Define biomedical waste Describe various categories of biomedical waste Their treatment and disposal as bmw guidelines 15-20 marks answer knruhs refer park
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Biomedical Waste: Definition, Categories, Treatment and Disposal
(As per BMW Management Rules, 2016 | Reference: Park's Textbook of Preventive & Social Medicine, 25th Ed., p. 895)
DEFINITION OF BIOMEDICAL WASTE
As per the Bio-Medical Waste Management Rules, 2016 (Ministry of Environment, Forest and Climate Change, Government of India):
"Bio-medical waste 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 of the Rules."
Bio-medical waste is also called hospital waste or health care waste. It includes infectious, pathological, chemical, pharmaceutical, radioactive and other wastes generated from health care facilities such as hospitals, clinics, nursing homes, dental clinics, veterinary facilities, blood banks, and research laboratories.
The BMW Rules, 2016 superseded the earlier Bio-Medical Waste (Management and Handling) Rules, 1998, and came into force on 28th March 2016. They apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste in any form.
CATEGORIES OF BIOMEDICAL WASTE (BMW Rules, 2016)
Under the 2016 Rules, biomedical waste has been reclassified from 10 categories (under 1998 rules) into 4 colour-coded categories based on treatment options. This was done to improve segregation at source.
CATEGORY 1: YELLOW (Non-Chlorinated Plastic Bags / Containers)
This is the largest and most hazardous category. It includes:
| Sub-type | Examples |
|---|---|
| (a) Human Anatomical Waste | Human tissues, organs, body parts, fetus below viability period (as per MTP Act 1971) |
| (b) Animal Anatomical Waste | Experimental animal carcasses, body parts, organs, tissues from veterinary hospitals/animal houses |
| (c) Soiled Waste | Items contaminated with blood/body fluids - dressings, plaster casts, cotton swabs, blood bags with residual blood |
| (d) Expired/Discarded Medicines | Pharmaceutical waste - antibiotics, cytotoxic drugs, items contaminated with cytotoxic drugs, glass/plastic ampoules, vials |
| (e) Chemical Solid Waste | Chemicals used in production of biologicals, used/discarded disinfectants |
| (f) Chemical Liquid Waste | Silver X-ray film developing liquid, discarded formalin, infected secretions, aspirated body fluids, floor washings |
| (g) Discarded Linen/Mattresses | Beddings contaminated with blood or body fluid |
| (h) Microbiology/Biotechnology/Lab Waste | Discarded biological specimens, culture media, microbiological waste, blood bags, cultures from labs |
Treatment and Disposal:
- Incineration OR Plasma Pyrolysis OR Deep Burial*
- In absence of above facilities: Autoclaving / Microwaving / Hydroclaving + shredding/mutilation, then sent for energy recovery
- Cytotoxic drugs: Returned to manufacturer for incineration at >1200°C, or Encapsulation, or Plasma Pyrolysis at >1200°C
- Chemical liquid waste: Discharged after treatment in effluent treatment system (ETS)
*Deep burial only in areas where CBMWTF is not available within 75 km
CATEGORY 2: RED (Non-Chlorinated Plastic Bags or Containers)
Contaminated Recyclable Waste
Includes:
- Tubing, bottles, IV sets and tubes, catheters, urine bags
- Syringes without needles
- Gloves and other plastic waste contaminated with blood/body fluids
Treatment and Disposal:
- Autoclaving / Microwaving / Hydroclaving followed by shredding or mutilation
- After sterilization and shredding, sent for recycling (not to landfill)
- Can be sent to registered recyclers after decontamination
CATEGORY 3: WHITE (Translucent) - Puncture-Proof, Leak-Proof, Tamper-Proof Containers
Waste Sharps including Metals
Includes:
- Needles, syringes with fixed needles
- Needles from needle tip cutters or burners
- Scalpels, blades
- Any other contaminated sharp objects that may cause puncture or cuts
Treatment and Disposal:
- Autoclaving / Dry Heat Sterilization / Chemical Treatment using 1% hypochlorite solution for 30 minutes
- Followed by shredding/mutilation/encapsulation
- Sent to registered metal recyclers, OR
- Sent to CBMWTF (Common Bio-Medical Waste Treatment Facility) for disposal
CATEGORY 4: BLUE (Cardboard/Boxes with Blue-Coloured Markings)
Glassware and Metallic Body Implants
Includes:
