Trainer’s Guide

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 Trainer’s Guide 1
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 FOREWORD

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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BMW(M&H):Training module and hand-out Trainer’s Guide 3
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 ADDRESS FROM PROJECT DIRECTOR: APAC-VHS-USAID

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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BMW(M&H):Training module and hand-out Trainer’s Guide 5
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 ADDRESS FROM DIRECTOR: B.D. INDIA PVT. LTD.

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
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Program purpose

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.

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Program context
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.

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Table of Contents

1. Agenda…………………………………………………………….......10
2. Module overview…………………………………………………..11
3. Implementation advice………………………………………….12
4. Resources……………………………………………………………….12
5. Instructions…………………………………………………………….12
6. Bin-it and Win-it……………………………………………………..13
7. KBC Quiz…………………………………………………………………13
8. Advance preparation……………………………………………..13
9. Target Audience………………………………………………….…13
10. Session Overview……………………………………………………14
11. Session 1……..………………………………………………………...15
12. Session 2………………………………………………………………..29
13. Session 3………………………………………………………………..36
14. Session 4…………………………………………………………………43
15. Session 5…………………………………………………………………54
16. Session 6…………………………………………………………………64

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Agenda

TRAINING AGENDA FOR PARTICIPANTS

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 maintenance / HCW safety    

30 min Hospital Tour - identifying best practices

Module overview
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 1. Session 1
 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

Implementation advice

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Resources

 LCD projector, Speakers

 Laptop with BMW (M&H) training module slide set
 Oru Nodi Podhum Video
 KBC quiz slide set
 Laser pen
 Flip Chart, paper and markers
 Hand-out: Participant guide
 Colour coded bins: red twin-bin, 15 litre red bin, 25 litre red
bin, 25 litre blue bin, 25 litre yellow bin, 25 litre black bin
 Box containing soft balls with stickers of different items used
in the hospital
 Stop-watch

Instructions

• Present the session using the following slides and handouts.

• Each slide includes the trainer’s Notes –instructions for you to

conduct the session. The instructions given in the trainer’s
notes would help to guide you throughout the conduct of the
presentation

• Participant guide – to be provided to the participants at the

beginning of the session. It has a print-out of the slide deck
along with adequate space for the participants to write down
notes against each slide.

• Note that the page numbers in the Trainer’s Guide will be

different from Participant Guide, but you can always refer
participants to the slide number which will be the same in
both Guides.

Bin-it in a Min-it! (Fun activity on segregation)

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 This game is to be played on an individual basis. First make sure that
you have all the requirements - Colour coded bins: red twin-bin, 15
litre red bin, 25 litre red bin, 25 litre blue bin, 25 litre yellow bin, 25
litre black bin, a box containing soft balls with stickers of different
items used in the hospital and a stop-watch.

Arrange the colour coded bins in a straight line next to each other.
Make a mark 5 to 7 feet away colour coded bins. Place the box
containing the soft balls, each with a sticker of a bio-medical waste
generated in the hospital. Select one member of the audience. The
member is given exactly one minute to take out one soft ball at a
time and to throw it into the appropriate colour coded bin. Award
one point to every soft ball which falls into the CORRECT colour
coded bin.

Repeat this activity with different members of the audience and

keep a tab on all their scores. The person with the highest number
of soft balls thrown into the correct colour coded bin is the winner.

KBC Quiz
Select one member of the audience and bring him/ her to the front
of the group. Let him be seated on the ‘hot-seat’. Using the slide set
on KBC (Kaun Banega Crorepati quiz) display the questions and
await their answers and ‘lock’ the same. Involve the audience only
after the selected member’s answer has been ‘locked’.

This can also be conducted by asking questions to the entire group

without selecting an individual member of the audience.

Advance preparation

Review Trainer’s notes, slides prior to the session. Ensure

LCD/overhead projector and speakers are in working condition.
Ensure adequate number of participant guides and all requirements
for the fun activities and KBC quiz are available.

Target audience

Training on BMW (M&H) best practices is intended for all healthcare

professionals-doctors and nurses, house surgeons, medical and
nursing students.

Session Overview:
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 Resources required
Steps Time Activity/ Methodology Content
10
1 min Group interaction Welcome Message & introduction  
10
2 min Video presentation Oru Nodi Podhum video LCD/overhead projector, speakers
10
3 min Group interaction Interactive session based on video LCD/overhead projector, flip charts
Biomedical waste its importance &
4 1 hour Trainer presentation risks LCD/overhead projector, flip charts
15
5 min Trainer presentation Lifecycle of waste LCD/overhead projector, flip charts
30 Need for Segregation & colour
6 min Trainer presentation coding LCD/overhead projector, flip charts
30
7 min Trainer presentation Importance of Disinfection LCD/overhead projector, flip charts
20
8 min Energiser activity Fun activity on segregation Colour bins, soft balls, stop-watch
30
9 min Trainer presentation Transport and storage LCD/overhead projector, flip charts
30
10 min Trainer presentation Treatment and disposal. LCD/overhead projector, flip charts
30 Management of other hazardous
11 min Trainer presentation waste LCD/overhead projector, flip charts
15 KBC quiz slide set, LCD/overhead
12 min Energiser activity KBC quiz projector
Surveillance / Record maintenance
13 1 hour Trainer presentation / HCW safety LCD/overhead projector, flip charts
30 In-house practice Hospital Tour - identifying best
14 min observation practices Guide for hospital visit

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 SESSION 1
Slide 1

Objective: Background explanation of the project

(slides 1-3) - 3 minutes

Trainer’s Notes:

