Biomedical waste

On-site versus off-site

These healthcare workers are being trained to safely handle contaminated wastes before being assigned to an outbreak of Ebola hemorrhagic fever.

Disposal occurs off-site, at a location that is different from the site of generation. Treatment may occur on-site or off-site. On-site treatment of large quantities of biomedical waste usually requires the use of relatively expensive equipment, and is generally only cost effective for very large hospitals and major universities who have the space, labor and budget to operate such equipment. Off-site treatment and disposal involves hiring of a biomedical waste disposal service (also called a truck service) whose employees are trained to collect and haul away biomedical waste in special containers (usually cardboard boxes, or reusable plastic bins) for treatment at a facility designed to handle biomedical waste.

Generation and accumulation

Biomedical waste should be collected in containers that are leak-proof and sufficiently strong to prevent breakage during handling. Containers of biomedical waste are marked with a biohazard symbol. The container, marking, and labels are often red.

Discarded sharps are usually collected in specialized boxes, often called needle boxes.

Specialized equipment is required to meet OSHA 29 CFR 1910.1450^[5] and EPA 40 CFR 264.173.^[6] standards of safety. Minimal recommended equipment include a fume hood and primary and secondary waste containers to capture potential overflow. Even beneath the fume hood, containers containing chemical contaminants should remain closed when not in use. An open funnel placed in the mouth of a waste container has been shown to allow significant evaporation of chemicals into the surrounding atmosphere, which is then inhaled by laboratory personnel, and contributes a primary component to the threat of completing the fire triangle. To protect the health and safety of laboratory staff as well as neighboring civilians and the environment, proper waste management equipment, such as the Burkle funnel in Europe and the ECO Funnel in the U.S., should be utilized in any department which deals with chemical waste. It is to be dumped after treatment.

Storage

Storage refers to keeping the waste until it is treated on-site or transported off-site for treatment or disposal. There are many options and containers for storage. Regulatory agencies may limit the time for which waste can remain in storage. Handling is the act of moving biomedical waste between the point of generation, accumulation areas, storage locations and on-site treatment facilities. Workers who handle biomedical waste must observe standard precautions.^[7]

Treatment

The goals of biomedical waste treatment are to reduce or eliminate the waste's hazards, and usually to make the waste unrecognizable. Treatment should render the waste safe for subsequent handling and disposal. There are several treatment methods that can accomplish these goals.

Biomedical waste is often incinerated. An efficient incinerator will destroy pathogens and sharps. Source materials are not recognizable in the resulting ash.

An autoclave may also be used to treat biomedical waste. An autoclave uses steam and pressure to sterilize the waste or reduce its microbiological load to a level at which it may be safely disposed of. Many healthcare facilities routinely use an autoclave to sterilize medical supplies. If the same autoclave is used to sterilize supplies and treat biomedical waste, administrative controls must be used to prevent the waste operations from contaminating the supplies. Effective administrative controls include operator training, strict procedures, and separate times and space for processing biomedical waste.

Microwave disinfection can also be employed for treatment of Biomedical wastes. Microwave irradiation is a type of non-contact heating technologies for disinfection. Microwave chemistry is based on efficient heating of materials by microwave dielectric heating effects. When exposed to microwave frequencies, the dipoles of the water molecules present in cells re-align with the applied electric field. As the field oscillates, the dipoles attempts to realign itself with the alternating electric field and in this process, energy is lost in the form of heat through molecular friction and dielectric loss. Microwave disinfection is a recently developed technology which provides advantage over old existing technologies of autoclaves as microwave based disinfection has less cycle time, power consumption and it requires minimal usage of water and consumables as compared to autoclaves.

For liquids and small quantities, a 1–10% solution of bleach can be used to disinfect biomedical waste. Solutions of sodium hydroxide and other chemical disinfectants may also be used, depending on the waste's characteristics. Other treatment methods include heat, alkaline digesters and the use of microwaves.

For autoclaves and microwave systems, a shredder may be used as a final treatment step to render the waste unrecognizable. Some autoclaves have built in shredders^[8].

United Kingdom

In the UK, clinical waste and the way it is to be handled is closely regulated.^[9] Applicable legislation^[10] includes the Environmental Protection Act 1990 (Part II), Waste Management Licensing Regulations 1994, and the Hazardous Waste Regulations (England & Wales) 2005, as well as the Special Waste Regulations in Scotland.

United States

In the United States, biomedical waste is usually regulated as medical waste. In 1988 the U.S. federal government passed The Medical Waste Tracking Act which allowed the EPA to establish rules for management of medical waste in some parts of the country. After the Act expired in 1991, responsibility to regulate and pass laws concerning the disposal of medical waste returned to the individual states. The states vary in their regulations from none to very strict.

In addition to on-site treatment or pickup by a biomedical waste disposal firm for off-site treatment, a mail-back disposal option allows generators of waste to return it to the manufacturer. For instance, waste medicines and equipment can be returned. The waste is shipped through the U.S. postal service. While available in all 50 U.S. states, mail-back medical waste disposal is limited by very strict postal regulations (i.e., collection and shipping containers must be approved by the postal service for use).

India

The Bio-medical Waste (Management and Handling) Rules, 1998 and further amendments were passed for the regulation of bio-medical waste management. On 28 th Mar 2016 Biomedical Waste Management Rules 2016 were also notified by Central Govt. Each state's Pollution Control Board or Pollution control Committee will be responsible for implementing the new legislation.^[11]

In India,though there are a number of different disposal methods,the situation is desultory and most are harmful rather than helpful. If body fluids are present, the material needs to be incinerated or put into an autoclave. Although this is the proper method, most medical facilities fail to follow the regulations. It is often found that biomedical waste is dumped into the ocean, where it eventually washes up on shore, or in landfills due to improper sorting or negligence when in the medical facility. Improper disposal can lead to many diseases in animals as well as humans. For example, animals, such as cows in Pondicherry, India, are consuming the infected waste and eventually, these infections can be transported to humans who consume their meat or milk. Large number of unregistered clinics and institutions also generate bio-medical waste which is not controlled.

Due to the competition to improve quality and so as to get accreditation from agencies like ISO, NABH, JCI, many private organizations have initiated proper bio-medical waste disposal but still the gap is huge.

Many studies took place in Gujarat, India regarding the knowledge of workers in facilities such as hospitals, nursing homes, or home health. It was found that 26% of doctors and 43% of paramedical staff were unaware of the risks related to biomedical wastes. After extensively looking at the different facilities, many were undeveloped in the area regarding biomedical waste. The rules and regulations in India work with The Bio-medical Waste (Management and Handling) Rules from 1998, yet a large number of health care facilities were found to be sorting the waste incorrectly.

The latest guidelines for segregation of bio-medical waste recommend the following color coding - ^[12]

• Red Bag - Syringes (without needles), soiled gloves, catheters, IV tubes etc should be all disposed of in a red colored bag, which will later be incinerated.
• Yellow Bag - All dressings, bandages and cotton swabs with body fluids, blood bags, human anatomical waste, body parts are to be discarded in yellow bags.
• Carboard box with blue marking - Glass vials, ampules, other glass ware is to be discarded in a cardboard box with a blue marking/sticker.
• White Puncture Proof Container (PPC) - Needles, sharps, blades are disposed of in a white translucent puncture proof container.
• Black Bags - These are to be used for non-bio-medical waste. In a hospital setup, this includes stationary, vegetable and fruit peels, leftovers, packaging including that from medicines, disposable caps, disposable masks, disposable shoe-covers, disposable tea cups, cartons, sweeping dust, kitchen waste etc.