medical waste management report

MEDICAL WASTE MANAGEMENT

ISHIT BHARADWAJ /M.ARCH (MEDICAL ARCHITECTURE) /1ST SEM

DISSERTATION

On

“Medical Waste Management”

Submitted in partial fulfilment of the

Requirement for the award of degree of

Master of Architecture

Submitted by Ishit Bharadwaj M-Arch- 1st sem

Medical Architecture

Guided by Abdul Halim Babbu

FACULTY OF ARCHITECTURE & EKISTICS JAMIA MILLIA ISLAMIA

NEW DELHI-110025 2013-2014



Department of Architecture

Faculty of Architecture & Ekistics,

Jamia Millia Islamia, New Delhi

Certificate

In the partial fulfilment of the M-Arch degree program, this is to certify that „Ishit

Bharadwaj‟ has worked on the Dissertation project entitled “Medical Waste

Management” under my guidance and supervision.

Abdul Halim Babbu Prof. S.M. Akhtar

Guide Dean

External Examiner 1 Abdul Halim Babbu Head of Department

External Examiner 2



Declaration

I Ishit Bharadwaj hereby declare that the Dissertation entitled “Medical Waste

Management” submitted in the partial fulfilment of the requirements for the award of the degree

of Masters of Architecture is my original design/ research work and that the information taken from

secondary sources is given due citations and references.

[Signature]

Ishit Bharadwaj

Roll. No:

Date: M.Arch. Sem. - 1st

Place: 2013-14



Acknowledgment

At various stages in doing of thesis, a number of people have given me invaluable support.In this regard I

owe a depth of gratitude to my inspiration & guide Abdul Halim Babbu. Who have cultivated devotion

& determination in me & have been a helping hand at every moment to support & motivate me. I would

deeply thank To the Classmates for the systematic structuring the dissertation so as to make it an gradual

process of learning and application; for his regular evoking insightful discussions.

I am Grateful to My Parents, who kept ultimate faith in me & always provided me backup with their

love & best wishes.

Above all, I am highly grateful to God, who provided me such a golden opportunity, brilliant guidance,

& kind support. I would finally thank My Friends for the much needed pep talks and discussions and all

those who made this thesis come alive.

At last I beg pardon from all those who helped me but, my self-centered mind escaped their names

With Regards,

Ishit Bharadwaj

M-Arch – Ist sem

Medical Architecture



Abstract

Bio medical waste (BMW) collection and proper disposal has become a significant concern for both

the medical and general community. Effective management of biomedical waste is not only a legal

necessity but also a social responsibility.

A review of medical waste management systems was performed to understand (a) the various handling

and disposal procedures (b) the knowledge and awareness of individuals involved in medical waste

generation, handling and disposal, and (c) the potential impacts of the waste stream on both human health

and the natural environment. The purpose of the study is to provide direction for further study.

Information was collected mainly from literature review and online search. It was found that a variety of

methods were used by the medical facilities to dispose their wastes including burning, burial, entombing,

selling, dumping, and removal by municipal bins. The waste disposal practice was found to be quite

unsafe, and both clinical and non-clinical wastes were found to be thrown together. There was

insufficient awareness of the magnitude of the medical wastes issue by concerned individuals

At different levels, study showed that the hospital staff including high officials, and waste “haulers” was

not aware of the safe disposal and handling of hospital waste. Laboratory analysis showed severe

contamination of infectious wastes to the environment. Children, adults, and animals all have the

potential to come into contact with these wastes which may pose severe health risks to them. There was

no safety measure observed in dealing with waste disposal or laboratory analysis of infectious or

hazardous diseases. The chemicals used for the staining and preservation of slides and for the

sterilization and cleaning of equipment and surroundings are potentially harmful to the laboratory

technician and the environment. Hospital wastes pose a significant impact on health and environment.

From this study it can be said that there is an urgent need for raising awareness and education on medical

waste issues. Proper waste management strategy is needed to ensure health and environmental safety. For

further study, it is needed to collect more information on impacts, disposal and management to draw a

clear conclusion. Need to collect information and examples from developed country or the country,

which has sound medical waste management system. Find alternatives and appropriate technologies for

developing countries. Need extensive study on this medical waste and its management aspects as well.



Table of Contents

1 SUMMARY .................................................................................................................................................. 10

1.1 INTRODUCTION .................................................................................................................................. 10

1.2 NEED OF THE STUDY .......................................................................................................................... 10

1.3 AIMS AND OBJECTIVES ....................................................................................................................... 10

1.4 LIMITATIONS OF THE STUDY .............................................................................................................. 11

1.5 METHODOLOGY ................................................................................................................................. 11

2 INTRODUCTION .......................................................................................................................................... 12

2.1 MEDICAL WASTE ................................................................................................................................ 12

2.2 NEED OF MEDICAL WASTE MANAGEMENT ....................................................................................... 12

2.3 FACTS AND FIGURES OF MEDICAL WASTE ......................................................................................... 13

3 TYPES AND SOURCES OF MEDICAL WASTE (HAZARDOUS WASTE) ........................................................... 14

3.1 PERCENTAGE DISTRIBUTION OF HAZARDOUS WASTE ...................................................................... 14

3.2 DESCRIPTION OF DIFFERENT MEDICAL WASTE ................................................................................. 15

3.3 MAJOR SOURCES OF MEDICAL WASTE .............................................................................................. 15

4 INJURIES BY MEDICAL WASTE AND SOME EXAMPLES ............................................................................... 16

4.1 INJURIES OCCURRED IN PAST............................................................................................................. 16

