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International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163Volume 1 Issue 8 (September 2014)www.ijirae.comBiomedical Waste: An Introduction to its ManagementDhruv P. HiraniKrish R. VillaitramaniSnehjit J. KumbharDept. of Civil Engineering,Mumbai UniversityDept. of Civil Engineering,Mumbai UniversityDept. of Civil Engineering,Mumbai UniversityAbstract— Biomedical Waste, (BMW), are those potential hazardous waste materials, consisting of solids, liquids,sharps, and laboratory waste which pose a grave danger to the health of humans as well as other living organisms.And in some cases, it may be lethal too. It is of extreme importance that this waste must be properly managed anddisposed off safely so as to prevent outbreak of infections to general public and disturb the health care settings in asociety. About 57% of the total waste generated in Maharashtra is biomedical waste. It is essential to understand whatbiomedical waste is, classify them and to manage them accordingly. In this paper, a concise effort is undertaken so asdepict biomedical waste substances generated, their origins and the methods to deal with them effectively.Keywords— Hazardous, infection, biomedical, management, health;I.INTRODUCTIONBiomedical Waste, (BMW) or bio wastes are those potential hazardous waste materials, consisting of solids, liquids,sharps, and laboratory waste. Biomedical waste differs from other types of hazardous waste, such as industrial waste, inthat it comes from biological sources or is used in the diagnosis, prevention, or treatment of diseases. One of the majorsources of biomedical wastes is hospitals and nursing homes. Hospital is one of the complex institutions which arefrequented by people from every walk of life in the society without any distinction between age, sex, race and religion.All of them produce waste which is increasing in its amount and type due to advances in scientific knowledge and iscreating its impact. The hospital waste, in addition to the risk for patients and personnel who handle these wastes poses athreat to public health and environment.According to the Ministry of Environment and Forests (MoEF) gross generation of BMW in India is 4,05,702 kg/dayof which only 2,91,983 kg/day is disposed, which means that almost 28% of the wastes is left untreated and not disposedfinding its way in dumps or water bodies and re-enters our system. The indiscriminate dumping of biomedical wastes byhospitals and nursing homes was a source of pollution that caused dangers to the health and environment. In order toovercome this crisis, the Bio Medical Waste (Handling and Management) Rules, were notified in July 1998. The rulesseek to introduce biomedical waste disposal practices in India. The emphasis is on ensuring a process change that willenable health care facilities to handle their waste through proper training and capacity building.These Rules are applicable to all persons who generate, collect, receive, store, transport, treat, dispose or handlebiomedical wastes. This includes hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses,pathological laboratories and blood banks.Although the Bio-Medical Waste (Management and Handling) Rules have already been introduced a few years back,not much attention has been paid to bio-medical waste management so far. Even if something is done, it is most of thetimes not properly done.The hospitals and the private nursing homes have raised a hue and cry against the cost of treatment and disposal ofbio-medical waste. It has been reported that the private agencies have quoted a disposal charge @ Rs. 20/bed/day, whichdoes not seem to be unreasonable.II.CLASSIFICATIONApproximately 75-90% of the biomedical waste is non-hazardous and as harmless as any other Municipal waste[1].The rest 10-25%, though mixed with non-hazardous waste, can be injurious to humans or animals and deleterious toenvironment. Biomedical wastes can be categorized based on their origin and physical, chemical or biologicalcharacteristics. General waste: Largely composed of domestic or household type waste. It is non-hazardous to human beings,e.g. kitchen waste, packaging material, paper, wrappers, and plastics. Pathological waste: Human body parts, tissues and organs. Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that could causediseases. It includes cultures and stocks of infectious agents from laboratories, waste from surgery, wasteoriginating from infectious patients. Sharps: Physically hazardous biomedical waste like needles, broken glass, saws, nail, blades, and scalpels. Pharmaceutical waste: Drugs and pharmaceutical products that are contaminated outdated or have been spilled. Chemical waste: chemicals disposed in cleaning, housekeeping, and disinfecting. Radioactive waste: It includes solid, liquid, and gaseous waste that is contaminated with radionuclides generatedfrom in-vitro analysis of body tissues and fluid, in-vivo body organ imaging and tumour localization andtherapeutic procedures. 2014, IJIRAE- All Rights ReservedPage -82

