Project for Upgrading Safety in

Healthcare
Bio-Medical Waste Management and Handling
Best Practices Learning Module
Bio-Medical Waste
A
Risky Affair!
 Risks
Almost 33 blood borne diseases can be transmitted but major
concern is the threat of spread of infectious and
communicable diseases like:

• HIV
• Hepatitis B & C
• Cholera
• Tuberculosis
• Diphtheria
 RISK : Viruses

There are at least 33 bloodborne pathogens that can be transmitted from a patient to a
HCW as a result of an occupational exposure.
RISK : Bacteria & Parasites
 Percentage of risk

Epidemiological studies indicate that a person who

experiences one needle - stick injury from a needle used on an
infected patient, has risks to be infected with:
• HBV - 30%
• HCV - 1.8%
• HIV - 0.3%
 Risks

• In 2002, the results of a WHO assessment conducted in

22 developing countries showed that the proportion of
healthcare facilities that do not use proper waste
disposal methods ranges from 18% to 64%.

(Source: AIDE-MEMOIRE by World Health Organization (WHO) Courtesy: Dept. of Protection of the Human Environment Water, Sanitation and Health)
 Worldwide Needlestick and
Sharp Object Injury estimates
• USA - CDC estimates 385,000 needlesticks
and other sharps related injuries each year
(hospital based HCWs only)1

• Canada – More than 69,000 sharps injuries

to HCWs every year

• UK - An estimated 100,000 HCWs suffer

needlestick injuries each year

• Australia – An estimated 13,000 sharps

injuries to HCWs every year2
HCW surveys indicate 40% or more
underreporting rates of needlestick and
other sharp object injuries
What is the true magnitude
of the NSI problem??
1. Estimates derived by combining data from the EPINet and NaSH networks
2. Report on the Inquiry into Nursing - The patient profession: Time for action. June 2002
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2002-04/nursing/report/ (Accessed 25 February 2008)
 What devices are causing the
Sharps Injuries?
• Aggregate data from NaSH indicates
that nearly 80% of all injuries are
caused by 6 devices
– Disposable syringes (32%)
– Suture Needles (19%)
– Winged Steel Needles (12%)
– Scalpel Blades (7%)
– IV Catheter Stylets (6%)
– Phlebotomy Needles (3%)

• Hollow bore needles are responsible

for 59% of all sharps injuries
(NaSH,2004)

*Figure 4 sourced from the Sharps Injury Prevention Programme Workbook, CDC 2004
 How are the Sharps Injuries
occurring?
* • Injuries caused by
hollow bore needles,
especially those used
for blood collection or
IV catheter insertion,
are associated with an
increased risk for HIV
transmission1.

1. Cardo DM, Culver DH, Ciesielski CA, Srivastava PU,

Marcus R et al. A casecontrol study of HIV seroconversion in
*Data sourced from “2003 Percutaneous Injury Rates”, Advances in Exposure health care workers after percutaneous exposure. N Engl J
Prevention – Vol 7, No 4, 2005 Med 1997;337:1485-90.
 Who is most at risk?
• Data from the CDCs National
Surveillance System for Healthcare
Workers (NaSH) show that Nurses,
Physicians and Laboratory
Technicians sustain the highest
number of percutaneous injuries

• EPINet data (NSW Health): Nurses =

40% sharps injuries

• 82% of all Blood/Body fluid exposures

reported to NaSH (1995-2000) due to
percutaneous injuries

*Figure 1 sourced from the Sharps Injury Prevention Programme Workbook, CDC 2004
 Who is at Risk and When?

• Generate
Doctors, nurses, paramedical
staff, House-keeping / sanitary
• Segregate staff, patients receiving
treatment.
• Disinfect Anybody,
Anywhere,
• Store Patients receiving treatment, Anytime!
Visitors to the hospital, House-
keeping / sanitary / waste
• Transport handlers staff, Community,
Scavengers
Workers in waste
• Treat and Dispose waste disposal facilities,
scavengers
 Questions

1. Define bio-medical waste.

2. Who are at risk if bio-medical waste is not managed
properly?
3. What are the effects of improper management of bio
medical waste?
4. Explain step by step approach of the life-cycle of waste.
 Answers

1.Define bio-medical waste :

As per Bio-Medical Waste (Management and Handling) Rules, 1998 and

amendments, any waste, which is generated during the diagnosis,
treatment or immunization of human beings or animals or in research
activities pertaining there to or in the production of testing of
biological and including categories mentioned in schedule 1 of the
Rule, is bio-medical waste.

