Biomedical Waste Management SGJ CON.pptx

1. National Webinar on: “Biomedical Waste Management : Nurses role. Organized by: Shree Gopaldev Jadhav College of Nursing, Kalaburagi. Organizing Chairperson: Prof. Vijayreddy Vandali, Principal SGJ CON, Kalaburagi. Date: 02-02-2023 Time 2:00PM to 4:00PM Join us on ZOOM meeting.

2. Biomedical Waste Management : Nurse’s role. Prepared by: Prof. VIJAYREDDY VANDALI, Shree Gopaldev Jadhav College of Nursing, Kalaburagi(KA) INDIA. & Mr. SURESH GAJI Assistant Nursing Superintendent All India Institute of Medical Sciences, Rishikesh(UK), INDIA.

3. • Definition • Types of BMW • Steps of BMWmanagement • BMW management rule • BMW management in special situations • BMW audit Contents

4. Wastes that are generated during the • Laboratory diagnosis • Ttreatment or • Immunization of human beings or animals • Research activities • Health camps Definition

5. In developing countries, the waste generated falls into two categories: Waste Generated in Hospitals

6. Biomedical waste management rules are not applicable to • Radioactive wastes • Hazardous chemical wastes • Lead batteries • Solid wastes • E wastes • Genetically engineered micro organisms

7. Disposal Treat Recover Reuse and recycle Prevent and reduce Largely based on the concept of the “3Rs”, namely: Reduce Recycle Recover Waste-management hierarchy

8. Generation Segregation Collection Transportation Treatment and disposal BMW management flowchart

9. Waste segregation (at the point of generation) into color coded containers Pre- treatment for lab liquid waste of waste from generation site to central storage area of the hospital Transport to common biomedical waste treatment facility (CBMWTF) T reatment &/or disposal Steps of Biomedical Waste Management

10. Specifications of the Receptacles • biohazard logos • non-inflammable, autoclavestable • non-chlorinated with a thickness of≥50 µm • Prebarcoaded • biohazard logos • well-fitting lids • removable by hand orpreferably operated by a foot pedal

11. Specifications of the Receptacles •Puncture-proof, leak-proof and tamper- proof •Impermeable container •Sealing system should have anarrow mouth

12. Biomedical Waste Management Rule, India, 2016 (including the amendment added in 2018 and 2019)

13. Type of waste Type of Bag/ container Treatment/Disposal options Human & animal anatomical waste and Yellow coloured non chlorinated plastic bags Incineration/ Plasma pyrolysis soiled waste Expired/discarded Cytotoxic label Sent back to medicines — manufacturer/ pharmaceutical CBMWTF for waste, cytotoxic incineration (cytotoxic drugs drugs at temperature >1200°C) YELLOW- Infectious (non plastic wastes)

14. