BIOMEDICAL WASTE

MANAGEMENT
 Scheme of Presentation

1 2 3 4
Bio-Medical Waste Bio-Medical Waste Bio-Medical Waste Bio-Medical Waste
Management : Management Management in Management in
History Rules : Armed Forces AFMC
Amendments
 Bio-medical Waste Management: History

• Hospitals :
Large Multidisciplinary Matrix
Organisation

• All the products consumed in

hospitals leave some unusable
leftovers
i.e. health care wastes

• Newer technologies :
new Waste
 Bio-medical Waste Management : History

• Non – Biodegradable : Further

adds to the problem

• Hospital waste : Different from

solid/Liquid waste : potentially
infective

• writ petition by Dr. B.L. Wadhera

in the Supreme Court
 Bio-medical Waste Management : History

The Biomedical Waste (Management

and Handling) Rules 1998 under the
environmental protection act 1988
 Bio-medical Waste Management : History

• Defined Bio-Medical Waste

• Laid down the duties of all people

• Delineated the various categories

of wastes

• Laid down all the

required schedules
 What is Hospital Waste??

All wastes (biologic or non biologic) that is discarded and is

not intended for further use (e.g. administrative wastes, dietary
wastes and medical waste)
 Medical Waste
Materials generated as a result of patient
Hospital Waste diagnostic procedures, therapeutic
procedures or immunization (e.g. soiled
dressings, intravenous tubings, catheters)

Infectious Waste
Portion of waste that could transmit an
infectious disease (microbiological waste,
sharps and so on). In Europe the term
`Clinical Waste’ is used instead of `Infectious
Waste’).
 What is Biomedical Waste??
Any waste, which is generated during the
diagnosis, treatment or immunization of
human beings or animal or in research
activities pertaining thereto or in the
production or testing of biologicals
 Quantity of Waste
• Average quantity of hospital waste in India : 0.5 kg to 2.2 kg per day per
bed

• Percentage of infected waste :1.5 % to 19-20%

• The maximum infected waste

• OT
• OBG wards
• ICU
(Safe management of wastes from health-care activities : WHO)
Categories of Waste (BMW 1998)

1 2 3 4 5
Anatomical Animal Waste Microbiology Waste Sharps Discarded
Waste and Medicines and
Biotechnology Cytotoxic
Waste Drugs
 Categories of Waste (BMW 1998)

6 1
7 8 9
0
Solid Waste Solid Waste other Liquid Waste Incineration Chemical
than the waste Ash Waste
sharps such as
tubings, catheters, IV
sets
 Bio-medical Waste Management Rules :
Amendments in 2016

YELLOW

Glassware /
WHITE/ ETP/STP Metallic
TRANSLUCENT Implants
RED
 Bio-medical Waste Management Rules :
Amendments in 2016
Glassware:
Human anatomical Broken or discarded
waste, Waste sharps and
Chemo drugs Contaminated
Plastic Waste including Metals contaminated glass
Soiled waste including medicine
Expired or (Recyclable) &
Rubber vials and ampoules
Discarded glassware
Medicines, soiled
linen

14
 Bio-medical Waste Management Rules
1998 Vs 2016
1998
• Schedule I – Categories
• Schedule II – Colour coding & type
• Schedule III – Label for container / bags
• Schedule IV – Label for transport
• Schedule V – Standards for treatment
and disposal
• Schedule VI – Schedule for waste
treatment facilities
2016
• Schedule I – Categories as per
Colour Coding
• Schedule II : Standards for
treatment & disposal of biomedical
waste
• Schedule III : List of prescribed
authorities & corresponding duties
• Schedule IV : Part A & B for Labels
of Bags/ Containers & for Transport
 Biomedical Waste Management Rules
1998 vs 2016
1998 2016
• Occupiers with more than 1000 beds • Every occupier generating BMW,
required to obtain authorization irrespective of the quantum of wastes
comes under the BMW Rules and
requires to obtain authorization
• Operator duties absent
• Duties of the operator listed

• No format for Annual Report

• A format for annual report appended
with the Rules
 Prescribed Authority : State
Pollution Control Board of a State or
Pollution Control Committees of a UT

Operator : Person who owns/

Relevant controls the Common Bio-waste
Treatment Facility
Definitions
Occupier : Person having control
over the institution & premises
generating BMW
Duties : Occupier

Ensure no harm to the environment

Provide safe premise for safe, secure & ventilated storage
Pretreat Lab waste
Phase out chlorinated bags
Training / Immunisation
Solid/ Liquid waste
Duties : Occupier

