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HOSPITAL

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HOSPITAL WASTE
MANAGEMENT

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K.V.G DENTAL COLLEGE & HOSPITAL

Content

Introduction
Definition
Areas of waste generation
Classification of BMW
Basic principals of BMW management

Bio-Medical Waste
Management in India
Standard (Universal)
Precautions

Different methods of waste treatment

Personal Protection
Dental wastes and its management
Conclusion
Reference

INTRODUCTION

WHAT BMW MEANS HERE???????

DEFINATLY
NOT

Definition
According
to
Bio-Medical
Waste
(Management and Handling) Rules,
1998 of India
"Bio-medical waste" means any waste,
which is generated during the diagnosis,
treatment or immunization of human
beings or animals or in research
activities pertaining thereto or in the

 The quantum of waste that is

generated in India

1-2 kg per bed/day in a

hospital and 600g per day/bed in a
general practioners clinic.
e.g. a 100 bedded hospital
will generate 100 200 kg of
hospital waste/day.
It is estimated that only 5

10%
of
this
comprises
of
hazardous/infectious
waste
(5
10kgs/day).

Areas of waste generation

Government hospitals
Private hospitals
Nursing homes
Physician's office/clinics
Dentist's office/clinics
Dispensaries
Primary health centers

Medical research &training establishments

Blood Banks & Collection Centers

Mortuaries
Animal & Slaughter houses
Laboratories & Research organizations
Vaccinating centers
BioTechnology institutions/Production Units

Classification of bio-medical waste

1

10 CHEMICAL WASTES

HUMAN ANATOMICAL WASTES

HUMAN
ANATOMICAL WASTE

Human tissues or fluids

e.g. Body parts
Blood and other body fluids
Fetuses

ANIMAL WASTES

animal tissues, organs,

body parts
waste generated by
veterinary hospitals

MICROBIOLOGICAL & BIOTECHNLOGICAL WASTE

Wastes from
laboratory cultures
vaccines
wastes from
production of
biologicals , toxins,
dishes and devices
used for transfer of

WASTE SHARPS
Sharps
Sharp waste
e.g. Needles
Infusion sets
Scalpels
Knives
Blades
Broken glass

DISCARDED MEDISINES AND CYTOTOXIC DRUG

Waste comprising of
outdated,
Contaminated &
discarded
medicines

SOLID WASTE CONTAMINATED WITH BLOOD

Items contaminated
with blood, and body
fluids:
including
cotton
dressings
soiled plaster cast
& other material
contaminated with

Solid Waste
Waste generated
from disposal items
other than the
sharps such a
tubings, catheters,
intravenous sets etc.

Liquid Waste

Waste generated
from laboratory and
washing, cleaning,
housekeeping and
disinfecting
activities)

Chemical waste
Waste
containing
substances

chemical

e.g. Laboratory reagents

Film developer
Disinfectants that are
expired or no longer needed.

Wastes with high content of heavy

metals
Batteries, broken thermometers;
blood-pressure gauges.

Pressurized containers
Gas cylinders, gas cartridges,
aerosol cans.

Radioactive waste

substances

Waste containing radioactive

Disposal practices commonly

followed
Mainly two types

Wastes sold to contractors, who in

turn, sell those that are usable/ worthy
for
recycling
others
for
proper
treatment.

Wastes dumped, along with common

urban wastes in corporation dustbins.

Bio-Medical Waste Management in

India
Bio-Medical Waste (Management and
Handling) Rule 1998, prescribed by the
Ministry of Environment and Forests,
Government of India, came into force

on 28th July 1998.

These rules applied to those who generate,
collect, receive, store, dispose, treat or
handle bio-medical waste in any manner

 According to this rule:

bio-medical waste should be
segregated into different color coded
containers/bags at the point of
generation, properly treated and
disposed off.

Color coding , Type of

container,
Method of Disposal

Yellow
Type of container
Plastic bag
Treatment options
Incineration/deep burial
Note : Waste collection bags for waste
types needing incineration shall not be
made of chlorinated plastics.

Waste category
Cat.
Cat.
Cat.
Cat.

