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Journal of the Academy of Hospital Administration

Guidelines for Bio-Medical Waste Documentation in Hospitals

Author(s): S. Satpathy*

Vol. 14, No. 1 (2002-01 - 2002-06)


It is a statutory requirement for hospitals now-a-days to maintain proper records as mandated by Bio-medical waste (management and handling) Rule 1998.

In addition to these requirements, some other documents have been developed for proper reporting as part of management information system.

Keywords: Bio-medical waste (BMW); medical documentation, needle stick injuries, management information system (MIS


The enhanced and legitimate concern regarding environmental protection has paved the way for the passage of legislation and notification of the Biomedical waste (management and handling) rules in 1998.1 These rules squarely put the onus of proper management of Biomedical wastes (BMW) on the "occupier", who has been defined as "the person who has control over the institution and its premises". The underlying principle is to ensure that the generators are sensitised regarding this aspect, and regularly, conscientiously segregate the waste at the point of generation.

Biomedical waste is one of the components of municipal solid wastes and contains wider range of pathogenic organisms in comparison to household or domestic wastes. Studies have also shown that improper handling of hospitals solid wastes may increase airborne bacteria and transmission of viable organisms to other patients, and even community.2 Presence of viable microorganisms has also been recently documented in the effluent generated in hospitals.3

Medical documentation is the process of recording the information generated during process/procedures carried out as a part of patient care activities. It helps in providing the documentary evidence required for managerial decision making and detection of problems, loopholes in the system. Thus it can be termed as a part of management information system. The following documents have a statutory character, and must be ensured.

I - Application for Authorisation: [Under rule 8 of the Act, it is mandatory on the part of "occupier" of the hospital/institution to apply for authorisation in the prescribed form I, along with the prescribed fee failing which the institution cannot deal with BMW]

Application for Authorisation (To be submitted in duplicate)


The Prescribed Authority

(Name of the Govt./UT Administration)


1. Particulars of Applicant

i. Name of the institution:____________________________________________________.


tel 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 from of handling_________________________________________________ .

3. Please state whether applying for fresh authorisation or for renewal: _____________________ .

(In case of renewal previous authorisation number and date)

4. i. Address of the institution handling bio-medical wastes: ____________________ .

i. Address of the place of the treatment facility: ____________________________ .

ii. Address of the place of disposal of the waste: ___________________________


5. i. Mode of transportation (in any) of bio-medical waste: ______________________ .

ii. Mode(s) of treatment: _______________________________________________.

6. Brief description of method of treatment and disposal (attach details): _______________


7. i. Category (see Schedule I) of waste to be handled _________________________ .

ii. Quantity of waste (category-wise) to be handled per month._________________

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.

Date: ____________________________________________

Signature of applicant______________________________________________________


Designation of the applicant__________________________________________________

2. Labels for transportation of BMW:

[The BMW generated by the hospital or health care institution has to be collected in colour coded plastic bags from all patient care areas generating wastes. These bags have to be labeled as shown below.]

Label for Transport of Bio-Medical Waste Containers/Bags




Waste category No._____________________________________________________

Date of generation_______________________________________________________

Waste class___________________________________________________________

Waste description_______________________________________________________


Sender's Name and Address_____________________________________________

Receiver's Name and Address___________________________________________
Phone No_______________________________

Phone No _______________________________

Telex No________________________________

Fax No_________________________________
Fax No_________________________________

Contact Person____________________________________________________________
Contact Person____________________________________________________________

In case of emergency please contact:

Name and Address:__________________________________________________________


Phone No.__________________________________________________________________


Label shall be non-washable and prominently visible.

3.Annual Report:

The rules stipulate that every occupier / operator shall submit an annual report to the prescribed authority in the form II as under by 31st January of every year. Subsequently this information will be compiled and sent to Central Pollution Control Board.

Annual Report

1. Particulars of the applicant: ______________________________________________________


i. Name of the authorised person (occupier/operator):_____________________________________

ii. Name of the institution: _________________________________________________________

Address ______________________________________________________________________

Tel No. __________________________

Telex No _________________________

Fax No __________________________

2 Categories of waste generated and quantity on a monthly average basis: ______________


3 Storage details: _________________________________________________________

4. Details of the treatment facility: ______________________________________________

In case of off-site facility:_____________________________________________________

i. Name of the operator ______________________________________________________

ii. Name and address of the facility: _____________________________________________

Tel No., Telex No., Fax No.

5. Category-wise quantity of waste treated: ______________________________________

6. Method / Mode of treatment with details: ______________________________________

7. Quantity of wastes disposed of:______________________________________________

Place of disposal and date: ___________________________________________________

1. Details of waste disposal operations:

Sl. No.

Date of Issuance of authorisation and Reference no.