 Background: Using your pointer, draw the

attention of the audience towards the project
title: PUSH-Project for Upgrading Safety in
Healthcare. Give a brief background stating
that TNHSP, APAC-VHS, BD India and the
other partnering bodies have collaborated to
strengthen 11 Medical colleges as REGIONAL
TRAINING CENTRES (RTCs) to provide quality
training to health care providers on various
aspects of Bio-medical waste (BMW) &
infection control (IC)
Slide 2

Trainer’s Notes:
Briefly state the objective of the PUSH in the following
manner:

 Objective: The objective of the project is to

ensure ‘complete awareness of proper
segregation and handling of BMW as per the
standards laid down by the Tamil Nadu Health
Systems in concurrence with the Tamil Nadu
pollution control board by conducting
continuous training
 Ask audience whether they recognize the
biohazard symbol, without naming it yourself.
Involve audience by asking where a blood
stained dressing should go and where
placenta should go. Appreciate correct
answers.

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 Slide 3

Trainer’s Notes:
Briefly mention the different sections that will be
covered in the training module
Slide 4
Slide 5

Trainer’s Notes:
Briefly state the broad objectives of the training
module as mentioned in the slide.

Encourage the audience to write down the salient

points and questions that may arise as the training
progresses.

Try to probe the audience to understand their

expectation/ what they would like to have learnt at
the end of the module.

Now use the flip charts to list down the stated

expectations of the audience.

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Slide 6
Slide 7

Trainer’s Notes:

It is best to read the description verbatim from the

slide. Ensure to highlight the following points:

That the definition is stated as per the Bio-Medical

Waste (Management and Handling) Rules, 1998

That BMW need not be produced only in hospitals.

It can also be generated at clinics, PHCs, labs, CROs

(contract research organisations-conducting clinical
trials)
Slide 8

Trainer’s Notes:
The objective of this slide is to simplify the definition
of BMW mentioned in the previous slide.

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Slide 9

Trainer’s Notes:
 Before explaining about the content of the
slides, give a brief background about how in
India (like in the other countries) medical
waste was considered a part of the municipal
waste till the BMW (M&H) Rules of 1998
 After mentioning the first two points of the
slide, emphasise more on the last point where
proper management of BMW is a statutory
requirement that is MANDATED BY LAW.
 Avoid using words like mandatory and
statutory while addressing audiences whose
language skills may not be advanced.
Slide 10

Trainer’s Notes:
The objective of this slide is to instil into each one of
the participants, the importance of being aware of
BMW.

Emphasise on the highlighted words in different

colours which are similar to the lights at the traffic
signal. Our thoughts and activities regarding BMW
handling are always at the red signal where we have
not wished to improve ourselves for the safety of the
community.

Now lead to the last point on the Hippocratic Oath

where you remind the audience about the
commitment to do no harm to the patient.

Emphasize that danger may not be far away but affect

anyone of the audience by reckless disposal methods.
Slide 11

Trainer’s notes:
This slide depicts the end objective of the entire gamut
of BMW(M&H) rules, which is to ensure the safety of
humans and the environment.

Pause and allow someone from audience to

summarize what has been learnt so far:
 All of us are responsible for proper waste
disposal.
 Any of us can get affected adversely at
anytime if proper care is not taken NOW!
There is a rule that makes correct disposal methods a
compulsory act.

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Slide 12

Trainer’s Notes:
 Using your laser pen, point out to the
quantity of waste that is generated in Indian
hospitals everyday on a per-bed basis. Please
keep in mind that there are other studies
which mention slightly different numbers as
well.
 There are also variations in the amount of
waste generated in the government and the
private hospitals.
 Before explaining about the classification of
hospital waste, mention that NOT ALL WASTE
GENERATED IN THE HOSPITAL IS BIO-MEDICAL
WASTE. In fact, most of the waste (80%) is
general waste.
 While mentioning about the classification of
BMW emphasise that not all BMW is
infectious waste. Pharmaceutical waste and
Slide 13

chemicals are non-infectious.

 Why do we emphasize segregation from a
practical point?Ask the audience.
 Firstly – We have to separate infectious from
non infectious waste AT THE POINT OF
GENERATION AND NOT DOWNSTREAM.
 Secondly,we have to separate waste that is
incinerable from waste that can be
autoclaved.Some wastes that contain plastic
when burnt produce cancer causing
substances like?(ask audience if they can
name) dioxins and furans.
 Hazardous waste may include mercury and
other heavy metals etc.
 Radioactive waste management does not
come under the purview of BMW (M&H)
rules, 1998.
 Involve audience here.
Slide 14

 This slide enumerates the different types of

BMW generated in the hospital.
 First list out the different types of BMW which
are mentioned in red on the flip chart.
 Increase interaction at this moment by
revisiting the flip chart and asking the
audience to come up with examples for waste
under each section.
 To build on the interaction, ask selected
members of the audience to tick on the type
of BMW that they come across/handle in
their daily working in the hospital.
 At the end of the interaction, try to analyze
and share with the audience, that which is
likely to be the most commonly generated
BMW in the hospital

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Slide 15

Trainer Notes:
Contaminated wastes are those wastes which are
contaminated with blood and/or other body fluids.

This slide depicts the different types of contaminated

waste.

To encourage interaction you could ask the audience

to name the different items on the slide.
Slide 16

Trainer’s Notes:

This slide shows the different types of BMW

GENERATED INSIDE DIFFERENT PARTS OF THE
HOSPITAL.

