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 ~  Abstract
 ~ Introduction
 ~ Schedules
 ~ Concluding Remarks
 ~  References
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  Table of Contents  
SPECIAL ARTICLE
Year : 2017  |  Volume : 35  |  Issue : 2  |  Page : 194-198
 

Biomedical waste management guidelines 2016: What's done and what needs to be done


1 Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
2 Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication5-Jul-2017

Correspondence Address:
Vikas Gautam
Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmm.IJMM_17_105

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 ~ Abstract 

The latest biomedical waste (BMW) management guidelines which have been introduced in 2016 are simplified and made easier so that they can be easily followed by various health agencies. The categories of BMW have been reduced from ten (in 1998) to four in the latest (2016) guidelines. Many changes have been made in these latest guidelines, which have been summarised in the article below. The segregation of hospital waste plays a very important role, so the waste has to be sorted out at the source of generation according to the category to which it belongs as given in the newer guidelines. Newer waste treatment facilities such as plasma pyrolysis, encapsulation, inertisation have been introduced, and we have to do away with older facilities such as incineration as toxic fumes (dioxins and furans) are produced which are harmful to both health and environment. We can even think of using these wastewater treatment plants to remove the antimicrobial resistance genes during the processing of the waste, which is being generated from the hospitals.


Keywords: 2016 guidelines, biomedical waste, categories, differences, duties, schedules


How to cite this article:
Singhal L, Tuli AK, Gautam V. Biomedical waste management guidelines 2016: What's done and what needs to be done. Indian J Med Microbiol 2017;35:194-8

How to cite this URL:
Singhal L, Tuli AK, Gautam V. Biomedical waste management guidelines 2016: What's done and what needs to be done. Indian J Med Microbiol [serial online] 2017 [cited 2017 Sep 26];35:194-8. Available from: http://www.ijmm.org/text.asp?2017/35/2/194/209589


Let the waste of the 'sick' not contaminate the lives of 'the healthy'.


 ~ Introduction Top


'Biomedical waste' (BMW) means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps, including the categories mentioned in Schedule I appended to these rules.[1] Infectious waste includes all those medical wastes, which have the potential to transmit viral, bacterial, fungal or parasitic diseases. It includes both human and animal infectious waste and the waste generated in any laboratory and during veterinary practice. Any waste with a potential to pose a threat to human health and life is called hazardous waste. Infectious waste is hazardous in nature, and if the infectious component mixes up with the general non-infectious waste in the black bag, the entire bulk of that black bag waste becomes potentially infectious and to be treated as infectious waste. Therefore, the hospital waste, in addition to the risk for patients and workforce who handle these wastes, poses a serious threat to public health and environment.[2],[3]

Taking cognizance of inappropriate BMW management, Ministry of Environment and Forests notified the 'BMW (management and handling) Rules, 1998' in July 1998. BMW Management Rules have thereafter undergone timely revisions to meet the prevailing needs. Till date, four amendments have been made in 2000, 2003 and 2011 with these latest guidelines coming into force from 28th March 2016. This article discusses comprehensively about the major changes to be implemented by a health facility in lieu of the new BMW rules 2016. These new rules are more comprehensive in nature and contain important features of BMW (M and H) rules, 1998 with several new provisions added to these new rules. BMW (M) rules 2016 contains 4 schedules, 5 forms and 18 rules. Following are the major changes in the new rules as compared to the previous version of the rules [Table 1],[Table 2],[Table 3],[Table 4].[1],[4],[5]
Table 1: Major differences between biomedical waste rules 1998 and 2016

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Table 2: Changes in the schedules

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Table 3: Changes in the forms

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Table 4: Types of biomedical waste (rule 2016) in Schedule I

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 ~ Schedules Top


Let's have a look in details, the changes in the schedules' contents, and as there is no change in the Schedule IV, therefore, it has not been discussed.

Schedule I

In Schedule I of BMW rules 1998, BMW has been categorised into ten categories according to the type of waste, and in new rules 2016, categorisation of BMW has been done according to colour code and type of waste with treatment/disposal options, which are described below. Major change is in the number of categories in these new rules to avoid confusion with the large number of categories, and the number of containers with new coloured container (white) added for the sharps. The key steps for safe and scientific management of BMW in any establishment include handling, segregation, disinfection, storage and proper disposal.[4] The most appropriate way of identifying the categories of BMW is that the waste is sorted out into colour-coded plastic bags or containers after identifying the category to which the BMW belongs [Table 4].[5] BMW needs to be segregated into containers/bags at the point of generation of waste only and no bag/container to be opened once the waste has been put into it.[5]

Schedule II

In Schedule II of BMW rules 1998, BMW has been categorised according to colour code, type of container, waste category and treatment options. The Schedule II of BMW rules 2016 enlists the standards for treatment and disposal of BMW (including plasma pyrolysis and dry heat sterilisation).

Standards for treatment and disposal of biomedical waste (2016)

Every healthcare facility dealing with BMW shall set up required waste treatment facilities such as autoclave and microwave system or make sure that the requisite treatment of waste occurs at a common BMW treatment facility (CBMWTF) or any other BMW treatment facility. The major change in the new rules is that if CBMWTF service is available within 75 km, on-site treatment and disposal facility shall not be established by any occupier. Before the commencement of its operation, every operator of CBMWTF shall set up requisite BMW treatment equipment such as incinerator, autoclave or microwave and effluent treatment plant.

Another concern raised in these new rules is the use of chlorinated plastic bags. Within 2 years from the date of notification of these rules, the use of chlorinated plastic bags, gloves and blood bags is to be phased out. The operator of a CBMWTF should not dispose of such plastics by incineration and the bags should comply with the Bureau of Indian Standards (BIS). The bags used for storing and transporting BMW shall be in compliance with the BIS. Till the standards are published, the carry bags need to be treated as per the Plastic Waste Management Rules, 2011.

Rationale: This is to make the installation and operation of common treatment facility a viable one.

Segregation, packaging, transportation and storage

There are two major changes in this schedule. First, as stated in previous guidelines, untreated waste not to be stored beyond a period of 48 h. If it is necessary to store such waste beyond such a period, the occupier shall take appropriate measures to ensure that the waste does not harm the human health and the environment. The prescribed authority should be informed along with the reasons for doing so. Second, microbiological and other clinical laboratory waste is to be pretreated by sterilisation to Log 6 or disinfection to Log 4, as per the World Health Organization (WHO) or National AIDS Control Organization (NACO) guidelines before packing and sending it to the CBMWTF.

Rationale: This will improve the segregation of waste at source and channelise proper treatment and disposal. It will eliminate obtaining permission within 48 h, which is not practically feasible.

Schedule III

Schedule III of BMW rules 1998 contains the label for BMW container/bags. The Schedule III of BMW rules 2016 enlists the prescribed authorities and the corresponding duties, which are as follows.

List of prescribed authorities and the corresponding duties

Duties of the operator:

  • To ensure that the BMW collected from the occupier is handled, stored, transported and disposed off properly after treatment without any harm to human health and environment
  • To ensure timely collection of BMW from the healthcare facilities
  • The prescribed authorities should be informed immediately about the healthcare establishments/facilities, which are not handling the segregated BMW
  • To provide training of all its workers
  • To undertake appropriate pre-placement and periodic medical examination and immunise all its workers and records for the same
  • To ensure occupational safety by providing protective equipment
  • To develop system of reporting of unintended accidents in Form III with annual report even the nil reporting
  • A log book of treatment equipment according to categories of waste treated; weight of batch should be maintained. Time, date, duration of treatment cycle and total hours of operation of the equipment to be noted in the log book.


Duties of healthcare facilities:

  • Initially, in 1998 guidelines, every occupier of an institution generating BMW was to take all the steps to ensure that the waste is handled without any adverse effect to human health and the environment.


Additions made in biomedical waste rules 2016

  • The laboratory waste, microbiological waste, blood samples and blood bags are to be pretreated through disinfection or sterilisation on-site in the same manner as prescribed by WHO or NACO guidelines, which should then be sent to the CBMWTF for final disposal
  • Within 2 years from the date of notification of these rules, the use of chlorinated plastic bags, gloves and blood bags are to be phased out
  • The healthcare workers and others involved in handling of BMW need to be trained at the time of induction, and at least once every year, thereafter
  • Immunise all its healthcare workers and others involved in handling of BMW for protection against diseases including hepatitis B and tetanus
  • Major accidents caused by fire hazards, blasts occurring while handling BMW and the remedial action accordingly taken need to be reported to State Pollution Control Board.



