Frequently asked Questions Biomedical Waste Management What are Biomedical wastes? Biomedical wastes are defined as waste that is generated during the diagnosis, treatment or immunization of human beings or animals, or in research activities pertaining thereto, or in the production of biological. What are biodegradable and non biodegradable wastes? Biodegradable waste means any waste that is capable of undergoing anaerobic or aerobic decomposition, such as food and garden waste, and paper and paperboard. It also includes waste from households, which because of its nature and composition is similar to biodegradable waste from households. Non biodegradable wastes are the wastes that cannot be decomposed by bacteria e.g plastics, bottles and tins. What is the quantum of waste that is generated by a hospital? The quantum of waste that is generated in India is estimated to be 1-2 kg per bed per day in a hospital and 600 gm per day per bed in a general practioner’s clinic. e.g. a 100 bedded hospital will generate 100 – 200 kgs of hospital waste/day. It is estimated that only 5 – 10% of this comprises of hazardous/infectious waste (5 – 10kgs/day) What are the hazards associated with poor health care waste management? Proper disposal of biomedical waste is of paramount importance because of its infectious and hazardous characteristics. Improper disposal can result in the following: · Organic portion ferments and attracts fly breeding · Injuries from sharps to all categories of health care personnel and waste handlers · Increase risk of infections to medical, nursing and other hospital staff · Injuries from sharps to health workers and waste handlers · Poor infection control can lead to nosocomial infections in patients particularly HIV, Hepatitis B & C · Increase in risk associated with hazardous chemicals and drugs being handled by persons handling wastes · Poor waste management encourages unscrupulous persons to recycle disposables and disposed drugs for   repacking   and reselling · Development of resistant strains of microorganisms Who are the persons at risk of the hazards of medical procedures? Depending on the type of procedures, the persons at risk and mode of transmission in some common medical procedures are: Procedure Person at risk Mode of Transmission Collection of blood samples Patient Health worker Contaminated needle, gloves, Skin puncture by needle or container, Contamination of hands by blood Transfer of specimens (within laboratory) Laboratory personnel Contamination of exterior of specimen container, Broken container, Splash of specimen HIV serology and virology Laboratory personnel Skin puncture, splash of specimen, Broken specimen container, Perforated gloves Cleaning and Maintenance Laboratory Personnel Supporting staff Skin puncture or contamination, Splashes, Contaminated work surface Waste Disposal Laboratory Personnel Support Staff Transport worker Contact with contaminated waste Puncture wounds and cuts Shipment of specimens Transport worker Postal worker Broker or leaking specimen, containers and packages What are the rules and regulations governing the disposal of these wastes? The Government of India has promulgated the Biomedical Waste (Management and Handling) Rules 1998. They are applicable to all persons who generate, collect, receive, store, transport, treat, dispose or handle biomedical wastes. This includes hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories and blood banks. What are the responsibilities of health care institutions regarding biomedical waste management? It is mandatory for such institutions to: Set up biomedical waste treatment facilities like incinerators, autoclave and microwave systems for treatment of the wastes Make an application to the concerned authorities for grant of authorization Submit a report regarding information about the categories and quantities of biomedical wastes handled during the preceding year by 31 Jan every year Maintain records about the generation, collection, reception, storage, transportation, treatment, disposal and/or any form of handling bio medical waste Report immediately any accident to the prescribed authority What are the different hospital waste categories? Category Type of Waste Treatment and Disposal Options Category 1 Human Anatomical Waste (Human tissues, organs, body parts) Incineration/Deep Burial Category 2 Animal