Use the laser pen to point at the different types of

BMW enlisting the following:

Sharps (Top-bottom): Blades, ampoules, flip caps of

vials, needles and vials.

Anatomical waste: Body parts –amputated limbs and

placenta

Pharmaceutical waste- capsules

Cytotoxic waste / Radioactive waste (signs)
Slide 17

Trainer’s Notes:
This slide shows the different types of BMW
GENERATED ONLY IN THE LAB like culture plates, slides
after examination and liquid waste.

Point to be driven is that both the sample AND the

container are contaminated and potentially infected.

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Slide 18
Slide 19
Slide 20

Trainer’s Notes:

Now that the classification of the BMW is clear, the

objective of this section would be to elaborate on the
lifecycle of different types of BMW right from
generation to the final disposal.

Use this opportunity to differentiate between point of

generation and point of disposal.Emphasize point of
generation and hit home the point that what happens
here trickles down the road.That is,good segregation
here prevents ……………..ask audience!
(infection and sharps injury to HCW and general
public,reduction in cancer causing substances)

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Slide 21

Trainer’s note:
 This slide gives the outline of the entire
lifecycle of BMW
 Using your laser pen, point out to all the
different stages mentioned in the slide
 Give an example of a particular type of BMW
like an I.V. tubing (or) give an example of a
particular ward and ask the audience to give
their opinion of what has to ideally happen in
every stage of the lifecycle
 Once the audience has completed the task of
creating an imaginary sequence, ask them
whether these practices are being carried on
in the hospital premises diligently
Slide 22

Trainer’s note:
 All the stages of BMW lifecycle are NOT
completed inside the hospital. Even within
the hospital, there are different areas which
are involved in the entire lifecycle
 The objective of this slide is to give a broad
picture of the movement of BMW across the
different areas
 Emphasis has to be made towards proper
segregation and disinfection since a gap early
in this lifecycle (where the healthcare
professionals are involved) would lead to a
failure downstream.
Slide 23

Trainer’s note:
 Involve audience by asking these interactive
questions.

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Slide 24

Trainer’s note:
Now that the audience is aware to an extent about the
lifecycle of BMW and its movement across different
areas, they should also realise that this would be a
risky affair if recommended guidelines are not
followed

Mention that one second is all it takes-oru nodi

podum!!
Slide 25

Trainer’s Notes:
 Point out to all the types of BMW mentioned
in the slide and emphasize on the high
number of the types of BMW that is risky
 ‘Risky’ as a term refers to the fact that the
BMW could cause an infection or is highly
likely to cause a ill-effect on the health of the
affected individual
Selected members of the audience could be asked to
enumerate the reasons why they think a particular
waste is risky?
Slide 26

Trainer’s Notes:
 In this slide, first point out to the pictures
which highlight the different unsafe practices
in BMW Management and Handling.
 Give examples for each of these unsafe
practices like improper collection of needles,
reuse of syringes and improper disposal of
waste in the surroundings respectively.
 Now move to the impact of these unsafe
practices which would be injuries (like needle
stick injuries), infections like Hep-B, HIV and
toxic effects like release of dioxins which are
carcinogenic released due to incomplete
incineration
 These risks will be discussed in the following
slides

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Slide 27

Trainer’s Notes:
This slide should be a follow up of the explanation in
the previous slide.
 Percutaneous injury refers to any injury on
the skin with a needle or any other sharps
 ‘Contact’ refers to contact of blood or other
body fluids which might contaminate the bio-
medical waste

Before moving to the next slide ask audience to list

three diseases that can be transmitted by blood borne
route.
Slide 28

Trainer’s note:
Mention that these diseases are of major concern to
us as HCW.
Slide 29

Trainer’s Notes:
Talk about viruses-only a brief overview of this list.
Emphasize on the long list, and what we know & talk
commonly are only 3 of these 33, which means that
there is lot more that could be transmitted via
occupational exposures.

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Slide 30

Trainer’s note:

Run through this list as before.

Adding that not only viruses, but a lot of bacterias &

parasites also have the potential to infect, via
occupational exposures.
Slide 31

Trainer’s Notes:
Point out to the incidence rates mentioned in the
slide. To give a clearer picture, mention that for every
100 persons infected with Hep B positive needles, 30
would be infected. Similarly 1.8 would be positive for
HCV but in the case of HIV it would be 3 cases for
every 1000 NSIs.

This should not be brushed away as an uncommon

occurrence. This should be validated by the results of
the WHO assessment made in 2002, mentioned in the
slide.
Slide 32

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Slide 33

Trainer’s note:
Explain the iceberg analogy and mention that what we
know is only the tip.
Slide 34

Trainer’s note:

Explain, which devices are causing the most injuries, of

which the maximum injuries are happening due to
disposable needles & 80% of the injuries are because
of 6 sharp devices, also name them
Slide 35

Trainer’s note:

Emphasize that hollow bore needles are more

dangerous than solid bore needles though both can
transmit blood borne diseases like HIV.
Trainer’s note:
Take the audience through this pie chart, mention

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Slide 36

Trainer’s Notes:
Which professionals in the hospital are at most risk,
highlight the most affected are Nurses & Physicians,
followed by technicians.
Slide 37

Trainer’s Notes:
 The objective of this slide is to portray the
high number of individuals who are exposed
to a risk at any given time.
 But the fact remains that anyone can be
exposed to the risk of improper management
and handling at any step of the lifecycle of
BMW.
Slide 38

