Biomedical waste management

Mr. Parag Chauhan

Introduction

Biomedical waste includes infectious, pathological, chemical, pharmaceutical, radioactive, and sharps waste produced during healthcare activities.

Why BMW management is critical:

  • Prevents hospital-acquired infections (HAIs)

  • Reduces transmission of HIV, HBV, HCV from sharps injuries

  • Prevents contamination of soil, air, and water

  • Complies with national and international regulations

  • Reduces legal liability for hospitals

  • Ensures the safety of:

    • Healthcare workers

    • Waste-handling staff

    • Scavengers

    • General public

    • Environment

Global Context:

  • WHO estimates 15–20% of healthcare waste is hazardous, but improper segregation makes up to 70% hazardous.

  • Developing countries face challenges due to inadequate treatment facilities.

 

Classification of Biomedical Waste

  • Biomedical waste management in India, as governed by the Biomedical Waste Management Rules (BMWM), 2016 and amendments (2018, 2019, 2023), mandates a standardized color-coded segregation system for safe collection, storage, transport, treatment, and disposal of healthcare-generated waste.
  • The six-color system ensures minimal cross-contamination, worker safety, reduced environmental toxicity, and efficient downstream processing.

 

1. Yellow Category – Incineration / Deep Burial / Autoclaving

Purpose:

Destruction of infectious, pathological, and anatomical waste that contains high microbial load and poses a risk of infection and environmental contamination.

What Goes Into Yellow Bags/Containers:

A. Human Anatomical Waste

    • Tissues, organs, limbs
    • Placenta, umbilical cord, fetus (≤24 weeks as per guidelines)

B. Animal Waste (from research labs, vets, animal houses)

    • Carcasses, body parts, tissues, organs

C. Soiled Waste

    • Blood-soaked cotton, gauze, dressings, swabs
    • Bandages, plaster casts with blood/body fluids
    • Materials contaminated with pus, sputum (e.g., TB wards)

D. Expired or Discarded Medicines

    • Antibiotics, cytotoxic drugs (non-genotoxic)
    • Ampoules, vials without sharps

E. Microbiology and Biotechnology Waste

    • Cultures, stocks, sample plates, broths
    • Autoclaved and disinfected microbiology waste (though some states require red bags after autoclaving)

Treatment & Disposal:

    • Incineration at ≥ 850°C (for hazardous infectious waste)
    • Deep burial (only for rural <5 lakh population)
    • Autoclaving + shredding where applicable
    • Cytotoxic drugs → secured landfills

Why Yellow?

High-risk waste that requires complete destruction rather than recycling.

2. Red Category – Recyclable Contaminated Waste

Purpose:

Collection of non-infectious, non-anatomical plastics that are contaminated but sterilizable and capable of being recycled.

What Goes Into Red Bags/Containers:

Contaminated Plastics:

  • IV tubing, catheters
  • Urine bags, enema bags
  • Syringes (without needles)
  • Gloves, masks, head-caps, shoe covers
  • Blood bags after expiry (without blood residue)

Lab Disposables:

  • Petridishes, Falcon tubes, microcentrifuge tubes (after disinfection)
  • Autoclavable plastic pipettes
  • Vacutainers (without needles)

Treatment & Disposal:

  • Pre-treatment: Autoclaving / microwaving / hydroclaving
  • Shredding into flakes
  • Recycling via authorised plastic recyclers

Why Red?

Represents waste that is not destroyable but recoverable, promoting hospital sustainability.

3. White Category (Translucent) – Sharps Waste Container

Purpose:

Safe containment of sharp objects that can puncture, cut, or cause percutaneous injury.

What Goes Into White Containers:

Sharps:

  • Needles (used/unused)
  • Scalpels, surgical blades
  • Lancets
  • Glass slides/coverslips (state-specific variations)
  • Metallic chips and orthodontic wires (dental)
  • Needle-tip of syringe after needle cutter

Critical Requirements:

  • Puncture-proof, leak-proof, tamper-proof containers
  • Must be rigid and sealed once 3/4th full

Treatment & Disposal:

  • Autoclaving / dry heat sterilization
  • Shredding or encapsulation
  • Metal recovery or disposal in secured landfill

Why White?

Neutral color for sharps to avoid association with other waste categories and ensure immediate identification.

4. Blue Category – Glassware and Metallic Implants

Purpose:

Segregation of breakable, reusable, or recyclable hard waste, particularly laboratory and pharmaceutical glassware.