4.1.1 DUE TO SHARPS.......................................................................................................................... 16

4.1.2 DUE TO VACCINE WASTE ........................................................................................................... 16

4.1.3 DUE TO RADIOACTIVE WASTE .................................................................................................... 16

5 PRINCIPLES OF WASTE MANAGEMENT ..................................................................................................... 17

5.1 SORTING ............................................................................................................................................. 17

5.2 HANDLING .......................................................................................................................................... 17

5.3 INTERIM ............................................................................................................................................. 17

5.4 DISPOSAL ............................................................................................................................................ 17

6 SEGREGATION OF MEDICAL WASTE .......................................................................................................... 18

6.1 NECESSITY OF SEGREGATING MEDICAL WASTE ................................................................................ 18

6.2 COLOR CODING OF WASTE ................................................................................................................ 18

6.2.1 HOW IT HELPS ............................................................................................................................ 18

6.2.2 DEMARKATION OF COLORS ....................................................................................................... 18

6.3 CATEGORIES OF WASTE ..................................................................................................................... 20



Human Anatomical Waste ................................................................................................................................. 20

Animal Waste ..................................................................................................................................................... 20

Waste sharps ...................................................................................................................................................... 20

[Soiled] Waste .................................................................................................................................................... 21

Solid Waste ........................................................................................................................................................ 21

Liquid Waste ...................................................................................................................................................... 21

Incineration Ash ................................................................................................................................................. 21

Chemical Waste ................................................................................................................................................. 22

6.4 COLOR CODING, TYPE OF CONTAINER AND TREATMENT OPTIONS .................................................. 22

7 HANDLING AND TRANSPORT OF MEDICAL WASTE ................................................................................... 23

7.1 ON SITE TRANSPORT .......................................................................................................................... 23

7.2 OFF SITE TRANSPORT ......................................................................................................................... 23

7.3 BAG FILLIING ...................................................................................................................................... 23

8 INTERIM STORAGE ..................................................................................................................................... 24

8.1 RECOMMENDATIONS FOR HOLDING WASTE IN HEALTH CARE FACILITIES ....................................... 25

9 SEGREGATION, PACKAGING, TRANSPORTATION AND STORAGE (A BRIEF IN ALL) ................................... 26

10 TREATMENT AND DISPOSAL .................................................................................................................. 27

10.1 TREATMENT TECHNOLOGIIES ............................................................................................................ 27

10.2 INCINERATION .................................................................................................................................... 28

10.2.1 STANDARDS FOR INCINERATORS ............................................................................................... 28

10.3 AUTOCLAVING .................................................................................................................................... 30

10.3.1 STANDARDS FOR WASTE AUTOCLAVING ................................................................................... 31

10.4 MICROWAVING .................................................................................................................................. 32

10.4.1 STANDARDS FOR MICROWAVING .............................................................................................. 32

10.5 HYDROCLAVING ................................................................................................................................. 33

10.6 IRRADIATION ...................................................................................................................................... 33

10.7 CHEMICAL DISINFECTING ................................................................................................................... 33

10.7.1 STANDARDS FOR LIQUID WASTE ............................................................................................... 34

10.8 SHREDDING ........................................................................................................................................ 34

10.8.1 STANDARDS FOR DEEP BURIAL .................................................................................................. 34

11 SAFETY MEASURES WHILE HANDLING MEDICAL WASTE ...................................................................... 35

11.1 HAZARDOUS CHEMICAL WASTE ........................................................................................................ 35

11.2 DISPOSAL OF USED SYRINGES ............................................................................................................ 35

11.3 SAFE SHARPS DISPOSAL ..................................................................................................................... 35

11.3.1 SHARPS CONTAINER DISPOSAL CRITERIA .................................................................................. 35



11.4 DISPOSAL OF LABORATORIES SPECIMENS ......................................................................................... 36

11.5 MANAGEMENT OF USED LENIN ......................................................................................................... 36

11.6 MANAGEMENT OF REUSABLE INSTRUMENT ..................................................................................... 36

12 PRESCRIBED AUTHORITY FOR MEDICAL WASTE MANAGEMENT .......................................................... 36

13 AUTHORISATION AUTHORITIES OF MEDICAL WASTE ............................................................................ 38

14 MAINTAINANCE OF RECORDS ................................................................................................................ 38

15 GUIDELINES BY CPCB FOR MEDICAL WASTE TREATMENT PLANT ......................................................... 38

15.1 LOCATION OF A CBWTF ..................................................................................................................... 39

15.2 LAND REQUIREMENT ......................................................................................................................... 39

15.3 COVERAGE AREA OF CBWTF .............................................................................................................. 39

16 CONCLUSION AND RECOMMENDATION ............................................................................................... 40

16.1 RECOMMENDATION .......................................................................................................................... 40



List of Figures

Figure 7. 1 Trolley used for transport of waste ....................................................................................23

Figure 7. 2 Sign of bio hazard waste at bags .......................................................................................23

Figure 8. 1 Containers for storage of waste .........................................................................................24

Figure 8. 2 Container for infectious waste ...........................................................................................25

Figure 10. 1 Incinerator machine used for treating waste ....................................................................28

Figure 10. 2 Process for incineration ...................................................................................................28

Figure 10. 3 Autoclave machine ..........................................................................................................30

Figure 10. 4 An autoclaving unit .........................................................................................................30



1 SUMMARY

1.1 INTRODUCTION

Medical waste or clinical waste refers to the waste that is generated by health care premises such as

hospitals , clinics , doctor‟s offices , veterinary hospitals and labs and is cannot be considered as

general waste.

