Print-ISSN: 0973-9122; Electronic-ISSN: 0972 9130;
Virendar Pal Singh(1), Gautam Biswas(2), Jag Jiv Sharma(3)
(1)Assistant Professor, (2)Associate Professor, (3)Prof & Head
Department of Forensic Medicine, Dayanand Medical College & Hospital, Ludhiana.
The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste1. The present scenario of biomedical waste (BMW) management in Indian hospitals is grim. However there is an emerging concern regarding biomedical waste management, particularly as a result of notification of Bio Medical Waste (Management and Handling) Rules, 1998 which makes it mandatory for the health care establishments to ensure that such waste is handled without any adverse effect to human health and environment. This article intends to create awareness amongst the personnel involved in health care services.
KEY WORDS: Bio Medical waste (BMW), Bio Medical Waste (Management and Handling) Rules, Indian Hospitals
“Bio Medical waste” is any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining to or in the production or testing of biologicals and categories mentioned in schedule 1 of Bio Medical Waste (Management and Handling) Rules2.
“Biologicals” is any preparation made from organisms or micro-organisms or product of metabolism and biochemical reactions intended for use in the diagnosis, immunization or the treatment of human beings or animals or in research activities pertaining thereto2.
Biomedical waste is generated in hospitals, nursing homes, clinics, medical laboratories, blood banks, animal houses etc. Such a waste can also be generated at home if health care is being provided there to a patient (e.g. injection, dressing material etc.)
Approximately 75-90% of the biomedical waste is non-hazardous and as harmless as any other municipal waste. The remaining 10-25% is hazardous and can be injurious to humans or animals and deleterious to environment. It is important to realise that if both these types are mixed together then the whole waste becomes harmful.
Safe disposal of biomedical waste is now a legal requirement in India. The ministry of Environment and Forests notified the Bio Medical Waste (Management and Handling) Rules, 1998 in July 1998. In accordance with these rules, it is the duty of every “occupier” i.e. a person who has the control over the institution or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment. The hospitals, nursing homes, clinics, dispensaries, pathological laboratories etc., are therefore required to set in place the biological waste treatment facilities. It is however not incumbent that every institution has to have its own waste treatment facility. The rule also envisages that common facility or any other facilities can be used for waste treatment. However it is incumbent on the occupier to ensure that the waste is treated with in a period of 48 hours. Bio Medical Waste (Management and Handling) Rules have six schedules as briefed in Table 22.
|Schedule I||Classification of biological waste in carious categories (Table 3)|
|Schedule II||Color coding and types of containers to be used for each category of biomedical waste (Table 4)|
|Schedule III||Proforma of the label to be used on container / bag|
|Schedule IV||Proforma of the label for transport of waste container / bag|
|Schedule V||Standards for treatment and disposal of wastes|
|ScheduleVI||Deadline for creation of waste treatment facilities|
Objectives of BMW management are:
Handling, segregation, mutilation, disinfection,
storage, transportation and final disposal are vital
steps for safe and scientific management of
BMW in any establishment
Waste should be collected and segregated at the site generation itself. Its aim is to keep the harmful waste separate from the harmless and noncontagious waste. The key to minimization and effective management of biomedical waste is segregation and identification of the waste. The most appropriate way of identifying the categories of biomedical waste is by sorting the waste in to color coded plastic bags or containers in accordance with schedule II of Bio Medical Waste (Management and Handling) Rules as given in Table 3 and Table 42.
