Participant’s Manual

On
Bio-Medical Waste
Management & Handling
Best Practices
Copyright © APAC/BD/TNHSP 2011.

All rights reserved. No part of this manual should be reproduced, stored in a retrieval system or transmitted in
any form or by any means: electronic, mechanical, photocopying, recording or otherwise without prior
permission.

Disclaimer of USAID - The data / information expressed in this booklet necessarily does not reflect the views of
USAID/ US Government

Printed in India in 2011.

BMW(M&H):Training module and hand-out Participant

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 FOREWORD

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 The Health and Family Welfare Department, Government of Tamil Nadu through the
Tamil Nadu Health Systems Project (TNHSP) is committed to provide effective health care
services to the community through all the primary health centres, secondary care hospitals
and tertiary teaching hospitals in the State of Tamil Nadu. The project has pioneered various
initiatives to increase the quality of care in public hospitals of the state.

The health care facilities in the state has always the risk of spreading the infections
through the blood, body fluids, secretions and excretions of infectious patients to the
general population and the health care service providers if it is not controlled effectively.

Infection control and bio-medical waste management practices including universal

work precautions in these health care facilities are very much critical for effective quality
health care delivery to the community. Health care facilities with a mandate to manage
communicable diseases such as HIV/AIDS, Hepatitis B and Hepatitis C infections, it is
mandatory that infection control and bio-waste management techniques / practices are
reinforced to all the hospital staff at all levels.

TNHSP in collaboration with Tamil Nadu State Aids Control Society (TANSACS), Tamil
Nadu Pollution Control Board (TNPCB), State Health Society (NRHM) and AIDS Prevention
And Control Project (APAC-VHS) supported by USAID has initiated capacity building of
health care service providers in the state to implement Bio Medical Waste Management in
seven Government Medical College Hospitals & four Private Medical College Hospitals in the
state. This project is termed as PUSH (Project for Upgrading Safety in Health Care) and aims
at training 150 health care providers as Trainers in Bio Medical Waste management. They in
turn would be entrusted the responsibility of training 40,000 health care providers in the
state within a span of two years. I wish to thank the financial & technical support of APAC-
VHS – USAID and the consultant Becton & Dickinson, India appointed for this project. I wish
this capacity building exercise a great success and hope that the learning be transformed
into practice & thereby bring a great reduction in hospital acquired infections.

Dr. S. Vijayakumar, I.A.S.,

Project Director
Tamil Nadu Health Systems Project

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 ADDRESS FROM PROJECT DIRECTOR: APAC-VHS-USAID

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Bio-waste management and practice of universal work precautions in health care facilities is
critical for quality health care delivery. With increasing number of health facilities having to
manage ICTC and ART services focusing on HIV testing and other infections it is mandatory
that infection control and bio-waste management techniques are reinforced, using available
state of the art technology and capacity-building of health task-force. This will eventually
contribute to decreasing the disease burden in community as well as well-being of health
care providers at all levels.

Biomedical waste if improperly managed, places health care workers, sanitation workers,
and the general public at risk of contracting dangerous diseases as twenty percent of the
medical waste is considered hazardous and/or infectious. Therefore it is critical to have an
Infection Control and Waste Management plan for the state.

The broad objective of proposed biomedical waste management plan is to ensure the
efficient and sustainable management of potentially harmful waste generated from
healthcare facilities, which helps in prevention, care and treatment of HIV/AIDS.

This initiative of capacity building of the 11 regional training centers on BMW would help in
strengthening the state health system in hospital infection control. The cascading training
would help in training about 40,000 health care providers in the state on infection control
and thereby help in reducing the overall incidence of hospital acquired infections.

AIDS Prevention And Control Project (APAC- VHS- USAID) is happy to have supported this
initiative of the Tamilnadu Health systems project & Tamilnadu State AIDS control Society
and we express our solidarity in the fight against the HIV epidemic.

Dr. Bimal Charles

Project Director
APAC- VHS- USAID

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 ADDRESS FROM DIRECTOR: B.D. INDIA PVT. LTD.
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Healthcare providers, regulatory bodies and patients too, are beginning to focus on
improving healthcare safety.

There are several drivers for this – patient education and awareness, litigation, competition,
corporate governance, medical tourism and need for accreditation, ability and willingness to
pay for better quality, and the realization that the “down stream” costs of “poor quality /
safety” more than justify the costs of improving safety.

We have seen in recent times, several initiatives start off in India, in which BD is playing a
key role - National Initiative of Patient Safety – started by Minister of Health, GOI – in which
BD is the Knowledge partner, and a program to build awareness around unsafe injections,
working with IAP and Min. of Health.

BD sees “Safety” holistically – “Total Safety for Patients, Health care workers and
Community”.

We believe that the constraint in improving safety, is NOT lack of awareness about “What
should be done” - everyone in healthcare delivery has access to the best standards like JCI,
NABH and CDC. The constraint lies in the “”How” to achieve those standards, the inertia
around current practices and the infrastructure constraints.

While training on “what” and “how” is a necessary step in the journey, BD has developed a
structured, comprehensive 12 month program – Safe-I Risk Reduction Program – to help
hospitals develop their own organizational capabilities like HICC, setting up protocols and
policies based on global best practices, surveillance systems, continuous education on
medication delivery practices, formation of Infusion teams to cascade the training down to
impact bed-side practices.

TN has once again showed why it is called one of the progressive states in India – by the
vision of creating 11 Centers of Excellence in Biomedical Waste Management, and we are
proud to have been chosen by TNHSP to conceptualize this training program basis an
assessment of current reality, and to conduct the entire training program, which will finally
cover all healthcare professionals and workers across the state of Tamil Nadu.

We wish you all success in making this PROJECT PUSH a reality, and ensuring that Tamil
Nadu gets recognized as THE best in Bio Medical Waste management practices.

