Presented by
Smt. Rameena V V
Assistant Engineer
Kerala State Pollution Control Board

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Health care unit Waste Management
Health care of public Prevention of health hazards caused due to the activities at a health care unit

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Biomedical waste ( BMW)
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Non Biomedical waste
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Sullage
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Sewage
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Garbage
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Emission from Generators
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Noise

Solid Waste -1.5 to 2 kg/bed/day
Liquid waste 450 l/bed/day

CLASSIFICATION
Hospital waste
1.5 to 2 kg/bed/day
General
(non-hazardous)
85%
Infectious
10%
Biomedical Waste
300 gm/bed/day
Toxic
5%

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W h a t i s b i o m e d i c a l w a s t e ?
I s b i o - m e d i c a l w a s t e i n f e c t i o u s ?
N e e d f o r m a n a g e m e n t o f b i o - m e d i c a l w a s t e s
W h y s e g r e g a t e ?
W h a t d o e s t h e c o l o r c o d e s i g n i f y ?
W h y u s e s e p a r a t e c o n t a i n e r s ?
W h a t i s t h e s a f e m e t h o d f o r S h a r p s d i s p o s a l ?
W h a t i s t h e m a x i m u m s t o r a g e t i m e f o r B M W ?
W h a t i s T r e a t m e n t & D i s p o s a l f a c i l i t y ?
W h a t a r e t h e a d v a n t a g e s o f C o m m o n f a c i l i t y ?
H o w a n d w h e r e t o l o c a t e C o m m o n f a c i l i t y ?
H o w t o t r a n s p o r t B M W t o c o m m o n f a c i l i t y ?
H o w t o r e d u c e B M W ?

Notified by Ministry of
Environment & Forests, Govt of
India in exercise of powers u/s 6, 8 &
25 of the Environment
(Protection) Act 1986

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Set up proper BMW treatment & disposal facilities (Rule 5)
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Ensure proper segregation, packaging, transportation & storage of BMW (Rule 6)
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Applying for authorization (Rule 8)
Furnishing annual report (Rule 10)
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Maintenance of records (Rule 11)
Accident reporting (Rule 12)

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Waste categorisation (Sch I)
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Colour coding & type of container (SchII)
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Labelling of containers/bags (Sch III)
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Labelling for transportation (Sch IV)
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Standards for treatment & disposal (Sch V)
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Time schedule to set up (Sch VI)

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Application for authorisation (Form I)
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Annual report (Form II)
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Accident reporting (Form III)
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Authorisation (Form IV)
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Appeal (Form V)

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Diagnosis, Treatment & Immunization
f human beings & animals and in
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categories mentioned in Schedule 1

• Bio-medical wastes are infectious and hazardous need to be managed carefully

COLLECTION TREATMENT DISPOSAL

BIO MEDICAL WASTE -
SOLID BIO MEDICAL WASTE LIQUID BIO MEDICAL WASTE

Type Nature Category
No.
1
2
3
6
7
8
9
10
4
5
Human anatomical waste
Animal waste
Microbiology and Biotechnology waste
Waste sharps
Discarded medicines and cytotoxic drugs
Soiled waste
Solid waste
Liquid waste
Incineration ash
Chemical waste
Infectious
Infectious
Infectious
Infectious
Potentially toxic
Infectious
Infectious
Infectious
Toxic waste
Toxic waste

Prescribed Authority for enforcement of the provisions of the rules

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Take all steps to handle wastes properly without causing any adverse effect to human health and the environment
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Obtain authorization
Submit annual returns
Maintain records
Report accidents
Occupier of a health care institution -
Person who has control over that institution and/or its premises

Why Biomedical Waste goes untreated?
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Pollutants are invisible
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Authorities are overburdened with their prime duties
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Lack of awareness
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Lack of training
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Lack of dedicated manpower for waste management

The purpose of legislation is to
1.
2.
To prevent the spreading of infection
To prevent the reuse of disposable items discarded from the hospitals

Salient features of the Bio-Medical Waste
(Management and Handling) Rules, 1998
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BMW shall not be mixed with other wastes
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No treated biomedical waste shall be stored for beyond 48 hours
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Biomedical waste shall segregated into containers/bags labelled according to schedule
3 at the point of generation in accordance with schedule 2 prior to its storage, treatment, transportation and disposal.

