Env - Biomedical Waste Management

Some suggestions to make BMW Rules more effective:
• Disinfection and mutilation of needle and syringes may be thought to be at the hospitals and other healthcare facilities itself to minimize risks of sharps injuries in transit.
• MSW segregation may follow what is provided in the MSW Rules 2000.
• Schedule I – Chlorinated plastic waste bags, such as blood bags may be mentioned as a separate category with option of disinfection etc in autoclave/microwave, discharge of content in sewer, and recycling of the waste blood bags.
• Schedule II – There appears to be repetition at Blue and Black bags (Col 3 & 4) – in both non chlorinated plastic bags have been mentioned. This may be clarified/rectified.
• Schedule II – Instead of black bags for MSW the colour may be in accordance with MSW Rules – 2000.
• No colour code has been provided for chlorinated plastic waste bags, which may be white as blue colour coding may be confusing with other municipal solid waste collection system.
• Waste may also be categorised as per intended option. This way number of waste categories will be less thus saving on cost. It may be better understood and compliance may be easier. Option based categorization, meaning thereby collection of biomedical waste may be as per the intended option as follows:

1. Bio-degradable-
Infected.
i. Papers, linen, cotton swabs etc
ii. Pathological waste
iii. Human & animal tissue & parts
iv. Food waste
v. Wrappings of medicine removed
in the wards/ patient care area
vi. Miscellaneous disposables used During patient care, in OT, and in laboratories
vii. Food waste (which has come in contact with the patients)
Non-infected.
i. Paper, linen etc
ii. Food waste (from kitchen, cafeteria etc.)
iii. Medicine wrappings removed before medicines are issued to the wards/ patient care areas
iv. Miscellaneous items

2. Bio-non-degradable
i. Infected. (including linen soiled/contaminated with blood and/or body fluids, intended to be reused)
ii. Plastic waste
iii. Metals used in healthcare
iv. Plastic & glass tubes used in patient care
v. Sharps
vi. Reusable plastic & rubber items
vii. Gloves
viii. Discarded POP casts

Non-infected
i. Plastic waste
ii. Plastic wrappings
iii. Metals & glass
iv. Sharps
v. Rubberized items

3. Liquid Waste
i. Wash from wards, OT, labor room, laboratory etc
ii. Wash from infectious & quarantine wards
iii. Faeces & urine waste from patients known to be suffering from renal and GI infections
Notes: -
• Liquid waste from healthcare facilities should be suspected to be infectious unless determined otherwise.
• Liquid waste in large HCF can be treated in Effluent Treatment Plant (ETP), which would afford added advantage of ensuring waste treatment, and also generate the reusable water.
• Liquid waste from highly infectious areas, such as from infectious wards and special wards (such as wards having SARS patients or patients suffering from Avian flu), should be contained and treated before letting it in the channel for ETP.
4. Recyclables
Recyclables are usually plastic waste, metal waste, glass waste, and sharp waste. Though all the recyclables are mentioned in the list above either as infectious or as non-infectious it would be better to view these as a separate entity. However all recyclables must undergo treatment to render it non-infectious before these can be shredded and sent for recycling.
So, if one was to devise classification of infected waste based on terminal treatment option/s the picture would emerge somewhat as follows: -

If this concept of option- based classification is applied, HCW may be classified in the following six categories, as below: -
Category A, Waste for WSU: -
1. Infected Paper waste
2. Paper wrappings from wards & patient care areas
3. Linen waste, soiled cotton & swabs waste etc
4. Food Waste
Category B, Waste for Microwave: -
Plastic waste
Category C, Waste for Incinerator: -
Human & Animal tissue waste/ parts
Category D, Waste for Autoclave: -
1. Pathological waste in the labs
2. Metal waste
3. Glass waste
4. Sharps waste
Category E, Waste for Recycling
1. General paper waste
2. Plastic waste
3. Rubber waste
4. Reusable linen waste
5. Metal waste, including volatile metal waste

Note: - Waste intended for recycling must be disinfected and mutilated, wherever required.