Rajnish Rohatgi,
Director
B.D. India Pvt. Ltd
Program purpose

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 The healthcare waste generation ranges between 0.5 kg – 2.0 kg per
bed per day. At present, a substantial proportion of this bio-medical
waste is being collected in a mixed state and disposed along with
municipal waste.

In any hospital, only 10-15% of the waste is contributed by Bio-

Medical Waste and the remaining 85% is general waste. Out of the
15% Bio-Medical Waste, 10% is infectious waste and 5% is hazardous
waste. Mixing of the Bio-Medical Waste with general waste converts
the entire hospital waste to Bio-Medical Waste and also makes it
more infectious.

Improper segregation of waste not only poses as a health hazard for

patients and the community but also poses a substantial risk to the
healthcare providers by increasing the chance of transmission of
infections like HIV, Hep-B, Hep-C etc.

Bio-Medical Waste management begins in the hands of the

responsible health care professionals and workers to create a safe,
healthy atmosphere for the community in general and the health care
workers in particular. The first step in ensuring proper Bio-Medical
Waste Management and Handling practices is to create awareness
amongst the healthcare professionals about the best practices based
on the BMW (M&H) Rules, 1998, standards and recommendations
laid down by TNHSP in concurrence with the TNPCB (Tamil Nadu
Pollution Control Board) through continuous training programs.

Program context

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 TNHSP, APAC-VHS, NRHM, TNPCB, TANSACS and BD India Pvt. Ltd,
have joined hands to roll out PUSH-Project For Upgrading Safety in
Healthcare. The objective of this project is to raise awareness on best
practices of Bio-Medical Waste Management and Handling based on
the BMW (M&H) Rules, 1998 and the recommendations of TNPCB and
TNHSP across all healthcare professionals and workers in the state of
Tamil Nadu.

This is envisaged through the set up of Regional Training Centres

(RTCs) which would implement the best practices in BMW (M&H) and
would be instrumental in imparting continuous training on the same.

Table of Contents

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 1. Agenda.............………………………………………………….............11
2. Module Overview.…………………………………………………..…....12
3. Session 1…….………………………………………………………...........13
4. Session 2..........................................................................27
5. Session 3.........................................................................34
6. Session 4.........................................................................41
7. Session 5.........................................................................50
8. Session 6.........................................................................60

Agenda

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 TRAINING AGENDA FOR PARTICPANTS
Time Topic Facilitator Remarks
5 min Welcome Message & introduction    
10
min Video    

5 min Interactive session based on video    

1
hour Biomedical waste-its importance & risks    
15
min Break    
15
min Lifecycle of waste    
30
min Need for Segregation & color coding    
30
min Importance of Disinfection    
20
min Fun activity on segregation    
30
min Transport and storage    
1
hour Lunch    
30
min Treatment and disposal.    
30
min Management of other hazardous waste    
15
min KBC quiz    
1
hour Surveillance / Record maintainance / HCW safety    
30
min Hospital Tour - identifying best practices   
(A print out of this table can be utilised to display the agenda to the audience at the
training hall)

Module overview
1. Session 1

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  Definition of BMW
 BMW (M&H) Rules, 1998
 Classification of Hospital Waste
 Types of BMW
 Lifecycle of BMW
 Movement of BMW
 Risks associated with BMW
2. Session 2
 Categories of BMW
 Colour codes for BMW
 Good segregation practices

3. Session 3
 Which waste is infected
 Methods of disinfection of BMW
 Autoclave
 Microwave
 Chemical methods
 Sodium hypochlorite
 Bleaching Powder
 Disinfection Protocols

4. Session 4
 Storage of BMW in wards, CSA, CTF
 Transportation of BMW
 Labeling
 Weighing
 Record Maintenance
 Vehicle for transport

5. Session 5
 Methods of disposal of waste
 Deep burial pit
 Sharps pits
 Secured landfill
 Liquid waste & its management
 Effluent Treatment Plant (ETP)
 Standards of Hospital Effluent

6. Session 6

 Mercury spillage
 Handling mercury spills
 RA waste
 Handling RA waste
 Precautions
 Safety of healthcare workers
 Surveillance
 Post exposure Prophylaxis
 Degree of exposure

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 Session 1:

In this session you would be able to understand

 Definition of BMW
 BMW (M&H) Rules, 1998
 Classification of Hospital Waste
 Types of BMW
 Lifecycle of BMW
 Movement of BMW
 Risks associated with BMW
Slide 1
Slide 2

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Slide 3
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ANSWERS
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Slide 40

ANSWERS

Session 2:

In this session. You will understand :

 Categories of BMW
 Colour codes for BMW
 Good segregation practices
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ANSWERS

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 Session 3:

In this session you will understand:

 Which waste is infected

 Methods of disinfection of BMW
 Autoclave
 Microwave
 Chemical methods
 Sodium hypochlorite
 Bleaching Powder
 Disinfection Protocols
Slide 60
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ANSWERS

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 Session 4:
In this session you will understand:
 Storage of BMW in wards, CSA, CTF
 Transportation of BMW
 Labeling
 Weighing
 Record Maintenance
 Vehicle for transport
Slide 80
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ANSWERS

Session 5:

In this session you will understand:

 Methods of disposal of waste
 Deep burial pit
 Sharps pits
 Secured landfill
 Liquid waste & its management
 Effluent Treatment Plant (ETP)
 Standards of Hospital Effluent
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ANSWERS

Session 6:

In this session, you will understand:

 Mercury spillage
 Handling mercury spills
 RA waste
 Handling RA waste
 Precautions
 Safety of healthcare workers
 Surveillance
 Post exposure Prophylaxis
 Degree of exposure

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ANSWERS
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