Project for Upgrading Safety in Healthcare

Bio-Medical Waste Management and Handling

Best Practices Learning Module
 We’ll Go Through

• Introduction • Other Hazardous wastes

• Biomedical waste (BMW) • PPE
• Classification & Types of BMW • Surveillance
• Risks associated with BMW • Post Exposure Prophylaxis
• Lifecycle of biomedical waste
o Segregation
o Disinfection
o Transport and storage
o Record maintenance
o Treatment and disposal
 What is Bio-Medical Waste?

Any waste generated during the

• Diagnosis, treatment or immunization of human beings or animals

• Production or testing of biologicals, in research activities

Schedule 1 of Biomedical Waste (Management & Handling) Rules

 Why Should I Know This?

• While working, in your daily work

o You SOMETIMES think of self-safety and use gloves/mask

o You RARELY think of community safety while disposing waste

• These are primary responsibilities of hospital staff and important

for safety of community
 Implementation of BMW Rules 1998

• BMW Rules have been adopted and notified with the objective
to STOP the indiscriminate disposal of hospital / bio-medical waste

• Ensure that such waste is handled without any adverse effect

on the human health and environment.
 Classification of Hospital Waste

Hospital Waste
Waste generated In Indian Hospitals – 1-2 Kgs / bed / day
with variations among Pvt. And Govt. establishments

80% General Waste 20% Biomedical Waste

• Kitchen waste (Food, peels, tea • 15% infectious / contaminated
cups, foil, plastic, fruit, vegetable • 3% Chemical & pharmaceutical
leftovers) • 1% Sharps
• General office waste (Wrapping • 1% Radioactive, cytotoxic and
paper, office papers, cartons, heavy metals
packing materials)
Source : http://www.geocities.com/isebindia/95_99/99-07-2.html
 Types of BMW : Hospital

• Contaminated plastic waste • Anatomical Waste

o Plastic syringes o Placenta
o IV catheters/tubes/sets o Amputated limbs
o Blood bags / Urosac bags o Excised organs
o Vacutainers • Pharmaceutical waste
o Endotracheal tubes / Ryles tube o Unused vials / ampoules /
• Sharps waste tablets / syrup
o Hypodermic needles • Cytotoxic Waste
o Scalpel blade o Methotrexate tablets
o Metal tops of vials o Drugs used for the treatment
o Broken ampoules
o
of cancers / leukemia
Vials
o Glass syringe – broken
• Radiological waste
o Radioactive Iodine
• Glass syringes/bottles Intact
o Itrium 90
• Gloves o Dosimeters
• Contaminated cotton / swabs • Rubber Catheters
 Types of BMW : Hospital

• Contaminated plastic waste

o Plastic syringes
o Endotracheal tubes / Ryles tube
o Vacutainers
o Blood bags / Urosac bags
o IV catheters/tubes/sets
 Types of BMW : Hospital

• Sharps waste
o Scalpel blade
o Broken ampoules
o Glass syringe – broken
o Metal tops of vials
o Vials
o Hypodermic needles
 Types of BMW : Hospital

• Anatomical Waste
o Placenta
o Amputated limbs
o Excised organs
 Types of BMW : Labs

• Pharmaceutical waste • Cytotoxic Waste • Radiological waste

o Unused vials / o Methotrexate tablets o Radioactive Iodine
ampoules / o Drugs used for o Itrium 90
tablets / syrup he treatment o Dosimeters
of cancers / leukemia
 Types of BMW : Labs

• Culture plate

• Slide after smear examination

• Liquid waste
o Remains of urine / stool specimen
o Blood / CSF / Pleural Fluid / Ascitic fluid
 Questions

• What is Biomedical Waste?