waste (Animal tissues, organs, body parts, carcasses, bleeding parts,blood and experimental animals used in research) Incineration/Deep Burial Category 3 Microbiology and biotechnology waste(waste from lab culture, specimens from microorganisms, vaccines, cell cultures, toxins, dishes, devices used to transfer cultures) Local Autoclaving/ Microwaving/ Incineration Category 4 Waste Sharps (Needles, Syringes, scalpels, blades, glass) Chemical Disinfection Autoclaving/ Microwaving, Mutilation and Shredding Category 5 Discarded medicines and cytotoxic drugs (outdated, contaminated, discarded drugs) Incineration/Destruction and disposal in land fills Category 6 Soiled waste (contaminated with blood and body fluids including cotton, dressings, soiled plasters, linen) Autoclaving/ Microwaving/ Incineration Category 7 Solid waste (tubes, catheters, IV sets) Chemical Disinfecion/Autoclaving/ Microwaving, Mutilation and Shredding Category 8 Liquid waste (Waste generated from laboratory and washing, cleaning, disinfection) Disinfection by chemical treatment and discharge into the drains Category 9 Incineration ash Land fills Category 10 Chemical waste Chemical disinfection and discharge into the drains What is Biosafety? Biosafety is essentially a preventive concept and consists of wide variety of safety precautions that are to be undertaken, either singly or in combination, depending on the type of hazard by all medical, nursing and paramedical workers as well as by patients, attendants, ancillary staff and administrators in a hospital. What are disinfection and sterilization? Disinfection and sterilization are important procedures in biosafety. Disinfection refers to procedures which reduce the number of microorganisms on an object or surface but not the complete destruction of all microorganism or spores. Sterilisation on the other hand, refers to procedures, which would remove all microorganisms, including spores, from an object. Sterilisation is undertaken either by dry heat (for 2 hours at 1700C in an electric oven – method of choice for glass ware and sharps) or by various forms of moist heat (i.e. boiling in water for an effective contact time of 20 min or steam sterilization in an autoclave at 15 lb/sq inch at 1210C for 20 min) What are the disinfectants commonly used for disinfection of materials contaminated with blood and body fluids? High level disinfectants like chlorine releasing compounds are used for disinfecting materials contaminated with blood and blood products. The recommended dilutions for these compounds are given as follows: Name of Disinfectant Available chlorine Required chlorine Required chlorine Contact period Amount of disinfectant to be dissolved in 1 ltr of water Sodium hypochlorite 5% 0.5% 30 min 100 ml Calcium hypochlorite 70% 0.5% 30 min 7.0 gm Na OCl powder - 0.5% 30 min 8.5 gm Na Dichloro isocyanurate (NaDCC) tablets 60% 0.5% 30 min 4 tabs Chloramine 25% 0.5% 30 min 20 gm How is disinfection of the various items commonly used in the hospital carried out? General use items Disinfection Bath water Add savlon when necessary Bed pans Wash with hot water and dry Disinfect with phenol after use by infected patients Autoclave Bowls Wash with hot water and keep dry Autoclave Crockery, Cutlery Wash with hot water/detergent and keep dry Floors Vacuum clean; No use of broom Furnitures Damp dust with detergent/phenol/2% Lysol Mattresses/Pillows Use water impermeable cover Wash cover with detergent and keep dry Disinfect with phenol/2%lysol Trolley tops Wipe with warm water and detergent to remove dust and keep dry Thermometers Wash with warm water/detergent and keep dry Endoscopes/ Arthroscopes/ Laparoscopes/ Fiberoptic Endoscopes Immerse in2% Cidex solution Use latex gloves, eye protection plastic covering mask while handling Alternatively, use ethylene oxide sterilization Endotracheal suction catheter Should be disposable Endotracheal tubes Recycled after cleaning and autoclaving Ambu Bags Ideally heat disinfect Immerse in 2% glutaraldehyde and wash with sterile distilled water to reduce respiratory irritation Oxygen delivery face mask Wash and dry Use 70% isopropyl alcohol to remove mucus Suction drainage bottles Ideally autoclave Ventilatory circuits, respiratory equipment in Neonatal/Pediatric unit Heat disinfection for 800 F for 30 min Autoclave Ethylene oxide sterilization Incubators Clean thoroughly