Definition ; Classification ; sources ; Type of bio medical waste ; personal safety devices ; BMW rule 1998-2006 ; Role of nurse

1. BIO MEDICAL WASTE MANAGEMENT
&
NURSES ROLE
1
Prepared by :
Dr.(Porf.) Sheikh Javed Ahmad
HOD, Department of Community H. Nsg
Faculty of Nursing , Rama University , Kanpur

2. ABOUT THE MODULE :-
- This module focuses up on the importance and the
purpose of Bio-medical waste management ,
- Definition of Bio-medical waste , risks associated and
advantages of proper management of Bio-medical waste .
2

3. LEARNING OBJECTIVES :-
- To know what is Bio-medical waste.
- To understand the importance and purpose of bio-medical
waste Management in hospitals.
- To understand the risks (environmental and occupational
health from Bio-medical waste.)
- Appreciate the advantages of proper management of Bio-
medical waste.
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4. INTRODUCTION :-
As per Bio – medical waste (Management and Handling ) rules, 1998 ,
“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 there
As per WHO norms the health – care waste includes all the waste
generated by health – care establishments , research facilities , and
laboratories. It also include the waste originating from minor or scattered
sources such as that produced in the course of health care undertaken in
the home (Dialysis, insulin injections etc.)
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5. Definition :-
“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
production or testing of biological”.
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6. Classification of Bio-Medical Waste
According to World Health Organization (WHO) :-
 General Waste
 Pathological
 Radioactive
 Chemical
 Infectious to potentially infectious waste
 Sharps
 Pharmaceuticals
 Pressurized containers
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7. General Waste
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8. 8

9. 9

10. Sharp waste :-
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11. Pharmaceuticals waste :-
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12. Pressurized containers :-
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13. Sources of Biomedical Waste
MAJOR SOURCES:-
 Govt. hospitals/private hospitals/nursing homes/
dispensaries.
 Primary health centers.
 Medical colleges and research centers/ paramedic
services.
 Veterinary colleges and animal research centers.
 Blood banks/mortuaries/autopsy centers.
 Biotechnology institutions.
 Production units.
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14. MINOR SOURCES :-
 Physicians/ dentists’ clinics
 Animal houses/slaughter houses.
 Blood donation camps.
 Vaccination centers.
 Acupuncturists/psychiatric clinics/cosmetic piercing.
 Funeral services.
 Institutions for disabled persons
The quantity of solid waste generated in hospitals and nursing
homes generally varies from ½- 2 kg per bed per day.
 In government hospitals ½-2 kg bed per day,
 In private hospitals ½-1 kg per day.
14