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Slide 39
Slide 40

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 SESSION 2
Slide 41

Trainers Notes:-
 In the lifecycle of BMW managements, all the
steps are very very important.
 However the most important step is the
segregation
can anyone explain why?
Slide 42

Trainers Notes:-
 Slide already discussed.
 Remind about the lifecycle of waste

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Slide 43

Trainers notes:-
 let us see the definition of segregation
 again repeating that the most important step
in the lifecycle of BMW management is……..
Slide 44

Trainers Notes:-
 what all do you think the hazards of improper
segregation and hence the mixing of the
waste is?
 Point out at each one of the point and
carefully read them with explanation of the
points
 Mixing of infectious and non infectious waste
makes the whole waste infectious.EMPHASIZE
this…
Slide 45

Trainers Notes:-
 We are all again and again stressing on the
importance of segregation, but we want to
segregate waste according to what?
 What are the guidelines?
 All Biomedical wastes are divided into 10
categories by the central pollution control
board.
 Lets quickly go through them….

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Slide 46

Trainers Notes:-
 Point out at each one of the pictures on the
slide and gives examples
1- human body parts or anatomical wastes
2- Animal and their tissues used at various
places like labs
3- All the laboratory wastes like live cultures
4- All forms of sharps like needles, scalpels,
glass,etc
5- All the discarded and expired medications and
the cytotoxic drugs
Slide 47

Trainers Notes:-
6- all the soiled or blood and bodyfluid
contaminated waste like plasters and
bandages soiled with blood.
7- Solid contaminated wastes like iv sets, plastic
tubings, IV bottles,etc
8- All liquids and chemicals used for cleaning
and like the detergents used in cleaning the
floors
9- Incineration ash derived from burning of the
wastes.
10- Solid and liquid chemicals like hypochlorite,
formalin and other chemicals
Slide 48

Trainers Notes:-
 Point out at each one of the colours on the
slide with attention on each of the categories
 These colours tell us the exact segregation
and the bins they are to be discarded in
 Yellow-1,2
 Blue- 4
 Red- 3,6 &7
 Black- 5, 9 & 10

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Slide 49

Trainers Notes:-

Emphasize that green is for General waste.

Patient attendants to be instructed that general waste

goes in green.
Slide 50

Trainers Notes:-
 So how does colour coding help in
segregation?
 Point out at the points one by one and explain
 Standardizing the practices so that the
understanding is uniform and hence the
compliance
 We can decide on where the bag has to be
sent (incineration/autoclaving,etc) just
looking at the colour coding and without
having to open each of the bins to check the
content. Imagine what would have happened
without the coding…the bin/bag would have
had to be opened every time we wanted to
discard any waste
 Thus with colour coding, a uniform practice
guideline can be laid down
Slide 51

If we do not segregate & dispose biomedical waste

appropriately, then at some point of the time we
might receive used disposable devices, which are
washed and repacked, which has been uncovered by
the media at various places in the country.

Spend 30 seconds on this slide and allow the audience

to laugh a bit and relax.Prepare them mentally for the
next few slides…

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 Slide 52

Trainers Note:-
 Here is the first of the colour coded bins with
what all is to be discarded in it.
 They include all the human anatomical wastes
and body parts and all forms of animal wastes
used in the laboratories for various purpose
like research, vaccine production, etc
Slide 53

Trainers Notes:-
 This slide show’s the colour coded blue bin
and the category of wastes that shall be
segregated into this blue coloured bin.
 Enumerate all the examples of category 4
(sharps) to avoid all confusion.
 All glass also are in this category as they are
potential sharps.
 Use pointer to show the pictures on the slide
projected
 The needles shall be destroyed in a needle
burner before discarding.
 The needles shall be then put in the blue twin
bin which contains freshly prepared 1%
sodium hypochlorite.

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Slide 54

Trainers Notes:- (demo of twin bin)

 This slide show’s the colour coded red bin and
the category of wastes that shall be
segregated into this red coloured bin.
 There are 3 types of red containers for
different categories of waste which go in the
red bins.
 These are cat 7 in a 25 ltr bin which will
comprise of all infected plastic waste like i.v.
sets, i.v. bottles, plastic tubings, (all infected
plastic solid waste) (use the pointer to show
each category and enumerate the examples in
each category)
 Cat 3 and 6 in the 15ltr bins which essentially
are non plastic but soiled with blood or body
fluid and laboratory waste like culture plates,
used media, etc ) (use the pointer to show
each category and enumerate the examples in
each category)
 The twin bin is used for decontamination of
contaminated plastics like sputum cups, used
syringes before they are emptied into the
25ltr red bin. (use the pointer to show each
category and enumerate the examples in each
category)
 The decontaminant commonly used is 1%
freshly prepared sodium hypochlorite with a
minimum contact time of 30 minutes.
Slide 55

Trainers Notes:-
 This slide shows the color coded black bin and
the category of wastes that shall be
segregated into this black colored bin.
 The categories of waste which are discarded
into this bin are category 5, cat 10 and cat 9.
(use the pointer to show each category and
enumerate the examples in each category)

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Slide 56

Trainers Notes:-

Green is for G as G is for General waste.

Slide 57

Trainers Notes:-
 Again stress on the fact that, of all steps
in the lifecycle of BMW management, the
most important is segregation. If
segregation is improper, the 20%
hazardous will contaminate the
remaining 80% of nonhazardous . Thus
100% of hospital waste becomes
hazardous.
 Thus good segregation will also save on
the cost to the hospital as disposal of
hazardous waste is the costliest and it
shall be limited to 20%.
 Also the HCW, especially the BMW
worker can be safe from injuries due to
sharps entering the wrong bag and thus
giving him/her a fatal NSI.
Slide 58

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Slide 59

SESSION 3
Slide 60

Trainers Notes:-
What is disinfection?
How is it different from sterilisation?

Emphasize need for cleaning as a prerequisite for

effective disinfection/sterilization.

Can you explain why disinfection of infectious waste is

necessary?(hint : prevents infection,reduces waste
volume)

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Slide 61

Trainers Notes:-
 We have seen generation of waste, the
segregation and its importance. Now lets
proceed to the next step in the cycle which is
‘Disinfection’.
Slide 62

Trainers Notes:-

Read each definition loudly and carefully and in the

language and method they will understand.
Explain the basic difference between disinfection and
sterilisation which would be removal of infective
organisms versus total removal of all organisms.
Sterilization of all the BMW is impractical and hence it
is better to disinfect the waste after segregation.
Slide 63

Trainers Notes:-
 This slide in a glimpse shows the various
categories of waste in the hospital which need
disinfection.
 Enumerate the categories and correlate them
with the colour coded bins with the help of
demonstration tools

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Slide 64

Trainers Notes:-
 Enumerate each of the waste.
 Ask if any participant is from the lab services
and ask him the type of wastes in his/her
clinical area
 Then ask his/her understanding of why the
wastes are hazardous for the benefit of other
participants.
 Explain the concept of live vaccines-i.e. they
contain live microorganisms or weakened
microorganisms.
 Culture in the lab is the process of growing-
isolating and identifying the microorganisms
responsible of causing disease. There are
various equipments used for this purpose like
petridishes, testtubes, etc
Slide 65

Trainers Notes:-
 Enumerate all examples with explanation of
scalpels, razors and how glass is sharp
(breakage)
Slide 66

Trainers Notes:-
 Soiled in this context means any material
contaminated with patient blood or body
fluid. This could be fresh(wet) or old (dried).
 Enumerate the examples
Throw a question as to where the sanitary pads would
go ??
Ask them where they dispose their cotton swabs in the
phlebotomy rooms?(which colored bags)?

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Slide 67

Trainers Notes:-
 These are items like IV sets, cvcs, and other
catheters.
 Ask them how they dispose these items at
present
 Ask them if used iv sets are contaminated and
why, (explain the concept of backflow and
negative pressure and hence they do not need
to be visibly blood stained to be
contaminated
 Use pointers to point the items.Emphasize
saline pouches.
Slide 68

Trainers Notes:-
 What are all the liquid wastes in the
hospitals?
 Use flip charts to enumerate all the liquid
wastes from the hospitals
 Try assigning them to the clinical areas they
are used in
 Assign on the flip charts the method of
disposal of these wastes
 Try to probe if these wastes are infectious are
hazardous? and reasons to why they think
this .
Tentative answers:- phenol, hypochlorite, formalin,
soap, bleach, other decontaminating agents.
Slide 69

Trainers Notes:-
Biologicals are materials used to prepare and grow
microorganisms, eg:- media used in the laboratories,
nutrient broth, glucose broth, etc

Insecticides used in the hospitals like baygon

( organophosphates), tik-20, organochlorides, etc

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Slide 70

Trainers Notes:-
 First ask whether recapping prevents sharps
injury and if it is considered a good practice?
 We all know that recapping is not a good
practice and still we do it intentionally or
unintentionally.
 Another problem is that we leave the needle
unattended, also wrong because it may harm
someone else.
 How will you realise that the needle which
was left unattended was contaminated or
not?
 Hence the best practices are……as given on
slides.
Ask them how they decontaminate the needles, if they
do?
How long do they immerse in the disinfectant
solution?
When and how they prepare the solution? Keep
sweets for the answers to increase participation.

Ask them which containers they use for disposing

sharps? probe them for the type of containers they use
and also importance of puncture resistant.
Slide 71

Trainers Notes:-
 Now we know the difference between
disinfection and sterilization.
 We also know that we have to segregate and
then decontaminate the BMW
 Now let us see the different ways in which
disinfection of waste is done
 Autoclaving---in which steam under high
pressure is used to disinfect
 Microwave--- in which materials are shredded
& soaked in water, water is then heated to
disinfect.
Chemical Method
 These are chemicals like sodium hypochlorite
or bleach, used for disinfection
 They also kill the infectious organisms by
multiple mechanisms
 The commonest concentration required
for disinfection is 1% sodium
hypochlorite.

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Slide 72

Trainers Notes:-
 This is one of the commonest used processes
 It is also efficient and reliable
Slide 73

Trainers Notes:-
 Also is another physical method of
disinfection
Slide 74

Trainers Notes:-
 In this method we can use different types of
chemicals are used as mentioned below
 They require no special equipments and can
be used for most BMW disinfection

BMW(M&H):Training module and hand-out Trainer’s Guide41

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Slide 75

Trainers Notes:-
 The commonest and most reliable chemical
used for disinfection is sodium hypochlorite
 There are various concentrations which are
used for disinfection of various BMWs
 As shown 1% is the most commonest in use
dilution which we use in the hospitals for
disinfection
 The commonest form in which this solution is
available is in 5% concentration, to be diluted
just before use
Slide 76

Trainers Notes:-
 It is very important that the solution is to be
freshly prepared, because when kept after
preparation, the solution begins loosing
chlorine and hence the ability to disinfect also
 Also, more the contaminant load, more will
be the disinfectant required. Therefore
heavily soaked material require a 10 %
concentration
 It corrodes some metals and hence plastic
containers are preferred for keeping the
freshly prepared hypochlorite solution
 Minimum contact time required is 30
minutes.
Slide 77

Trainers Notes:-
 Here are the disinfection protocols for a few
common waste materials.
 Ask the participants that in their setup, what
is the concentration used for these items?
 Are they different or the same concentration
is used uniformly?

