Module-10

Bio - Medical Waste

Management

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Chapter : 10.1
Introduction to Bio-waste
Management

Learning Objectives
By the end of this chapter, the learner would be able to

 What is bio-waste management

 Sources of bio medical waste
 Classification of waste
 Categories of bio-medical waste
 Need of Bio waste management and who are at risk?

Introduction

One of the main causes for the spread of infections and disease is the improper disposal of
waste. It is a health hazard for hospital employees, patients, and society. Hospital employees
come in close contact with infected tissues, biological fluids, and infected materials of
patients. Similarly, doctors, nurses, labor staff, and technical staffs working in laboratories
face the risk of accidental infection.

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There is a possibility of nosocomial infection. It is a common practice that many hospitals,
nursing homes, and health care centers dump all the waste at the garbage collection site from
where the garbage is taken away by the vehicles for final disposal. Most of the sites are prone
for rag pickers who may get infected while handling such infected items.

The items picked up are often sold to the market where the concerned persons tend to recycle
the used needles, syringes, gloves, discarded drugs, etc. Those who use these items face the
risk of infection. The Ministry of Environment and Forest has specified the guidelines for
handling and disposing biomedical waste. These guidelines stress on

(a) Segregation

(b) Storage

(c) Disinfection

(d) Disposal.

"Bio-medical waste" means any waste, which is generated during the diagnosis, treatment or
immunization of human beings or animals or research activities pertaining thereto or in the
production or testing of biological or in health camps

Hospital Waste : refers to all waste , biological or non biological that is discarded and is not
intended for further use.

Medical waste : refers to materials generated as a result of patient diagnosis , treatment ,

immunization of human beings or animals

Infectious waste : are the portion of medical waste that could transmit an infectious disease

Pathological waste : waste removed during surgery / autopsy or other medical procedures
including human tissues , organs , body parts , body fluids and specimens along their
containers.

Who’s at risk ?
All individuals exposed to hazardous HCW are potentially at risk of being injured or infected.
They include:
Medical staff: doctors, nurses, sanitary staff and hospital maintenance personnel;
In- and out-patients receiving treatment in health-care facilities as well as their visitors;
Workers in support services linked to health-care facilities such as laundries, waste handling
and transportation services;
Workers in waste disposal facilities, including scavengers;
General public and more specifically the children playing with the items they can find in

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the waste outside the health-care facilities when it is directly accessible to them.

Occupational and public health risks

During handling of wastes, the medical and ancillary staff as well as the sanitary labourers
can be injured if the waste has not been packed safely. In that respect, sharps are
considered as one of the most dangerous category of waste. Many injuries occur because
syringe needles or other sharps have not been collected in safety boxes or because these
have been overfilled.
On dumpsites, scavengers during their recycling activities may also come in contact with
infectious waste if it has not been properly treated or disposed of The general public can be
infected by HCW either directly or indirectly through several routes of contamination.
Dumping HCW in open areas is a practice that can have major adverse effects on the
population. The “recycling” practices that have been reported, particularly, the reuse of
syringes is certainly the most serious problem in some of the developing countries. The
WHO estimates that over 20 million infections of hepatitis B, C and HIV occur yearly due to
unsafe injection practices (reuse of syringes and needles in
the absence of sterilization).

Indirect risks via the environment

Finally, the dumping of HCW in uncontrolled areas can have a direct environmental effect by
contaminating soils and underground waters. During incineration, if no proper filtering is
done, air can also be polluted causing illnesses to the nearby populations. This has to be
taken into consideration when choosing a treatment or a disposal method by carrying out a
rapid environmental impact assessment

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Sources of Biomedical Waste
 Government /private hospitals
 Nursing Homes
 Physician/dentist office or clinic
 Dispensaries
 Primary health care centres
 Medical research and training centres
 Animal/slaughter houses
 Labs/research organisations
 Vaccinating centres
 Biotech institutions / production unit

Classification of Waste

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A Non-risk HCW
Non-risk HCW includes all the waste that has not been infected like general office waste,
packaging or left over food. They are similar to normal household or municipal waste and
can be managed by the municipal waste services. They represent between 75% and 90% of
the total amount of HCW generated by medical institutions. Three groups can be
established:

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A1 Recyclable waste It includes paper, cardboard, non-contaminated plastic or metal, cans
or glass that can be recycled
A2 Biodegradable HCW
This category of waste comprises for instance, left over food or garden waste that can be
composted.
A3 Other non-risk waste
(Are included in this category all the non-risk waste that do not belong to categories A1 and
A2.