1.2 NEED OF THE STUDY

Poor management of health care waste potentially exposes health care workers, waste handlers,

patients and the community at large to infection, toxic effects and injuries, and risks polluting the

environment.

So, it is essential that all medical waste materials are segregated at the point of generation,

appropriately treated and disposed of safely.

1.3 AIMS AND OBJECTIVES

The basic aim is to protect the public and the environment from potentially infectious

diseases caused due to lack of management of medical waste.

To find out the types of wastes produced by the hospital and how much it is affecting the

living animals i.e. humans or animals.

To find out the linkages between the clean area and dirty area in the hospital.

To find out how the waste is segregated at its generation point, how it is treated inside a

hospital compound and how it is disposed.

To find out the awareness of waste management amongst the hospital staff.

The objective of this study is to safeguard the lives of humans, animals or plants from any

disease.

To cut down the risk of cutting and edging of waste handlers.

To prevent the use of used products such as syringes which is a major cause to communicate

any disease.



1.4 LIMITATIONS OF THE STUDY

This study will not deal with the technical issues regarding the treatment of medical waste.

The diseases caused due to the poor waste management will be briefly discussed not will be

fully elaborated.

1.5 METHODOLOGY

The study will be based on the information provided on the internet and architecture journals

or magazines.

Information from case study of different hospitals will also be mentioned.

Interaction with the related people will also be done to do a better research.

Interaction with the hospital staff will also be done to know the awareness of waste

management among them.

To frame out certain guidelines which would help in management of medical waste in a

better way and to preserve the environment and lives from its adverse effects.



2 INTRODUCTION

2.1 MEDICAL WASTE

Medical waste means any solid and/or liquid waste including its container and any intermediate

product, which is generated during the diagnosis, treatment or immunization of human beings or

animals or in research or in the production or testing.

OR

Any waste which consists entirely or partly of human or animal tissue, blood or other body fluids,

excretions, drugs or other pharmaceutical products, dressings or syringes, needles or other sharp

instruments.

Medical waste includes all infectious waste,

hazardous (including low-level radioactive

wastes), and any other wastes that are generated

from all types of health care institutions,

including hospitals, clinics, doctor‟s (including

dental and veterinary) offices and medical

laboratories.

2.2 NEED OF MEDICAL WASTE MANAGEMENT

Poor management of health care waste potentially

exposes health care workers, waste handlers,

patients and the community at large to infection,

toxic effects and injuries, and risks polluting the

environment.

Health-care waste contains harmful micro-

organisms which can infect hospital patients,

health-care workers and the general public

Other potential infectious risks may include the

spread of drug-resistant micro-organisms from health-care establishments into the environment.

Figure2. 1 Medical waste of several types

Figure2. 2 Inappropriate disposal of waste



Medical waste can potentially be re used without

sterilization, this reuse of non-sterile waste

material poses a serious threat of the diseases.

It may also damage the environment (e.g.

,contamination of water, air, and food).in

addition, if waste is not disposed off properly,

members of the community may have an

opportunity to collect disposable medical items

(particularly syringes) and to re pack and sell

these materials..

2.3 FACTS AND FIGURES OF MEDICAL WASTE

Of the total medical waste 80% is the general waste which can be comparable to domestic

waste.

The remaining 20% is considered hazardous which may be infectious, toxic or radioactive.

High-income countries generate on average up to 0.5 kg of hazardous waste per bed per day.

While low-income countries generate on average 0.2 kg of hazardous waste per bed per day.

However, health-care waste is often not separated into hazardous or non-hazardous wastes in

low-income countries making the real quantity of hazardous waste much higher.

Figure2.3 Rag picker collecting useful materials from waste



3 TYPES AND SOURCES OF MEDICAL WASTE (HAZARDOUS WASTE)

3.1 PERCENTAGE DISTRIBUTION OF HAZARDOUS WASTE

INFECTIOUS WASTE

PATHOLOGICA L WASTE

SHARPS

CHEMICAL WASTE

PHARMACEUTICAL WASTE

GENOTOXIC WASTE

HEAVY METAL WASTE



3.2 DESCRIPTION OF DIFFERENT MEDICAL WASTE

Infectious waste: waste contaminated with blood and its by-products, cultures and stocks of

infectious agents, waste from patients in isolation wards, discarded diagnostic

samples containing blood and body fluids, infected animals from laboratories,

and contaminated materials (swabs, bandages) and equipment (such as

disposable medical devices).

Pathological waste: recognizable body parts and contaminated animal car cases.

Sharps: syringes, needles, disposable scalpels and blades, etc.

Chemical waste: for example mercury, solvents and disinfectants.

Pharmaceuticals: expired, unused, and contaminated drugs; vaccines and sera.

Genotoxic waste: highly hazardous, mutagenic, teratogenic1 or carcinogenic, such as cytotoxic

drugs used in cancer treatment and their metabolites.

Radioactive waste: such as glassware contaminated with radioactive diagnostic material or radio

therapeutic materials.

Heavy metals waste: such as broken mercury thermometers.

3.3 MAJOR SOURCES OF MEDICAL WASTE

Hospitals and other health-care establishments.

Laboratories and research centres.

Mortuary and autopsy centres.

Animal research and testing laboratories

Blood banks and collection services

Nursing homes for the elderly.



4 INJURIES BY MEDICAL WASTE AND SOME EXAMPLES

Radiation burns;

Sharps-inflicted injuries;

Poisoning and pollution through the

release of pharmaceutical products, in

particular, antibiotics and cytotoxic drugs;

Poisoning and pollution through waste

water;

Poisoning and pollution by toxic elements

or compounds, such as mercury or

dioxins that are released during

incineration.