What Goes Into Blue Containers (Cardboard boxes with blue marking):

Glass Waste:

  • Glass vials
  • Ampoules (non-hazardous residues)
  • Broken or discarded laboratory glassware (beakers, test tubes)
  • Reagent bottles

Metallic Waste:

  • Implants (orthopedic plates, screws, prostheses)
  • Dental amalgam capsules (requires pre-treatment if containing mercury)

Treatment & Disposal:

  • Disinfection / autoclaving
  • Recycling by authorised recyclers
  • Mercury-containing waste → special mercury reclamation process

Why Blue?

Indicates recyclable non-plastic rigid material.

5. Black Category – Hazardous Chemical Waste / Pharmaceutical Waste

Note: Black category is used in many states for chemical/expired drug waste storage, although recent guidelines try to reduce its usage. Many hospitals still use black for heavy chemicals.

Purpose:

To store waste that cannot be incinerated due to toxic fumes, cannot be recycled, and is unsuitable for yellow bag incineration.

What Goes Into Black Containers:

Chemical Waste:

  • Laboratory chemical reagents
  • Solvents, acids, alkalis
  • Fixatives (formalin)
  • Disinfectants and expired laboratory reagents

Pharmaceutical Waste:

  • Cytotoxic drugs (chemotherapy waste)
  • Genotoxic materials
  • Ampoules containing toxic chemicals
  • Heavy metal waste (mercury thermometers, batteries)

Treatment & Disposal:

  • Chemical neutralization
  • Incineration at specialized hazardous waste facilities
  • Secured landfilling

Why Black?

Represents non-infectious but chemically dangerous waste.

6. Green Category – General / Non-Biomedical Waste

Purpose:

Segregation of non-contaminated, domestic-type waste produced inside healthcare settings.

What Goes Into Green Containers:

General Waste:

  • Paper, cardboard
  • Food leftovers
  • Packaging material
  • Non-blood stained cotton, gauze
  • Plastic wrappers, cups, plates
  • Office waste

Treatment & Disposal:

  • Municipal waste handling
  • Recycling
  • Composting (for biodegradable waste)

Why Green?

Indicates safety and recyclability, ensuring waste is not over-classified as biomedical.

 

Workflow of Biomedical Waste Management

Below is a full hospital-level workflow incorporating regulatory, administrative, and operational components.

Generation

Occurs in:

  • OT, ICU, Wards

  • Labs (biochemistry, microbiology, hematology)

  • Radiology

  • Dialysis unit

  • Emergency

  • Blood bank

Segregation at Source (Critical Control Point)

This step determines the success of the entire BMW system.

Key requirements:

  • Must be done at the point of generation

  • No secondary segregation allowed

  • Use BIS-approved color-coded bins

  • Sharp containers must be closed when 3/4 full

Segregation errors cause:

  • Increased cost

  • Increased infection risk

  • Overloading of treatment plants

  • Legal non-compliance

Collection and Internal Movement

  • Waste should be collected every 2–4 hours depending on hospital size

  • Use closed trolleys with foot-operated lids

  • Trolleys must follow designated waste routes separate from patient areas

  • Avoid bag rupture and spillage

Intermediate Storage

  • Maximum holding time: 48 hours

  • Storage zone must have:

    • Impermeable flooring

    • Drainage system

    • CCTV surveillance

    • Restricted access

    • Biohazard signboard

    • Record register

Temperature Control:

  • Microbiological waste: 4–8°C (if not autoclaved immediately)

Barcoding and GPS Tracking

Mandatory since the BMW (Amendment) Rules 2018.

Benefits:

  • Prevents pilferage

  • Ensures traceability

  • Enables monitoring of waste flow

  • Reduces illegal disposal

External Transportation

  • Uses special BMW vehicles with:

    • GPS

    • Leak-proof containers

    • Disinfection protocol

    • Driver certification

Treatment Technologies

1. Autoclaving

    • 121°C at 15 psi (30 min)

    • Kills bacteria, viruses, spores

    • Validation: Biological indicators (Bacillus stearothermophilus)

2. Hydroclave

    • Uses steam + mechanical agitation

    • Suitable for moisture-rich waste

3. Microwave Irradiation

    • Heats waste using electromagnetic energy

    • No incineration emissions

4. Incineration

    • Two-stage combustion:

      • Primary: 800–900°C

      • Secondary: 1000–1200°C

    • Used for yellow category and cytotoxic waste

    • Requires scrubbers, filters, and chimneys to remove pollutants

5. Plasma Pyrolysis

    • Converts waste into syngas at >5000°C

    • Environmental friendly

6. Chemical Disinfection

For liquid waste:

    • Sodium hypochlorite

    • Formaldehyde

    • Glutaraldehyde

7. Deep Burial

Only for rural areas with no access to CTFs.