Description of BMW and Category

Mode of transfer and site of disposal

Disposal method


Additional : if any

9. Certified that the above report is for the period from ________ to ________

Date ___________

Signature _________________________________________________


Designation ________________________________________________

4. Accident Reporting:

Under rule 12, the officer In-charge is required to report in the prescribed form III; whenever any accident (needle stick injury or) occurs in the institution or facility during handling or transportation of waste.

Accident Reporting

1. Date and time of accident:

2. Sequence of events leading to accident:

3. The waste involved in accident:

4. Assessment of the effects of the accidents on human health and the environment.

5. Emergency measures taken:

6. Steps taken to prevent the recurrence of such an accident:





Besides these statutory documents, some others have also been developed for proper monitoring of the BMW management. These are:

a. Daily checklist for Biomedical waste Treatment facility: This is applicable for those hospitals which have treatment facilities under their administrative and financial control, being operated by engineering staff.

Bio-Medical Waste Treatment

(Daily Check list)


1. Receipt of bags for Bio-

Medical Waste Management

-> Yellow (Number) (weight)

-> Blue / Red (Number) (weight)


2. Time of Receipt:

3. Incinerator operation:-

- Switched on (time)_____________

- Pre load heating ______________(min/hours)

- Temperature (at loading) (a) Primary Chamber______ 0 C

(3b) Secondary Chamber______ 0 C

4. Autoclave operation:-

- Switched on (time)____________

- Boiler functioning ______Yes/No; Steam - adequate/not

- No of batches processed ___________

- Average period (time) per batch __________.

- Record (documentation) _______ Yes/No.

- Temperature and Pressure details.

5. Shredder operation:-

- Switched on (time) __________

- No of batches processed ________________

- Switched off (time)

- Any problems ___________ Yes/No.

6. Sanitation and Hygiene at site_________________

7. Use of protective gear (gloves, wash, gum book)_______________Yes/No

8. Ash clearance by civic authorities ________________ Yes/No

9. Clearance of shredded plastic wastes _______________Yes/No



[Note: Hospitals having other equipments like Hydroclave, nuiw wave should devise parameters to be checked.]

b. Waste survey form: This is a very useful document for hospitals which are in the preliminary process of waste identification and quantification. This gives an idea about the wastes generated in the hospital and how they are being managed.4

Waste Survey Form

Hospital Name : ____________________________________________

Date : ____________________________________________

Time/Shift : ____________________________________________

Unit/Ward/OT etc. : ____________________________________________

Type of Segregation : ____________________________________________

Type of Treatment, Designation of Worker

Onsite : ____________________________________________

Offsite : ____________________________________________

Method of storage : ____________________________________________

Method of Collection : ____________________________________________

And Frequency

Whether Poster/Instructions : ____________________________________________


Other Comments : ____________________________________________

S. No.

Type of Waste




Type of Treatment

if any




c. Format for recording needle stick / sharp injury:

Studies have proved that the chances of needle stick injuries in health care settings in high5 hence it is imperative track keep of these and take remedial measures. The following form helps in documenting this process.4]

Needle Stick/Sharp Injury Protocol

Name of Designation : ___________________________________________________

Deptt./Section : ________________________________________________________

Employment ID No. : ___________________________________________________

History of Injury

Date of Needle Stick/Sharp Injury: _________________________________________

Date of Reporting to Casualty: _____________________________________________

Site and Depth of Injury: __________________________________________________

Nature of Injury: Needle Prick/Sharp Cut/Laceration/Splash of Fluids/Splattered Glass

History of Hepatitis B Immunization : ________________________________________


Intradermal/Intramuscular _________________________________________________

Anti HBs Titre (Date of Test)_______________________________________________

HbsAg Yes/No _________________________________________________________

HIV Yes/No ___________________________________________________________

Action Taken in Casualty

Hep. B. Vaccination Yes/No

HBIg Yes/No

Tetanus Toxoid Yes/No

Source of Injury (if available)

Serum sent for : (report to be entered in follow: up visit)




It is evident from the above that in addition to the legal/statutory requirements, many improvisations can be done to have better medical documentation process for BMW. In the ultimate analysis, proper record keeping and documentation, not only safeguard against statutory insolations; but also help in streamlining the Management Information System.


  1. Biomedical Waste (Management and Handling) Rules 1998 : Gazette of India extraordinary, Part II, Sector-3, Subsections II), 1998, dated 28th July 1998.
  2. Wallrce LP, Zaltman R, Burchinal JC. Where solid waste comes from; where it goes. Modern Hospitals 1973 Sept; 121(3) 91-2.
  3. Chitnis V, Chitnis DS, Patil S, Ravikant. Hospital Effluent: a source of multiple drug resistant bacteria. Current Science 2002; 79(7): 989-91.
  4. Mehta G. Draft Guidelines for Hospital waste management; (1999) GOI/WHO Project; MOHFW, New Delhi.
  5. Branson M. Hazards of Sharps' disposal. British Journal of Nursing. 1995 Feb-March, 4(4); 193-5.
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