4.1 INJURIES OCCURRED IN PAST

4.1.1 DUE TO SHARPS

Who estimated that, in 2000, injections with contaminated syringes caused 21

million hepatitis b virus (hbv) infections, two million hepatitis c virus infections

and 260 000 hiv infections worldwide. Many of these infections were avoidable if

the syringes had been disposed of safely.

4.1.2 DUE TO VACCINE WASTE

In june 2000 six children were diagnosed with a mild form of smallpox (vaccinia

virus) after having played with glass ampoules containing expired smallpox

vaccine at a garbage dump in vladivostok (russia).

4.1.3 DUE TO RADIOACTIVE WASTE

Serious accidents have been documented in brazil in 1988 (where four people died

and 28 had serious radiation burns), mexico and morocco in 1983, algeria in 1978

and mexico in 1962.

Figure 4.1 Burial of medical waste in open environment



5 PRINCIPLES OF WASTE MANAGEMENT

FOUR MAIN PRINCIPLES ARE

5.1 SORTING

Sorting is separating waste by type (e.g., infectious waste, pharmaceutical waste) into

color-coded bags at the place where it is generated.

5.2 HANDLING

Handling is collecting and transporting waste within the facility.

5.3 INTERIM

Interim storage is storing waste within the facility until it can be transported for final disposal.

5.4 DISPOSAL

Final disposal is the elimination of solid medical waste, liquid medical waste, sharps, and hazardous

chemical waste from the health facility.

SORTING HANDLING INTERIM STORAGE

DISPOSAL



6 SEGREGATION OF MEDICAL WASTE

6.1 NECESSITY OF SEGREGATING MEDICAL WASTE

The plastic that is used in the hospitals is infected. It gets mixed with the other waste which

lies exposed till it is collected by the municipality.

The rag pickers come and collect it. In the process they handle this with bare hands, which is

a hazardous practice.

They sell this plastic material. This material is repackaged and sold. It is injurious to health.

It is necessary to recycle this plastic. It should first be disinfected. Hence it must be

segregated from non infectious waste.

To make the process easier color coded bags are provided by the organization.

6.2 COLOR CODING OF WASTE

6.2.1 HOW IT HELPS

Tells other staff what is in the container.

Tells the contractor what to do with the waste.

Can apply to both sacks and rigid containers.

6.2.2 DEMARKATION OF COLORS

This bag is used for collecting dry waste material which is

not infectious.

Materials like paper, plastics, cardboard boxes, and other dry

waste generated in hospital office or in the wards are disposed

in this bag.

This is not biomedical waste.

This bag is used for highly infectious items

Like pathological waste, human anatomical waste such as

body parts, amputated parts/organs, tumors, placentas, aborted

or dead fetuses, blood soaked cotton bandages, animal tissues,

organs, carcasses etc.

Figure 6. 1Black bag or bin

Figure 6. 2 Yellow bag or bin



This bag is used for collecting the

segregated metal sharps such as needles,

blades, saws, scalpels and glass pieces.

These bags must be puncture proof.

A metal box or a plastic canister should be

used for collecting the metal sharps.

It is strongly recommended that even metal

sharps and broken glass articles should be

segregated.

Broken glass sharps should be collected in

blue/ white bags.

This bag is used for the disposal of plastics collected from

Ot‟s, icu‟s and wards.

These containers are used for collecting radioactive wastes.

This waste is to be disposed as per the guidelines provided by

bhabha atomic research centre (barc), mumbai.

Radioactive wastes, especially cobalt needles used for brachy

treatment must be returned to barc.

Cytotoxic waste can be stored in sturdy cardboard boxes and

later can be incinerated.

Figure 6. 3 White and Blue bin

Figure 6. 4 Red bag

Figure 6. 5 Lead container for

radioactive waste



6.3 CATEGORIES OF WASTE 1[Waste

Category

No.]

Waste Category 2[Type] Treatment and

Disposal 3[Option

+]

Category

No.1 Human Anatomical Waste

(human tissues, organs, body

parts )

Incineration@

/deep

burial*

Category

No.2 Animal Waste

(animal tissues, organs, body

parts carcasses, bleeding parts,

fluid, blood and experimental

animals used in research, waste

generated by veterinary hospitals,

colleges, discharge from

hospitals, animal houses)

Incineration@

/deep

burial*

Category

No.3

Microbiology & Biotechnology

Wastes

(Wastes from laboratory cultures,

stocks or specimens of micro-

organisms live or attenuated

vaccines, human and animal cell

culture used in research and

infectious agents from research

and industrial laboratories,

wastes from production of

biologicals, toxins, dishses and

devices used for transfer of

cultures)

local autoclaving/micro-

waving/incineration@

Category

No.4 Waste sharps

(needles, syringes, scalpels,

blades, glass etc. that may cause

puncture and cuts. This includes

disinfection (chemical

treatment@@

/auto

claving/ microwaving

and multilation

/shredding ##

1 Substituted by Rule 9 (i) of the Bio-Medical Waste (M & H) (Second Amendment) Rules, 2000 notified vide S.O.545(E), dated 2.6.2000.