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If a container is transported from its originated premises to any waste treatment facility outside the premises, it shall also carry information prescribed in schedule 4 apart from a label prescribed in schedule 3.
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Biomedical waste shall be treated and disposed in accordance with schedule 1 and in compliance with the standards in schedule 5.

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Every occupier has to obtain authorization of state pollution control board under biomedical waste rules.
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Every occupier/operator shall submit an annual report to the prescribed authority in for 2 by 31 Jan every year including details on categories and quantities of biomedical waste handled during the preceding year.

Every authorized person shall maintain records related to generation, collection, reception, transportation, treatment, disposal of biomedical waste in accordance with these rules and guidelines.
When an accident occurs at any institution for biomedical waste treatment or during its transportation, the authorized person shall report the accident in Form 3 to the prescribed authority.

to be obtained by
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All hospitals having inpatients
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All clinics, pathological laboratories, blood banks etc. serving more than
1000 persons per month
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All operators providing facilities for biomedical waste transport, treatment and disposal

Information about categories & quantities of BMW in Form II before the 31 st January every year by the HCIs to SPCB in specified format before the 31 st
March by the SPCB to the CPCB

-- related to generation, collection, reception, storage, transportation, treatment and disposal to be maintained by HCIs

-during handling or transportation of
BMW to Board’s offices by telephone/fax/ telegram and in Form III

Any person aggrieved by an order made by the Board can prefer appeal within 30 days before the Appellate Authority

Penal provisions (Sn.15 of
Environment Act)
Noncompliance with the provisions of the Rule is a criminal offence and shall be punishable with imprisonment for a term that may extend up to
5 years or with fine, which may extend to one lakh rupees or with both
If the failure or contravention continues, with an additional fine which may extend to Rs. 5000 for every day in which the failure continue after the first conviction.
If the failure or contravention continues beyond a period of one year after the date of conviction, the imprisonment term may extend to 7 years

SCHEDULE II- COLOUR CODING
Human
Anatomical waste
Microbiology
&
Biotechnology waste
Waste sharps
Microbiology
&
Biotechnology waste
Soiled waste
Solid
Waste
Soiled waste
Cat 1,2,3 &6
Solid Waste
Cat 3,6 &7
Cat 4&7
Discarded
Medicines &
Cytotoxic drugs
Incineration ash
Chemical waste
Cat 5,9 & 10

ARRANGEMENTS FOR SEGREGATION
AT NURSING STATION

1.
Post Operative Organs
2.
Placenta
-
3.
Plaster Of Paris (POP)
-
4.
Microbiological Waste
-

5.
Soiled Cotton
6. Dressing Materials
7 . Beddings, Blood contaminated clothes
8. Teeth

1.
Syringes
2. I.V. Sets
-
3. Catheters -
4. Gloves
Red

5. Urine Bags
-
6. Blood Bags
-
7. Dialysis Kit
-
Red

1. Broken Glass
2. Ampules -
3. Slides
4.
VIELS

1. Needles
-
2.
Blades-
3.
Scalpels
-
4.
Nails-

1.SOLID CHEMICALS
2.
Cytotoxic Drugs

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Option Waste Category Treatment and Disposal
Category no.1
Category no. 2
Category no. 3
Human Anatomical waste
Animal Waste
Microbiology and biotechnology waste
Incineration; deep burial
Incineration; deep burial
Local autoclaving microwaving/incineration
Category no. 4
Waste Sharps Disinfection (chemical treatment autoclaving/microwaving) and mutilation/shredding

Category no. 5
Category no. 6
Category no. 7
Discarded medicines and cytotoxic drugs.
Soiled Waste
Solid Waste
Incineration; destruction and drugs disposal in secured landfill.
Disinfection by chemical treatment autoclaving/micro-waving and mutilation / shredding.
Chemical Disinfection/autoclaving
/microwaving/ (disposables) shredding
Category no. 8
Category no. 9
Category no. 10
Liquid waste
Incineration Ash
Chemical waste
Disinfection by chemical treatment and treated in ETP.
Disposal in Municipal landfill.
Chemical treatment; and discharge into drains for liquid and secured land fill for solids.

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Storage of waste (from generation till treatment) shall not exceed 48 hours. Refrigerated storage is preferable
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Indoor storage areas shall have restricted access and shall be located away from pedestrian traffic.
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Storage area shall be constructed with smooth and easily cleanable materials that are impervious to liquids.
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Liquid generated from floor washing in the storage area should be diverted to the waste water treatment plant.