2. Who are at risk if bio-medical waste is not managed properly?

Risk to all those who Generate, Collect, Segregate, Handle, Package,

Store, Transport, Treat and Dispose waste
 Answers
3. What are the effects of improper management of bio-medical waste?
Poor bio-medical waste management exposes us to the risk of:
• Infection, Toxic effects and Injuries.
• This includes Risk of Over 20 blood borne diseases can be transmitted
but particular concern is the threat of Spread of infectious and
communicable diseases like HIV, Hepatitis B, Hepatitis C, Cholera,
Tuberculosis & Diphtheria.

4. Explain step by step approach of Life cycle of waste.

Step by step approach of Life cycle of waste is as follows :
Generation  Segregation  Disinfection  Storage  Transportation
 Monitoring & Record Maintenance  Treatment & disposal.
 Black Colored Bin

Category 5
Discarded
Medicines &
Cytotoxic Category 10
Drugs Chemical Waste,
solid & liquid

Category 9
Incinerator Ash
 Green colored bin

• General waste
• Paper /cardboard
• food items
•Needle caps

Remember to tell your patients and attenders!

 Good Segregation Practices

Correct segregation of waste at the POG (Point of Generation)

relies on a clear identification of the different categories of
waste:
• It minimizes the possibility of injury to the waste handlers
• It reduces the risk of spread of infections to general public
• It leaves the POG area neat and tidy
• Reduced quantum of hazardous waste that needs to be
handled
• Reduced costs for handling hazardous waste.
 Questions

1. When and where do we segregate waste?

2. What materials are required to ensure proper segregation?

3. Name the categories of bio-medical waste and mention

color coded bins or bags for their segregation?
 Answers
1.When and where do we segregate waste?
 Immediately after use at the POG
2. What materials are required to ensure proper segregation?
 Containers/bins
 Lined with disposable plastic liners,
 Color coded as per rules,
 Bins & bags with biohazard symbol,
 designed for safe and easy handling,
 Liners to be appropriately labeled, tied, not more than ¾ full, before
transportation
3. Name the categories of bio-medical waste and mention color coded
bins or bags for their segregation?
 Yellow - 1,2,3, & 6
 Blue – 4
 Red - 7
 Black - 5,9, & 10
Disinfection
 Sodium Hypochlorite

• It acts by inhibiting protein synthesis.

• 1% is the in-use dilution.
• 1 part of 5% solution to be diluted in 4 parts of clean water.
• Disinfection of material contaminated with blood and body
fluids.
• Should be used in well-ventilated areas.
• PPE required while handling and using undiluted solution.
• Do not mix with strong acids to avoid release of chlorine gas.
 Sodium Hypochlorite

• Freshly prepared 1% Sodium Hypochlorite should be used

• The prepared solution should be changed daily
• In case of heavily soaked material or spill 10% bleach to be
used
• Waste has to be completely soaked for a min. contact time
of 30 mins.
• Highly effective against vegetative bacteria, viruses and fungi
• Stock solutions decay with time, light and temperature
• Corrodes some metals and damages rubber
 Disinfection Protocol

Blood / blood bags / Body fluid

• The bag containing the above should be emptied in 5% sodium
hypochlorite sol. For 30 mins.
• The bag should also be immersed in the same sol. For 30 mins.

Blood spills
• Disinfect the surface with 5% sodium hypochlorite for 10-15 mins.

Sharps
• The used needles/sharps should be immersed in 1% for 30 mins.

Sputum cups
• Dip the sputum cup in 5% hypochlorite for 12 hrs.
 Quiz

• What waste is to be disinfected?

• Disinfection can be done by which methods?

• Which methods are most commonly used?

• What is the percentage concentration to be used of

hypochlorite for disinfecting sharps and blood?
 Answers
• What all wastes are to be disinfected?
o Microbiological and biotechnology waste.
o Waste sharps
o Soiled waste (such as dressing)
o Solid waste (tubings, catheters etc)
o Liquid waste (from laboratory, washing)
o Chemical waste (chemical used in production of biologicals, chemicals in
insecticides etc)
• Disinfection can be done by which methods?
o Mechanical (Autoclave / Microwave)
o Chemical (Sodium hypochlorite / Phenol / Bleach powder)
• Which methods are most commonly used?
o Autoclaving ,Sodium hypochlorite, also depending on the availability
• What is the percentage concentration to be used of hypochlorite for disinfecting
sharps and blood?
o Blood (5%)
o Sharps (1%)
 A Well Equipped CSA
• Storage Area should have a Bio-hazard symbol