B Biomedical and health-care waste requiring special attention

B1 Human anatomical waste
This category of waste comprises non-infectious human body parts, organs and tissues and
bloodbags.
Examples of such wastes: tissue waste, removed organs, amputated body parts, placentas,
etc…

B2 Waste sharps
Sharps are all objects and materials that are closely linked with health-care activities and
pose a
potential risk of injury and infection due to their puncture or cut property. For this reason,
sharps are considered as one of the most hazardous waste generated in the HCF and they
must be managedwith the utmost care.
Examples of such wastes: all types of needles, broken glassware, ampoules, scalpel blades,
lancets, vials without content

B3 Pharmaceutical waste
The term "pharmaceuticals" embraces a multitude of active ingredients and types of
preparations.The spectrum ranges from teas through heavy metal containing disinfectants
to highly specificmedicines. Waste management therefore requires the use of a
differentiated approach. This categoryof waste comprises expired pharmaceuticals or
pharmaceuticals that are unusable for other reasons(e.g. call-back campaign).
Pharmaceutical wastes are divided into three classes. Their management occurs in a class-
specific manner .

B31 Non-hazardous pharmaceutical waste

This class includes pharmaceuticals such as camomile tea or cough syrup that pose no
hazard
during collection, intermediate storage and waste management. They are not considered
hazardous wastes and should be managed jointly with municipal waste.

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B32 Potentially hazardous pharmaceutical waste
This class embraces pharmaceuticals that pose a potential hazard when used improperly by
unauthorised persons. They are considered as hazardous wastes and their management
must take place in an appropriate waste disposal facility.

B33 Hazardous pharmaceutical waste

Class B33 pharmaceutical waste comprises heavy metal containing and unidentifiable
pharmaceuticals as well as heavy metal containing disinfectants, which owing to their
composition require special management. They must be considered as hazardous wastes
and their management must take place in an appropriate waste disposal facility.

Cytotoxic pharmaceutical waste

Cytotoxic pharmaceutical wastes are wastes that can arise by use (administration to
patients), manufacture and preparation of pharmaceuticals with a cytotoxic (antineoplastic)
effect. These chemical substances can be subdivided into six main groups: alkylated
substances, antimetabolites,antibiotics, plant alkaloids, hormones, and others. A potential
health risk to persons who handlecytotoxic pharmaceuticals results above all from the
mutagenic, carcinogenic and teratogenic properties of these substances. Consequently,
these wastes pose a hazard, and the measures to be taken must also include those required
by occupational health and safety provisions.
Examples of such wastes: Discernible liquid residues of cytotoxic concentrates, post-
expiration-date cytotoxic pharmaceuticals and materials proven to be visibly contaminated
by cytotoxic pharmaceuticals must be disposed of as cytotoxic pharmaceutical waste.

B5 Blood and body fluids waste

It includes wastes that are not categorised as infectious waste but are contaminated with
human or animal blood, secretions and excretions. It is warranted to assume that these
wastes might be contaminated with pathogens.
Examples of such wastes: Dressing material, swabs, syringes without needle, infusion
equipment without spike, bandages

C Infectious and highly infectious waste

Infectiousness is one of the hazard characteristic listed in annex II of the Basel Convention
and defined under class H6.2. Special requirements regarding the management of infectious
wastes must be imposed whenever waste is known or – based on medical experience –
expected to be contaminated by causative agents of diseases and when this contamination
gives cause for concern that the disease might spread. In this category two groups can be
considered depending on the degree of infectiousness that is expected.