2 Added by Rule 9(ii), ibid.

3 Substituted by Rule 9 (iii), ibid.



both used and unused sharps)

Category

No.5

Discarded Medicines and Cytotoxic

drugs

(wastes comprising of outdated,

contaminated and discarded

medicines)

incineration@

/destruction

and drugs disposal in

secured landfills

Category

No.6 4[Soiled] Waste

(Items contaminated with blood,

and body fluids including cotton,

dressings, soiled plaster casts,

lines beddings, other material

contaminated with blood)

incineration @

autoclaving/microwaving

Category

No.7 Solid Waste

(wastes generated from

disposable items other than the

waste 5[sharps] such as tubings,

catheters, intravenous sets etc.)

disinfection by chemical

treatment@@

autoclaving/

microwaving and

mutilation/shredding##

Category

No.8 Liquid Waste

(waste generated from laboratory

and washing, cleaning, house-

keeping and disinfecting

activities)

disinfection by chemical

treatment @@ and

discharge into drains.

Category

No.9 Incineration Ash

(ash from incineration of any

bio-medical waste)

disposal in municipal

landfill

4 Substituted by rule 9(iv), ibid.

5 Substituted by Rule 9 (v) of the Bio-Medical Waste (M & H) (Second Amendment) Rules, 2000 notified vide S.O.545(E), dated 2.6.2000.



Category

No.10 Chemical Waste

(chemicals used in production of

biologicals, chemicals used in

disinfection, as insecticides etc.)

Chemical treatment @@

and discharge into drains

for liquids and secured

landfill for solids

6.4 COLOR CODING, TYPE OF CONTAINER AND TREATMENT OPTIONS

Colour

Coding

Type of

Container

Waste

Category

Treatment options as per

Schedule I

Yellow Plastic bag Cat.1, Cat. 2,

Cat.3, Cat. 6

Incineration/deep burial

Red Disinfected

container/plastic

bag

Cat. 3, Cat.6,

Cat.7

Autoclaving/Microwaving/

Chemical Treatment

Blue/White

translucent

Plastic

bag/puncture

proof container

Cat.4, Cat.7 Autoclaving/Microwaving/

Chemcial Treatment and

destruction/shredding

Black Plastic bag Cat.5 and

Cat.9 and

Cat.10 (Solid)

Disposal in secured landfill

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.



7 HANDLING AND TRANSPORT OF MEDICAL WASTE

Medical waste should be handled as little as possible before disposal.

It should not be collected from patient-care areas by emptying into open carts; this may lead

to contamination of the surroundings and to scavenging of waste as well as to an increased

risk of injury to staff, clients and visitors.

7.1 ON SITE TRANSPORT

Health-care waste should be transported within the hospital

or other facility by means of wheeled trolleys, containers,

or carts that are not used for any other purpose and meet

the following specifications:

Easy to load and unload;

No sharp edges that could damage waste bags or

containers during loading and unloading;

Easy to clean

The vehicles should be cleaned and disinfected daily with

an appropriate disinfectant.

Different colored bags have to be segregated in the storage room.

7.2 OFF SITE TRANSPORT

Waste should be arranged by concerned municipal / local authority.

The waste should be transferred to the vehicle by sanitary worker under the supervision of

WMO.

7.3 BAG FILLIING

Waste and sharps containers should be discarded

when they become three quarters full and at least

once daily or after each shift.

The reason for this is to reduce the risk of plastic

bags splitting open and of an injury from a protruding

sharp item in sharps containers.

Figure 7. 1 Trolley used for transport of waste

Figure 7. 2 Sign of bio hazard waste at bags



8 INTERIM STORAGE

Waste should be transported to interim storage at the end of every shift. To reduce the risk of

infection and of injury, minimize the amount of time waste is stored at the facility.

Waste should be stored in an area of controlled access that is minimally trafficked by staff,

clients, and visitors.

Interim storage time should not exceed two days.

It is preferable to have a room to store waste on each floor of the facility, but, if this is

difficult, one central storage room should be designated.

The storage area should also be included in a cleaning schedule.

A storage location for health-care waste should be designated inside the health-care

establishment or research facility.

The waste, in bags or containers, should be stored in a separate area, room, or building of a

size appropriate to the quantities of waste produced and the frequency of collection.

Source - www.emag.suez-environnement.com

Unless a refrigerated storage room is available, storage times for healthcare waste (i.e. The delay

between production and treatment) should not exceed the following:

Temperate climate: 72 hours in winter

48 hours in summer

Warm climate: 48 hours during the cool season

24 hours during the hot season

Figure 8. 1 Containers for storage of waste



Cytotoxic waste

Should be stored separately from other health-care waste in a designated secure location.

Radioactive waste

Should be stored in containers that

prevent dispersion, behind lead

shielding.

Waste that is to be stored during

radioactive decay should be labelled

with the type of radionuclide, the date,

and details of required storage

conditions.

8.1 RECOMMENDATIONS FOR HOLDING WASTE IN HEALTH CARE

FACILITIES

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.

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.

Figure 8. 2 Container for infectious waste

Source - www.emag.suez-environnement.com



9 SEGREGATION, PACKAGING, TRANSPORTATION AND STORAGE

(A BRIEF IN ALL)

Bio-medical waste shall not be mixed with other wastes.

Bio-medical waste shall be segregated into containers/bags at the point of generation in

accordance with Schedule II prior to its storage, transportation, treatment and disposal. The

containers shall be labeled according to Schedule III.

If a container is transported from the premises where bio-medical waste is generated to any

waste treatment facility outside the premises, the container shall, apart from the label

prescribed in Schedule III, also carry information prescribed in Schedule IV.

Notwithstanding anything contained in the Motor Vehicles Act, 1988, or rules thereunder,

untreated bio-medical waste shall be transported only in such vehicle as may be authorised

for the purpose by the competent authority as specified by the Government.

No untreated bio-medical waste shall be kept stored beyond a period of 48 hours :

provided that if for any reason it becomes necessary to store the waste beyond such period,

the authorised person must take permission of the prescribed authority and take measures to

ensure that the waste does not adversely affect human health and the environment.