Table 3: Categories of biomedical wastes and methods of their disposal.2
|Category||Waste Type||Treatment and Disposal Method|
|Category 1||Human Wastes (Tissues, organs, body parts||Incineration @/ deep burial
|Category 2||Animal Waste||Incineration @/ deep burial
|Category 3||Microbiology and Biotechnology waste||Autoclave/microwave/incineration
|Category 4||Sharps||Disinfection (chemical treatment)+/autoclaving/microwaving and mutilation shredding
|Category 5||Discarded Medicines and Cytotoxic Drugs||Incineration
|Category 6||Contaminated solid waste||Incineration
|Category 7||Solid waste (disposable items other than sharps)||Disinfection by chemical treatment+ microwaving/autoclaving & mutilation shredding
|Category 8||Liquid waste (generated from laboratory washing, cleaning, housekeeping and disiunfecting activity)||Disinfection by chemical treatment+ and discharge into the drains|
|Category 9||Incineration ash||Disposal in municipal landfill|
|Category 10||Chemical Wastes||Chemical Treatment + and discharge in to drain for liquids and secured landfill for solids|
@ There will be no chemical treatment before incineration.
Chlorinated plastic shall not be incinerated.
* Deep burial shall be an option available only in
towns with population less than 5 lakhs and in
+ Chemical treatment using at least 1% hypochlorite
solution or any other equivalent chemical reagent.
It must be ensured that chemical treatment
** Mutilation/shredding must be such, so as to
prevent unauthorized reuse.
|Color Coding||Type of Container||Waste Category||Treatment Option|
|Yellow||Plastic Bag||Cat 1,2,3,6||Incineration / deep burial|
|Red||Disinfected container / plastic bag||Cat 3,6,7||Autoclave/microwave/chemical treatment|
|Blue/white translucent||Plastic bag/ Puncture proof||Cat 4,7||Autoclave/microwave/chemical treatment and destructin shredding|
|Black||Plastic bag||Cat 5,9,10||Disposal in secure landfill|
The waste may be temporarily stored at the central storage area of the hospital and from there it may be sent in bulk to the site of final disposal once or twice a day depending upon the quantum of waste. During transportation following points should be taken care of:
Transportation from health care establishment to the site of final disposal in a closed motor vehicle (truck, tractor-trolley etc.) is desirable as it prevents spillage of waste on the way. Vehicles used for transport of BMW must have the “Bio-Hazard” symbol and these vehicles should not be used for any other purpose.
The infected waste that can not be incinerated (e.g. Plastic and rubber items, sharps) has to be disinfected first, before it is sent for final disposal.
Incineration is a high temperature dry oxidation process, which reduces organic and combustible waste to inorganic incombustible matter. This method is usually used for the waste that can not be reused, recycled or disposed of in landfill site.
Characteristics of waste1 suitable for incineration are:
Waste types1 not to be incinerated are:
Sharps (needles and blades etc) are being used in a day to day practice in all health care establishments. To avoid recycling of sharps, their burial in safe pit is an effective and economical disposal method. It can be constructed by 5 feet deep circular concrete ring of 3’ diameter. A slab is used on top in which GIC pipe with 5” or 6” diameter is used which is fitted lock and key arrangements. Size of the pit may vary as per the quantum of sharp waste to be disposed of. The pit is plastered inside at bottom and around. When it is filled up, cement slurry can be used to close it and second pit is constructed.
It is another method of final disposal of BMW. If a municipality or medical authority genuinely lacks the means to treat the waste before disposal, sanitary landfill observing certain standards can be as an acceptable choice especially in developing countries.
Standards for deep burial2
In India hospitals and other health care establishments are not well equipped to handle the enormous amount of biomedical waste. There is an urgent need to raise the awareness amongst all concerned. Information can be disseminated through organizing seminars, workshops, practical demonstrations, group discussions, lectures etc. It is vital to formulate an effective education and training programs specific for different target groups involved in biomedical waste handling and management.
The hospital waste, in addition to the posing risk to the patients and personnel who handle these wastes, is also a threat to the public health and environment4,5. It is emerging as a health hazard to the community at large. Keeping in view, inappropriate management of biomedical wastes, the Ministry of Environment and Forests notified the “Bio Medical Waste (Management and Handling) Rules 1998.” These rules are meant to protect the society, patients and health care workers. The most imperative component of the waste management plans is to develop a system and culture through education, training and persistent motivation of the health care staff.
Corresponding Author: Dr.Virendar Pal Singh
215 – A, Sewak Colony, Patiala, Punjab