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Slide 78
Slide 79

SESSION 4

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Slide 80

Trainers Notes:-
Ask the participants what all steps we have covered till
now and next is what?
Slide 81

Trainers Notes:-
 After disinfection we all keep the waste in our
wards for some time till the waste transport
worker comes to transport it
 Lets see the important points in the this
storage of the waste
Slide 82

Trainers Notes:-
 There is storage of waste at different places
and for different amount of time which is ….

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Slide 83

Trainers Notes:-
 This shows the flow pattern of the BMW
along with the temporary storage areas
 Point and read each of the blocks and a brief
explanation for each
Slide 84

Trainers Notes:-
Note how each of the bins have a poster on
segregation above on the wall.
Also note the type of gloves used by the workers

which is the right type (rubber heavy duty gloves) use

a pointer to indicate the different colour bins, the

posters and the type of gloves and also the mask.

BMW(M&H):Training module and hand-out Trainer’s Guide45

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 Slide 85

Trainers Notes:-
 The central storage area should be away from
the public traffic
 It should be closed and secured area under
lock and key
 No animals, rodents or pests should be
allowed to enter the area
 The entry to the facility should be dedicated
 The area should be dry and clean with no
spillage or stray materials lying on the floor
 The area should have separate areas for
different colour coded bins storage
 It should have a functional weighing scale for
weighing the waste and recording before it
leaves the hospital facility
 The worker incharge of this facility should be
vaccinated.
Slide 86
Slide 87

Trainers Notes:-
 Continue with the points of CSA

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Slide 88

Trainers Notes:-

Emphasize the point, that untreated waste should not

be stored in the hospital beyond 48 hrs.
Slide 89

Trainers Notes:-
 Point the CTF and say that once the waste
arrives there it should ideally be disposed in
24 - 48 hrs.

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Slide 90

Trainers Notes:-
 Now summarize each of the steps of lifecycle
of the waste we have seen till now.
Slide 91

Trainers Notes:-
 Use the pointer as you revise these steps in
the lifecycle and stop at transportation
Slide 92

Trainers Notes:-
 The waste has to be transported at multiple
levels from the point of generation to the CSA
and from the CSA to the CTF.
 These BMW, most of them are hazardous and
hence precautions have to be taken during
the transport
 Lets see what these NOT to be forgotten
points are during this multistep transport of
the BMW.
 Point the points at the bottom of the slide and
read out loud to stress on the importance.

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Slide 93

Trainers Notes:-
Ask the participants to name the symbol and where all
it should be used in the hospital and outside.
Slide 94Slide 95

Trainer’s Notes:-
1) Briefly discuss about the Transportation of BMW
from the wards to CSA.
2) Talk for a few minutes about the best practices to
be followed while transporting BMW to CSA
 All the bags should be labelled and secured
 the bags should not be more than 3/4ths
full
 designated trolleys should be used for
transportation
grade IV workers transporting the waste should
wear appropriate PPE

Emphasize PPE when an opportunity like this

appears!

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 Trainer’s Notes:-
1) Highlight the listed points and discuss for a few
minutes about the essential things to remembered
during the transportation stage.

2) Also emphasise on why PPE and Universal

Precautions are important.
Slide 95
Slide 96

Trainer’s Notes:-

 Try to invite the audience to come up with

points as to why labelling is important
 Then based on the points, ask them to
enlist their own minimal list of required
details to be labelled
 If time permits, ask them to design a label
that is appropriate and sufficient for their
facility
Slide 97

Trainer’s Notes:-

Display this picture of an ideally labelled BMW bag

and briefly discuss the advantages for some time

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Slide 98

Trainer’s Notes:-

Provide a link to the previous slides and try to

validate all the mentioned details

Also provide a imaginary scenario where the mixed

waste collected at the CSA could be traced back to
one particular ward,thus improving accountability
Slide 99

Trainer’s Notes:

1) Introduce the Slide named Weighing and the

advantages of weighing.

2) Weighing to be done at wards and CSA

3) Weighing prevents pilferage on the

transportation path.

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Slide 100

Trainer’s Notes
 Talk about the key personnel entrusted
with the task of record maintenance

 How each Health care worker contributes

his part for correct record maintenance?
Slide 101

Trainer’s Notes:-
 Speak for a few minutes on the best
practices to be followed During Transport
of BMW
 Talk about the dangers of mixing BMW
 And steps to prevent spillage
Slide 102

Trainer’s Notes:-
 Here more details on the trolleys used for
transport of BMW are discussed

 Speak about the puncture proof containers

for sharps

 While transportation, the waste should be

contained and have closed lids.

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Slide 103

Trainer’s Notes:-
 Speak about the vehicles used for
transporting BMW from CSA to CTF

 Speak about maintaining a healthy work

place for preventing diseases.
Slide 104

Trainer’s Notes:-

 Elaborate on the vehicles used for

transporting BMW
Slide 105

Trainer’s Notes:-

Questions are asked to evaluate the level of

understanding of participants.

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 SESSION 5
Slide 106

Trainer’s Notes

Answers are discussed and participants’ doubts are

cleared.