6[(6)The Municipal body of the area shall continue to pick up and transport segregated non

bio-medical solid waste generated in hospitals and nursing homes, as well as duly treated bio-

medical wastes for disposal at municipal dump site].

6 Inserted by Rule 3 of the Bio-Medical Waste (M & H) (Second Amendment) Rules, 2000 vide notification S.O.545(E), dated 2.6.2000.



10 TREATMENT AND DISPOSAL

Bio-medical waste shall be treated and disposed of in accordance with Schedule I, and in

compliance with the standards prescribed in Schedule V.

Every occupier, where required, shall set up in accordance with the time-schedule in

Schedule VI, requisite bio-medical waste treatment facilities like incinerator, autoclave,

microwave system for the treatment of waste, or, ensure requisite treatment of waste at a

common waste treatment facility or any other waste treatment facility.

10.1 TREATMENT TECHNOLOGIIES

These are the technologies used for treatment of medical waste.

These treatments are done for different types of medical waste as per the category they lie

under.

Treatment can be done inside the hospital compound at a small level and at a common

treatment facility also provided by the government.

TREATMENT

TECHNOLOGIES OF

MEDICAL WASTE



10.2 INCINERATION

Incineration is a waste treatment

process that involves

the combustion of organic substances

contained in waste materials.

Incineration and other high-

temperature waste treatment systems

are described as “thermal treatment".

Incineration of waste materials

converts the waste into ash,fumes,gas and heat.

It is a controlled combustion process where waste is completely

Oxidized and harmful microorganisms present in it are destroyed/

Denatured under high temperature.

According to the EPA 90% of medical waste is incinerated.

Strict regulations regarding air emissions.

Incinerator ash is generally land filled.

10.2.1 STANDARDS FOR INCINERATORS

All incinerators shall meet the following operating and emission standards :

A. Operating Standards

1. Combustion efficiency (CE) shall be at least 99.00%.

Figure 10. 1 Incinerator machine used for treating waste

Figure 10. 2 Process for incineration



2. The Combustion efficiency is computed as follows :

%CO2

C.E. =____________________ x 100

% CO2+ % CO

The temperature of the primary chamber shall be 800 ± 50co.

The secondary chamber gas residence time shall be at least 1 (one) second at 1050 ± 50co, with

minimum 3% Oxygen in the stack gas.

B. Emission Standards

Parameters Concentration mg/Nm3 at (12% CO2 correction)

(1) Particulate matter 150

(2) Nitrogen Oxides 450

(3) HCl 50

(4) Minimum stack height shall be 30 metres above ground.

(5) Volatile organic compounds in ash shall not be more than 0.01%.

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.O./L.S.H.S./Diesel shall be used as fuel in the incinerator.



10.3 AUTOCLAVING

Highly effective and inexpensive,unsuitable for heat sensitive objects.

DESIGN AND CONTROL:

To be effective against spore forming bacteria and viruses, autoclaves need to:

Have steam in direct contact with the material being sterilized (i.e. loading of items is very

important).

Create vacuum in order to displace all the air initially present in the autoclave and replacing it with

steam.

Implement a well designed control scheme for steam evacuation and cooling so that the load does

not perish.

The efficiency of the sterilization process depends on two major factors:

One of them is the thermal death time, i.e. the time microbes must be exposed to at a

particular temperature before they are all dead.

The second factor is the thermal death point or temperature at which all microbes in a

sample are killed.

The steam and pressure ensure sufficient heat is transferred into the organism to kill them. A series

of negative pressure pulses are used to vacuum all possible air pockets, while steam penetration is

maximized by application of a succession of positive pulses

Figure 10. 4 An autoclaving unit

Figure 10. 3 Autoclave machine



Autoclaving is a low-heat thermal process where steam is brought into direct contact with

waste in a controlled manner and for sufficient duration to disinfect the wastes.

For ease and safety in operation, the system should be horizontal type and exclusively

designed for the treatment of bio-medical waste.

Often followed by compaction process, and eventually reaches landfills.

10.3.1 STANDARDS FOR WASTE AUTOCLAVING

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 121oC 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 135oC 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 149oC and a pressure of 52 psi for an autoclave residence time

of not less than 30 minutes.

(II) When operating a vacuum autoclave, medical waste shall be subjected to a minimum of one

pre-vacuum pulse to purge the autoclave of all air. The waste shall be subjected to the following :

a temperature of not less than 121oC and pressure of 15 psi per an autoclave residence time of not

less than 45 minutes ; or

(ii) a temperature of not less than 135oC 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.

(IV) Recording of operational parameters

Each autoclave shall have graphic or computer recording devices which will automatically and

continuously monitor and record dates, time of day, load identification number and operating

parameters throughout the entire length of the autoclave cycle.



(V) Validation test

Spore testing :

The autoclave should completely and consistently kill approved biological 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 millilitre. 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 121oC or a pressure less

than 15 psi.

(VI) Routine Test

A chemical indicator strip/tape that changes colour when a certain temperature is reached can be

used to verify that a specific temperature has been achieved. It may be necessary to use more than

one strip one strip over the waste package at different location to ensure that the inner content of the

package has been adequately autoclaved.

10.4 MICROWAVING

In microwaving, microbial inactivation occurs as a result of the thermal effect of

electromagnetic radiation spectrum lying between the frequencies 300 and 300,000 mhz.

The heating occurs inside the waste material in the presence of steam.

