BMW 2016 rule

1. BIOMEDICAL WASTE
MANAGEMENT
Department of Community Medicine , CIMS , Bilaspur
Dr. Aditi Chandrakar
MD (Community Medicine)
CIMS Bilaspur

2. INTRODUCTION

3. Biomedical waste
• According to biomedical waste (management and Handling
rules 1998 of India) – Biomedical Waste means
“ any waste, which is generated during the diagnosis, treatment
and immunization of human beings
or
animals
or
in research activities pertaining thereto or in the production or
testing of biologicals .”

4. Health Care Waste categorization

6. Sources of Health Care Waste
• Government hospitals
• Private hospitals
• Nursing hospitals
• Physician’s office/clinics
• Dentist’s office/clinics
• Dispensaries
• Primary health centers
• Medical research and training
establishments
• Mortuaries
• Blood banks and collection
centers
• Animal houses
• Slaughter houses
• Laboratories
• Research organizations
• Vaccinating centers
• Biotechnology
institutions/production
units

7. SOURCES OF BIOMEDICAL WASTE

8. Need for bio medical waste management
• Nosocomial infection to patients from poor infection control
practices and poor waste management.
• Drugs which have been disposed of, being repacked and sold
off to unsuspecting buyers.
• Risk of air ,water and soil pollution directly due to waste , or
due to defective incineration emission and ash.
• Risk of infection outside hospital for waste handlers and
scavengers, other people.

10. HEALTH HAZARDS OF HEALTH-
CARE WASTE
• Exposure to hazardous health –care waste can result in disease
or injury due to one or more of the following characteristics:
• It contains infectious agent
• It contains toxic or hazardous chemical or pharmaceuticals
• It contains sharps
• It is genotoxic
• It is radio-active

11. • Gastro enteric through faeces and /or vomit
eg. Salmonella, Vibrio cholera, Helminthes,
Hepatitis A
• Respiratory through inhaled secretions
eg. Mycobacterium tuberculosis , Measles virus,
Streptococcus pneumonia
• Ocular infection through eye secretions
eg.Herpes virus
• Skin infections through pus
eg. Streptococcus spp,
Most common infection

12. •Meningitis through cerebrospinal fluid
eg. Neisseria meningitides
•Blood borne disease
AIDS,Septicaemia and bacteraemia Viral hepatitis B and C
•Hemorrhagic fever through body fluids

13. • The infectious agents enter into the body through
• a) puncture
• b) abrasion
• c) cut in the skin
• d) through mucous membrane
• e) by inhalation and ingestion.
Hazardous health care waste can result in
(1)Hazards from infectious waste and sharps

14. • Many of the chemicals and pharmaceuticals are toxic,
genotoxic, corrosive, flammable, explosive or shock-sensitive.
• Although present in small quantity they may cause intoxication,
either by acute or chronic exposure, and injuries, including
burns.
(2) Hazardous from chemical and
pharmaceutical wastes

15. 3) Genotoxicity and cytotoxicity
• The severity of the hazards depend on extent and duration of
exposure.
• The main pathway of exposure is -
inhalation of dust or aerosols, absorption through the skin ,
ingestion of food accidentally contaminated with cytotoxic
drugs, chemicals or wastes etc.
• Irritant to skin and eyes
• eg. Alkylating agent, intercalating agent
• Carcinogenic and mutagenic
• eg. Secondary neoplesia due to chemotherapy

16. (4)Radioactivity hazards
• The type of disease caused by radio-active waste is determined
by the type and extent of exposure .
• Radioactive waste exposure may cause- headache, dizziness,
vomiting, genotoxicity and tissue damage,visual impact of the
anatomical waste ,recognizable body parts.
• It is genotoxic, it may also affect genetic material.

18. Biomedical Waste Management Process
1. Source Identification.
2. Segregation.
3. Collection and storage.
4. Transport.
5. Treatment and Disposal.

19. 1. Source Identification
• Identification of source required both at -
1. At the Macro level.
(Institutes that generates wastes)
2. At the Micro level.
(Points and activities within the institution).

20. 2. Segregation
• “Separation of different types of waste as
per treatment and disposal options.”
• It is the key to the active process of scientific
waste management.

21. 3. Collection and Storage
• Storage of waste refers to storage within wards or
collection points within the departments.
• Collection centers are planned between 2-3 wards.
• Central collection.
• Common Treatment Facility (CTF)

22. • No untreated biomedical waste shall be kept
stored beyond period of 48 hours.
• If any reason it is necessary then permission of
the prescribed authority is essential.

23. 4. Transport
• Transportation system
should be secured with
special containers and well
defined route with
minimum patient influx.
• The containers should have
non-washable and
prominently visible label
showing the type of waste it
contains – Cytotoxic or
Biohazrds.