- Broken/discarded and contaminated glass items (slides, cover slips, glass ampoules, vials)
- Metallic body implants
Treatment and Disposal:
- Disinfection by soaking in 1% hypochlorite solution for 30 minutes OR autoclaving
- Broken glass: sent to glass recyclers
- Metallic implants: sent to metal recyclers
- Disposed through CBMWTF
SUMMARY TABLE: Colour Coding at a Glance
| Colour | Category | Container | Key Waste | Treatment |
|---|---|---|---|---|
| Yellow | 1 | Non-chlorinated plastic bags | Anatomical, soiled, pharma, chemical, lab waste | Incineration / Plasma Pyrolysis / Deep burial |
| Red | 2 | Non-chlorinated plastic bags | Contaminated recyclables (IV sets, catheters, gloves) | Autoclave + Shredding → Recycling |
| White | 3 | Puncture-proof translucent containers | Sharps (needles, scalpels, blades) | Autoclave/Chemical treatment + Shredding → Metal recycler |
| Blue | 4 | Cardboard boxes/blue-marked containers | Glassware, metallic implants | Disinfection + Recycling |
TREATMENT METHODS - BRIEF DESCRIPTION
1. Incineration
- Thermal oxidation at high temperatures (850-1100°C, cytotoxic >1200°C)
- Destroys pathogens completely
- Used for anatomical waste, soiled waste, cytotoxic drugs, chemical waste
- Produces ash (sent for landfill) and gases (must meet emission standards)
- Secondary chamber mandatory with adequate retention time
2. Autoclaving (Steam Sterilization)
- Saturated steam at 121°C / 15 psi for 30-60 minutes
- Suitable for sharps, infectious lab waste, red category waste
- After autoclaving - shredded and sent for recycling
3. Microwaving
- Moist heat (95°C for 45 minutes) generated by microwave energy
- Effective for infectious waste, sharps
- Not suitable for anatomical or chemical waste
4. Plasma Pyrolysis
- High-temperature thermal process in oxygen-deficient environment
- Destroys both infectious and chemical waste
- Produces vitrified slag (inert, non-leachable)
- Acceptable alternative to incineration
5. Hydroclaving
- Pressurized steam treatment (similar to autoclaving)
- For infectious waste and sharps
6. Chemical Disinfection
- 1% hypochlorite solution for liquid waste or sharps
- Used in labs for liquid waste before ETS discharge
7. Deep Burial
- Pit of adequate depth lined with lime
- Used in remote/rural areas where CBMWTF/incinerator not within 75 km
- Not for cytotoxic or chemical waste
OTHER IMPORTANT PROVISIONS OF BMW RULES, 2016
Segregation
- Waste must be segregated at the point of generation into respective colour-coded bags/containers
- No mixing of categories is permitted
Storage
- Segregated BMW must not be stored beyond 48 hours
- Beyond 48 hours: prior permission from SPCB required with reasons stated
- Cold storage mandatory for anatomical waste if kept beyond 48 hours
Transportation
- Must use bar-coded bags/containers and GPS-tracked vehicles
- Authorised vehicles only; waste manifests to be maintained
Records
- All records of generation, collection, storage, transport, treatment and disposal to be maintained for 5 years
Accident Reporting
- Major accidents: immediate intimation + report within 24 hours to prescribed authority with remedial steps
Duties of Occupier (Health Facility)
- Provide safe, ventilated, secured storage within premises
- Immunize all workers against Hepatitis B and Tetanus
- Provide regular training to all healthcare workers
- Establish bar-code system for BMW bags
- Phase out use of chlorinated plastic bags within 2 years of notification
CBMWTF (Common Bio-Medical Waste Treatment Facility)
- No healthcare facility shall set up on-site treatment facility if CBMWTF exists within 75 km
- CBMWTFs must be operated by authorized operators with proper permits
Schedules Under BMW Rules, 2016
- Schedule I (Part 1 & 2): Categorization and management of BMW
- Schedule II: Standards for treatment and disposal
- Schedule III: Prescribed authorities and duties
- Schedule IV: Labels for containers/bags and transport
PREVIOUS CLASSIFICATION (BMW Rules, 1998) - Key Point for Exams
Under 1998 rules, waste was classified into 10 categories based on type of waste (Categories 1-10). The 2016 rules replaced this with 4 colour-coded categories based on treatment options - a major change to streamline segregation, reduce confusion, and improve compliance at source level.