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C1 Infectious waste
This class comprises all biomedical and health-care waste known or clinically assessed by a
medical practitioner or veterinary surgeon to have the potential of transmitting infectious
agents to humans or animals.
Waste of this kind is typically generated in the following places: isolation wards of hospitals;
dialysis wards or centres caring for patients infected with hepatitis viruses (yellow dialysis);
pathology departments; operating theatres; medical practices and laboratories which
mainly treat patients suffering from the diseases specified above. It includes:
Discarded materials or equipment contaminated with blood and its derivatives, other body
fluids or excreta from clinically confirmed infected patients or animals with hazardous
communicable diseases. Contaminated waste from patients known to have blood-borne
infections undergoing haemodialysis (e.g. dialysis equipment such as tubing and filters,
disposable sheets, linen, aprons, gloves or laboratory coats contaminated with blood);
Carcasses as well as litter and animal faeces from animal test laboratories, if transmission of
the above-mentioned diseases is to be expected.

Examples of such wastes: Blood from patients contaminated with HIV, viral hepatitis,
brucellosis, Q fever. Faeces from patients infected with typhoid fever, enteritis, cholera.
Respiratory tract secretions from patients infected with TB, anthrax,
rabies, poliomyelitis…

C2 Highly infectious waste

It includes:
All microbiological cultures in which a multiplication of pathogens of any kind has occurred.
They are generated in institutes working in the fields of hygiene, microbiology and virology
as well as in medical laboratories, medical practices and similar establishments; Laboratory
waste (cultures and stocks with any viable biological agents artificially cultivated to
significantly elevated numbers, including dishes and devices used to transfer, inoculate and
mix cultures of infectious agents and infected animals from laboratories). Examples of such
wastes: Sputum cultures of TB laboratories, contaminated blood clots and glassware
material generated in the medical analysis laboratories, high concentrated microbiological
cultures carried out in medical analysis laboratories.

D Other hazardous waste

This category of waste is not exclusive to the health-care sector. They include: gaseous,
liquid and solid chemicals, waste with high contents of heavy metals such as batteries,
pressurized containers, etc…

Chemical waste consists of discarded chemicals that are generated during disinfecting
procedures or cleaning processes. Not all of them are hazardous but some have toxic,
corrosive, flammable, reactive, explosive, shock sensitive, cyto- or genotoxic properties.

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They must be used and disposed of according to the specifications provided with each type
of chemical.
Waste with high contents of heavy metals and derivatives are potentially highly toxic. They
areconsidered as a sub-group of chemical waste but should be treated specifically.
Pressurised containers consist of full or emptied containers or aerosol cans with pressurised
liquids, gas or powdered materials.

Examples of such wastes: thermometers, blood-pressure gauges, photographic fixing and

developing solutions in X-ray departments, halogenated or non-halogenated solvents,
organic and in-organic chemicals.

E Radioactive health-care waste

Radioactive waste includes liquids, gases and solids contaminated with radionuclides whose
ionizing radiations have genotoxic effects. The ionizing radiations of interest in medicine
include Xand γ-rays as well as α- and β- particles. An important difference between these
types of radiations is that X-rays are emitted from X-ray tubes only when generating
equipment is switched on whereas γ- rays, α- and β- particles emit radiations continuously.
The type of radioactive material used in health-care facilities results in low level radioactive
waste.

Biohazardous waste is defined as:

 Laboratory waste, cultures and stocks of infectious agents from research
laboratories, wastes from the production of biological agents, discarded live and
attenuated vaccines, and culture dishes and devices used to transfer, inoculate and
mix cultures or material which may contain infectious agents and may pose a
substantial threat to health. All non-sterilized cultures shall be presumed to be
biohazardous.
 Any specimens sent to a laboratory for microbiologic analysis shall be presumed to
be biohazardous.
 Surgical specimens including animal parts or tissues removed surgically or by autopsy
shall be presumed to be biohazardous.
 Sharps, including any objects or devices having acute rigid corners, edges, or
protuberances capable of cutting or piercing, and including, but is not limited to,
hypodermic needles, blades, microscope slides and slip covers.
 All of the above listed items, except sharps, are considered putrefying waste and
should be stored in the waste freezer.