International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163Volume 1 Issue 8 (September 2014)www.ijirae.comIII.SOURCESThe main sources of biomedical waste are hospitals, medical clinics, laboratories and pharmaceutical factories. Othersources include: Blood donation camps Slaughter houses Cosmetic services Vaccination centres Funeral services.IV.MANAGEMENT OF BIOMEDICAL WASTEDue to the grave potential threats biomedical waste pose, managing and regulating its collection, storage,transportation, treatment and disposal method is essential. Safe disposal of biomedical waste is also a legal requirementin India. The objectives of BMW management are: To prevent transmission and spreading of pathogens and diseases To prevent injury to people in health care services and workers who handle BMW To prevent general exposure to the harmful effects of the cytotoxic, genotoxic and chemical biomedical waste To prevent environmental degradation.A. Handling EquipmentProtective gear must be used by the handling personnel to prevent any direct contact with the BMW.1) Gloves: Heavy-duty rubber gloves should be used for waste handling by the waste retrievers. This should be brightyellow in colour. After handling the waste, the gloves should be washed twice. The gloves should be washed after everyuse with carbolic soap and a disinfectant. The size should fit the operator.2) Aprons, gowns, suits or other apparels: Apparel is worn to prevent contamination of clothing and protect skin. It couldbe made of cloth or impermeable material such as plastic. People working in incinerator chambers should have gowns orsuits made of non-inflammable material.3) Masks: Various types of masks, goggles, and face shields are worn alone or in combination, to provide a protectivebarrier. It is mandatory for personnel working in the incinerator chamber to wear a mask covering both nose and mouth,preferably a gas mask with filters.4) Boots: Leg coverings, boots or shoe-covers provide greater protection to the skin when splashes or large quantities ofinfected waste have to be handled. The boots should be rubber-soled and anti-skid type. They should cover the leg up tothe ankle [2].Fig 1 Personal handling equipmentB. Storage and ContainmentThe key to minimization and effective management of biomedical waste is segregation and identification of the waste.BMW must be segregated from other types of waste at the point where it is created. It must be kept from direct contactwith humans, animals, insects, and environmental elements, such as rain and wind. Limited access should be granted andto people who are trained and authorized to handle this waste. Sharps must be contained in leak-proof, rigid, puncture-resistant, break-resistant containers which are labelledand tightly lidded during storage, handling, and transport. For biomedical waste, excluding sharps, dispose of the waste in leak-proof plastic bags strong enough to preventripping, tearing, breaking, or bursting under normal conditions of use. Rigid plastic, single-use, or approvedmultiple-use marked containers may also be used. Biomedical waste that is held in plastic bags should 2014, IJIRAE- All Rights ReservedPage -83

International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163Volume 1 Issue 8 (September 2014)www.ijirae.com additionally be placed in another leak-proof container such as disposable or reusable pails, drums, or bins duringstorage or transport.Secure bags or containers to prevent leakage or expulsion during storage.The container holding the biomedical waste should be conspicuously labelled with the international biohazardsymbol and the words "Biomedical Waste" (or words that clearly denote biomedical waste).Fig 2 standard symbols Biomedical waste contained in disposable containers as prescribed above, shall be placed for storage, handling,or transport in disposable or reusable pails, cartons, boxes, drums, dumpsters, or portable bins. The containmentsystem shall have a tight fitting cover and be kept clean and in good repair.These containers shall not be used for other purposes even after the biohazard symbol is removed.C. Transportation of BMWThe waste should be transported for treatment either in trolleys or in covered wheelbarrow. Manual loading should beavoided