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Biohazard symbol should be clearly displayed.
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The symbol shall be non-washable and prominently visible
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In cases where the storage area is used for both general and biomedical waste storage, care shall be given to prevent contamination of general waste from biomedical waste.
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Packages containing biomedical waste should remain sealed until it reaches the treatment site; no compaction or squeezing is allowed.

BIOHAZARD
HANDLE WITH CARE
CYTOTOXIC HAZARD

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Vehicle shall be authorized by the KSPCB for the purpose.
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Vehicle shall be labeled with biohazard symbol
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No compaction of waste is allowed.
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Residual or accidental spills of packages should be washed and diverted to the liquid waste stream for treatment and disinfection.
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Transporter should not accept the waste if it is not properly segregated, packed and labeled .

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Transporter shall give a receipt of pick up of waste to the waste generator.
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Before returning the vehicle, it shall be decontaminated.
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In case of any accident, the transporter shall report in Form III to KSPCB
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Driver of the vehicle shall be trained on how to deal with accidents, break down etc.
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Compliance with the provisions under Motor
Vehicle Rules

Day ............ Month ..............
Year ...........
Date of generation ...................
Waste category No.
Waste class…
Waste description…
Sender's Name & Address Receiver's Name & Address
Phone No ........
Telex No ....
Fax No ...............
Contact Person ........
Phone No ...............
Telex No ...............
Fax No .................
Contact Person .........
In case of emergency, please contact
Name & Address :
Phone No.

• Land to be identified & provided by Local body
• Detailed work plan to be submitted by local body/ entrepreneur to SPCB
• SPCB after evaluation of proposal shall issue
‘Consent to Establish’ with required conditions
• On establishing the facility, it shall be inspected by SPCB for checking adequacy and authorization shall be issued by the
SPCB with necessary conditions

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1. Only Septic tank-soak pit facilities are provided for the treatment of sewage and sullage.
2. No segregation/ treatment of bio-medical liquid effluent which is having highly hazardous potentials before sending to ETP
3. No access to ETP
4. Poor maintenance of ETP

5. No trained operator for ETP and incinerator
6. Variation in actual bed strength and agreement document
7. No display board with respect to segregated collection
8. Inadequate colour coded containers
9. Deep burial pit without meeting specifications
10. Inadequate number in needle cutters/burners
11. No record keeping
12. Annual report submission – non compliance and incorrect information

The Board introduced an integrated clearance procedure and State Govt accepted the proposal and amended the Water Rules and the Air Rules dated 9/6/2006.
As a part of integrated clearance, air act, water act, hazardous waste rules and plastic rules has been integrated.

Check list for the integrated clearance of the Board
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BMW
Segregation as per Schedule II
Affiliation to IMAGE/ NOT
Mutilation of injection syringes, catheters, IV bottles
Maintenance of Registers for the category wise generation of waste and disposal
If not affiliated to IMAGE individual facilities as per Schedule I
Operation and Maintenance of each facility
Disinfection of biomedical liquid effluent
Disposal as per Schedule I
Maintenance of registers as above
Annual report submission by 31 st January

Waste water
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•
•
•
•
•
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Facility for effluent treatment has to be provided
Ensure that all streams, sewage, sullage ( floor wash, hand wash, bathroom wash and canteen effluent & laundry and disinfected biomedical liquid effluent) are connected to ETP
80 % of the water consumption is considered as Effluent generation. Ensure adequate capacity for ETP
Water meters should be installed to record water consumption
Monthly water consumption reports has to be submitted
Operation and maintenance of ETP
Effluent monitoring reports as per the periodicity specified
Proper disposal of treated effluent as specified

CHARACTERISTICS OF WASTEWATER FROM
HOSPITALS
Characteristics
Physical
Chemical
Biological
Parameters
Odour, Colour, Turbidity, suspended solids, Total dissolved solids.
pH, BOD, COD, Chloride, Sulphate,
Phosphate, Total Nitrogen, Oil and grease.
Pathogenic Organics indicated by presence of Coli form organisms