Biomedical wastes include the following:

 Human blood, blood products, body fluids, tissues, organs and anatomical parts;
 Waste saturated with human blood, blood products, or body fluids;

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  Discarded "sharps" used in patient, animal, or cadaver care or in medical or
biomedical research laboratories;
 Cultures and stocks of infectious agents and devices used to transfer, inoculate, and
mix cultures;
 Discarded clinical specimens and the associated containers or vials;
 Discarded biologicals and waste from the production of biologicals;
 Recombinant DNA wastes;
 Carcasses, body parts, bedding, or other waste generated by research facilities from
animals containing organisms or agents not usual to the normal animal environment
and which are pathogenic or hazardous to humans;
 Cytotoxic drugs not identified as hazardous waste;
 Material that has come in contact with and has no more than a trace of cytotoxic
agents.

General Classification of Biohazard Wastes

Generally, biohazardous wastes can be grouped into one of the following
categories: Dry Solid Wastes include petri dishes, culture tubes, culture flasks ,plastic
serological pipettes, pipette tips, and gloves

Sharps include any sharp instrument that can be identified as being associated with animal
or human care or can be associated with use in medical and research laboratories regardless
of the presence of infectious materials, hypodermic needles and syringes, pasteur pipettes
or other glass pipettes, scalpels or scalpel blades, blood vials or test tubes, and
contaminated glassware that cannot be cleaned or is damaged
Liquid Wastes include liquid cultures of bacteria, viruses, etc.
Animal Waste includes animal carcasses, body parts, and blood products.

Learning Outcomes :
We have learned about :

 Biomedical waste and sources of generation

 Classification of biomedical waste
 Need of disposal of biomedical waste

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Chapter 10.2
Biomedical-waste Disposal &
Transportation

Learning Objective
By the end of this chapter, the learner would be able to
 What is biomedical waste Disposal
 Colour coding for segregation
 Procedure of biomedical waste disposal
 What are disposal methods of biomedical wastes
 How Biomedical waste is transported

Biomedical waste management is a part of healthcare hygiene and maintenance activities

But when hazardous waste is not segregated at the source of generation and mixed with
non – hazardous waste then waste becomes hazardous.

Procedure of biomedical waste disposal

Generation of waste

Segregation at source

Collection of waste

Transportation

Treatment

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Colour Coding for Segregation of BMW
Waste segregation refers to the storing of waste in separate waste containers
according to its type or category.Each waste is placed into a specific category. For each
category, the most appropriate, efficient, and safe method of treatment and disposal is
determined.
Waste segregation has to be performed at the point at which the waste is generated.
Attempting to do so later, or elsewhere, would defeat the whole purpose of segregation, as
infectious and non-infectious waste would thus become mixed together. Therefore, if
hazardous wastes (such as biomedical wastes) are mixed with general waste, the entire
waste would have to be treated as infectious and hence in need of costly treatment prior to
disposal. Given that most wastes generated by healthcare facilities—approximately 80 per
cent according to some studies—is general (i.e., non-hazardous) in nature, the resultant
costs of not separating infectious wastes from non-infectious wasteswould be to
dramatically, and unnecessarily, increase waste treatment costs.

Further benefits that arise from practicing waste segregation are:

 It reduces the chances of spreading infection by keeping infectious wastes separate
from the general waste stream;
 It dramatically reduces the occupational health hazard to those who have to handle
wastes as part of their daily routine. Since only a relatively small portion of the waste
stream is infectious and hence dangerous, by it being properly segregated out of the
general waste stream, those entrusted to handling it can take the necessary
precautions, such as wearing protective gear, and appropriate resources allocated to
the handling of this type of waste; and
 It can dramatically reduce disposal costs.

Waste Segregation using Colour-Coding

A colour-coding system can be used to implement a waste segregation programme. The
following system for colour-coding is widely used in many countries for waste containers
and can be adopted by your facility:

Yellow dustbin & Bags

 Amputated limbs, placenta, intestine,uterus,ovary etc.
 Cotton pads, swabs,gauge,Dressings,Gowns
 Bandages, Swab sticks

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Red Dustbin & Bags
 All infectious non sharp waste
 Blood contaminated plastics (Syringes , micro-tips , culture plates , gloves , IV sets,
Urine bags, Blood tubes , Vomits, Pus, Sputum, other body fluids

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Blue/White Dustbin ( Sharp Bin )
Needles, Scalpels, blades, glass ampoules and needles etc. that may cause puncture or cuts .
This include both used and unused.