15. Need of Biomedical waste management in
hospitals :-
- To prevent nosocomial infections in patients :-infection are
considered nosocomial if they first appear 48 hrs or more after
hospital admission or within 30 days after discharge.
- To reduce the Risk of infection outside hospital for waste handlers
and scavengers.
- To reduce the Risk associated with hazardous chemicals, drugs to
persons handling wastes at all levels.
- To reduce the Risk of air, water and soil pollution directly due to waste,
or due to defective incineration emissions and ash
- To Improve the quality of health care
- To Surveillance of hospital infection
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16. Type of Bio Medical Waste
A. Non-hazardous (85%)
B. Hazardous (15 %) :- Infectious (10%)
Non-Infectious (5%)
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17. INFECTIOUS WASTE
a. Lab cultures plate
b. Human tissues or fluids
c. Body parts
d. Blood
e. Body fluids
f. Foetus
g. Sharps-needles
h. Scalpels
i. Knives
j. Blades
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18. NON-INFECTIOUS WASTE
a. Drugs expired
b. Expired disinfectants
c. Batteries
d. Broken thermometer
e. Radioactive waste
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19. NURSE SEFETY FROM NEEDLE STICK INJURY
-Wound and skin sites exposed to blood or body fluid should be washed
with shop and water and mucous membranes flushed with water.
- If blood or body fluids have gotten in to eyes, splash eyes with clean water.
- Immediately report the incident to a designated person.
- Retain , if possible , the item involved in the incident, get detail of its source
for identification of possible infection.
- Seek additional medical attention in an emergency health department as
soon as infection identified.
- Get blood tests or other tests and counseling , if indicated.
- Record the incident
- Investigate the incident and identify and implement remedial action to
prevent similar incidents in the future.
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20. Precaution during handling biomedical waste :-
- While handling waste , wear appropriate protective clothing , including a
water resistant apron, thick gloves, boots or closed-toe shoes na deye
protection.
- Handle all sharp with care to minimize needle stick injury.
- Do not sort waste or open waste containers to sort waste
- Wash hand after working with waste or infected material.
- Be aware of procedures for treatment of injuries , cleaning of contaminated
areas , and reporting sharps injuries or accidents or accident to appropriate
personnel.
- A full course of hepatitis B and tetanus vaccination will protect the nurse
from the hepatitis – B virus and tetanus – anyone handling sharps should be
vaccinated.
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21. PERSONAL SAFETY DEVICES
Mandatory for all the personnel handling waste:
a. GLOVES: - Rubber gloves
- Puncture- resistant gloves when
handling sharps containers
- The size should fit the operator
b. APRON , GOWNS, SUITS:-
- Rubber or plastic aprons provide a protective,
waterproof barrier to the body.
- People working in incinerator chambers should
have gowns or suits made of non- inflammable
material.
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22. c. MASK:
-Working in the incinerator
chamber to wear a mask
covering both nose and mouth
d. BOOT :-
- leg covering , boots or shoe-
covers protection to a plashing
- Anti-skid type
- Should cover leg up to ankle
e. GOGGLES :-
- Plastic goggles can protect the
eye from accidental splashes.
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23. 23

24. ROLE OF NURSES IN BIO MEDICAL WASTE MANAGEMENT :-
- Administration of medication, eg. Tablets, injections, infusions and
transfusion on prescription, or according to standing instructions.
- Assisting doctors in various medical and surgical diagnostic procedures.
- Performing simple diagnostic procedures viz. haemoglobin % etc.
- Collecting and sending of specimens for laboratory diagnostic
procedures.
- Recording of vital signs eg. Temperature, pulse, respiration and blood
pressure.
- Performing gastric lavage, giving enema etc.
- Prepares patients for operations with all necessary papers and
medicines.
- Take care of eyes, ears , back , bowel, bladder, perineum and breast etc.
- Give expert bed-side nursing to all patients.
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25. BIO-MEDICAL WASTE (MANAGEMENT AND
HANDLING)RULE,1998 AND AMENDMENT :-
The Biomedical Waste Management & Handling) Rules, 1998 came into
force on july 1998. The Bio–Medical Waste (Management and Handling )
Rules emphasizes legal aspects and proper procedure of how to categorize
, segregate ,Handle ,Transport ,Treat ,and dispose the Bio-Medical waste .
Rules apply to all persons who generate , collect , receive , store , transport
, treat ,dispose, or handle bio-medical waste in any form. In accordance
with these Rules bio medical waste management consists of
six schedules.
Schedule I Schedule II
Schedule III Schedule IV
Schedule V Schedule VI
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26. 26