5
6
3
4
1.
2
7
8
RANGE OF CHARACTERISTICS OF WASTEWATER
Sl.No
Parameter Unit pH
Odour
Suspended Solids mg/l
Total dissolved solids (inorganic) mg/l
COD mg/l
Range Tolerance limits stipulated by KSPCB
6.76-7.85
5.5-9.0
Foul Smell -
275-1636
248-715
100
2100
295-935 250
160-481 30 BOD 5 days at
20 0 C
Chloride (as Cl) mg/l mg/l
Sulphate (as SO4) mg/l
44-169
14-36
1000
1000

9
10
11
12
13
Phosphates (as
P) mg/l
Total Nitrogen
(as N) mg/l
Oil and Grease mg/l
Total Coliforms MPN/
100 ml
6-19
66-168
4-18
>1800
Faecal E.Coli
Counts
100 ml
22->1800
5
100
10
0
0

IMPACT OF THE POLLUTANTS ON ENVIRONMENT
Parameter
1.Odour
Impact on Environment
Poor apetite for food, lowered water consumption, impaired respiration, nausea and vomiting, mental perturbation
,deterioration of personnel and community pride, interfere with human relations, discourage capital investment, lower socioeconomic status and deter growth.
2.Colour
3.Turbidity
Inhibits penetration of light to water limiting photosynthesis by microorganisms and thereby adversely affecting natural oxygenation of water.
Inhibits penetration of light to water limiting photosynthesis by microorganisms and thereby adversely affecting natural oxygenation of water.

4. Total dissolved solids (inorganic)
Inhibits penetration of light to water limiting photosynthesis by microorganisms and thereby adversely affecting natural oxygenation of water.
5. Suspended solids
6. pH
Aesthetically displeasing and provided adsorption sites for chemical and biological agents. Organic solids may be degraded, biologically, resulting in objectionable byproducts. Biologically active (live) suspended solids may include diseasecausing organisms as well as organisms such as toxin- producing strains of algae.
Alter the concentration of hydrogen ion in the receiving water body.

7. BOD
8. COD
9. Chloride
10. Sulphate
11. Phosphate
Deplets dissolved oxygen from water causing danger to aquatic life.
Depletes dissolved oxygen from water causing danger to aquatic life.
Bitter taste, Free chlorine toxic to fish and other aquatic life.
Products H
2 corrosive.
SO
4 which is
Overgrowth of objectionable plant forms (eutrophication), may bring about oxygen depletion in water.

12. Nitrogen
13. Oil and grease
Nitrate poisoning can cause death,’blue body’ syndrome
(methamog lobinemia)
Interfere with the biological life in the surface waters and create unsightly floating matter and film, cut off sunlight from water limiting photosynthesis by microorganisms and thereby affecting the natural oxygenation of water.
14. Pathogenic Organisms Cause disease of gastro-intenstinal tract such as typhoid and paratyphoid fever, dysentery, diarrhoea and cholera.

METHODS AND EQUIPMENTS FOR WASTE WATER TREATMENT
Method
1. Preliminary treatment
2. Primary treatment
3. Secondary treatment a. Aerobic
Purpose Equipments
To remove larger floating and suspended solid matter
Grit removal
Removal of oil and grease
Screens
Grit tanks
Skimming tanks
To remove suspended solids Settling tanks or clarifiers with or without flocculation or chemical coagulation
To remove organic matter biologically
Trickling filters, activated sludge process , fluidized bed bio-reactors, rotating biological contactor, aerated lagoon

b. Anaerobic
Anaerobic lagoon, anaerobic contactor and filter, anaerobic fluidized bed bioreactor
4. Tertiary treatment Final treatment for further improvement of wastewater
Micro strainer, sand filters, lagoons, land treatment, activated carbon adsorption, disinfection, ion exchange.

Sl.
N o.
Characteristics
1 pH
2 Suspended Solids
3 BOD (3 days at 27 0
C)
4 Oil & Grease
5 Bio assay test
Unit
mg/l mg/l mg/l
Tolerance limit
6.5 – 9
100
30
10
90% survival of fish after 96 hours in
100% effluent

EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNIT

EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNIT

EFFLUENT TREATMENT PLANT AT A HEALTH CARE UNIT

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D.G. sets shall be acoustically enclosed

Exhaust pipe of D.G. sets shall meet the height restrictions.

Incinerator shall be of the desired specification and shall be equipped with the air pollution control facilities and its chimney shall meet height specifications.
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Periodical emission monitoring reports shall be submitted.