Black Dustbin & Bags

 Waste fir disposal in municipal dustbins
 General waste like paper, wrappers,cardboard,kitchen waste , left over eatables etc.

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Disposal Methods of Biomedical waste
 Incineration
 Chemical disinfection
 Autoclave
 Microwave
 Shredder
 Deep Burial

Incineration
Incineration is a process by which combustible material is burned at high temperature under
controlled condition to convert waste into harmless mineral residue and gases.
The waste generally passes through the incinerator on a belt and because most medical
waste can be incinerated, the waste is not sorted or separated prior to treatment,
incineration has the benefit of reducing the volume of the waste , sterilizing the waste and
eliminating the need for pre-processing the waste before treatment. The resulting
incinerated waste can be disposed off in traditional methods such as brought to a land fill.
The down sounds of incineration is potential pollution from emissions generated during
incineration.
The largest concern associated with incineration is air pollution from emissions. The EPA
says that at least 20% of medical waste is plastic. The biggest concern is that the incinerator
may create toxic compounds. Dioxins and furans can be produced when these plastic burns.
Another concern is incinerator ash. As incinerators are designed with pollution prevention
equipment more of the potentially toxic chemicals that previously ended up in emissions
now remained in the ash. Incinerator ash is generally disposed of in landfills.

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Waste type not to be incinerated are :
1. Pressurized gas containers
2. Large amount of reactive chemical waste
3. Radiography waste
4. Halogenated plastics such as PVC
5. Waste with high mercury or cadmium content such as broken thermometers, used
batteries.
6. Sealed ampoules or ampoules containing heavy metals

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Autoclaving
Autoclaves ae closed chambers that apply both heat and pressure, sometimes steam over a
period of time to sterilize medical equipment . Autoclaves have been used for nearly a
century to sterilize medical instruments for re-use . Autoclaves are used to destroy
microorganisms that may be present in medical waste before disposal in a traditional
landfill.
Medical waste that is subjected to an autoclave is often also subjected to a compaction
process , such as shredding , after treatment so that it is no longer recognizable and cannot
be re-used for other purposes . The compaction The compaction process reduces the
volume of the treated waste significantly . After treatment and compaction , the treated
waste can be combined with general waste and disposed of in traditional manners. Waste
that treated using an autoclave is still recognizable after treatment and therefore must be
shredded after treatment to allow for disposal with general waste.
Autoclaves are not recommended for the treatment of pathological waste (radioactive
material or cytotoxic compounds ) because of appearance of the waste after treatment and
possibility that pathological waste may contain low levels of radioactive material or
cytotoxic compounds. One problem with autoclaves is that the process can aerosolize
chemical present in the waste and depending on the design of the autoclave , these
chemicals can be released in to the air when the autoclave is opened.
Autoclaves can be used to process up to 90% pf medical waste , and are easily scaled to
meet the needs of any medical organization . Small counter –top autoclaves are often used
for sterilizing reusable medical instruments while large autoclaves are used to treat large
volumes of medical waste.

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Horizontal Autoclave
Vertical Autoclave

Chemical Disinfection
Chemical Disinfection of liquid waste is accomplished by the addition of a disinfecting agent
such as bleach or hypochlorite to the liquid in the proper proportions. Once disinfected , the
liquid may be poured into the sanitary sewer system followed by a water rinse. Please note
that the liquid cannot have been mixed with other hazardous material that is not suitable
for drain disposal.

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Microwave
Microwaves are electromagnetic waves which enter into or penetrates materials .When
exposed to microwave energy , molecules of a mass are put to vibration which produces
heat resulting in disinfection .Maintenance of temperature of 95 ̊C to 100 ̊C for a holding
time of 25 minutes ensures that all microorganisms are killed . Unlike autoclaving
microwave process is more automated process. It results in volume reduction of waste unto
about 80% of its original mass. However one major disadvantage is that it is not able to
penetrate large objects like amputated limbs and similar anatomical waste.