wiyh warm water / soap Use 70% isopropyl alcohol Humidifiers Empty daily refill with sterile water Disinfect when contaminated with 1% Na hypochlorite Autoclave Urinary Catheter Should be disposable How are common hospital instruments sterilized? Instuments should be disinfected for 30 min, cleaned and sent for sterilization Sterilization Methods:   Dry Heat Autoclave Ethylene oxide 2% Glutaraldehyde Formaline Gamma radiation Gloves - a - - - a Plastic Syringe - - a - - - Glass Syringe - a - - - - Needles - - - - - - Endoscopic instruments - - - a a - Suction tubes - - - a - - Suction bottles - a a a a a Cautery cable - - a a a a Cautery points - - - a a a Laryngoscopes - - - a a a Endotracheal tubes - - a a a a Catheters - - a a a a Cath Lab Material - - a a - a Blanket a - - - - - Mattresses a - - - - - Suturing Material a - - a - a What are the colour codes and type of containers used for disposal of biomedical waste? Colour codes and type of containers used for disposal of biomedical waste are as follows: Colour coding Type of Container Waste Category Treatment options Yellow Plastic Bags Human and animal wastes, Microbial and Biological wastes and soiled wastes (Cat 1,2,3 and 6) Incineration/ Deep Burial Red Disinfected container/ Plastic bags Microbiological and Biological wastes, Soiled wastes, Solid wastes (Cat 3,6,7) Autoclave/ Microwave/ Chemical Treatment) Blue/ White/ Transparent Plastic bag, Puncture proof container Waste sharps and solid waste ( Cat 4 &7) Autoclave/ Microwave/ Chemical Treatment Destruction and Shredding Black Plastic bag Discarded medicines, Cytotoxic drugs, Incineration ash and chemical waste (Cat 5,9 & 10) Disposal in secured land fills Green Plastic Container General waste such as office waste, food waste & garden waste Disposed in secured landfills How long can bio medical waste be stored? Immediate treatment and disposal are ideal procedures to be followed for disposal of bio medical waste. Untreated bio medical waste however, can be stored for not more than 48 hrs. If for some reason it becomes necessary to store the waste beyond such period, permission from the local state authority must be taken and it must be ensured that it does not adversely affect human health and the environment. What are the standards and requirements for autoclaving? Gravity flow autoclaving: · temp > than 1210C and 15 pound per sq inch (psi) pressure for 60 min · temp > than 1350C and 31 pound per sq inch(psi) pressure for 45 min · temp > than 1490C and 52 pound per sq inch (psi) pressure for 30 min Vacuum autoclaving: · temp > than 1210C and 15 pound per sq inch (psi ) pressure for 45 min · temp > than 1350C and 31 pound per sq inch psi ) pressure for 30 min What are the standards and requirements for microwaving? · Microwave treatment shall not be used for cytotoxic, hazardous or radio active wastes, animal carcasses,   body parts and metal items. · The microwave should be able to kill all bacteria and microorganism completely and consistently. The indicator   organism is Bacillus subtilis spores using vials or spore strips with at least 1X104 spores per millimetre What are the emission standards for incineration? Parameters Conc mg/N m3 at 12% CO2 correction Particulate matter 150 Nitrogen oxides 450 HCL 50 What are the standards and requirements for incineration? · Minimum height of the stack should be 30 metres above the ground · Above emission limits should be achieved · Waste to be incinerated not to be disinfected with chlorine substance · Chlorinated plastics should not be incinerated · Toxic metals in incineration ash should be limited to within regulatory quantities · Only low sulphur fuels like LDO/LSHS to be used as fuel · The common treatment facility (CTF) should be located away from human habitation What are composting and vermiculture? The organic wastes are easier to handle because it will decompose over a period of time. It is this which through the process of composting produce rich manure, which is safe and better than chemical fertilizers. The use of earthworms in the process of composting is known as vermiculture and is proving to be very useful and successful. What materials can be recycled? · Glass after cleaning and disinfection/sterilization · Paper · Corrugated cardboard · Aluminium · X ray film · Reclaimed silver from X ray film · Plastics: non infectious component only