1 :Human Anatomical Waste,

2:Animal Waste
3:Microbiology and Biotechnology
6:Solid waste

RED
Type of container
Disinfected container/plastic bag
Treatment options
Autoclaving
/Microwaving/Chemical
Treatment
Note: Red bag is never incinerated.
This is because it contains lead which is
heavy metal and cause emission problems.

Waste category

Cat3:
Microbiology
and
Biotechnology
Cat
6: Solid waste contaminated with blood
Cat 7: Solid waste other than waste sharps

Blue/white translucent
Type of container
Plastic bag/puncture proof
container
Treatment options
Autoclaving/Microwaving/
Chemical Treatment and
Destruction/Shredding

Waste category
Cat 4:Waste sharps
Cat 7: Solid waste

Chemical treatment using at least 1 % hypo

chloride solution or any other equipment
chemical reagent. It must be ensured that
chemical treatment ensures disinfection.
Mutilation / shredding must be such so as to
prevent unauthorized reuse.

Black
Type of container
Plastic bag
Treatment options
Disposal in secured land fill

 Discarded medicines and Cytotoxic

drugs.
Wastes comprising of outdated,
contaminated and discarded medicines.
Also Black bag is Internationally used
for Non infectious municipal Solid waste
management.

Standard (Universal)
Precautions
In 1996, CDC developed a new system
of standard precautions synthesizing
the features of universal precautions
and body substance isolation.
Standard precautions are used in the
care of all patients and apply to blood,
all body fluids, secretions and
excretions except sweat, regardless of
whether they contain visible blood.

Standard precautions include:

Hand washing
Barrier protection
Safe handling of sharp items
Safe handling of specimen (blood,
etc.)
Safe handling of spillage of
blood/body fluids
Use of disposable/sterile items

Basic Principals of Biomedical Waste

Management

Waste Minimization
Waste treatment on-site
Waste transportation
Waste treatment off-site
Final Disposal

Cradle to Grave Aspect

Segregation (Separation)
Identification
Collection
Storage
Transport
Measurement
Treatment
Disposal
Training, Health and safety records of
the workers

 Poor
segregation is noted as a
primary cause for increased risk of
bio-medical waste management

NUCLEAR
WASTE

Different methods of waste

treatment
Incinerators
Comes from a Greek word ..Meaning
BURN TO ASHES
No universal incinerator exists
It
must
be
specifically
selected,
designed , and built to meet the needs of
the individual Hospital
Design depends upon type of waste ,
calorific value ,quantities and volume of
waste

Important things to
Know

The
incinerator
must
reach
temperatures above 300C.
As per Biomedical rules, for incinerators
the combustion efficiency must be at
least 99% with zero emission standards.
There will be no chemical pretreatment
before incineration.
Chlorinated plastics shall not be
incinerated.

Waste types not to be

incinerated are :
(a) Pressurized gas containers
(b) large amount of reactive chemical wastes
(c)
Silver
salts
and
photographic
or
radiographic wastes
(d) Halogenated plastics such as PVC
(e) Waste with high mercury or cadmium
content, such as broken thermometers, used
batteries, and lead-lined wooden panels
(f) Sealed ampules or ampules containing
heavy metals

Formaldehyde

Glutaraldehyde

Chlorine dioxide

Sodium hypochlorite

Chemical disinfection
Chemicals are added to waste to kill or
inactivate the pathogens it contains.
This treatment usually results in
disinfection rather than sterilization.
Chemical disinfection is most suitable
for treating liquid waste such as blood,
urine, stools or hospital sewage.
However,
solid
wastes
including
microbiological cultures, sharps etc.
may also be disinfected chemically with
certain limitations.

Recommended concentration/dilution of Chemical

disinfectants
DISINFECTANT
( A contact period 0f 30
minutes is required for
effective disinfection )

CONTAMINATE
GROSSLY
D CONDITION CONTAMINATED
CONDITION

Sodium hypochlorite 5%
available chlorine as liquid
bleach

20 ml / L

200 ml /L

Tincture of Iodine/Povidone
Iodine

2.5 %

2.5 %

Ethyl Alcohol

70 %

70 %

Isopropyl Alcohol

70 %

70 %

Gluteraldehyde 2 %

2.5 %

2.5 %

Formaldehyde 40 %

5%

10 %

Savlon

5%

10 %

Dettol 4.8 % v/v

4%

10 %

2.5 %

5%

Cresol

Advantages :
Highly efficient disinfection under good
operating conditions.
Some
chemical
disinfectants
are
relatively inexpensive.