• Water supply for cleaning purposes

• Good drainage facility

• Locking facility to prevent access by unauthorized persons, animals

& not accessible to birds

• The flooring and walls to a height (of 2m from floor) should be

finished with smooth and fine material
 A Well Equipped CSA
• Good lighting and at least passive ventilation

• Untreated waste not to be stored beyond 48 hrs

• In the case of emergency, prior approval must be obtained
from prescribed authority (SPCB)

• Sharps must be stored in puncture proof containers to prevent

injuries and infection to people who handle them.
Common Treatment Facility (CTF)

CTF

CTF to store received waste bags separately, as per the color codes &
take up for treatment and disposal within 24 - 48 hrs.
Transportation
 Lifecycle of Waste

Generation

Segregation Treatment & Disposal

Disinfection Monitoring & Record

Maintenance

Storage Transportation
 Transportation of BMW

Segregated Waste from each Ward

1) Transportation to CSA

CSA

2) Transportation to CTF

CTF
• Transport and Storage of BMW, is a very important step in the process of
successful BMW management
• BMW should NOT be spilled during transportation
All the bins, bags and trolleys used for transport
of BMW should contain Bio-hazard symbol
 Transportation to CSA

• The BMW from all wards/depts. should be transferred to a

Common Storage Area (CSA)

• Different route/corridors for transporting BMW to CSA, to

prevent exposure / injuries to patients / HCW

• CSA is a secured hall/room, covered, lockable, where waste

is stored before CTF collects it for final disposal
 Transport: Things to Remember

While transporting waste to CSA, things to remember:

• Pre Transport
o Labeling
o Weighing
o Maintain records

• During Transport
o Use PPE (Heavy duty gloves, mask, etc.,)
o Use trolleys dedicated to BMW transportation only
 Labeling

• Labeled at the respective ward/op/lab/theatre

• Labeled using water-proof marker pen.

Details of:
1) Name of ward
2) Weight of bags
3) Signature of person assigned
 Labeling

Ward number:
Weight:
Date:
Sign:

Med. Ward No. 12

20 Kgs.
Date:01/01/2011
Sign:
 Labeling

• Containers should have the name of the dept / lab

• This creates accountability

• Color coding and proper labelling provides great assistance

in waste separation

• No need for opening bags

• Maintaining a register regarding Quantitative details

 Weighing

• Ensures that waste is neither re-

circulated nor deviates from its
designated path of movement.

• Compare the amount of wastes

generated from various
departments.

• For statistical Purposes.

 Record Maintenance

• Nursing in-charge - registers at wards, for ward wise

information

• Sanitary workers – ward wise BMW collection register

• Hospital suprintendent / CMO – consolidated monthly

register on BMW & register for NSI

• Hospital infection control officer – overall monitoring &

record maintenance of BMW management.
 During Transport

• Special care should be taken during

transport so that no spillage occurs

• Bags shall be filled only 3/4th of their

capacity

• Secure ties should be used for

individual bags

• Do not mix BMW while

transportation
 Transport
• Avoid dragging of waste bags to prevent spillage
• Use only trolleys for collection and transport of BMW in
hospital premises

Trolleys

• Trolleys should be covered and should have a bio-hazard

symbol
• The waste bags should be transported to the respective
colour bins kept in the trolley
• Transportation of sharps in closed secure, puncture-
proof containers, to prevent injuries and infection to
staff & patients
• Trolleys should be cleaned and disinfected daily
 2) Transportation to CTF

• The BMW collected in colored containers shall be

transported to the CBWTF in a fully covered vehicle
• Such vehicle shall be dedicated for transportation
of bio-medical waste only

The vehicle must posses the following:

• Separate cabins shall be provided for driver/staff

and the bio-medical waste containers
• The base of the waste cabin shall be leak proof to
avoid pilferage of liquid during transportation
• The waste cabin may be designed for storing waste
containers in tiers
 Vehicle
• The waste cabin shall be so designed that it is
easy to wash and disinfect
• The inner surface of the waste cabin shall be
made of smooth surface to minimize water
retention
• The waste cabin shall have provisions for
sufficient openings in the rear and/or sides so
that waste containers can be easily loaded and
unloaded
• The vehicle shall be labeled with the bio-
medical waste symbol (as per the Schedule III
of the Rules) and should display the name,
address and telephone number of the CBWTF.
• The cabin should be lockable
 Quiz

• Which are the two stages of transportation of waste?