10.4.1 STANDARDS FOR MICROWAVING

1. Microwave treatment shall not be used for cytotoxic, hazardous or radioactive wastes,

contaminated animal carcasses, body parts and large metal items.

2. The microwave system shall comply with the efficacy test/routine tests and a performance

guarantee may be provided by the supplier before operation of the unit.

3. The microwave should completely and consistently kill the bacteria and other pathogenic

organisms that is ensured by approved bio-logical indicator at the maximum design capacity of each

microwave unit. Biological indicators for microwave shall be Bacillus Subtilis spores using vials or

spore strips with at least 1x104 spores per milliliter.



10.5 HYDROCLAVING

Hydroclaving is similar to that of autoclaving except that the waste is subjected to indirect heating

by applying steam in the outer jacket.

The waste is continuously tumbled in the chamber during the process.

10.6 IRRADIATION

Exposure of waste to cobalt source gamma radiation inactivates all microbes.

Special treatment sites are required (no mobile or in house process)

High capital cost.

Operators‟ safety risk in irradiation plant is an issue.

Does not sterilize pathological wastes.

10.7 CHEMICAL DISINFECTING

Primarily through the use of chlorine products.

Waste is first shredded and mixed with water.

Though chemical disinfection is also an option for

the treatment of certain categories of bio-medical

waste but looking at the volume of waste to be



disinfected at the cbwtf and the pollution load associated with the use of disinfectants,

The use of chemical disinfection for the treatment of bio-medical waste at cbwtf is not

recommended.

10.7.1 STANDARDS FOR LIQUID WASTE

The effluent generated from the hospital should conform to the following limits :

PARAMETERS PERMISSIBLE LIMITS

pH 6.5-9.0

Suspended solids 100 mg/1

Oil and grease 10 mg/1

BOD 30 mg/1

COD 250 mg/1

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.

10.8 SHREDDING

Shredding is a process by which waste are deshaped or cut into smaller pieces so as to make the

wastes unrecognizable.

It helps in prevention of reuse of bio-medical waste and also acts as identifier that the waste have

been disinfected and are safe to dispose off.

10.8.1 STANDARDS FOR DEEP BURIAL

A pit or trench should be dug about 2 metres 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.

It must be ensured that animals do not have any access to burial sites. Covers of galvanized

iron/wire meshes may be used.

On each occasion, when wastes are added to the pit, a layer of 10 cm of soil shall be added

to cover the wastes.

Burial must be performed under close and dedicated supervision.

The deep burial 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 groundwater. The area should not be prone to flooding or

erosion.

The location of the deep burial site will be authorized by the prescribed authority.

The institution shall maintain a record of all pits for deep burial.

11 SAFETY MEASURES WHILE HANDLING MEDICAL WASTE

11.1 HAZARDOUS CHEMICAL WASTE

Always wear heavy utility gloves and shoes when handling or transporting hazardous

chemical waste.

Afterwards, wash both gloves and shoes if

they become contaminated.

Cleaning solutions and disinfectants should be

handled as liquid medical waste.

After disposal, rinse containers thoroughly

with water, wash glass containers with

detergent and water.

Do not reuse plastic containers.

Disposing of cytotoxic and radioactive waste should be done in accordance with all local and

national laws and regulations.

11.2 DISPOSAL OF USED SYRINGES

Place all used syringes in designated sharps container and never recap needles.

11.3 SAFE SHARPS DISPOSAL

Never discard needles and sharps in clinical waste bags, as the

housekeeping staff might get injured.

11.3.1 SHARPS CONTAINER DISPOSAL CRITERIA

There are four major criteria for sharps disposal container safety

performance:

Functionality, Accessibility, Visibility & Accommodation:

Functionality: Containers should remain in a good state during

their entire usage. They should

be leak resistant on their sides and bottoms and puncture resistant

until final disposal. Individual



containers should have adequate volume and safe access to the opening.

Accessibility: Containers should be accessible to all workers who use, maintain, or dispose off sharp

devices. Containers should be placed in all areas where sharps are used and, if necessary, portable

within the workplace.

Visibility: Containers should be visible to the workers who use them. Workers should be

able to see the degree to which the container is full (for plastic containers only).

Accommodation: Container designs should be convenient, environmentally sound, and easy to

store.

11.4 DISPOSAL OF LABORATORIES SPECIMENS

All laboratory specimens should be considered as „Potentially infectious‟.

„BIOHAZARD‟ stickers should be placed on all such specimen and request forms.

11.5 MANAGEMENT OF USED LENIN

Put all linen soiled with blood or body secretions, in isolation bag then in red plastic bag for laundry

return.

11.6 MANAGEMENT OF REUSABLE INSTRUMENT

All instruments soiled with blood or body fluids should be put first in isolation bag and then in red

plastic bag for central sterilized supply department (CSSD) return.

In small facilities where CSSD does not exist a clear decontamination and sterilization policy should

be developed in accordance with infection control principles and strictly adhered to.

12 PRESCRIBED AUTHORITY FOR MEDICAL WASTE MANAGEMENT

7[(1) 8[Save as otherwise provide, 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].

7 Substituted by Rule 4 of the Bio-Medical Waste (M & H) (Second Amendment) Rules, 2000 vide notification S.O.545(E), dated 2.6.2000.

8 Substituted by Rule 2 (a) of the Bio-Medical Waste (M&H) (Amendment) Rules, 2003 vide notification S.O.1069 (E), dated 17.9.2003.



9[(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 I 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 giving a reasonable

opportunity to the occupier/operator of being heard.