Deep Burial
A pit or trench should be dug about 2m deep .It should be half filled with waste , and
covered with lime within 50cm of the surface before filling the rest of the pit with soil. It
should be ensured that animals do not have access to burial sites. Cover of galvanised
iron/wire meshes may be used. On each occasion , when wastes are added to the pit , a
layer of 10cm of soil be added to cover the wastes. Burial must be performed under close
and dedicated supervision.
The site should be relatively impermeable and no shallow well should be close to the site .
The pits should be distant from habitation and sited so as to ensure that no contamination
occurs of any surface water or ground water. Area should not be prone to flooding or
erosion. The location of the site will be authorised by the prescribed authority. Record must
be maintained for all pits for deep burial.

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Standard for Deep Burial
 Entry of scavengers to the burial site be prevented may be by using covers of
galvanised iron/wire mash. After every burial in the same secured pit a layer of 10cm
soil be added.
 Burial must be performed under close and dedicated supervision
 Deep burial site should be relatively impermeable and distant from habitat
 There should be no well, lake, river etc. close to the site to avoid contamination of
surface water or ground water.
 Location of the deep burial site to be authorised by the prescribed authority
 The occupier shall maintain record for all the pits

Waste requiring pre-treatment before disposal

Microbiological waste
Method : Autoclaving
Final disposal as a general waste –Black bag
Tubes used for serum separation , centrifugation pf samples , preparation of dilutions etc.
sample cups , tips,caos.Any other contaminated plastic wares pipettes , broken test tubes,
needles , razor blade Method : Chemical Disinfection (Sodium Hypochlorite)
Final Disposal as general waste –Red Bag

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Preparation of Hypochlorite Solution
 Hypochlorite is available in 4 or 5% solution. Make a solution of 1% as below:
o 4% - Mix 1 parts of Hypochlorite and three parts of water.
o 5% - Mix 1 part of Hypochlorite and four parts of water

 1% Hypochlorite solution to be used for bench top cleaning and spillages

 Yellow bag , contaminated gloves , latex & plastic , contaminated tissue/blotting
papers, contaminated cotton , human tissue/organs , waste disposed without pre-
treatment

Precautions
Gloves, laboratory apron has to be worn at all times during sample collection .
 Change gloves preferably for all patients else it’s a must to use hand sanitizer
in between patients.
 In case the gloves get soiled, it is discarded and a fresh set is worn immediately.
 In collecting specimens take care to avoid unnecessary contamination of the material
and self infection by spillage, aerosol or splashing into the eye, by contamination of
broken skin or needle stick injury.
 Ensure that the container remains upright in transit to the laboratory

Transportation
Internal Transport

Dedicated trucks, trolleys, or wheeled containers are needed to transport

biomedical waste containers to storage areas. In order prevent contamination
they should not be used for any other purpose. They need to be designed and
constructed so that they:
 Are easy to clean and drain;
 Contain any leakage from damaged bags or containers;
 Are easy to load and unload;
 Do not offer harbourage for insects or vermin; and
 Do not allow waste particles to become trapped on edges or cervices.
Waste containers for on-site transport need to be steam cleaned or disinfected
following leakages or spills, and at regular intervals. If containers are heavily
used, cleaning is likely to be required at least weekly. The biomedical waste
management policy should specify the method and frequency of steam cleaning
or disinfection.

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Transport off-site
Most of the duties and responsibilities for the proper transport and disposal of
biomedical wastes once moved off-site will accrue to the local waste
management service provider:
 Any vehicle used for the transport of clinical waste is suitable for that purpose and is
adequately maintained.
 The driver receives specified information which must include details of the complete
load.
 The driver is appropriately trained on how to handle dangerous goods;
 The wastes are loaded, stowed, and unloaded in a way that does not create a risk or
significantly increase any existing risk to the driver’s health;
 The vehicle is marked at the front and rear with an orange biohazard plate; and
Adequate precautions against fire or explosion are in place.

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Learning Outcomes :
We have learned about :
 Need of bio - medical waste disposal
 Procedure of bio-medical waste disposal
 Segregation of Bio-waste using color code
 Preparation of 1% hypo chlorite
 Safe transportation of bio-medical waste

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