Disadvantages :
Requires highly qualified technicians for
operation of the process.
Uses hazardous substances that require
comprehensive safety measures.
Inadequate for pharmaceutical, chemical
and some types of infectious waste.

THERMAL TREATMENT
1. WET THERMAL TREATMENT
2. DRY THERMAL TREATMENT

WET THERMAL
TREATMENT

Wet
thermal
treatment
or
steam
disinfection is based on exposure of
shredded infectious waste to high
temperature, high pressure steam, and is
similar to the autoclave sterilization
process.
The process is inappropriate for the
treatment of anatomical waste and
animal carcasses, and will not efficiently
treat chemical and pharmaceutical waste.

HYDROCLAVE
This is a steam
sterilization
technology
in which the
steam is
used as an
indirect
- heating
The holding
time for waste is 15 minutes
source
at
132C
thus
30organic
minutes
at 121C. of the waste are
allowing
total
- or
The
components
dehydration
of
hydrolyzed
and
waste
the waste matter is reduced by weight
-

Advantages:
Environmentally sound.
Relatively low investment and operating
costs.

Disadvantages:
Shredders
are
subject
to
frequent
breakdowns and poor functioning.
Operation requires qualified technicians.
Inadequate
for
anatomical,
pharmaceutical, chemical waste and waste
that is not readily steam-permeable.

Dry thermal treatment

SCREW-FEED TECHNOLOGY:
Screw-feed technology is the basis of a
non-burn,
dry
thermal
disinfection
process in which waste is shredded and
heated in a rotating device.
Waste is reduced by 80 per cent in
volume and by 20-30 per cent in weight.
This process is suitable for treating
infectious waste and sharps, but it should
not be used to process pathological,
cytotoxic or radioactive waste.

Microwave irradiation
Most microorganisms are destroyed by the
microwave of a frequency of about 2450 MHz
and a wave length of 12.24 cm.
The water contained within the waste is
rapidly heated by the microwaves and the
infected components are destroyed by heat
conduction. -The heat produced at 95 100C for a holding period of 25 minutes
The efficiency of the microwave disinfection
should
be
checked
out
through
bacteriological and virological tests.

Advantages:
Good disinfection efficiency under
appropriate operating conditions.
Drastic reduction in waste volume.
Environmentally sound.

Disadvantages:
Relatively
high
investment
and
operating costs.
Potential operation and maintenance
problems.

Land disposal
MUNICIPAL DISPOSAL SITES:
If a municipality or any authority
genuinely lacks the means to treat
waste disposal, the use of a land fill
has to be regarded acceptable disposal
route.
There are two types of
Open dumps
Sanitary landfills

Sanitary landfills are designed to have at

least advantages over open dumps :
Geological isolation of from the
environment.
Appropriate engineering preparation
before the site is ready to accept waste.
Staff present on control operations.
Organized deposit and daily coverage of
waste.

Inertization
The process of Inertization involves
mixing waste with cement and other
substances before disposal, in order to
minimize the risk of toxic substances
contained in the wastes migrating into the
surface water or ground water.
A typical proportion of the mixture is:
65 % pharmaceutical waste
15 %
cement
15 % lime
5%
water

 A homogeneous mass is formed and

cubes or pellets are produced on site
and then transported to suitable
storage sites.

Advantages:
Relatively inexpensive.

Disadvantages:
Not applicable to infectious waste.

Safe burying
Advantages:
Low costs.
Relatively safe if access to site is
restricted
and
where
natural
infiltration is limited.

Disadvantages:
Safe only if access to site is limited
and certain precautions are taken.

Personal protection
General
Hand washing facility : Soap and
water should be available at all times.
Drinking water: Safe drinking water
must be available for waste handlers
working near boilers to prevent
dehydration.
Immunization : Tetanus, Hepatitis B.
Maintenance of health records.

 Personal protective clothing (PPC) and

personal protective equipment (PPE)
must be available to the staff and its
usage ensured

Personal protective clothing

(PPC)
1.Gloves
a. Disposable vinyl gloves in all patient care
areas
b. Latex surgical gloves for operative
procedures
c. Heavy duty thick rubber gloves for waste
handlers.
2.Masks: Simple, reusable plastic masks to
protect health care workers from splashes.
3.Aprons : Full sleeved, knee length cotton
aprons must be worn at all times.