Source: Park's Textbook of Preventive and Social Medicine, 25th Edition, p. 895 (Table 3, Schedule I, Part 1); Bio-Medical Waste Management Rules, 2016, Ministry of Environment, Forest and Climate Change, Government of India (notified 28th March 2016, GSR 343(E)).
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BIOMEDICAL WASTE: DEFINITION, CATEGORIES, TREATMENT AND DISPOSAL
As per BMW Management Rules, 2016 | Park's Textbook of Preventive & Social Medicine, 25th Ed.
I. DEFINITION OF BIOMEDICAL WASTE
As per the Bio-Medical Waste Management Rules, 2016 (Ministry of Environment, Forest and Climate Change, GOI):
"Bio-medical waste 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 of these Rules."
Bio-medical waste is also referred to as hospital waste or health-care waste (HCW). It originates from hospitals, nursing homes, dental clinics, veterinary hospitals, pathological laboratories, blood banks, animal houses, research institutions, and health camps.
II. SOURCES OF BIOMEDICAL WASTE
| Source | Examples |
|---|---|
| Patient care areas | OPDs, IPDs, ICUs, emergency departments |
| Diagnostic areas | Pathology labs, radiology, microbiology labs |
| Surgical areas | Operation theatres, labour rooms, OT suites |
| Treatment areas | Dialysis units, chemotherapy wards |
| Support services | Laundries, pharmacies, mortuaries |
| Research facilities | Animal houses, biotechnology labs |
III. COMPOSITION OF HEALTH-CARE WASTE (Park's, p. 892)
As per surveys of 10 large hospitals in Mumbai, Kolkata, Delhi and Nagpur (NEERI 1997), the average composition of hospital waste in India is:
| Material | % (wet weight) |
|---|---|
| General waste (food waste, sweepings) | 53.5% |
| Rags | 15% |
| Paper | 15% |
| Plastics | 10% |
| Glass | 4.0% |
| Infectious waste | 1.5% |
| Metal (sharps etc.) | 1% |
As a general estimate in developing countries:
- 80% is general (non-hazardous) health-care waste
- 15% is pathological and infectious waste
- 1% is sharps waste
- 3% is chemical and pharmacological waste
- <1% is special waste (radioactive, cytotoxic, pressurized containers)
IV. HEALTH HAZARDS OF BMW (Park's, p. 892-893)
Exposure to hazardous BMW can cause disease/injury through the following characteristics:
(a) Infectious waste and sharps: Pathogens enter through punctures, cuts, abrasions, mucous membranes, by inhalation or ingestion. HIV, Hepatitis B and C have strong evidence of transmission via health-care waste. Antibiotic-resistant bacteria add further hazard.
(b) Chemical and pharmaceutical waste: Toxic, genotoxic, corrosive, flammable, reactive, or explosive substances. Disinfectants form highly toxic secondary compounds. Cause acute/chronic intoxication and burns.
(c) Genotoxic waste: Cytotoxic drugs - exposure through inhalation of aerosols, skin absorption, or ingestion. Severity depends on toxicity and duration of exposure.
(d) Radioactive waste: Causes headache, dizziness, vomiting; genotoxic effects affecting genetic material.
(e) Public sensitivity: General public is sensitive to visual impact of health-care waste, especially anatomical waste.
Groups at risk include:
- Doctors, nurses, healthcare auxiliaries, hospital maintenance staff
- Patients and visitors in health-care establishments
- Workers in support services (laundries, waste handling, transportation)
- Workers in waste disposal facilities (landfills, incinerators, scavengers)
V. LEGISLATIVE BACKGROUND
| Rule | Year | Key Provision |
|---|---|---|
| BMW (Management & Handling) Rules | 1998 | First BMW rules in India; 10 categories of waste |
| BMW Management Rules | 2016 | Replaced 1998 rules; 4 colour-coded categories; effective 28 March 2016 |
| BMW (Amendment) Rules | 2018 | Revised lab waste pre-treatment norms; revised deadlines |
| BMW (Amendment) Rules | 2019 | Clarity on liquid waste and chlorinated plastic bags |
The 2016 Rules apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle biomedical waste in any form. They do NOT apply to: radioactive waste, municipal solid waste, lead-acid batteries, hazardous wastes, and e-waste.