• Mention the things to remember at pre-transport and
during transport.
• Things to mention on the label while labeling waste bags.
• How many times is BMW transported & from where to
where?
• What are the standards for the trolleys to transport BMW?
• Mention important requirements for BMW vehicles, while
the waste is transported to CTF
 Answers
• Which are the two stages of transportation of waste?
o From wards to CSA & from CSA to CTF
• Mention the things to remember at pre-transport and during transport.
o Labeling, weighing & record maintaining
• Things to mention on the label while labeling waste bags.
o Name of ward, weight of the bag & name of the person who has
handed over the bag
• What are the standards for the trolleys to transport BMW?
o Trolleys should be closed, there should be minimum transfer of waste,
moreover sharps should be transported in puncture-proof containers
• Mention important requirements for BMW vehicles, while the waste is
transported to CTF
o They should have a biohazard symbol, locking facility for the storage
bin, smooth inner surfaces, intact cabin to prevent spillage of BMW.
Monitoring & Record
Maintenance
 Lifecycle of Waste

Generation

Treatment & Disposal

Segregation

Monitoring & Record

Disinfection Maintenance

Storage Transportation
Monitoring & Record Maintenance

• Record maintenance is important as it contains

information for analysis such as type of waste generated &
amount from each ward and can help in tracking purposes
• All bags must be labeled properly so that in case of any
errors, they can be tracked back to the ward from where
they were generated
• Poor record maintenance leads to lack of accountability
among the health care workers.
• This leads to ineffective segregation at source and mixing
of infectious and non infectious waste as a result.
 Record Maintenance

• Hospitals should maintain records for BMW generated and

disposed from their premises
• The records must be maintained at the ward level and at
the central storage area
• BMW registers are of 4 types
o Registers for daily collection of BMW at source
o Register of source wise collection of BMW for the day
o Monthly consolidation register for collection of BMW
o Register for NSIs
 Annexure 1 (To be filled by the Staff Nurse/Paramedical Staff in charge)
Biomedical Waste Management
Register for Daily Collection of Biomedical Waste at Source
Name of District Ward No:
Name of Source No of beds:
Name of Staff Nurse/ Paramedical Staff In-charge

Sl Total Total Signa Signat Signature Re

No Date no of Biom ture ure of m
colou edical of Hospital ar
of
r bags Wast Staff Infection ks
Bags Blue Bags Yello Bags Black Bags Medic control
Red used e Nurse
w al officer
per Collec In
day ted in charg Officer
kg e In
charge

Note: Source means a place such as a ward, OTs, Ops, etc. where the waste is generated
 Annexure 2 (To be filled by the Sanitary worker/Hospital Worker)
Biomedical Waste Management
Register for Source-wise collection of Biomedical Waste at Source
Name of District Ward No:
Date:
Name of the sanitary worker/
Collection of waste from ……no. of sources
hospital worker in charge:

Sl Nam Ward Total Total Sign Signa Signatur R

No e of no no Bio atur ture e e
sour of medi e of m
of
ce colo cal of Hospital ar
Bags Blue Bags Yello Bags Black Bags Medi Infectio ks
Red ur Wast
w cal n
bags e Staff
Office control
used Colle Nurs officer
per cted e In r In
day in kg char charg
ge e

Note: Source means a place such as a ward, OTs, Ops, etc. where the waste is generated
 Annexure 3 (To be filled by the Hospital Superintendent/ Chief Medical Officer)
Biomedical Waste Management
Register for Source-wise collection of Biomedical Waste at Source
Name of District Name of the hospital infection control officer:
Name of the hospital:
Name of the Hospital Superintendent/ Chief Medical Officer: Month/year:

Sl Nam Ward Total Total Sign Signa Signatur R

No e of no no Bio atur ture e e
sour of medi e of m
of
ce colo cal of Hospital ar
Bags Blue Bags Yello Bags Black Bags Medi Infectio ks
Red ur Wast
w cal n
bags e Staff
Office control
used Colle Nurs officer
per cted e In r In
day in kg char charg
ge e

Note: Source means a place such as a ward, OTs, Ops, etc. where the waste is generated
 Annexure 4 (To be filled by the Hospital Superintendent/ Chief Medical Officer)
Biomedical Waste Management
Register for Source-wise collection of Biomedical Waste at Source
Name of District Name of the Hospital Superintendent
Name of the hospital: Name of the hospital infection control officer:

S.N Date Name of Staff Designa Age Ward in Investig Whether If yes, Follow up
with needle -tion which -ation PEP drugs Date
stick injuries the done started of
staff is Yes/No issue
posted

Note: Source means a place such as a ward, OTs, Ops, etc. where the waste is generated
Treatment & Disposal
 Lifecycle of Waste

Generation

Segregation Treatment & Disposal

Disinfection Monitoring & Record

Maintenance

Storage Transportation
 Treatment & Disposal

• The segregated BMW collected From the hospital should

be transported to the Common Treatment Facility (CTF) for
final disposal

• CTF or Common Biomedical Waste Treatment Facility

(CBMWTF) is the place where the BMW is treated and
disposed in accordance to the Bio-medical Waste
(Management & Handling) Rules 1998
 CTF : Considerations

• At a place reasonably far away from residential area

• As near to its area of operation as possible in order to
minimize the travel distance
• Requires minimum of 1 acre of land
• May be allowed to cater up to 10,000 beds at the approved
rate
• Shall not be allowed to cater healthcare units situated
beyond a radius of 150 km
• There shall be two waste storage rooms, one for storage of
untreated waste, another for treated wastes
 CTF : Prerequisite

Main waste storage room

• Provided near the entry point of the CTF
• This room is used to unload and store all BMW that have
been transported to the facility by vehicle

Treated waste storage room

• In this room wastes treated by different means shall be
stored
• The wastes shall be stored in separate group
 Technology used for
Treatment & Disposal of Waste

Treatment
Incineration
Autoclave
Shredder
Disposal
Sharp Pits
Deep burial Pits
Secured Land Fill
 Incineration

• Is a process of burning of anatomical wastes such as

human tissues, organs, placenta and waste collected
in yellow bag without disinfection
• It destroys waste and reduces the bulk in high
temperature
• Temperature of the primary chamber shall be 800 +/-
50 °C &
• Secondary chamber temp. at 1050 +/- 50 °C
• The final residue is ash
 Incineration

• Should be installed and made operational as per

specification under the BMW rules 1998 regarding the
incinerator and norms of combustion efficiency and
emission levels
• Minimum stack height shall be 30 meters above ground

Note:
• Waste to be incinerated shall not be chemically treated
with chlorinated disinfectants
• Chlorinated plastics shall not be incinerated.
 Autoclave

• The infected BMW collected is autoclaved

• Autoclave is a process in which the waste is treated

under high pressure and temperature of about 120° C
for a min. period of 30 min. thereby destroying all
forms of fungus, bacteria and other micro-organisms
including virus.

• The autoclaved waste is safe and sterile.

 Shredding

• A process by which waste is de-shaped and

cut into smaller pieces so as to make them
unrecognizable
• It helps in preventing reuse of biomedical
waste
• The plastics (IV bottle, IV sets, syringes,
catheters, etc.),
• Sharps (needles, blades, glass, etc) should
be shredded but only after chemical
treatment / microwaving / autoclaving,
ensuring disinfection
 Deep Burial Pit 
• A pit or trench about 2 meters deep
• Is an alternate technology for disposing small quantities of
BMW, which can decompose naturally, in areas not
covered by CTF & has <5 lacs population
• It should be half filled with waste, then covered with lime
within 50 cm of the surface
• It must be ensure that animals do not have any access to
burial site
• Pits should be distant from habitation
• Fencing of the deep burial pit has to be maintained
Deep Burial Pit
 Sharps Pit

• The sharps like disinfected needles, are

disposed in the sharps pit at CTF
• All the sides of the pit should be
plastered with cement
• A cylindrical metal pipe of 4 inches
diameter or more is fixed at the ceiling
of the pit
• The sharps are deposited in this pit
through the pipe from the puncture
proof translucent container after
disinfecting & mutilating
 Secured Land Fill
• Secured land fill is one which has containment measures such as
liners and a leach ate collection system so that materials placed in
the land fill will not migrate into the surrounding soil, air and water.