25. 5. Treatment and Disposal
• Treatment is the process that modify the waste
in some way before it finally disposed off.
• The main objectives of treatment are -
- disinfection and decontamination.
- volume reduction.

26. • Broadly two categories –
• 1. BURN -TECHNOLOGY.
• 2. NON-BURN TECHNOLOGY.

27. BURN TECHNOLOGY NON-BURN TECHNOLOGY
1. Open Burning.
2. Small Scale incinerators.
3. Single Chamber Incinerators.
4. Double Chamber Incinerator.
5. Pyrolyltic incinerators and
Rotary Kiln.
1.Chemical Disinfection.
2. Microwave Irradiation.
3. Dry and Wet thermal
techniques.(AUTOCLAVING)
4. Sanitary landfill
5. Deep Burial
6. Inertization and Encapsulation.

28. INCINERATION
• Method of choice for most hazardous health care
waste.
• High temp dry oxidation process.
• Reduces organic and combustible waste to inorganic
and incombustible material.
• Significant reduction in waste volume and weight.

29. INCINERATORS
SINGLE CHAMBER
INCINERATOR
DRUM/BRICK INCINERATION

30. INCINERATORS
ROTARY KILN PYROLYTIC INCINERATOR

31. CHEMICAL DISINFECTION
• Most suitable for treating liquid waste such as
infected blood, urine, stools, or hospital
sewage.
• Chemicals are added to waste to kill the
pathogens.

32. AUTOCLAVING
(Wet and Dry Thermal techniques)
• Autoclaving is efficient thermal disinfection
process.
• Commonly used for reusable medical equipments.
• Research has shown that effective inactivation of
all the micro-organism and bacterial spores at 134
degree C temperature and 30 psi pressure for 3
minutes holding time.

33. TEMPERATURE PRESSURE HOLDING TIME
134 C 30 psi 03 minutes
126 C 20 psi 10 minutes
121 C 15 psi 15 minutes

34. MICROWAVE IRRADIATION
• Microorganisms are
destroyed by the action
of microwave at -
- a frequency of about
2450 MHz and
- a wavelength of 12.24
nm.

35. LAND DISPOSAL
• Whatever may the modality of waste
treatment, final product has to be taken to the
land.
• Two types of methods –
• 1. Open dump.
• 2. Sanitary landfill.

36. Land Disposal Facility for Cities &
Towns

37. INERTIZATION
• Mixing of waste with cement and other substances .
• Commonly used for the pharmaceutical waste.
• A typical proportion of mixture is –
- 65 % of Pharmaceutical waste.
- 15 % lime
- 15 % cement and
- 5 % water.

38. Biomedical Waste Management
Rule
• Prescribed by Ministry of Environment and Forest affairs.
• Come into force on 28th
July 1998.
• 1st
amendment was done on 6th
march 2000.
• 2nd
amendment was done on 17th
September 2003.
• Recent amendment was done on 28th
March 2016 and published on
Gazette of India.

39.  Applicable
• to all persons who generate, collect , receive, store, transport,
treat, dispose, or handle bio medical waste in any form.
 Rule is not applicable for –
• Radioactive waste
• Municipal solid waste
• E-waste
• Hazardous micro-organisms and cells
• Lead acid batteries
• Hazardous waste

40. Bio-Medical Waste Management
Rules, 2016
• come into force on the date of their publication in the Official
Gazette, New Delhi i.e on 28th March, 2016
 RULES : I – XVIII
 SHEDULE : I – IV
 FORMS : I - V

41. RULES:
1. Short title and commencement
2. Application
3. Definitions
4. Duties of the Occupier
5. Duties of the operator of a common
bio-medical waste treatment and
disposal facility
6. Duties of authorities
7. Treatment and disposal
8. Segregation, packaging,
transportation and storage
9. Prescribed authority
10. Procedure for authorization
11. Advisory Committee
12. Monitoring of implementation
of rules in health care facilities
13. Annual report
14. Maintenance of records.
15. Accident reporting
16. Appeal.
17. Site for common bio-medical
waste treatment and disposal
facility
18. Liability of the occupier,
operator of a facility

42. SCHEDULES
1. Biomedical wastes categories and their segregation,
collection , treatment, processing and disposal options.
2. Standards for treatment and disposal of bio-medical wastes.
3. List of prescribed authorities and the corresponding duties.
4. Label for bio-medical waste containers or bags & label for
transporting bio-medical waste bags or containers.