VI. CATEGORIES OF BIOMEDICAL WASTE (BMW Rules 2016 - Schedule I, Part 1)
Under BMW Rules 2016, waste is classified into 4 colour-coded categories based on treatment options (reduced from 10 categories under 1998 rules to improve segregation at source).
CATEGORY 1 - YELLOW (Non-chlorinated plastic bags / containers)
The largest and most hazardous category. Contains 8 sub-types:
(a) Human Anatomical Waste: Human tissues, organs, body parts and fetus below viability period (as per MTP Act, 1971)
(b) Animal Anatomical Waste: Experimental animal carcasses, body parts, organs, tissues from veterinary hospitals/colleges/animal houses
(c) Soiled Waste: Items contaminated with blood/body fluids - dressings, plaster casts, cotton swabs, blood bags with residual blood and blood components
(d) Expired/Discarded Medicines: Pharmaceutical waste including antibiotics, cytotoxic drugs, all items contaminated with cytotoxic drugs, glass/plastic ampoules and vials
(e) Chemical Solid Waste: Chemicals used in production of biologicals, used/discarded disinfectants
(f) Chemical Liquid Waste: Silver X-ray film developing liquid, discarded formalin, infected secretions, aspirated body fluids, lab/floor washings, housekeeping and disinfecting activity liquids
(g) Discarded Linen/Mattresses/Beddings: Contaminated with blood or body fluid
(h) Microbiology/Biotechnology/Clinical Lab Waste: Blood bags, laboratory cultures, stocks/specimens of micro-organisms, live/attenuated vaccines, human and animal cell cultures, residual toxins, dishes and devices used for cultures
Treatment and Disposal:
- Incineration or Plasma Pyrolysis or Deep Burial* (preferred)
- If above not available: Autoclaving / Microwaving / Hydroclaving + shredding/mutilation → sent for energy recovery
- Cytotoxic drugs: Returned to manufacturer or incinerated at >1200°C, or Encapsulation, or Plasma Pyrolysis at >1200°C
- Chemical liquid waste: Pre-treated → Effluent Treatment System (ETS) → discharge as per Schedule III norms
- Lab/microbiology waste: Pre-treated with non-chlorinated chemicals on-site (as per WHO/NACO guidelines) → then Incineration
*Deep burial only where CBMWTF is not within 75 km; NOT for cytotoxic/chemical waste
CATEGORY 2 - RED (Non-chlorinated plastic bags or containers)
Contaminated Recyclable Waste
Includes:
- Tubing and bottles
- Intravenous tubes and sets
- Catheters, urine bags
- Syringes without needles
- Gloves and other plastic items contaminated with blood/body fluids
Treatment and Disposal:
- Autoclaving / Microwaving / Hydroclaving followed by shredding or mutilation
- After sterilization and shredding → sent to registered plastic recyclers
- Must NOT be sent to landfill
CATEGORY 3 - WHITE TRANSLUCENT (Puncture-proof, leak-proof, tamper-proof containers)
Waste Sharps including Metals
Includes:
- Needles, syringes with fixed needles
- Needles from needle tip cutters or burners
- Scalpels and blades
- Any other contaminated sharp objects that may cause puncture or cuts
Treatment and Disposal:
- Autoclaving / Dry Heat Sterilization / Chemical Treatment (1% Sodium Hypochlorite for 30 minutes, OR 10% Sodium Hypochlorite for 2 minutes)
- Followed by shredding, mutilation or encapsulation
- Sent to registered metal recyclers, OR
- Disposed through CBMWTF
CATEGORY 4 - BLUE (Cardboard boxes with blue-coloured markings)
Glassware and Metallic Body Implants
Includes:
- Broken/discarded and contaminated glass (slides, cover slips, glass ampoules, vials, bottles)
- Metallic body implants
Treatment and Disposal:
- Disinfection by soaking in 1% Sodium Hypochlorite for 30 minutes OR autoclaving
- Broken glass → sent to glass recyclers
- Metallic implants → sent to metal recyclers
- Disposed through CBMWTF
VII. SUMMARY TABLE - COLOUR CODING (Exam Quick Reference)
| Colour | Waste Type | Container | Treatment |
|---|---|---|---|
| Yellow | Anatomical, soiled, pharma, chemical, lab waste | Non-chlorinated plastic bag | Incineration / Plasma pyrolysis / Deep burial |
| Red | Contaminated recyclables (IV sets, catheters, syringes without needle) | Non-chlorinated plastic bag | Autoclave + Shredding → Recycling |
| White | Sharps (needles, scalpels, blades) | Puncture-proof translucent container | Autoclave/Chemical + Shredding → Metal recycler |
| Blue | Glassware, metallic implants | Cardboard box | Disinfection + Recycling |
VIII. TREATMENT TECHNOLOGIES IN DETAIL (Park's, p. 893-894)
1. Incineration
A high-temperature dry oxidation process that reduces organic/combustible waste to inorganic, incombustible matter with significant reduction in volume and weight.
