Everything about new Biomedical waste management

Definition / What is Biomedical waste?

Definitions related to BMW according to Ministry of Environment and Forests are.

This refers to all waste, biological or non‐ biological that is discarded and not intended for further use.

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 biologicals, and including categories mentioned in Schedule I, of the BMW rules, 2016.

Health hazards of Biomedical Waste

1. Harmful microorganisms from BMW can infect hospital patients, health workers, and the general public.
2. Passage of drug-resistant microorganisms from health facilities into the environment.
3. Toxic exposure to pharmacy products, like antibiotics, cytotoxic drugs released into the environment.
4. The radioactive substance used in treatment can cause radiation injuriesChemical burns and thermal injuries arising from biomedical waste management itself.
5. Sharps from BMW can inflict injuries.
6. Similar hazards to animals and birds causing a change in human-environments balance.

Modes of Disposal of BMW

1. Involves steam sterilization.
2. Introduces very hot steam for a determined amount of time.
3. Costs much less than other methods.
4. No personal health risks.

1. It is quick, easy, and simple.
2. Removes the waste entirely and effectively.
3. Emissions during burning can be dangerous.

1. Useful for liquid waste.
2. Chlorine is commonly used.
3. Introduced to the liquid waste to kill microorganisms and pathogens. In the case of solid waste, they are grinded first.
4. Once decontaminated, the liquid is disposed into the sewer system.

1. Waste is shredded first, mixed with water, and then heated to kill microorganisms.
2. Shredding lowers the volume of biomedical waste, Which is a plus of this method.
3. Can’t be used for all biomedical wastes.

1. Uses extremely high temperatures in an oxygen-deprived environment to completely dissociate waste.
2. Uses heat generated by graphite electrode-based plasma arc system.

Overview of New Guidelines

The hospital waste management guidelines in India has been updated recently in 2016.

There are many changes in rules for segregation, packaging, transport, storage, and disposal of biomedical waste. They are more simplified now.

There can be important questions based on these highlights in DNB theory exams, OSCE, and even for clinical viva.

It is imperative to know older guidelines so as to realize and memorize the differences.

What are the old guidelines?

According to the old guidelines (1998 and 2011 update), the following categories of hospital waste management were recognized.

The old classification for the type of container used for medical waste segregation was as follows.

Color code	Container	Category	Treatment
Yellow	Plastic Bag	1,2,3,6	Incineration/ Deep burial
Red	Disinfected container/Plastic bag	3,6,7	Autoclaving / Microwaving / Chemical treatment
Blue / White	Puncture proof	4,7	Autoclaving / Microwaving / Chemical treatment & Destruction / Shredding
Black	Plastic Bag	5,9,10 (solid)	Disposal in secured landfill

New Guidelines for Biomedical Waste management 2016

As Per the New guidelines on hospital waste management the Bio-medical waste is now classified into just 4 categories. This is way less confusing than the 10 categories in previous guidelines.

The 2011 update brought down the number to eight categories of biomedical waste from ten categories in the 1998 notification. The 2016 notification further brings down the number of categories to four.

Table 3 - Updated Biomedical waste management categories and waste disposal methods 2016.
Source -Reference 1

Category	Type of container	Type of waste	Treatment
Yellow	Non-chlorinatedplastic bags	- Human Anatomical Waste Animal - Anatomical Waste- Soiled Waste- Expired Medicines- Chemical Waste- Chemical Liquid Waste- Discarded linen, mattresses, beddings contaminated withblood or body fluid.- Microbiology, Biotechnology andclinical laboratory waste	Incineration or Plasma Pyrolysis ordeep burial
Red	Non-chlorinatedplastic bags orcontainers	Contaminated Waste (Tubing, bottles, Intravenous tubes and sets, catheters, urine bags, syringes (without needles and fixed needle syringes) and vacutainers with their needles cut) and gloves )	Autoclaving or micro waving/hydroclaving and then recycling ( no land fill here)
White	Puncture proof,Leak proof,tamper proofcontainers	Waste sharps including Metals (Needles, syringes with fixed needles, needlesfrom needle tip cutter or burner, scalpels, blades, or any othercontaminated sharp)	Autoclaving or Dry Heat Sterilization followed by shredding, mutilation or encapsulation.
Blue	Cardboard boxeswith bluecolored marking	Glassware (Broken or discarded and contaminated glass including medicine vials and ampoules except those contaminated with cytotoxic wastes)	Disinfection/ autoclaving/ microwaving/ hydroclaving and then sent for recycling

What are the Major changes in Biomedical waste management 2016 guidelines from that in 1998?

Highlights of changes are

1. Authorization mandatory for all no matter how small is the HCF (Health care facility)
2. Formal annual report
3. Schedule and forms changed
4. Chemical pretreatment with 10% hypochlorite instead of 1%
5. New methods of disposal like pyrolysis, hydrolysis, encapsulation, and inertization
6. More emphasis on recycling now

Major changes in Biomedical waste management 2016 from 1998 guidelinesImage source: Reference 2

What are the various symbols used for biomedical waste segregation and management?

This is of particular importance in Image-based OSCE questionsin exams.

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Author

Ajay Agade | DNB(Pediatrics), FNB(Pediatric Intensive Care), Fellowship in Pediatric pulmonology and LTV

Ajay is a Paediatric Intensivist, currently working in Pediatric Pulmonology & LTV at Great Ormond Street Hospital NHS, London