as far as far as possible. The Container containing BMWs should be lidded before transportation. Beforetransporting the bag containing BMWs, it should be accompanied with a signed document by Nurse/ Doctor mentioningdate, shift, quantity and destination.Special vehicles must be used so as to prevent direct contact with the waste by the transportation operators, thescavengers and the public. The transport containers should be properly enclosed. The effects of traffic accidents shouldbe considered in the design, and the driver must be trained in the procedures he must follow in case of an accidentalspillage. It should also be possible to wash the interior of the containers thoroughly.Fig 3 Biomedical Waste Transport VehicleD. Handling devices1) Trolleys: The use of trolleys will facilitate the removal of infectious waste at the source itself, instead of adding anew category of waste.2) Wheelbarrows: Wheelbarrows are used to transfer the waste from the point source to the collection centres. Thereare two types of wheelbarrow – covered and open. Wheelbarrows are made of steel and provided with two wheelsand a handle. Care should be taken not to directly dump waste into it. Only packed waste (in plastic bags) should becarried. Care should also be taken not to allow liquid waste from spilling into the wheelbarrow, as it will corrode.These are ideal for transferring debris within the institution. Wheelbarrows also come in various sizes depending onthe utility.3) Chutes: Chutes are vertical conduits provided for easy transportation of refuse vertically in case of institutions withmore than two floors. Chutes should be fabricated from stainless steel. It should have a self-closing lid. These chutesshould be fumigated everyday with formaldehyde vapours. The contaminated linen (contaminated with blood and orother body fluids) from each floor should be bundled in soiled linen or in plastic bags before ejecting into thechute. Alternately, elevators with mechanical winches or electrical winches can be provided to bring down wastecontainers from each floor. Chutes are necessary to avoid horizontal transport of waste thereby minimizing therouting of the waste within the premises and hence reducing the risk of secondary contamination.E. Treatment1) Chemical processes:These processes use chemical that act as disinfectants. Sodium hypochlorite, dissolved chlorine dioxide, per acetic acid,hydrogen peroxide, dry inorganic chemical and ozone are examples of such chemical. Most chemical processes arewater-intensive and require neutralizing agents. 2014, IJIRAE- All Rights ReservedPage -84

International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163Volume 1 Issue 8 (September 2014)www.ijirae.com2) Thermal processes:These processes utilize heat to disinfect. Depending on the temperature they operate it is been grouped into ystems.Low-heat systems (operates between 93-177 C) use steam, hot water, or electromagnetic radiation to heat anddecontaminate the waste. Examples are: Autoclaving is a low heat thermal process and it uses steam for disinfection of waste. Autoclaves are of twotypes depending on the method they use for removal of air pockets are gravity flow autoclave and vacuumautoclave. Microwaving is a process which disinfects the waste by moist heat and steam generated by microwave energy.High-heat systems (operates between 540-8,300 C) employ combustion and high temperature plasma to decontaminateand destroy the waste. Examples are: Hydroclaving - steam treatment with fragmentation and drying of waste. Incineration is a burn technology. It is a controlled combustion process where waste is completely oxidized andharmful microorganisms present in it are destroyed/denatured under high temperature.Fig 5 AutoclaveFig 4 Incinerator for contraband drugs3) Mechanical processes:These processes are used to change the physical form or characteristics of the waste either to facilitate waste handling orto process the waste in conjunction with other treatment steps. The two primary mechanical processes areCompaction - used to reduce the volume of the wasteShredding - used to destroy plastic and paper waste to prevent their reuse. Only the disinfected waste can be used in ashredder.4) Irradiation processes:These processes expose wastes to ultraviolet or ionizing radiation in an enclosed chamber. These systems require postshredding to render the waste unrecognizable.5) Biological processes:These processes use biological enzymes for treating medical waste. It is claimed that biological reactions will not onlydecontaminate the waste but also cause the destruction of all the organic constituents so that only plastics, glass, andother