Criteria for suitable waste:
- Low heating value >2000 kcal/kg (single-chamber) or >3500 kcal/kg (pyrolytic double-chamber)
- Combustible matter >60%
- Non-combustible solids <5%
- Non-combustible fines <20%
- Moisture content <30%
Types of incinerators:
- (a) Double-chamber pyrolytic incinerators - specially designed for infectious health-care waste (preferred)
- (b) Single-chamber furnaces with static grate - used only if pyrolytic not affordable
- (c) Rotary kilns at high temperatures - for genotoxic and heat-resistant chemical waste
Waste NOT to be incinerated:
- Pressurized gas containers
- Large amounts of reactive chemical wastes
- Silver salts and radiographic wastes
- Halogenated plastics (PVC)
- High mercury/cadmium content waste (broken thermometers, batteries)
- Sealed or heavy-metal-containing ampoules
2. Chemical Disinfection
Chemicals added to waste to kill or inactivate pathogens (disinfection, not sterilization).
Most suitable for: Liquid waste (blood, urine, stools, hospital sewage); also solid waste including microbiological cultures and sharps with limitations.
Agents used:
- Sodium Hypochlorite 1% - for 30 minutes (sharps, glass)
- Sodium Hypochlorite 10% (30% residual chlorine) - for 20 minutes (Schedule I, Part 2)
- Glutaraldehyde, formaldehyde, hydrogen peroxide
- Lime (calcium hydroxide) for deep burial pits
3. Autoclaving (Steam Sterilization)
- Saturated steam at 121°C / 15 psi for 30-60 minutes (gravity cycle) or 134°C / 30 psi for 3-4 minutes (vacuum cycle)
- Effective for sharps, red category waste, infectious lab waste
- Not suitable for anatomical, chemical, or pharmaceutical waste
- After autoclaving: shredded and sent for recycling
4. Microwaving
- Uses microwave energy to generate moist heat (~95°C for 45 minutes)
- Effective for infectious waste and sharps
- Requires pre-shredding and mixing with water
- Not suitable for anatomical, chemical, pharmaceutical, or radioactive waste
5. Hydroclaving
- Pressurized steam treatment (similar principle to autoclaving)
- Used for infectious waste and sharps
- Waste is shredded after treatment
6. Plasma Pyrolysis
- High-temperature thermal process in oxygen-deficient environment
- Converts waste into a vitrified slag (inert, non-leachable)
- Effective for both infectious and chemical waste
- Acceptable alternative to incineration for yellow category waste
7. Deep Burial
- Pit of adequate depth (generally >2 m), lined with lime
- Only in remote/rural areas where no CBMWTF exists within 75 km
- Only for anatomical and soiled waste
- NOT for cytotoxic, chemical, or pharmaceutical waste
IX. BMW MANAGEMENT PROCESS (Step-wise)
Generation → Segregation → Collection → Storage → Transportation → Treatment → Disposal
1. Segregation
- At the point of generation into colour-coded bags/containers
- Segregation is the key to scientific waste management
- No mixing of categories permitted
2. Collection and Storage
- Collection centres planned between 2-3 wards
- Central collection point with impermeable floor, proper drainage, exhaust and water supply
- No untreated BMW to be stored beyond 48 hours
- Beyond 48 hours: prior permission from SPCB required
- Cold storage mandatory for anatomical waste if stored beyond 48 hours
3. Transportation (On-site and Off-site)
- Separate dedicated trolleys/carts for BMW and general solid waste
- Vehicles must comply with existing national rules and UN norms
- Vehicle body must carry name, address of carrier and hazard signs
- Bar-coded bags + GPS-tracked vehicles for off-site transport