Occupational Safety / Health checkups

Provide safe premise for safe, secure & ventilated storage

Reports : Major accident and Annual

Duties : Operator

Inform prescribing authority in case of non compliance of

Occupier with prescribed rules
Assist occupier in training

Allow occupier to see whether thee treatment is being carried out

as per rules
Duties : Storage / Packaging / Transport

Segregation as per schedule I

Storage labelling as per schedule IV

Transport only in vehicles in compliance with the SPCB norms

and labeled as per Schedule IV
Untreated waste not to be stored for > 48 hrs

Pre-treatment of Lab waste as per standards prescribed by WHO

 Authorization Procedure
Once for Non Provisional
bedded occupiers Authorisation Occupier

within
90
days

Form III Form II In case of any

change

Prescribed
authority
 Annual Report

Occupier

Form
Ministry
IV

31st July
31st August 30th June

Central
Pollution Prescribed
Control Authority
Board
 Accident Reporting
• What Is Major Accident : Accident having the potential to affect large
masses of public
• Toppling of the transport truck
• Accidental release of bio-medical waste

Immediate

Intimation to the prescribed authority

Within 24 hrs
FORM I

Remedial steps taken

Where Will You Put ????
Where Will You Put??
Bio-medical Waste : 2018
• Phase out use of Chlorinated Plastic : By March 2019

• HCF with <10 beds : STP by Dec 2018

Imp points BMW 2016
((a) The ambit of the rules has been expanded to include vaccination
camps, blood donation camps, surgical camps or any other healthcare
activity
(b) Phase-out the use of chlorinated plastic bags, gloves and blood bags
within two years
(c) Pre-treatment of the laboratory waste, microbiological waste, blood
samples and blood bags through disinfection orsterilization on-site in the
manner as prescribed by WHOor NACO
(d) Provide training to all its health care workers and immunize all health
workers regularly
Imp points BMW 2016

(e) Establish a Bar-Code System for bags or containers containing bio-

medical waste for disposal
(f) Report major accidents
(g) The new rules prescribe more stringent standards for incinerator to
reduce the emission of pollutants in environment
(h) Existing incinerators to achieve the standards for retention time in
secondary chamber and Dioxin and Furans within two years
Imp points BMW 2016
(j) Bio-medical waste has been classified in to 4 categories instead of 10
(k) Procedure to get authorization simplified. Automatic authorization for
bedded hospitals. The validity of authorization synchronized with validity
of consent orders for Bedded HCFs. One time Authorization for Non-
bedded HCFs
(l) No occupier shall establish on-site treatment and disposal facility, if a
service of `common bio-medical waste treatment facility is available at
distance of seventy-five kilometers
(m)Operator of a common bio-medical waste treatment and disposal facility
to ensure the timely collection of bio-medical waste from the HCFs and
assist the HCFs in conduct of training
 Kayakalp - More than Clean Hospitals
Enhanced Patient
Satisfaction
Improved cleanliness

Improved
Speedy Recovery
Aesthetics
Healthy
Behaviour

Less Hospital Stay

Reduced
Infections
Morbidity
 KAYAKALP : A Brief

STAFF INTERVIEW (SI)

OBSERVATION (OB)

RECORD REVIEW (RR) PATIENT INTERVIEW (PI)

KAYAKALP : What does it say about BMW
KAYAKALP : A Brief
 All Requirements in Checkpoint are Meeting
Full
Compliance
2  All Tracers given in Means of verification are
available
 Intent of check point is meeting

 Some of the requirements in checkpoints are

Partial
Compliance 1 meeting
 50% -99% of tracers in Means of verification
are available
 Intent of check point is partially meeting

Non  Most of the requirements are not meeting

Compliance
0  Less than 50% of tracers in Means of
verification are available
 Intent of Check point is not meeting
 BMW
Mgt in
AFMS

BMW
Mgt
Rules
Guidelines For Management
Of
BMW In The Armed Forces
 Guidelines for Armed Forces

If required
3548/DGAFMS/D
3548/1(d)/BMW/D guidelines can be
G-3A dt 27 feb
GAFMS/DG-3A dt modified for AF
2008 & 05 May
10 Dec 2016 regards to BMW
2008
handling and mgt
 Uniform guidelines for
handling and disposing BMW
in HCEs of Armed Forces in
conformity with BMW rules
2016
Aim
Gives an outline for mgt of
BMW form highest echelon to
the unit level and framework
for the SOP to be prepared at
the functional levels
 Application of BMW Rules 2016

To all who generate, collect, receive, store, transport, treat,

dispose or handles BMW in any form

Includes Hosp, Dispensaries, animal houses, path labs, blood

banks, Clinical establishments, research & educational
institutions, health camps, blood donation camps
(All Health Care establishments in Armed Forces come under the
purview of these rules)
 Advisory Committee
Chairman:
DGHS (AF)