• The ash from incinerators and waste from black bags including
cytotoxic drugs and expired drugs will be disposed to secured land
fills.
Secured Land Fill
 Liquid Waste

• Liquid waste refers to waste generated from

laboratory, washing, cleaning, house-keeping,
disinfecting activities.
• Liquid waste from hospitals include:
o Human blood
o All body fluids (Ascitic fluid/pleural fluid/seminal
fluid/CSF)
o Urine
o Human excreta
• Among the BMW, liquid waste is difficult to handle,
as it is highly mobile & moves to a wider area after
entering water bodies.
 Management of Liquid BMW

In big cities & towns having drainage system:

• Liquid waste from kitchen sinks, wash basins, bathrooms &

decontaminated liquid waste from OT / Labour room / lab /
blood bank, can be led into the drainage system

• ETP – Effluent treatment plants, carry out primary,

secondary and tertiary treatment of liquid BMW followed
by chlorine disinfection and sludge treatment, is the
requirement for all hospitals, especially those not
connected to municipal treatment plant.
Effluent Treatment Plant (ETP)
 Management of Liquid BMW

In semi-urban & rural settings without drainage system:

• Soakage pits: allows water to drain into the soil

• Evapotranspiration Method: Used especially where soil

conditions do not allow liquids seep into the ground. Waste
water is led into the ground where fast growing grasses
take up water and release it into the atmosphere through
transpiration and evaporation
 Standards for Hospital Effluents

• The effluent generated from the hospital should conform

to the following limits:
o PH 6.3-9.0,
o Suspended solids - 100 mg/l,
o Oil and grease - 10 mg/l,
o BOD - 30 mg/l,
o COD -250 mg/l,
o Bio-assay test - 90% survival of fish after 96 hours in
100% effluent.
 Quiz
1. What is CTF?
2. What are the different technologies used for
TREATMENT & DISPOSAL?
3. What is Incineration?
4. What is an Autoclave?
5. What is Shredding?
6. What is the depth of Deep Burial Pit?
7. What are the different Liquid waste generated from the
hospital?
 Answers
What is CTF?
It is the place where the BMW is treated and disposed in accordance to the Bio-medical Waste
(Management & Handling) Rules 1998
What are the different technologies used for TREATMENT & DISPOSAL?
Incineration, Autoclave, Shredder, Sharp pits, Deep burial pits, Secured Land fills
What is Incineration?
It is a process of burning of anatomical wastes such as human tissues,
organs, placenta and waste collected in yellow bag without disinfection
What is Autoclave?
Autoclave is a process in which the waste is treated under high pressure and
temperature of about 120° C for a min. period of 30 min. thereby destroying all
forms of fungus, bacteria and other micro-organisms including virus
What is Shredding?
A process by which waste is de-shaped and cut into smaller pieces so as to make them
unrecognizable
What is the depth of Deep Burial Pit?
2metres
What are the different Liquid waste generated in the hospital?
Human blood, All body fluids,Urine, Human excreta
Management & Handling
of
Other
Hazardous Wastes
Other Hazardous Waste

Mercury

Radioactive waste
 Mercury

• Mercury is present in many items of

routine use in the hospital such as
thermometers &
sphygmomanometers (BP apparatus)

• Mercury spillage can cause

neurological and kidney damage
 Handling Mercury Spillage

The following steps are to be taken:

1. Remove everyone from the area that has been
contaminated with mercury
2. Keep the heat below 20°C and ventilate the area if
possible
3. Put on face mask in order to prevent breathing of
mercury vapor
4. Remove all jewelry from hands and wrists so that the
mercury cannot combine (amalgamate) with the
precious metals
 Collection of Mercury Beads
• Appropriate personal protective equipment (rubber gloves, goggles /
face shields and clothing) should be used while handling mercury

• Locate all mercury beads carefully

• Cardboard sheets should be used to push the spilled beads of mercury
together
• Mercury should be placed carefully in a container with some water
 Managing Mercury Spills..

• Never use a broom or a vacuum cleaner.

• It should not be swept down the drain and

wherever possible, it should be disposed off at
a hazardous waste facility or given to a
mercury-based equipment manufacturer

• Mercury spills must not be vacuumed or swept

as this results in further contamination
 Radioactive (RA) waste
• The main radioactive waste used in hospitals are
technetium 99, iodine 131, iodine 125, iodine 123,
fluorine 18, carbon 14 and tritium

• Majority of the radioactive waste generated in

hospital is liquid with a small amount being solid
(such as swabs) and the remainder gaseous

• Safe disposal of radioactive waste is a vital

responsibility and ensures that workers and
general public are not adversely affected

• The management of radioactive waste should be

undertaken as per the guidelines of BARC
 Handling RA Waste
• The two primary ways of disposal after collection of
radioactive waste are:

1. Delay and decay

2. Dilute and disperse

• The delay and decay method is used for radioactive material

with medium duration half-lives and these are initially
contained in lead lined chambers
• Gaseous radioactive waste is passed through charcoal based
particulate filters before letting them off high in the
atmosphere
 Handling of RA Waste

• The urine and feces of patients undergoing treatment with radioactive

material is collected in lead lined ‘delay tanks’, stored upto three half-
lives and then allowed into the general drainage

• The dilute and disperse method is ideal for low activity solid waste
such as vials, swabs etc. where they are treated as other solid waste.