Final Disposal

Depends on treatment method:

Waste Type Final Disposal
Autoclaved plastics Shredding + Recycling
Incinerator ash Secured landfill
Sharps Encapsulation + Landfill
Glass waste Recycling
Chemical waste Neutralization + Disposal

 

Biomedical Waste in Laboratories: Advanced Level

Biochemistry Lab Waste

  • Reagents containing acids, alkalis

  • Organic solvents

  • Heavy metal-containing reagents (copper, arsenic)

  • Disposable pipette tips

  • Blood/urine samples

Management:

  • Neutralization

  • Chemical deactivation

  • Autoclaving of contaminated plastics

Microbiology Lab Waste

  • Live cultures

  • Petri dishes

  • Biohazardous materials

Must undergo:

  • Autoclaving

  • Surface disinfection

  • High-level PPE usage

Histopathology Lab Waste

  • Xylene

  • Formalin

  • Tissue blocks

  • Staining reagents

Must follow:

  • Chemical waste protocols

  • Fume hood regulations

 

Liquid Biomedical Waste

Sources:

  • Diagnostic labs

  • Dialysis units

  • Operation theatres

  • Laundry

  • Radiology wash areas

Required Treatments:

  • Chlorination (0.5–1% available chlorine)

  • pH correction

  • Neutralization

  • Biological oxidation

  • CPCB standards final discharge

 

Occupational Health & Safety

Hazards:

  • Needle-stick injuries

  • Chemical burns

  • Aerosol exposure

  • Radiation exposure (in imaging centers)

Protection:

  • PPE

  • Biosafety cabinets

  • HBV vaccination

  • NSI protocol

  • Exposure register maintenance

 

Monitoring, Auditing & Quality Assurance

Hospitals must adopt a continuous monitoring system:

Internal Audits

  • Weekly BMW inspections

  • Color-code compliance checks

  • Waste composition analysis

External Audits

  • State Pollution Control Board inspections

  • NABH/NABL accreditation audits

Performance Indicators

  • Segregation efficiency (% non-infectious waste in red bags)

  • Per-capita waste generation rate

  • Sharps injury incidents

  • Timeliness of waste transport

 

Legal, Ethical & Environmental Framework

Legislative Requirements (India):

  • Bio-Medical Waste Management Rules, 2016

  • Supplementary Amendments 2018, 2019, 2022

  • CPCB guidelines

  • Environment Protection Act 1986

  • Water & Air (Prevention & Control of Pollution) Acts

Penalties for Non-compliance:

  • Heavy fines

  • Suspension of hospital license

  • Criminal charges

  • Environmental compensation fees

 

Innovations & Future Trends in Biomedical Waste Management

IoT-Enabled Smart Bins

  • Automatic segregation

  • Fill-level sensors

  • Real-time monitoring

RFID-Based Waste Tracking

  • Ensures complete traceability

AI-Based Waste Prediction Models

  • Helps optimize waste collection routes

  • Reduces costs

Green Hospital Concepts

  • Zero-waste systems

  • Solar-powered autoclaves

  • Waste-to-energy systems

 

MCQs

1. Biomedical waste management rules in India were first implemented in which year?

a) 1995
b) 1998
c) 2000
d) 2005
Answer: b) 1998

2. The latest amendment of Biomedical Waste Management Rules was issued in:

a) 2016
b) 2018
c) 2019
d) 2021
Answer: c) 2019

3. The primary objective of BMW management is:

a) Reduce hospital cost
b) Reduce legal burden
c) Reduce health and environmental risk
d) Improve aesthetics
Answer: c) Reduce health and environmental risk

4. The agency responsible for regulating BMW in India is:

a) WHO
b) NCDC
c) CPCB
d) ICMR
Answer: c) CPCB

5. How many color-coded categories are used in BMW segregation?

a) 4
b) 5
c) 6
d) 7
Answer: a) 4 (Yellow, Red, White, Blue)

6. Yellow bin is used for:

a) Plastic waste
b) Sharps
c) Infectious and pathological waste
d) Glassware
Answer: c) Infectious and pathological waste

7. Red bin is meant for:

a) Anatomical waste
b) Recyclable contaminated plastic waste
c) Metallic implants
d) Glass bottles
Answer: b) Recyclable contaminated plastic waste

8. White (translucent) container is used for:

a) Sharps waste
b) Human tissues
c) Cytotoxic drugs
d) Gloves
Answer: a) Sharps waste

