. Solid wastes Disposable items other than the waste sharps, such as tubing,
catheters, IV sets etc.
9. Liquid wastes Waste generated from laboratories, washing, cleaning,
house-keeping and disinfection activities
10. Incineration ash Ash from incineration of any medical wastes
11. Chemical wastes Chemicals used in production of biological, disinfection,
insecticides

1
The Gazette of India (1998)
 The distribution of the Health Care Waste (HCW) in India comprises 80% of the general
waste includes (food waste, sweeping from hospital premises, paper, wrappers etc.) 15% of
pathological & Infectious waste, 1% Sharps waste, 3% Chemical & pharmacological waste and 1%
special waste viz. waste from oncology centre, mercury spillage etc.
With the rapid advances in the Medical Science and introduction of Hi-Tech technologies in
the hospitals the generation of the waste has been increased in diversity as well as in quantity. The
segregation and collection of the waste is very important for the scientific disposal of the waste as
per the laid regulations. The Bio-Medical Waste (Management & Handling) Rules 1998 of India has
stipulated the coding of the segregation of the waste under Schedule II as below:

Colour Type of Container -I Waste Category Treatment options as per

Coding Schedule I

Yellow Plastic bag Cat. 1, Cat. 2, and Cat. 3, Cat. 6. Incineration/deep burial

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

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)

The thumb rule for the segregation of bio-medical waste is "Segregation of the waste at the
point of generation". This means that the waste generated at the point of generation immediately be
placed in the specific colour coded containers lined by the colour coded bags ladled as per the
schedule III of the BMW (Handling and Management) Rules 1998. The rules also states that "It
shall be the duty of every occupier of an 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 to take all steps to ensure that such waste is
handled without any adverse effect to human health and the environment." Thus the proper
Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are key
vital steps for the safe and scientific management of the Bio-medical waste in any Health Care
Facility (HCF) and its duty. The key step in the BMW management is its segregation, if the
segregation is not proper then no plan for management of scientific disposal of BMW can be
worked out or be successful. The improper segregation may result in maximization of the BMW. In
various available literatures it has been mentioned that when un-treated BMW (independent of
quantity) is introduced in the General /Municipal waste, the total quantity of the waste in that bin
turns to be BMW. Thus the hospital waste, in addition to the risk for patience and personnel who
handle these wastes, poses a threat to public health and environment.
 In order to avoid accumulation of the waste and as per the laid regulations no Bio-Medical
waste should be kept for more than 48Hours (from generation to final disposal, including both on-
site and off-site storage too), the waste must be collected and transported on a regular basis to the
storage area. The off-site storage area/yard should be as per the guidelines issued by Central
Pollution Control Board's guidelines for the treatment of Bio-Medical waste.
The waste then from the on-site/off-site storage is then scientifically disposed off as per the
treatment options provided under the Schedule I and Schedule II of Bio-Medical waste
(Management & Handling) Rules 1998.
The problem of Bio-Medical waste disposal in the HCF should be of top priority as per the
concern to the public at large and environmental issues.
Inadequate waste management thus will cause environmental pollution, unpleasant smell,
growth and multiplication of vectors like insects, rodents and worms and may lead to the
transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from syringes
and needles contaminated with human. Although there are no exhaustive documented studies on
health hazards associated with poor hospital waste management, some indicators like progressive
increase in hospital infection rate, and similar indicators are the pointers to the way in which poor
hospital waste management can contribute to the ill health plaguing the health care institutions. In
addition to health risks associated with the poor management of bio-medical waste, due
consideration must be given to the impact on environment, especially to the risks of pollution of
water, air and soil.
Hence, collection and disposal of waste in the proper manner is of great importance as it can
decrease directly and indirectly health risk to people, and damage to flora, fauna and the
environment (Centres for Disease Control and Prevention, 2001). There is an urgent need of
development of Plan for the BMW management at grass root level. In all the courses, whether
Diploma or Degree, Medical / Para-Medical or Nursing there should be updated module for the Bio-
Medical waste management including hands on training. This can be achieved through a holistic
approach toward the development of efficient and effective decision making protocols and
procedures.