27. SCHEDULE - I :- CATEGORIES OF BIO MEDICAL WASTE
OPTION WASTE CATEGORY TREATMENT & DISPOSAL
Category No. 1 Human Anatomical Waste(tissue,organ,parts) Incineration / deep burial
Category No. 2 Animal Waste(tissue organ ,body parts,fluid) Incineration / deep burial
Category No. 3 Microbiology & Biotechnology Waste
(laboratory culture, vaccine , cell culture)
Local autoclaving / microwaving / incineration
Category No. 4 Waste Sharps(needle, syringes, scalpels
blades, glass etc.)
Disinfection by chemical treatment / autoclaving /
microwaving and mutilation / shredding
Category No. 5 Discarded Medicines and Cytotoxic drugs
(outdated and contaminated & discarded)
Incineration / destruction and drugs disposal in secured
landfill drugs disposal in secured
Category No. 6 Solid Waste(Items content blood & body fluids
eg. Cotton dressing ,soiled plaster casts, line
beddings)
Incineration / autoclaving / microwaving
Category No. 7 Solid Waste(disposable items eg. Tubing ,
catheters, intravenous sets etc.)
Disinfection by chemical treatment / autoclaving /
microwaving and mutilation / shredding
Category No. 8 Liquid Waste(generated from laboratory &
washing , cleaning , house-keeping etc.)
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 biological , chemical, used in disinfection , as
insecticides etc.)
Chemical treatment and discharge into drains for liquids
and secured land fill for solids
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28. SCHEDULE – II :- COLOUR CODING AND SEGREGATION OF BMW
Colour Coding Type of Containers Waste
category
Treatment Options
Yellow
Human tissue , organs, body parts,
Item contaminated by blood/blood
fluid , soiled cotton & dressing , soiled
plaster casts etc.
I , II , III
VI
Incineration / deep burial
Red Catheters , tubes, cannulae , syringes,
plastic IV bottles & sets, used gloves,
infected plastics, specimen containers,
lab waste, microbiological cultures ,
used or discarded bags of blood/blood
products , vaccines etc.
III , VI ,
VII
Autoclaving
Micro waving
Chemical treatment
BLUE/
WHITE
Glass items, needles, syringes, scalpels,
blades, used and unused sharps
IV , VII Autoclaving
Micro waving
Chemical Treatment and
destruction/shredding
BLACK
Discarded medicines, discarded
cytotoxic drug etc.
V , IX , X
(Solid)
Disposal in secured
landfill
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30. 30

31. 31

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35. 35

36. SCHEDULE-III :- LABLE FOR BIO-MEDICAL WASTE
CONTAINERS/BAGS
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Cytotoxic waste is the by-product of cytotoxic drug therapy administered to
patients (such as chemotherapy). Cytotoxic waste typically includes all drug
administrative equipment (eg. needles, syringes, dripsets etc) as well as all gowns
and body fluids/waste from patients undergoing such treatment.

37. SCHEDULE-IV :- LABLE FOR TRANSPORTATION OF BIO-
MEDICAL WASTE CONTAINERS/BAGS
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LABEL FOR TRANSPORTATION OF
BIO-MEDICAL WASTE CONTAINERS/ BAGS
Waste category No. ……… Day…………… Month …………..
Waste class Year…………..
Waste description Date of generation……………
Sender’s name & Address Receiver’s Name & Address
Phone No. ……………………….. Phone No. …………………………
Telex No. …………………………. Telex No. …………………………..
Fax No. ……………………………. Fax No. ……………………………..
Contact Person ……………….. Contact Person …………………
In Case of Emergency , Please Contact :-
Name & Address :- …………………………………
Phone No. :- …………………………………………….
Note :- Label shall be Non-Washable and prominently visible.

