containers must comply with requirements set out by the food and drug administration, while 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 march 2016 biomedical waste management rules (bmw 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. new regulations affect the distribution of medical waste by medical professionals into their proper receptacles. 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 biomedical 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. update around 26 march 2020. the national green tribunal (ngt) has been stringent on the application of the bmw 2016 over the past 12 months. there are now over 200 licensed common bio medical waste treatment and disposal facilities (cbwtdf) or common treatment facility (ctf) in the country. the rules have been updated over the years. the training of health care facility staff and the awareness of the hazards of bio medical waste is still a challenge in most of the country. the compliance is being enforced through penalties and via awareness. the ctf are operational in most tier 1 cities and tier 2 cities of india and compliance is high today because of ngt. but lack of awareness lead to issues of improper segregation. in tier 2 and 3 cities the general waste is also mixed with biomedical waste. the latest guidelines for segregation of bio-medical waste recommend the following color coding: 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. cardboard 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. environmental impacts the syringe tide environmental disaster the syringe tide environmental disaster of 1987–1988 raised awareness about medical waste as medical syringes washed ashore in connecticut, new jersey, and new york. the syringes endangered marine species and posed a threat to humans who visited the beach. the crises spurred scientists and lawmakers to create mechanisms, policies, and laws so that health care providers would process their bio-waste in an environmentally friendly way. effects of medical waste on the environment accumulation of biomedical waste in a hospital basement. improper management of health care waste can have both direct and indirect health consequences for health personnel, community members and on the environment. indirect consequences in the form of toxic emissions from inadequate burning of medical waste, or the production of millions of used syringes in a period of three to four weeks from an insufficiently well planned mass immunization campaign. biomedical waste is not limited to medical instruments; it includes medicine, waste stored in red biohazard bags, and materials used for patient care, such as cotton and bandaids. the most serious effect that biomedical waste has on our seas is the discharge of poisons into the waters that could then be consumed by ocean life creatures. toxins would interject into the food chain and eventually reach humans who consume sea creatures. human exposure to such toxins can stunt human growth development and cause birth defects. the high volume of plastic use in the medical field also poses a dangerous threat to the environment. according to north and halden, 85% of disposable plastic materials make up all medical equipment. our current reliance on plastic materials is rooted in their unique capabilities to be lightweight, cost-effective, and durable while preserving the sterility of medical equipment. in addition to the serious health implications of releasing harmful toxins in the environment from medical waste deposits, introducing this volume of single-use plastics can catalyze the compounding health detriments caused by macro and microplastics. methods of biomedical waste incineration the three type of medical waste incinerators are controlled air, excess air, and rotary kiln. controlled air is also known as starved-air incineration, two-stage incineration, or modular combustion. this is the process of which waste is fed to a combustion chamber and combustion air begins to dry and facilitates volatilization of the waste. as a result, carbon dioxide and other excess gases are released into the atmosphere. the second type of incineration is the excess air process. this is similar to the controlled air process, such as the waste being dried, ignited, and combusted by heat provided by the primary chamber burner. however, the main difference is that moisture and volatile components in the waste are vaporized. in a rotary kiln, the process is similar to the two mention above, however, it is more versatile in terms of being able to mix wet and dry waste components and viewed by many waste engineers as being the most environmentally friendly. impact on the environment post incineration process, toxic ash residue is produced and is often disposed at landfills. these landfills are not protected by any barrier and the residue has the potential of reaching underground water that is often exposed to human use. the combustion of plastic material releases toxic gases that escapes and joins breathable air. human and animal exposure to such gases can cause long term breathing and health issues. the rotation of toxic air does not only impact human well-being, but also of animals and plants. air pollution caused by the incinerators depletes the ozone layer, causes crop and forest damage, and increases the effects of climate change. constant exposure to such toxins and chemicals in the air could be deemed detrimental to trees and plants and could eventually lead to extinction of certain plants in specific areas. pollution and chemical leaks also affect the fruits of trees and would cause them to be poisonous and therefore inedible. medical waste management program california created the medical waste management program, which regulates the generation, handling, storage, treatment, and disposal of medical waste by providing oversight for the implementation of the medical waste management act. precautions have been taken in california which permits and inspects all medical waste offsite treatment facilities and medical waste transfer stations. in order to dispose waste, the department recommends the following process to make controlled substance waste non-retrievable. pills containing a controlled substance are crushed before placing the residue into a pharmaceutical waste container. controlled substance that is remaining in a syringe is wasted into a pharmaceutical waste container before disposing of the syringe in a sharps container. expired medications should be returned through a reverse distributor. environmentally friendly alternatives reusable rmw or sharps containers reduce the amount of plastic sent to landfills and co2 emissions. non-incineration treatment includes four basic processes: thermal, chemical, irradiative, and biological. the main purpose of the treatment technology is to decontaminate waste by destroying pathogens. modern technology invented mechanics that would allow medical professionals and hospitals to dispose medical waste in an environmentally friendly way; such as: autoclaving, plasma pyrolysis, gasification, chemical methods, and microwave irradiation. these alternatives are also highly versatile and can be used for all different types of waste. an autoclave, similar to a pressure cooker, uses high-temperature steam to penetrate waste material and kill micro-organisms. autoclave treatment has been recommended for microbiology and biotechnology waste, waste sharps, soiled and solid wastes. microwave irradiation is based on the principle of generation of high frequency waves. these waves cause the particles within the waste material to vibrate, generating heat and killing the pathogens from within. a simple yet effective method is chemical disinfection: 1% hypochlorite can kill thriving bacteria. plasma pyrolysis is an environment-friendly mechanism, which converts organic waste into commercially useful byproducts. the intense heat generated by the plasma enables it to dispose all types of waste including municipal solid waste, biomedical waste and hazardous waste in a safe and reliable manner. gasification can offer carbon sequestration and energy generation, reducing the carbon footprint of biomedical waste treatment. other possible solutions initiative from corporations and hospitals is essential to creating a healthier environment, however, there are various methods in which involves action from the general population and would contribute to a clean air environment. by creating surveillance groups within hospitals, everyone would be held accountable for misconduct and improper disposal of waste. consequences could be implemented where individuals would be required to pay a fine, or face unpaid suspension from work. companies and governmental organization should also initiate non-routine checkups and searches, this would place pressure on hospitals to ensure that waste is properly disposed all year round. voluntary clean-ups would involve hospital staff in assuring that medical waste is not littered around the hospital or thrown into regular garbage bins.