Trainers Notes:-
 Introduce the new slide which deals about
Slide 108

Monitoring & Record Maintenance

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 Trainers Notes:-
Slide 107

 Slide already discussed

 Recollect the lifecycle of waste and put the
pointer at the Monitoring and Record
Maintenance part
Slide 109

Trainers Notes:-
 Talk for a few minutes about the
advantages of proper record keeping

 Ask the participants about the

conditions of records in their wards.
Slide 110

Trainers Notes:-

 Talk for a few minutes about the need

for keeping registers at the ward level
and at CSA
 Slide talks about the personnel in
charge of maintaining the record
documents.
 Motivate the participants to do
adequate record maintenance after
reaching back to their departments.

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Slide 111

Trainer’s notes:

 Go through the following annexures in a

sequential manner.

 They describe the format for record

keeping.

 Annexure 1, is for maintaining record at

source & needs to be filled-up by the
staff nurse / paramedical staff incharge
Slide 112

 Annexure 2, is for maintaining record at

Common storage area & needs to be
filled-up by the sanitary worker /
hospital worker.
Slide 113

 Annexure 3, Monthly consolidated

register for collection of BMW at
Medical superintendents office
 To be filled-up by the medical
superintendent / Chief medical officer.

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Slide 114
 Annexure 4, is for maintaining records
of Needle Stick injuries
 To be filled-up by the medical
suprintendant / Chief medical officer
Slide 115

Trainers Notes:-

 Introduce the new slide

Treatment & Disposal
Slide 116

Trainers Notes:-

 Slide already discussed

 Using your laser pen, point out to all
the different stages mentioned in the
slide
 Stop at Treatment & Disposal

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Slide 117

Trainers Notes:-

 Introduce the term CTF

 Talk for a few minutes about CTF
 Ask whether the participants are aware
of the CTF of their hospital
Slide 118

Trainers Notes:-

 Talk more about the different aspects of

CTF.
Slide 119

Trainers Notes:-

 Speak for a few minutes about the

prerequisites of CTF.

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Slide 120
Trainers Notes:-

 Briefly discuss about the technology

used in Treatment & Disposal of waste
 Ask the participants whether they are
aware of the above technologies.
Slide 121

Trainers Notes:-

 Introduce the technology Incinerator

 Talk about primary and secondary
chambers.
Slide 122

Trainers Notes:-
 Continuation of previous slide

 Mention various rules governing the

use of Incinerator.

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Slide 123

Trainers Notes:-
 Introduce the technology Autoclave
 Briefly discuss about the process and
the advantages.
Slide 124

Trainers Notes:-
 Introduce the Technology Shredding

 Speak for a few minutes about the

advantages of shredding and the wastes
that are disposed through the above
technology
Slide 125

Trainers Notes:-
Talk for a few minutes about deep burial pit.

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Slide 126

Trainer’s notes :

Introduce slide by talking about alternate

methods, which are available for areas distant
from CTF.

Mention the following :

 Deep burial pit: an alternate
method of disposing small amounts
of BMW.

 It is done primarily where the

population is less than 5 lakhs.

It should be well secured and safe from animals.

Slide 127

Trainer notes :

 Define sharps pit – a deep pit where

disinfected sharps like needles are
disposed in CTF.
 Specify its layout – Surrounded by
cement wall on all sides and having a
cylindrical pipe through which sharps
are deposited.
Slide 128

Trainer notes :

 Definition – an area with containment

measures such as leachate collection
system and liners so that the contents
do not pollute the surrounding air, land
or water.

 Why used? – Ash from incinerators,

waste from black bags and cytotoxic
drugs.

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 Slide 129
Trainer notes:

1. Spend 2 minutes explaining the diagram

of a secured landfill

 Interact with the participants to find

out how many know what is a secured
land fill and that if they are using it.

 For users of landfill ask them the

importance of specifications like how
deep the pit is to be, and how far from
the population

 Then use the pointer to read each of

the dimensions of the landfill

Also explain that it should be away from the

residing population and from any water source
to avoid contamination of the water source.
Slide 130

Trainer’s notes :

 Define liquid waste. (blood, body fluids,

urine and excreta)

 What is the special challenge in handling

it?(highly mobile and enters water bodies
to be spread into a wider area)

Ask them how they discard their liquid waste at

present, e.g.-pleural or ascitic fluid and the
possibilities of it causing untoward outcomes.
Slide 131

Trainer’s notes :

 Link up to the previous slide saying , hence

the treatment of the liquid waste is
important before it is led into the drainage

 If the facility does not have an ETP, ensure

complete disinfection of the liquid waste
before it is let into the general sewer.

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 Trainer’s notes :
Slide 132

Display picture of a large ETP in a city.

Slide 133

Trainer’s notes :

 Introduce slide by talking about need for

alternatives in the rural setting.

 Talk about soakage pits and

evapotranspiration methods as the
alternatives.
Slide 134

Trainer’s notes :

 Briefly run through this slide on the

standards for hospital effluents.

 Pause, summarize and ask for questions.

It is not necessary to divulge into the details, the

objective is to give the audience an idea of the
different standards to be met for the hospital
effluent.

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Slide 135
Slide 136

SESSION 6

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Slide 137
Trainer’s notes :

 Introduce the next topic – other hazardous

wastes.

 We will be dealing with mercury spillage

(mention a word on why it is important-
affects nervous and renal systems) and
radioactive waste.