Any waste generated during the
 Diagnosis, Treatment or immunization of human beings or animals
 Production of testing of biological substances in research activities
• How much waste is generated in a hospital? How much of this is BMW.
 1-2 kgs/bed/day with variations among Pvt . and Govt establishments.
20% of this waste is BMW.
• Can you give a few examples of Sharps waste?
 Broken ampoules, vials, needles, scalpel blade, metal tops of vials
Lifecycle of BMW
 Lifecycle of BMW

Generation Treatment & Disposal

Segregation Monitoring & Record

Maintenance

Disinfection Transportation

Storage

Generated BMW has to undergo certain process to ensure its safe management
 Movement of BMW
Across Lifecycle

Common Storage
In the Wards Area @ Hospital In CTF

Transport Transport

• Generation • Storage • Treatment

• Segregation • Record Maintenance • Disposal
• Disinfection • Record Maintenance
• Record Maintenance
Bio-Medical Waste
A
Risky Affair!
 Which Waste is Risky?
Sharps Chemical waste Infectious waste
Needels, Infusion Sets, lab Reagents, Disinfectants, Lab cultures, Waste from
Scapels, Knives, Blades Solvents. isolation wards, Tissues, etc.

Genotoxic waste Pressurized containers

Cytotoxic Drugs, Genotoxic Gas cylinders, Catridges
chemicals
Risky and Aerosol Cans

Waste with high heavy Pharmaceutical Waste Pathological waste

metal contents Expired or Longer Needed Body Parts. Blood and
Pharmaceuticals. other fluids
Batteries, Broken
Thermometers, Blood
Pressure Gauges.
 Risks Involved
Poor bio-medical waste management and handling, increases the risk of:

Unsafe Segregation Reuse of Equipment Unsafe Disposal

• Injuries
• Infections
• Toxic Effects
 Risks

• Occupational exposure to blood can result from:

• Percutaneous injury (needle stick or other sharps injury)

• Mucocutaneous injury (splash of blood or other body fluids into the eyes,
nose or mouth) or blood

• Contact with non-intact skin

 Risks

Risk

• Over 20 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
 Risks

• 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% Environment Protection Training & Research Institute, (EPTRI)
 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)
 Who is at Risk and When?

Generate
Doctors, nurses, paramedical
staff, House-keeping / sanitary
staff, patients receiving
Segregate
treatment,
Anybody
Disinfect

Patients receiving treatment, Anywhere

Store Visitors to the hospital, House-
keeping / sanitary / waste
handlers staff, Community,
Scavengers
Anytime
Transport

Workers in waste disposal

Treat and Dispose waste facilities, scavengers
 Questions

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?

 Answers

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

3. What are the effects of improper management of bio-medical waste?

Poor bio-medical waste management exposes risk of
• Infection, Toxic effects and Injuries
• This includes Risk of diseases like HIV, Hepatitis B, Hepatitis C,
Cholera, Tuberculosis & Diphtheria and many others
Segregation
 Lifecycle of Waste

Generation Treatment & Disposal

Segregation Monitoring & Record

Maintenance

Disinfection Transportation

Storage
 Segregation

• Segregation means separating or isolating

• 1st step to in the lifecycle of waste, to ensure safe and

sound management of biomedical waste

• Refers to separating health care waste according to various

categories as prescribed by the BMW rules
 Importance

• Incorrect segregation / mixing of waste leads to occupational hazards for the

health care worker

• Mixing of wastes makes the whole waste harmful

• So segregation of waste should be done at the point of generation and

maintained till the point of treatment
 Categories of
Biomedical Waste
 Categories of Biomedical Waste

Human Anatomical Waste Animal Waste Lab Waste

Category 1 Category 2 Category 3

Sharp Waste Discarded Medicines & Cytotoxic Drugs

Category 4 Category 5
 Categories of Biomedical Waste

Soiled Waste Solid Waste Liquid Waste

Category 6 Category 7 Category 8

Incineration Ash Chemical Waste, solid & liquid

Category 9 Category 10
 Color Codes for Segregation
Segregation of Waste in Specific Colored Bins
Depending on Treatment and Disposal Technology

Yellow Plastic Bag – Cat-1 Human Anatomical Waste

Non Chlorinated Cat-2 Animal Waste

Blue Puncture proof

Cat-4 Sharps Waste
containers

Red Disinfected container / Cat-3 Microbiology & Biotechnology Waste

plastic bag Cat-6 Soiled Waste
Cat-7 Solid Waste

Cat-5 Discarded Medicine & Cytotoxic Drugs

Black Plastic bag Cat-9 Incineration Ash
Cat-10 Chemical Waste (solid)
 Importance of Color Coding

• Color coding helps

• Standardizing the practices

• Identifying the contents, without opening the bags

• Improving compliance, as everybody, including doctors at one end

and housekeeping staff at another, can co-relate the bin /
bags color & contents
 Color Codes for Segregation

80% are General Waste

• Green is the container used for general waste.
• Examples of items that go into green are:
1. Office paper
2. Food items like chips.
3. Wrappings and covers etc.
 Remember

Inappropriate segregation results in a mess!!