Personal Protective
Equipment

Footwear: Gumboots for waste handlers,

The trousers must remain outside the gum
boots.
Eye shield.
Apron
:
A
reusable
heavy
duty,
autoclavable rubber apron may be worn
where heavy
contamination/excessive
splashing is expected, e.g. in labour room,
operation theatre etc.

Dental wastes and its

management
Amalgam wastes

contact and non-contact scrap

amalgam from capsule mixing, chairside traps & vacuum pump filters,
amalgam sludge from separators
Elemental mercury
Unused x-ray developer
Lead foil from x-ray film
Worn out lead aprons ,Lead lined boxes
Cleaning and disinfecting solutions

Amalgam waste
management
Amalgam waste is separated to prevent

polluting our environment. It is placed

along the vacuum suction line to
prevent amalgam from entering the
drain lines which ultimate goes out to
our environment.
Do not dispose amalgam capsules in the
garbage, the red biomedical bag or
through incineration.
The capsules are hazardous waste and
must be properly recycled or disposed

What should we do in the case of a

mercury spill?
Put on disposable nitrile gloves and
clean it up immediately.
(Note : Do not use latex gloves as
mercury can penetrate latex).
Clean up all visible elemental mercury
using a mercury spill kit.
Never suck up spilled mercury with a
vacuum cleaner.

X-ray wastes
Used fixer from X-ray processing is
defined as a dangerous waste
because
it
contains
high
concentrations of silver 3,000 to
8,000 parts per million (anything over
5 ppm is dangerous waste).
UNUSED
developer
contains
hydroquinone which is a toxic
substance, so unused developer
cannot go down the drain.

 Because hydroquinone is used up in the

developing process, USED developer is
non-hazardous and is safe to be disposed
to SEWER.
Used x-ray film contains silver. If the
silver concentration is high enough, the
used film would be a dangerous waste.
Although most film does not contain
enough silver to make it a dangerous
waste, the best management practice is
to collect it for silver recycling.

 Lead is a dangerous waste and should

not be put in the garbage or in with
red bag biomedical waste or sharps.
Collect lead foil from x-ray packets for
recycling.
When lead aprons are no longer
usable, they must be disposed of as
dangerous waste due to their lead
content.

Effective Waste
Management
Waste Avoidance
Waste Reduction
Waste Re-Use/Recycling/Reclamation
Waste Treatment
Waste disposal

CONCLUSION

Let the wastes of

the sick
not contaminate
the lives of
the healthy

Reference
Parks text book of preventive and
social medicine, K. Park, 14th edition.
Short text book of medical
microbiology, Satish Gupte, 6th edition.
http//www.Hospital Bio-Waste
Management.com.
http//www.Indian Society of Hospital
Waste Management.com.

H
Y

A
O

 All the activities, administrative and

operational,
involved
in
handling,
treatment, conditioning, storage and
disposal
of
waste
(Including
transportation) comes under waste
management.
This includes hospitals, nursing homes,
clinics,
dispensaries,
veterinary
institutions, animal houses, pathological
laboratories and blood banks.

Waste is considered
Infectious
Contaminated by an organism that is
pathogenic to healthy humans.
The organism is not routinely
available in the environment.
The organism is in significant quantity
and virulence to transmit disease.

Classification of waste

GOOD AFTERNOON

Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE

Option

Waste Category

Treatment &
Disposal

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

In

80

Schedule-I
CATEGORIES OF BIO-MEDICAL WASTE (continue)
Category No. 6

Soiled Waste
(items contaminated with
blood, and body fluids
including cotton, dressings,
soiled plaster casts, lines,
bedding, other material
contaminated with blood)

incineration@autoclaving/micro
waving

Category No. 7

Solid Waste
(Waste generated from
disposal items other than
the sharps such a 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, housekeeping 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

Category No. 10

Chemical Waste
(Chemicals used in
production of biologicals,
chemicals used in
production of biologicals,
chemicals used in

chemical treatment@@ and

discharge into drains for liquids
and secured landfill for solids
81