- Waste manifests to be maintained
X. CBMWTF (COMMON BIO-MEDICAL WASTE TREATMENT FACILITY)
- No HCF shall set up on-site treatment facility if CBMWTF is available within 75 km
- CBMWTFs must be operated by authorized operators under prescribed authority permits
- Responsible for transporting BMW from HCFs, treating, and final disposal
- Must upgrade existing incinerators to achieve standards for dioxins and furans and secondary chamber retention time
XI. DUTIES OF OCCUPIER (Health Care Facility)
- Provide safe, ventilated, secured storage within premises
- Segregate BMW at source into colour-coded bags/containers
- Hand over segregated BMW to CBMWTF
- Pre-treat laboratory, microbiological, blood samples and blood bags through disinfection/sterilization (per WHO/NACO guidelines) before sending to CBMWTF
- Provide regular training to all health care workers (at joining, then at least annually)
- Immunize all workers against Hepatitis B and Tetanus
- Establish a Bar-Code System for BMW bags/containers
- Phase out chlorinated plastic bags, gloves, and blood bags within 2 years of notification
- Maintain records of generation, collection, transport, treatment and disposal for 5 years
- Report major accidents immediately; submit remedial report within 24 hours
- Set up a BMW Management Committee in the health facility
XII. SCHEDULES UNDER BMW RULES, 2016
| Schedule | Content |
|---|---|
| Schedule I (Part 1) | Categorization of BMW, colour coding, treatment options |
| Schedule I (Part 2) | Standards for treatment and disposal (chemical treatment standards) |
| Schedule II | Standards for incinerators, autoclaves, microwaves (emission standards, operational standards) |
| Schedule III | Prescribed authorities and their corresponding duties |
| Schedule IV | Labels for containers/bags (Part A) and labels for transportation of BMW (Part B) |
XIII. KEY DIFFERENCES: BMW Rules 1998 vs 2016
| Feature | 1998 Rules | 2016 Rules |
|---|---|---|
| Categories | 10 categories based on type of waste | 4 categories based on treatment options |
| Colour coding | Multiple (yellow, red, blue, black, white) | 4 colours: Yellow, Red, White, Blue |
| Storage limit | 48 hours (with permission process unclear) | 48 hours; cold storage mandatory beyond this |
| Bar coding | Not mandatory | Mandatory for all BMW bags |
| GPS | Not required | Mandatory for transport vehicles |
| Chlorinated plastics | Permitted | Phase-out within 2 years |
| Immunization | Not specified | Hep B + Tetanus mandatory for all workers |
| On-site treatment | Permitted | Only if no CBMWTF within 75 km |
| Radioactive waste | Included | Explicitly excluded (under Atomic Energy Act) |
| Records | Not specified | 5 years mandatory |
XIV. MANAGEMENT OF SPECIAL WASTES
Radioactive Waste:
- Not covered under BMW Rules (governed by Atomic Energy Act, 1962)
- Isotopes with long half-life: stored at authorized disposal site (storage = 10 times the half-life)
- Low-level radioactive liquid waste: may be discharged in sewers
COVID-19 / Pandemic Waste:
- Specific guidelines issued under BMW Rules during COVID-19 pandemic (2020)
- Waste from quarantine centres and home care treated as BMW
- Dedicated colour-coded bags; daily collection; disinfect bags with 1% sodium hypochlorite; dedicated vehicles
Source: Park's Textbook of Preventive and Social Medicine, 25th Edition, pp. 891-895; Bio-Medical Waste Management Rules 2016 (GSR 343(E), 28 March 2016) and Amendment Rules 2018; AIIMS BMW Manual 2016.
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