inert will remain in the residues.V.BIOMEDICAL WASTE MANAGEMENT RULESThe Ministry of Environment and Forest established the Biomedical Waste Management & Handling Rules in 1998under the Environment Protection Act [3]. In accordance with these rules, it is the duty of every “occupier” i.e. a personwho has the control over the institution or its premises, to take all steps to ensure that waste generated is handled withoutany adverse effect to human health and environment. It consists of six schedules. The BMW rules classify it into 10categories.Schedule ICategories of Biomedical WasteOptionCategory No. 1Waste CategoryHuman Anatomical WasteIncineration/deep burialTreatment & DisposalCategory No. 2Animal WasteIncineration/deep burialCategory No 3Microbiology & Biotechnology Wastelocal autoclaving / micro-waving / incinerationCategory No 4Waste sharpsdisinfection (chemical treatment/autoclaving/micro- waving andmutilation/ shreddingCategory No 5Discarded Medicines and Cytotoxic drugsIncineration /destruct ion and drugs disposal in secured landfills 2014, IJIRAE- All Rights ReservedPage -85

International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163Volume 1 Issue 8 (September 2014)www.ijirae.comCategory No 6Solid WasteIncineration autoclaving / micro-wavingCategory No. 7Solid Wastedisinfection by chemical treatment autoclaving/micro-waving andmutilation/shreddingCategory No. 8Liquid WasteDisinfection by chemical treatment and discharge into drains.Category No. 9Incineration Ashdisposal in municipal landfillCategory No. 10 Chemical Wastechemical treatment and discharge into drains for liquids and securedlandfill for solidsDepending on the category, different types of BMW are stored in different coloured containers. Schedule II givesstandard colour codes for different categories [4].Schedule IIColour Coding and Type of Disposal for BMWColour CodingType of Container -IWaste CategoryYellowRedPlastic bagDisinfected container/plastic bagCat. 1, Cat. 2, and Cat. 3, Cat. 6.Cat. 3, Cat. 6, Cat.7.Blue/WhitetranslucentPlastic bag/puncture proof Container Cat. 4, Cat. 7.BlackPlastic bagCat. 5 and Cat. 9 andCat. 10. (solid)Treatment options as per Schedule IIncineration/deep burialAutoclaving/Microwaving/Chemical TreatmentAutoclaving/Microwaving/Chemical Treatment anddestruction/shreddingDisposal in secured landfillFig 6 Coloured Plastic Bags for Biomedical WasteVI.BENEFITS OF BIOMEDICAL WASTE MANAGEMENTBMW management plays a vital role in preventing any outbreak of infectious diseases and protecting the society fromtransmission of these diseases. Here are few benefits that biomedical waste management programs provide [5]. Reduction in the cost of medical expenses due to reduced cases of infections Hygienic and healthy environment in medical centres Low incidence of community and occupational health hazards Low impact on ecological system Potential epidemics are prevented Low incidence of community and occupational health hazards Improved public health and cleaner environment Improved image of the healthcare establishment and increased quality of life.VII.CONCLUSIONSBiomedical waste should be safely and efficiently identified, segregated, stored, transported and disposed afterappropriate treatment. Its effective implementation in our community is of prime importance to protect public health andenvironment. With a growing population, biomedical waste is also growing in quantity in our country. Management ofthis waste is a rising concern in India. Segregation of BMW at its origin is the key to the efficiency of wastemanagement. Following regulations and scientifically managing BMW is in the best interest of the public as well as theenvironment. 2014, IJIRAE- All Rights ReservedPage -86

International Journal of Innovative Research in Advanced Engineering (IJIRAE) ISSN: 2349-2163Volume 1 Issue 8 (September 2014)www.ijirae.comREFERENCES[1] Indian Journal of Forensic Medicine & Toxicology: Biomedical Waste Management - An Emerging Concern inIndian Hospitals[2] C.P.R Environmental educational centre, Government of India, Online-Available: http://www.cpreec.org/pubbookbiomedical.htm[3] Ministry of Environment and Forest Webpage: http://envfor.nic.in/legis/hsm/biomed.html[4] “Manual on hospital waste management”, Central Pollution Control Board, Delhi, 2000.[5] teMgmt.pdf[6] The Bio Medical Waste (Management and Handling) Rules, (1998). 2014, IJIRAE- All Rights ReservedPage -87

Sharps: Physically hazardous biomedical waste like needles, broken glass, saws, nail, blades, and scalpels. Pharmaceutical waste: Drugs and pharmaceutical products that are contaminated outdated or have been spilled. Chemical waste: chemic