Question about the two symbols by highlighting

them and if they have seen them in their facility
and where?
Slide 138
Slide 139

Trainer’s notes :

Any personal experience in contact with mercury

and what was their response after the contact

 What happens if humans come in contact

with this toxic metal?

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Slide 140
Trainer’s notes :

 Introduce the next slide by asking how do

we handle mercury spillage? invite
responses from the audience.

Walk the audience through the steps involved in

safe handling of spillage.
Slide 141

Trainer’s notes :

 Emphasize the need for personal protective

equipment.

 Focus audience attention on the picture

and give some take home points – PPE,
meticulous location and cleaning and
storage under water.

Explain that mercury starts evaporating even at

room temperature and the fumes are harmful and
hence to be stored under water to prevent fumes
due to evaporation.
Slide 142

Trainer’s notes :

 Some important don’ts.

 Mention that there is no disposal as such

for mercury, only recycling.

Ask them what they have done to spilled mercury in

the past.

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Slide 143
Trainer’s notes :

 Introduce this slide by talking briefly on the

dangers of radiation exposure like cancers,
mutation, sickness and even death

 Define the main radioactive substances.

 Mention the forms of RA waste –majority

liquid with small amount of solids and
gases.

 Explain how hospital uses RA waste, e.g.-

radiotherapy for cancers, radioactive
elements for diagnosis like iodine, etc.

Check if any participant has ever worked in such

department and make him share his experience on
handling.
Slide 144

Trainer’s notes :

 What are the two principal methods for

disposal of radioactive waste?

 Explain how radioactivity decreases with

time and is caused decay and hence to be
kept. thus the method of delay & decay

 Also explain that we can dilute the waste

and decrease the harmful radiation and
hence the second technique

 Define when to use what?

Gaseous waste is passed through charcoal filters

and let high in the atmosphere.
Slide 145

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Slide 146
Trainer’s notes :

1. Emphasize the need for proper personal

protective equipment.

Mention the need to wear radiation counters and

the need for annual monitoring using a Geiger
counter.
Slide 147

Trainer’s notes :

A brief talk that other heavy metals must also be

handled carefully and handed to CTF.

Pause,summarize and ask for questions.

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Slide 148
Slide 149
Slide 150

Trainer’s notes :

1. Introduce next topic.

We have now arrived at a point where we have to

ensure our own safety by use of adequate personal
protective equipments to complement the safe
practices

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Slide 151
Trainer’s notes :

 Make session more interactive by asking

the participants to name a few personal
protective equipments, in use at their
hospital.

Emphasize, by mentioning diseases like hepatitis B

and HIV which can be contracted if proper PPE is
not worn.
Slide 152

Trainer’s notes :

Pause,invite feedback/questions from audience?

Slide 153

Trainer’s notes :
Introduce the next slide PEP

Introduce topic by describing a typical needle prick

scenario.

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Slide 154
Trainer’s notes:

 Use the opportunity to underline the

danger involved in re-capping needles

 Form the link between how unsafe BMW

practices ties into PEP.

That is, if you get pricked accidentally, you have to

take measures to protect yourself.
Slide 155

Trainer’s notes :

 Define in simple words the post exposure

prophylaxis.

 Prophylaxis against what?

Why is it important and what are the benefits?

Slide 156

Trainer notes:

 Can you name some body fluids that are

infectious?

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Slide 157
Trainer notes:

 Describe a scenario that involves recapping

by a nurse. Ask audience if it is safe?

 Describe a scenario that involves needles

jutting out from a bag, ask if it is safe?

What can be done to remedy the scenario?

(puncture proof containers)
Slide 158

Trainer’s notes :

 Define mild, moderate and severe

exposure.

 Emphasise that the degree of exposure

depends on the severity of injury, region of
contact, and type of device that inflicts the
injury (if any).
Slide 159

Trainer’s notes:

Underscore the point that the more extensive the

exposure, the greater the risk.

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Slide 160
Trainer’s notes:

 Take time to review the first aid do’s and

don’ts.

Underscore the seriousness of the issue.

Slide 161

Trainer notes:

 Emphasize need for early PEP.

 Why is time of essence here? (because

earlier the PEP, lesser is the chance of
contracting HIV).
Slide 162

Trainer notes:

Without entering into a detailed reading out of the

table, briefly explain the difference between 2 and
3 drug regimens.(when to use what?)

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Slide 163
Trainer’s notes:

Go through this slide briefly, building on the

previous slide.
Slide 164

Trainer’s notes:

Briefly talk about PEP regimens followed

Slide 165

Trainer’s notes:

 Ask what is hepatitis B (depending on

audience)?

 How is it transmitted?

 What is the vaccine schedule?

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Slide 166
Trainer notes:

 Emphasize the importance of time in

Hepatitis B vaccination.

 When is HBIG indicated?

Slide 167

Trainer notes:

Briefly run through this slide.

Slide 168

Trainer’s notes:

Briefly ask the audience if they know how HCV is

transmitted?

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Slide 169
Trainer’s notes:

Emphasize need to refer to a specialist.

Slide 170

Trainer’s notes:

Briefly go through flowchart.

Slide 171

Trainer’s notes :

 Introduce the next topic by asking

audience why surveillance is needed?

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Slide 172
Trainer’s notes :

 Define surveillance.

Differentiate active surveillance and underline it’s

importance in pre empting hazardous practices
Slide 173

Trainer’s notes :

 Before explaining the content on the slide

invite the audience to come up with a list
of all the details which they think should
be monitored on a regular basis
Slide 174

Trainer’s notes:

Conclude by summarizing logo ‘ just a second’.

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Slide 175

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