 ~ Concluding Remarks Top


Newer guidelines have been simplified, and the rules have been made easier to be followed by various health agencies. However, there is always a scope of improvement. Antibiotic resistance is a burning issue today, and it is often conferred by specific genes called as antibiotic resistance genes.[6] The major cause of the accumulation of these genes in the environment is human activity including the waste generated from various health agencies,[7] and the failure of wastewater treatment plants to remove these genes during processing. As observed in various Indian water matrices, a very high hazard quotient represents a potential environmental concern, especially in pharmaceutical industrial wastewater.[8] This is something which we need to focus on priority in future lest our country faces dire consequences in terms of environmental, agricultural and medical fields. Hospitals are the main source of antibiotics which are released into environment and to reduce these residues, research to improve knowledge of the dynamics of antibiotic release from hospitals is essential.[9]

Furthermore, newer technologies need to be adapted fast in our country. Most medical waste is being incinerated, a practice that is short lived because of environmental considerations. The burning of solid and regulated medical waste generated by healthcare system creates many problems such as emitting toxic air pollutants and toxic ash residues, which are the major source of dioxins in the environment. Public concerns about incinerator emissions and its toxic emissions, as well as the creation of strict regulations for medical waste incinerators, are causing many healthcare facilities to reconsider their choices in medical waste treatment. The newer non-incineration treatment technologies can be adapted to create a toxin-free environment.[10]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 ~ References Top

1.
Ministry of Environment and Forests, Notification N. S.O.630 (E). Biomedical Waste (Management and Handling) Rules, 1998. The Gazette of India, Extraordinary, Part II, Section 3(ii), Dated 27th July, 1998. p. 10-20, 460.  Back to cited text no. 1
    
2.
Singh IB, Sarma RK. Hospital waste disposal system & technology. J Acad Hosp Adm 1996-1997;8-9:33-9.  Back to cited text no. 2
    
3.
Chitnis V, Vaidya K, Chitnis DS. Biomedical waste in laboratory medicine: Audit and management. Indian J Med Microbiol 2005;23:6-13.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Acharya DB, Meeta S. The Book of Hospital Waste Management. New Delhi: Minerva Press; 2000. p. 15, 47.  Back to cited text no. 4
    
5.
Ministry of Environment, Forest and Climate Change, Notification. The Gazette of India, Extraordinary, Part II, Section 3(i). Available from: http://www.iwma.in/BMW%20Rules,%202016.pdf. [Last accessed on 2016 Mar 28].  Back to cited text no. 5
    
6.
Zhu YG, Zhao Y, Li B, Huang CL, Zhang SY, Yu S, et al. Continental-scale pollution of estuaries with antibiotic resistance genes. Nat Microbiol 2017;2:16270.  Back to cited text no. 6
    
7.
Chandran SP, Diwan V, Tamhankar AJ, Joseph BV, Rosales-Klintz S, Mundayoor S, et al. Detection of carbapenem resistance genes and cephalosporin, and quinolone resistance genes along with oqxAB gene in Escherichia coli in hospital wastewater: A matter of concern. J Appl Microbiol 2014;117:984-95.  Back to cited text no. 7
    
8.
Mutiyar PK, Mittal AK. Risk assessment of antibiotic residues in different water matrices in India: Key issues and challenges. Environ Sci Pollut Res Int 2014;21:7723-36.  Back to cited text no. 8
    
9.
Diwan V, Stålsby Lundborg C, Tamhankar AJ. Seasonal and temporal variation in release of antibiotics in hospital wastewater: Estimation using continuous and grab sampling. PLoS One 2013;8:e68715.  Back to cited text no. 9
    
10.
Gautam V, Thapar R, Sharma M. Biomedical waste management: Incineration vs. environmental safety. Indian J Med Microbiol 2010;28:191-2.  Back to cited text no. 10
[PUBMED]  [Full text]  



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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