38. SCHEDULE-V :- STANDARDS FOR – INCINERATION,
AUTOCLAVING, SEWERAGE , DEEP BURIAL
- STANDARD FOR INCINERATORS
- STANDARD FOR WASTE AUTOCLAVING
- STANDARD FOR LIQUID WASTE
- STANDARD FOR MICROWAVING
- STANDARD FOR DEEP BURIAL
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39. STANDARD 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%.
2). The Combustion efficiency is computed as follows:
%C02
C.E. = ------------------ X 100
%C02 + % CO
3)The temperature of the primary chamber shall be a minimum of 800°C
and the secondary chamber shall be minimum of 1050°C + or - 50°C.
4). The secondary chamber gas residence time shall be at least 2 seconds.
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40. B. Emission Standards :-
Parameters concentrating mg/Nm3 at
(12% co2 correction)
1. Particulate matter 150
2. Nitrogen Oxide 450
3. HCL 50
4. Minimum stack height shall be 30 meters above ground
5. Volatile organic compounds in ash shall not be more than
0.01%
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41. STANDARD FOR WASTE AUTOCLAVING :-
The autoclave should be dedicated for the purposes of
disinfecting and treating bio-medical waste
a. When operating a gravity flow autoclave, medical waste shall be
subjected to:
(i) A temperature of not less than 121° C 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 135° C 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 149° C and a pressure of 52 psi for an
autoclave residence time of not less than 30 minutes.
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42. b. When operating a vacuum autoclave, The waste shall be s
subjected to the following:-
(i) A temperature of not less than 121°C and pressure of 15
psi
per an autoclave residence time of not less than 45 min.
or
(ii) A temperature of not less than 135°C and a pressure of 31
psi for an autoclave residence time of not less than 30
minutes.
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43. STANDARDS FOR LIQUID WASTE :-
The affluent generated from the hospital should conform to
the following limits :-
PARAMETERS PERMISSIBLE LIMITS
PH 63-9.0
Susponded solids 100 mg/l
Oil and grease 10 mg/l
BOD (Biochemical oxygen demand) 30 mg/l
COD (Biochemical oxygen demand) 250 mg/l
Bio-assay test 90% survival of fish after
96 hours in 100% effluent
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44. STANDARD FOR MICROWAVING :-
- Microwave s are electromagnetic waves that lie between the 300 to 300,000 mega
hertz range in the electromagnetic radiation spectrum.
- They are able to penetrate materials and create vibrations in all the dipole
molecules such as water in the waste materials.
- This vibration generates friction, which in turn produces heat to disinfect the
waste material.
- The heat produced at 95-100°c for a holding period of 25 minutes.
Microwave treatment shall not be used for
- Cytotoxic,
- Hazardous or
- Radioactive wastes,
- Contaminated animal carcasses,
- Body parts and
- Large metal items.
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45. STANDARD FOR DEEP BURIAL :-
(1) A pit or trench should be dug about 2 meters 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.
(2) It must be ensured that animals do not have any access to burial sites. Covers
of galvanized iron or wire meshes may be used.
(3) On each occasion, when wastes are added to the pit, a layer of 10 cm of soil
shall be added to cover the wastes.
(4) Burial must be performed under close and dedicated supervision.
(5) The deep burial site should be relatively impermeable and no shallow well should be close
to the site.
(6) The pits should be distant from habitation, and located so as to ensure that no
contamination occurs to surface water or ground water. The area should not be prone to
flooding or erosion.
(7) The location of the deep burial site shall be authorised by the prescribed authority.
(8) The institution shall maintain a record of all pits used for deep burial.
(9) The ground water table level should be a minimum of six meters below the lower level of
deep burial pit.
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47. 47

48. SCHEDULE-VI :-SCHEDULE FOR WASTE TREATMENT FACILITIES
LIKE INCINERATOR/AUTOCLAVE/MICROWAVE SYSTEM
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- TREATMENT BY INCINERATOR
- TREATMENT BY AUTOCLAVE
- TREATMENT BY MICROWAVE

49. INCINERATOR:-
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- 85% to 90% of the total BMW is treated by incineration.
- Incineration systems uses high temperature combustion under controlled
condition to convert wastes containing infectious and pathological
material to inert mineral residues and gases
- Incineration is a process where the combustible waste is reduced to exhaust
gaseous products and the incombustible waste is reduced to ash
- The key parameter in an incinerator are :-
- - Temperature should be 900-1000°C
- The waste be exposed for at least two seconds
- Incinerator should have the air pollution control equipment.

50. 50

51. AUTOCLAVING :- The autoclave process is technology for the treatment of
microbiology laboratory waste, human blood , any body fluid waste , waste
sharps and anatomical waste. It is time testing process of sterilization of medical
waste using high temperature (121°C)and high pressure(105kPa) steam.
51

52. MICROWAVE :- It is used to heat up the waste material from inside.
Microwave are electromagnetic waves that lie between the 300 to 3000000
mega hertz range in the electromagnetic radiation spectrum. they are able to
penetrate material and create vibrations in all the dipole molecules. This
vibration generates friction , which in turn produces heat to disinfect the
waste material. The heat produced at 95-100°C for a holding period of 25
min.
52

53. Bio- Medical waste process :-
THERE ARE SEVERAL PROCESS OF BIO-MEDICAL WASTE
MANAGEMENT SUCH AS :-
- Separation (Segregation)
- Identification(different colors- coded begs)
- Handling (collection, measurement, storage, transport)
- Treatment(off-site and on site)
- Waste reduction (by shredding)
- Disposal
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54. 54