Member Secretary:
Dir AFMS (H) Rep from MOHFW

Rep from MOD Rep from MOE & F

Reps from DGsMS,

DGDS, RVC Dte, E –in – C
Branch
 Functions of the Advisory Committee
• To lay down the general policy for implementation of
Rules

• To assist DGAFMS in effective mgt of BMW in HCEs

• To scale all consumables including Chemicals required

at each levels

• Periodic revision of scales and authorization in ME

scales
Contd.
• Dir AFMS (H)

• To assist in implementation DGHS (AF) & Addl DGAFMS

(MR) in implementation
• Ensuring timely submission of all reports to MOD/ MOE
&F
• Disseminate info and guidelines to the three service Dtes
• To incorporate info related to BMW functioning in Annual
Health Report of Armed Forces
O/ o The DGsMS

BMW
Committee

Dir Health/ Jt Dir Health 02 Offrs designated

 Functions

• Assist in implementation of BMW Rules in the HCEs of

the respective services

• Compile and analyze reports & returns from Comds

• Timely submission DGAFMS/ DG-3A

 Commands

• MG Med/ CMO/ CPO Comds

• To critically analyze and implement BMW orders

• To inspect BMW facilities during Tech Inspection

• To designate One Offr to assist in effective

implementation
 Corps/ Div/ Area

• MG Med/ Brig Med/ Col Med

• A designated Nodal Offr to assist

• Nodal Offrs to visit HCEs once a yr to monitor

functioning and to advice for improvements

• To designate One Offr to assist in effective

implementation
 HCEs
• CO is responsible for implementation
• To make an application for authorization in Form II for
Initial and Renewal to the Prescribed authority
• Appoint BMW committee
• To submit Annual Report in Form IV by 31 Jan every yr
to O/ o DGMS
• To report any major accidents
• Procurement of consumables (LP if Central supply does
not materialize
 BMW Committee
• Sr Registrar
• Pathologist
• PM
• QM/ Adm Offr
• OC SHO/ Community Med Spl
• Rep of MES
• JCO i/c Sanitation
• Senior most HK
• Any other person deemed necessary
 Function of BMW

• Segregation at source, Collection, Labelling, Storage, Transport

to site of T/t, final disposal

• Inventory of waste, Wt and Category wise

• Maintaining record

• Ensuring use of protective clothing/ eqpt

• Ensuring education & trg of handler and staff (twice a yr)

 Authorization
• Every occupier/ operator handling BMW to make an application
in Form II
• Bedded HCEs: Form II + Inspection Report(induplicate) to be
fwd to O/ o DGAFMS for New/ Renewal
• Non Bedded HCEs: One time authorization, shall be deemed to
have been granted if not objected by O/ o DGAFMS
 Reports & Returns
S Reports/ Returns Periodicity Remarks
No.
(a) Authorization/ Renewal of Once every 5th yr To reach 03 mths
authorization certificate before the expiry
(b) Annual Report HCEs to initiate
by the 31st Jan of
the following yr
DGsMS to fwd
consolidated
report to O/o
DGAFMS by 15th
Mar
 Monitoring
• Internal/ External waste audit to be carried out to assess the
functioning of BMW mgt system to rectify shortcomings
• Waste mgt Offr to inspect the facility once in a month. Comdt/ CO to
evaluate the system once in a quarter
• Community Med Spl/ nodal Offr designated to inspect BMW facility of
HCEs while applying for Initial or Renewal of authorization
• CPCB to monitor implementation in respect of AF HCEs under MoD
• CPCB Along with 1 or more rep of Advisory committee can inspect
after prior intimation
 Funds
• Service HQ to make provision and allot funds required for
outsourcing of BMW to CBMWTF
 BMW
Mgt in
AFMC

BMW
Mgt in
AFMS
 AFMC BMW Mgt

• Before 01 July 2017

• After 01 July 2017

 Scheme
• Need Analysis & Plan Formulation

• Implementation of Plan
 Need Analysis & Plan Formulation
• Based on existing setup

• BOO (? O/s or In-house)

• Fund

• Procurement (PPE, IEC, Waste Bins, Rickshaw)

• Trg
 BMW COMMITTEE

• Formulation of SOP & its Amendment time to time

• Supervision on BMW Guideline Compliance
• Trg
• Ensure use of PPE
• Medical Examination & Vaccination
• Internal Audit, Report & Return
 BENCHMARK
• Zero error in segregation

• 100% use of PPE while segregating (donning/removing

sequence)

• 100% BMW SIGN labeled bin

 CONTD……
• 100% use of non-chlorinated bag only with bar
code

• No storage beyond 24 hrs or 100% same day

disposes off to CKS

• 100% availability of Anti-Spill kit at source