9. Blue bin is used for:

a) Infectious waste
b) Broken glassware and metallic implants
c) Sharps
d) Plastic tubing
Answer: b) Broken glassware and metallic implants

10. Which waste must be disposed of by incineration only?

a) Gloves
b) Syringes
c) Human tissues
d) IV sets
Answer: c) Human tissues

11. What is the maximum storage time for BMW in a health-care facility?

a) 12 hours
b) 24 hours
c) 48 hours
d) 72 hours
Answer: b) 24 hours

12. Cytotoxic waste should be disposed by:

a) Autoclaving
b) Microwave
c) Incineration at ≥1200°C
d) Chemical disinfection
Answer: c) Incineration at ≥1200°C

13. Plastic waste is treated by:

a) Deep burial
b) Autoclaving + shredding
c) Incineration
d) Chemical disinfection only
Answer: b) Autoclaving + shredding

14. Sharps must be disinfected using:

a) Sodium hypochlorite
b) Autoclave
c) Both a and b
d) Formaldehyde
Answer: c) Both a and b

15. Bar-coded bags in BMW management are:

a) Mandatory
b) Optional
c) Only for yellow category
d) Only for red category
Answer: a) Mandatory

16. What is the color code for microbiology laboratory waste?

a) Red
b) Yellow
c) Blue
d) White
Answer: b) Yellow

17. Which of the following is not hazardous biomedical waste?

a) Blood-soaked cotton
b) Used syringes
c) Food leftovers
d) Used gloves
Answer: c) Food leftovers

18. What is the permissible chlorine concentration for chemical disinfection?

a) 0.1%
b) 0.5%
c) 1%
d) 5%
Answer: c) 1%

19. The common method for treating liquid biomedical waste is:

a) Autoclaving
b) Incineration
c) Chemical disinfection
d) Deep burial
Answer: c) Chemical disinfection

20. Deep burial is allowed only in:

a) Rural areas
b) Metro cities
c) Industrial zones
d) Coastal areas
Answer: a) Rural areas

21. Which type of waste is “soiled waste”?

a) Blood bags
b) Contaminated cotton, dressings
c) Cytotoxic bottles
d) Glassware
Answer: b) Contaminated cotton, dressings

22. Glassware used in labs is disposed in which bin?

a) Red
b) White
c) Blue
d) Yellow
Answer: c) Blue

23. Anatomical waste includes:

a) Lab cultures
b) Human tissues and organs
c) Plastic syringes
d) Chemical waste
Answer: b) Human tissues and organs

24. Waste generated from blood bags goes to:

a) Yellow
b) Red
c) Blue
d) White
Answer: a) Yellow

25. Used IV tubing (without needles) should be disposed in:

a) Yellow
b) Red
c) White
d) Blue
Answer: b) Red

26. The symbol for biomedical waste is:

a) Skull
b) Biohazard sign
c) Radiation sign
d) Poison sign
Answer: b) Biohazard sign

27. BMW segregation point is:

a) Hospital gate
b) Treatment facility
c) Point of generation
d) Storage room
Answer: c) Point of generation

28. Bitcoin pit is used for:

a) Laboratory waste
b) Sharps waste
c) Placenta disposal
d) Cytotoxic drug disposal
Answer: c) Placenta disposal

29. Needle destruction should occur:

a) Before use
b) After use
c) Before sending to treatment plant
d) At storage area
Answer: b) After use

30. Immunization waste (syringes without needles) goes to:

a) Blue
b) Red
c) White
d) Yellow
Answer: b) Red

31. Antibiotics and expired medicines fall under:

a) Cytotoxic waste
b) Pharmaceutical waste
c) Chemical waste
d) Hazardous liquid waste
Answer: b) Pharmaceutical waste

32. Biomedical waste accounts for how much % of total hospital waste?

a) 1–2%
b) 5–10%
c) 15–20%
d) 25–30%
Answer: b) 5–10%

33. What is the preferred method for sharp destruction?

a) Gravimetric disposal
b) Needle cutter or burner
c) Deep burial
d) Chemical disinfection
Answer: b) Needle cutter or burner

34. The temperature for autoclaving BMW should be:

a) 80°C
b) 100°C
c) 121°C
d) 150°C
Answer: c) 121°C

35. Which committee is responsible for hospital BMW monitoring?

a) Infection Control Committee
b) Waste Surveillance Committee
c) Hospital Waste Management Committee
d) Quality Control Committee
Answer: c) Hospital Waste Management Committee