43. FORMS:
1. Accident reporting
2. Application for authorization or renewal of authorization
3. Authorization
4. Annual report
5. Application for filing appeal against order passed by
the prescribed authority

44. Schedule I- Biomedical waste categories and their collection,
treatment ,processing and disposal options

46. Segregation- Color codes

48. Part -2 (Schedule-I)
1. All plastic bags shall be as per BIS standards as and when published,
till then the prevailing Plastic Waste Management Rules shall be
applicable.
2. Chemical treatment using at least 10% Sodium Hypochlorite having
30% residual chlorine for twenty minutes.
3. Mutilation or shredding must be to an extent to prevent unauthorized
reuse.
4. There will be no chemical pretreatment before incineration, except
for microbiological, lab and highly infectious waste.
5. Incineration ash (ash from incineration of any bio-medical waste)
shall be disposed through hazardous waste treatment, storage and
disposal facility, if toxic or hazardous constituents are present
beyond the prescribed limits as given in the Hazardous Waste
(Management, Handling and Tran boundary Movement) Rules, 2008
or as revised from time to time.

49. 6. Dead Fetus below the viability period (as per the Medical
Termination of Pregnancy Act 1971, amended from time to time)-
human anatomical waste - handed over to the operator of common
bio-medical waste treatment and disposal facility in Yellow bag with
a copy of the official Medical Termination of Pregnancy certificate
from the Obstetrician or the Medical Superintendent of hospital or
healthcare establishment.
7. Cytotoxic drug vials shall not be handed over to unauthorized person
under any circumstances- sent back to the manufactures for necessary
disposal at a single point
or
can be sent for incineration at common bio-medical waste treatment
and disposal facility
or
plasma pyrolysis is at temperature >1200 0C.

50. 8. Residual or discarded chemical wastes, used or discarded
disinfectants and chemical sludge can be disposed at hazardous waste
treatment, storage and disposal facility.
9. On-site pre-treatment of laboratory waste, microbiological waste,
blood samples, blood bags should be disinfected or sterilized as per
the Guidelines of World Health Organisation or National AIDS
Control Organisation and then given to the common bio-medical
waste treatment and disposal facility.
10 .Installation of in-house incinerator is not allowed.

51. 11. Syringes should be either mutilated or needles should be cut
and or stored in tamper proof, leak proof and puncture proof
containers for sharps storage.
12. Bio-medical waste generated in households during healthcare
activities shall be segregated as per these rules and handed over
in separate bags or containers to municipal waste collectors.

52. Schedule-II- Standards for treatment and disposal of BMW
Standards
a. for incinerators
b. for autoclaving
c. for microwaving
d. for deep burial
e. for efficacy of chemical disinfection
f. for dry heat stabilization.
g. for liquid waste

53. Schedule III-Lists of prescribing authorities and their
corresponding duties
• Ministry of Environment ,forest and climatic change, Govt of
India
• State ministry/central ministry of Health and Family welfare,
Animal husbandry and Veterinary
• Ministry of Defence
• Central Pollution control board
• State Government of Health or Union Territory Government
or Administration
• State Pollution Control Boards or Pollution Control
Committees
• Municipalities or Corporations, Urban Local Bodies and Gram
Panchayats

54. Schedule -IV
Part –A Label for Bio-medical Waste Containers or Bags
Handle with Care Handle with Care

57. Forms
• Form 1 Accident Reporting
• Form 2 Application for authorization and renewal of
authorization
• Form 3 Authorization for operating facility
• Form 4 Annual Report – to be submitted by occupier by 31st
January to prescribed authority
• Form 5 Application for filling appeal against order pass by the
prescribe authority

58. Who is the Occupier / Operator ?
• Occupier in relation to any institution generating
Biomedical Waste which includes a hospital, nursing home,
Clinic, dispensary, pathological laboratory, blood bank, by
whatever name called, means a person who has a control
over the institution.
• Operator of a Biomedical facility means a person who
owns or controls or operates a facility for the collection,
reception, storage, transport, treatment, disposal or any
other form of handling waste.

59. 59
Duty of Occupier
 It shall be the duty of every occupier of an institution
generating bio-medical waste to:
• Take all steps to ensure that waste is handled without any
adverse effect to human health & the environment
• To install an appropriate facility to ensure requisite treatment
of waste in accordance with Schedule - I & in compliance
with standards prescribed in Schedule - V
• Ensure proper segregation of waste into containers/
bags at the point of generation in accordance with Schedule -
II
• Ensure proper labeling of containers/bags according to
Schedule - III & IV

60. 60
• Submit an Annual Report to SPCB in Form - II by 31st
January every year.
• Maintain Records about generation, collection, storage,
treatment & disposal of wastes.
• Report Accidents occurred while handling waste in Form - III
to State pollution control board.

61. Thank you