• Similarly liquid radioactive waste with activity less than a microcurie

level can be disposed into sanitary waste with adequate flushing of
water immediately.
 Precautions

• A well fitting mask, gloves, apron

and cap must be worn while
handling special hazardous
waste

• The workers must be monitored

annually for their exposure levels

• This is done by measuring levels

on special monitors worn by
these workers using Geiger
counters.
 Miscellaneous
– Heavy metals and genotoxic
waste represent less than 1% of
the total hospital waste

– These include cadmium and

chemicals such as benzene
derivatives, azathioprine which
are potential carcinogens

– These must not be incinerated

as the heavy metal fumes stay in
the atmosphere for a long time

– They must be handled with care

and handed to CTF
 SAFETY
of
Health Care Workers (HCW)
Personal Protective Equipment
(PPE)

PPE required for management and handling BMW

PPE should be used / worn
Appropriately
Post Exposure Prophylaxis
Post Exposure Prophylaxis

• As seen in this
picture,accidental needle prick
may occur mostly while
resheathing.
• When this happens,the
chances of acquiring blood borne
diseases such as HIV,Hep B and
Hep C increases.
• To pre empt this,post exposure
prophylaxis comes to play.
 Post Exposure Prophylaxis

• Post exposure prophylaxis (PEP) refers to comprehensive

medical management to minimise the risk of infection
among Health Care Workers (HCW) following potential
exposure to blood-borne pathogens (HIV, HBV, HCV)

• This includes counseling, risk assessment, relevant

laboratory investigations based on informed consent of the
source and exposed person, first aid and depending on the
risk assessment, the provision of short term (four weeks) of
antiretroviral drugs, with follow up and support.
 Potentially infectious body fluids
Exposure to body fluids considered ‘at Exposure to body fluids considered ‘not
risk’ at risk

Blood Tears
Semen
Vaginal Secretions Sweat
Cerebrospinal fluid
Synovial, pleural, peritonial, Urine & Faeces
Pericardial fluid
Amniotic fluid Saliva
Other body fluids contaminated with
visible blood

National AIDS Control

(NACO) Guidelines
 Practices that influence Risk

Certain work practices increase the risk of needlestick injury

such as:
• Recapping needles (Most important).
• Transferring a body fluid between containers.
• Failing to dispose of used needles properly in puncture-
resistant sharps containers.
• Poor healthcare waste management practices

National AIDS Control

(NACO) Guidelines
 Degree of Exposure
• Mild exposure
(mucous membrane/non-intact skin with small volumes)
e.g.: a superficial wound (erosion of the epidermis) with a
plain or low calibre needle, or contact with the eyes or
mucous membranes, subcutaneous injections following small-
bore needles

• Moderate  exposure
(mucous membrane/non intact skin with large volumes OR
percutaneous superficial exposure with solid needle)
e.g. : a cut or needle stick injury penetrating gloves
National AIDS Control (NACO) Guidelines
 Degree of Exposure

• Severe exposure
(percutaneous with large volume)
e.g.: an accident with a high calibre needle (>18 G) visibly
contaminated with blood; a deep wound (haemorrhagic
wound and/or very painful); transmission of a significant
volume of blood; an accident with material that has previously
been used intravenously or intra-arterially.

National AIDS Control (NACO) Guidelines

 Management of the Exposed
Person

• Step 1: Management of Exposure Site–First Aid

• Step 2: Establish eligibility for PEP
• Step 3: Counselling for PEP
• Step 4: Prescribe PEP
• Step 5: Laboratory Evaluation
• Step 6: Follow-up of an Exposed Person

National AIDS Control (NACO) Guidelines

 HIV

• PEP needs to be started as early as possible after exposure

and within 72 hrs.