55. SEPARATION (SEGREGATION)
Segregation refers to the basic separation of different
categories of waste generated at source and thereby reducing
the risks as well as cost of handling and disposal. Segregation is
the most crucial step in bio-medical waste management.
Effective segregation alone can ensure effective bio-medical
waste management
55

56. 56

57. IDENTIFICATION(DIFFERENT COLORS- CODED
BEGS) :-
THE COLOR CODING AND
TYPE OF CONTAINER FOR
DISPOSAL OF BIOMEDICAL
WASTES WILL BE MADE
ACCORDING TO SCHEDULE II.
57

58. HANDLING
(Collection, Measurement, Storage, Transport)
The collection containers
for be to be sturdy , leak proof
of adequate size and wheeled ,
Two wheeled bins may used.
The four wheeled containers
have to fixed wheels and two
Castors and they are fitted
with wheel locking devices to
prevent on wanted rolling.
58

59. STORAGE :
a. Once collection occurs than
biomedical waste is stored in a
dedicated place.
b. The duration of storage should not
exceed 24 hrs. each container must
be clearly labeled to show the ward
or room where it is kept-may be
necessary to trace the back to its
source.
c. Besides this , storage area should
be marked with a BMW hazard
sign.
59

60. TRANSPORTATION:
a. Locally transportation for
treatment either in trolleys or
in covered wheelbarrow.
b. The bags/container containing
BMW should be tied/lidded
before transportation.
c. Bio hazard symbol
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61. TREATMENT(off-site and on site)
Five categories of BMW treatment :-
A. Mechanical Process
B. Trermal Process
C. Chamical Process
D. Irradiation Process
E. Biological Process
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62. MECHANICAL PROCESS
Mechanical process are used to change the physical form
or characteristics of the waste, either to facilitate waste
handling or to process the waste in conjunction with
other treatment steps. The two primary mechanical
Process are :- - Compaction
- Shredding
COMPACTION:- It involves compressing in waste in to
containers to reduce its volume.
62

63. SHREDDING :- In this process include granulation,
grinding, pumping is used to break the waste to prevent
their reuse. Only the disinfected waste can be used in a
shredder.
- For plastic – only after
autoclaving
- After autoclaving – send to
shredders
- Sold to authorized plastic
molder unit
- Have set of revolving blades
that cut waste in to small
pieces
63

64. 64

65. DISPOSAL
ASH - To land fill
RECYCLABLE WASTE – To registered or authorized recyclers
or plastics to diesel or fuel oil or for road
making whichever is possible
MATALS – Sent for final disposal to iron foundries to produce
metal castings
NEEDLES – Pits or Encapsulation
65

66. THERMAL PROCESS
√ These process utilize heat
√ Depending on the temperature they operate , it is been
grouped in to two categories
○ Low- heat systems :-
Autoclave & Microwave
○ High – heat system :-
Incinerator & Hydroclaving
66

67. Low-heat system
I. Autoclaveing is a low heat thermal process and it uses
steam for disinfection of waste.
II. Microwaving is a process which disinfects the waste
by moist heat and steam generated by microwave
energy.
67

68. Autoclave -
PRINCIPLE
Ø Steam penetrates objects in the autoclave
Ø Moist heat kills microorganisms via coagulation
of proteins
Ø Temperature of not less than 121°c and pressure of
15 pound per cycle for not less than 60 minutes
Ø Use- for microbiological waste, blood & blood
product, body fluid , used sharps
68

69. 69

70. Microwaving -
- LOADING DEVICE -Transfers the waste in to shredder
- SHREDDER – Break in to small pieces
- Shredded waste mixed with water – subjected to
microwaves
- Water in waste heated by microwave.
- Heat waste to temp. of 97-100°c. Cycle time- 40 to 45
min.
- Infectious components destroyed by heat conduction.
- Finally passed to landfill.
70