 Yellow Colored Bin

Human Anatomical Waste Animal Waste

Category 1 Category 2
 Blue Colored Bin
Intact needles to be destroyed
in needle burners
Burnt needles

Twin Bin for disinfection

Needle Burners (1% Hypochlorite Sol. For 30 mins.)

Sharp Waste

Sharp Waste Sharp Waste

Category 4 Category 4
 Red Colored Bin
Twin Bin, 25 ltrs. and 15 ltrs.

Twin Bin 25 ltrs. 15 ltrs.

Twin Bin
(for plastic waste disinfection with 1% Hypo for 30 minutes)

25 ltrs. : PLASTIC waste

Category 7 - Solid Waste

15 ltrs. : NON-Plastic waste

Category 3 - Lab Waste, Category 6 - Soiled Waste
 Red Colored Bin
25 ltrs.

Twin Bin Solid Waste

(for plastic waste disinfection Category 7
with 1% Hypo for 30 minutes)

For PLASTIC waste

 Red Colored Bin
15 ltrs.

Lab Waste Soiled Waste

Category 3 Category 6

For NON-Plastic waste

 Black Colored Bin

Discarded Medicines & Incinerator Ash

Cytotoxic Drugs Category 9
Category 5

Chemical Waste, solid & liquid

Category 10
 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. Name the categories of bio-medical waste and mention color coded bins or bags
for their segregation?
 Answers

1. Name the categories of bio-medical waste and mention color coded bins or bags
for their segregation?
• Yellow - 1 and 2
• Blue - 4
• Red - 7
• Black - 5,9, & 10
Management of BMW
Category 1: Human Anatomical waste

BODY PART YELLOW BIN

CENTRAL STORAGE
TRANSPORTATION TO CTF PLACE
 Category 2: Animal Waste

EXPERIMENTAL ANIMAL YELLOW BIN

TRANSPORTATION TO CTF CENTRAL STORAGE

PLACE
 Category 3: Microbiology

MICROBIOLOGY WASTE RED BIN TRANSPORTATION

COMMON BIO-MEDICAL TRANSPORTATION CENTRAL STORAGE AREA

WASTE TREATMENT FACILITY
 Category 4: Waste Sharps

WASTE SHARPS MUTILATION & DISINFECTION

TRANSPORTATION TO CTF CENTRAL STORAGE TRANSPORTATION

PLACE
Category 5: Discarded drugs and medicines

DISCARDED MEDICINES & BLACK BIN

CYTOTOXIC DRUGS

TRANSPORTATION TO CTF CENTRAL STORAGE AREA

 Category 6: Soiled Waste (PLASTIC)
25 ltrs.

DISINFECTED SOLID RED BIN (25 ltrs.) CENTRAL STORAGE AREA

WASTE (PLASTIC)

TRANSPORTATION TO CTF
 Category 6: Soiled Waste
15 ltrs.

SOILED WASTE RED BIN (15 ltrs.) CENTRAL STORAGE AREA

TRANSPORTATION TO CTF
Category 8: Liquid Waste

LIQUID WASTE

EFFLUENT
TREATMENT PLANT

DISCHARGE INTO DRAIN

Category 10: Chemical Liquid Waste

CHEMICAL LIQUID WASTE

EFFLUENT
TREATMENT PLANT

DISCHARGE INTO DRAIN

Other Hazardous 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
 SAFETY
of
Health Care Workers (HCW)
 Personal Protective Equipment (PPE)

Mask Cap

Gloves Boots Apron

PPE required for management and handling BMW

 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 Exposure to body fluids

considered ‘at risk’ considered ‘not 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
 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.
 Management of the Exposed Person

What should one do.

• Immediately contact your supervisor in charge or Doctor , Nurse.

National AIDS Control (NACO) Guidelines

 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.
THANK YOU