• Assess the risk status of the exposed person

• Report immediately to the designated officer in charge of

occupational injuries

National AIDS Control (NACO) Guidelines

HIV

National AIDS Control (NACO) Guidelines

HIV

National AIDS Control (NACO) Guidelines

HIV

National AIDS Control (NACO) Guidelines

 HBV

• Risk of HBV infection related to-

degree of contact with blood in the work place
hepatitis B e antigen (HBeAg) status of the source person
• All health staff should be vaccinated against hepatitisB
• The vaccination for Hepatitis B consists of 3 doses-
initial, 1 month, and 6 months

CDC. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV and HIV and recommendations for post-exposure prophylaxis. MMWR Jun 29 2001; 50 (No. RR-
11): 1-42
 HBV

• When HBIG is indicated, it should be administered as

soon as possible after exposure (preferably within 24
hours)

• When hepatitis B vaccine is indicated, it should also be

administered as soon as possible (preferably within 24
hours)

CDC. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV and HIV and recommendations for post-exposure prophylaxis. MMWR Jun 29 2001; 50 (No. RR-
11): 1-42
 HBV
Exposure Unvaccinated person Previously vaccinated
person
Percutaneous- Needle Administer Hepatitis B Administer Hepatitis B
stick Injury vaccine series and vaccine Booster dose
HBIG(Immunoglobulin)
Mucosal Exposure to Administer Hepatitis B Administer Hepatitis B
HBsAg positive blood or vaccine series and vaccine Booster dose
body fluids HBIG(Immunoglobulin)

When indicated immune prophylaxis should be indicated as soon as

possible preferably within 24 hrs.
A person who is in the process of being vaccinated but who has not
completed the vaccine series should complete the series and receive
treatment as indicated.
CDC. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV and HIV and recommendations for post-exposure prophylaxis. MMWR Jun 29 2001; 50 (No. RR-
11): 1-42
 HCV
• HCW should be aware of dangers of HCV infection
• Transmission occurs mainly from hollow bore needles
compared with other sharps.
• No PEP for HCV
• For the source, perform testing for anti-HCV
• For the person exposed to an HCV-positive source
--- perform baseline testing for anti-HCV and ALT activity
• Perform follow-up testing (e.g., at 4--6 months) for anti-
HCV and ALT activity (if earlier diagnosis of HCV infection is
desired, testing for HCV RNA may be performed at 4--6
CDC. Updated US Public Health Service guidelines for the

weeks). management of occupational exposures to HBV, HCV and HIV

and recommendations for post-exposure prophylaxis. MMWR
Jun 29 2001; 50 (No. RR-11): 1-42
 HCV

• Confirm all anti-HCV results reported positive by enzyme

immunoassay using supplemental anti-HCV testing (e.g.,
recombinant immunoblot assay [RIBA™])

• When HCV infection is identified early, the person should

be referred for medical management to a specialist
knowledgeable in this area.

CDC. Updated US Public Health Service guidelines for the

management of occupational exposures to HBV, HCV and HIV
and recommendations for post-exposure prophylaxis. MMWR
Jun 29 2001; 50 (No. RR-11): 1-42
 HCV

CDC. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV and HIV and recommendations for post-exposure prophylaxis. MMWR Jun 29 2001; 50 (No.
RR-11): 1-42
Surveillance
 Surveillance

• Surveillance is the process of continuous monitoring and

evaluation of the biomedical waste segregation practices
across the hospital.

• The information obtained is used to modify / improve

existing systems and practices.

• Active surveillance is where the data is collected on a

continuous, ongoing basis
 Surveillance

Monitoring has to be done on aspects such as whether:

• Adequate color coded bins in good working order
• Containers and bags have a biohazard symbol
• Waste is being segregated at source on a correct and
consistent basis
• It is important to continually monitor whether good
segregation practices are being followed across the
hospital
• Record keeping is happening at all stages
 Conclusion
• Inappropriate waste management, handling and disposal promotes the spread of infection
in hospitals, and can thus undermine doctors' efforts to heal their patients.
• Moreover, it can cause infection outside the hospital, So proper disposal of hospital waste
is in everyone's interest.

Requirements to achieve this,

• Guidelines
• Organizational measures
• Hospital personnel must be trained
• Safety devices to ensure HCWs safety
• Convinced of the need for appropriate disposal method and monitored
• Waste must be collected in appropriate color coded containers at the place where it is
generated and transported without being transferred or compacted
• Healthcare workers shouldn’t be afraid that saving another’s life will endanger their own
• Hospital waste management should be with a view to minimize risk to healthcare workers,
patients, community and cause minimum damage to the environment
 Thank You
&
Lets Start,
Best Waste Management Practices