71. No microwave to be done for :-
- Cytotoxic /
Radioactive
waste.
- Contaminated
body parts,
Tissues
71

72. Incinerator
PRINCIPAL :
-High temperature , dry oxidation process that reduces
organic & combustible waste to inorganic &
incombustible waste
- Convert the waste in to ash , gas , and heat.
- Gases are cleaned of gaseous and particulate pollutions
before they are dispersed in to the atmosphere
-Wastes to be incinerated shall not be chemically treated
with any chlorinated disinfectants.
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73. Type of incineration
I. DOUBLE CHAMBERED
II. SINGLE CHAMBERED
I. DOUBLE CHAMBERED:
- Pyrolytic chamber/ primary chamber – 800°c
- Post combustion / secondary chamber – 1000°c
- Chimney
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75. 75

76. USES
- Infectious waste
- Pathological waste
- Pharmaceuticals
NOT TO BE INCINERATED
- Broken thermometers , used batteries
- Ampoules containing heavy metals
76

77. HYDROCLAVE:-
Medical waste is deposited in the Hydroclave vessel
STAGE ONE
The Hydroclave van process
Pathological waste
Sharps containers
Liquid container
Metal objects
77

78. Stage two
The waste fragmentation and sterilization
a. Powerful rotators mix the
waste and breaks it into
small pieces.
b. Steam fills the vessel and
heats the vessel interior.
c. The liquids in the waste
turn to steam.
d. After 20 min. the waste and
liquids are sterile
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79. Stage three
Vessel venting and dehydration
A. The vent is opened , and
the vessel de-pressurizes.
B. Steam heat and mixing
continue until all the liquids
are evaporated and the
waste is dry.
79

80. Stage four
Unloading the waste
A. The unloading door is opened.
B. The mixer now rotates in the
opposite direction, so angled
blades on the mixer can push the
waste out the unloading door.
C. The dry, sterile waste can be fine-
shredded further or dropped in a
waste disposal bin.
The waste is now ready for safe disposal.
80

81. Advantages of hydroclave :
a. Dry waste
b. Low odor, due to the
drynes
c. Volume reduction to 85%
d. Weight reduction to 70%
e. Accepted as harmless
waste.
81

82. Chemical process:
Sodium hypochlorite solution with a min. contact period
of 30 min.
10,000 ppm for spillage
2500 ppm for discard container
1000 ppm for cleaning
Other chemical such as
- Phenol compound - Iodine alcohol
- Iodine - Formaldehyde-alcohol
- Hexachlorophene
Suitable for Liquid waste treatment, blood, urine, stool.
82

83. Irradiation process:
- This involves exposing the waste
matter to Ultraviolet or Ionizing
radiation in an enclosed chamber.
- Decontamination occurs when
nucleic acids in the living cell are
irradiated
- The adventage of this technology is
that energy input is minimal and it
is used to treat items, which can not
be heated.
- Cobalt 60 and electron beam gun
use for irradiating and sterilizing
the medical waste.
83

84. Biological process:
This techniques required
for sanitary and secured land
Filling and nonhazardous
and nontoxic may be taken
care By composting and
control recycling of packing
material.
84

85. Disposal of used syringes /needles/broken vials
a. After administration injection ,needle destroyed
using a needle destroyer / cutter
b. Followed by cutting of the plastic hub of the syringe
without detaching the needle from the syringe.
85

86. Transport & Disposal
a. Transport
- Trolleys
- To BMW shed at the backside of
hospital
b. Disposal :
- Incinerator – Not used
- General waste collected by municipality truck
- BMW collected by state BMW agency for disposal in BMW plant
86

87. Role of staff nurses in BMW:
 Administration of medication such as tablets, injection ,
infusions and transfusion on prescription or according to
standing instruction.
 Assisting doctor in various medical and surgical diagnostic
procedures by preparing patients and getting ready with
required things
 Collecting and sending of specimens for laboratory diagnostic
procedures.
Observer all patients conditions and take suitable action
accordingly and reports changes to ward in charge / or doctor
 Performing simple diagnostic procedures viz. haemoglobin %
etc.
 Prepares patients for operations and see that he / she is sent
to operation theater with all necessary papers and medicines.
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