9 Inserted sub-rule (1A) by Rule 2(b), ibid.



13 AUTHORISATION AUTHORITIES OF MEDICAL WASTE

Every occupier of an institution generating, collecting, receiving, storing, transporting,

treating, disposing and/or handling bio-medical waste in any other manner, except such

occupier of clinics, dispensaries, pathological laboratories, blood banks providing

treatment/service to less than 1000 (one thousand) patients per month, shall make an

application in Form I to the prescribed authority for grant of authorisation.

Every operator of a bio-medical waste facility shall make an application in Form I to the

prescribed authority for grant of authorisation.

Every application in Form I for grant of authorisation shall be accompanied by a fee as may

be prescribed by the Government of the State or Union Territory.

10[(4)The authorisation to operate a facility shall be issued in Form IV, subject to conditions

laid therein and such other condition, as the prescribed authority, may consider it necessary.]

14 MAINTAINANCE OF RECORDS

Every authorised person shall maintain records related to the generation, collection,

reception, storage, transportation, treatment, disposal and/or any form of handling of bio-

medical waste in accordance with these rules and any guidelines issued.

All records shall be subject to inspection and verification by the prescribed authority at any

time.

15 GUIDELINES BY CPCB FOR MEDICAL WASTE TREATMENT PLANT

A common bio-medical waste treatment facility (cbwtf) is a set up which has been legally

introduced in India.

It is a set up where bio-medical waste, generated from a number of healthcare units, is

imparted necessary treatment to reduce adverse effects that this waste may pose.

The treated waste may finally be sent for disposal in a landfill or for recycling purposes.

10

Inserted by Rule 5 of the Bio-Medical Waste (M&H) (Second Amendment) Rules, 2000 vide notification S.O.545(E), dated 2.6.2000.



Installation of individual treatment facilities by small healthcare units requires comparatively

high capital investment. In addition, it requires separate manpower and infrastructure

development for proper operation and maintenance of treatment systems.

The concept of cbwtf not only addresses such problems but also prevents proliferation of

treatment equipment in a city. In turn it reduces the monitoring pressure on regulatory

agencies.

Its considerable advantages have made cbwtf popular and proven concept in many developed

countries.

15.1 LOCATION OF A CBWTF

A cbwtf shall be located far away from residential and sensitive area so that it has minimal

impact on these areas.

Near to its area of operation as possible in order to minimize the travel distance in waste

collection, thus enhancing its operational flexibility.

The location shall be decided in consultation with the state pollution control board

(spcb)/pollution control committee (pcc).

15.2 LAND REQUIREMENT

It is felt that a cbwtf will require minimum of 1 acre land area to provide all required systems.

15.3 COVERAGE AREA OF CBWTF

In any area, only one cbwtf may be allowed to cater up to 10,000 beds.

A cbwtf shall not be allowed to cater healthcare units situated beyond a radius of 150 km.



16 CONCLUSION AND RECOMMENDATION

After doing this dissertation and going through all the studies I concluded that there are various laws,

standards, rules and regulations prescribed for medical waste management i.e. for segregation of

medical waste, handling of medical waste, holding of waste in a hospital compound, disposal of

waste and the treatment technologies for different type of medical wastes.

But there is still lack of compliance of medical waste management rules and regulations in the

practical field.

As the segregation of waste at the time of generation is not done properly or efficiently this leads to

the risk of infections to the patients as well as for the other people or staff in the hospital premises.

The litter bins for different types of wastes are sometimes placed to the close vicinity of the waiting

areas where there is always a high risk to the people of getting infected from dangerous diseases.

Lying of waste here and there without being concealed in the respective color coded bags can also be

seen in various health care facilities this is just due to the ignorance attitude of the staff members

involved in management of medical waste.

So, there is a special need of introducing various new technologies in management of medical waste

to reduce the human interventions and therefore reducing the risk for staff members and most

importantly to avoid the mistakes done by the or made by the human personnel in managing the

waste.

16.1 RECOMMENDATION

The recommendation includes the providing of small litter bins close to the place from where the

waste is generated but in the enclosed area to avoid the chances of spreading the infections in the

vicinity of hospitals.

The introduction of RFID (RADIO FREQUENCY IDENTIFICATION) in managing of medical

waste can also be done to manage the waste easily and efficiently.

RFID is a real time tracking tool that can automatically retrieve pre-stored data without human

intervention.

Radio frequency identification technology offers tracking capability to locate equipment and people

in real time.

It uses radio waves for data collection and transfer.

RFID tag is a small object, such as an adhesive sticker, that can be attached to or incorporated into a

product.

So, this is all that I want to recommend for the management of medical waste and making this

management more efficient so as to reduce the risks from medical waste.



Bibliography

(1998). THE BIO-MEDICAL WASTE (MANAGEMENT AND HANDLING) RULES,. New Delhi:

MINISTRY OF ENVIRONMENT & FORESTS.

Color Coding of wastes. (n.d.). Retrieved from www.envirovigil-

bmwm.com/Management/Segregation.html

CPCB. (n.d.). Bio-Medical Waste. parivesh.

Health Care Waste Management. (n.d.). Retrieved from https://www.gov.uk/healthcare-waste

Leybovich, F. (2012). Medical Waste Management.

WHO. (2011). Waste from health-care activities.

C Lee, George Huffman, and Richard Nalesnik Environmental Science & Technology 1991 25 (3), 360-363

Links

http://en.wikipedia.org/wiki/Biomedical_waste

https://www.gov.uk/healthcare-waste

http://www.who.int/topics/medical_waste/en/

www.healthcarewaste.org/

http://en.wikipedia.org/wiki/Biomedical_waste

http://www.who.int/topics/medical_waste/en/

medical waste management report

Healthcare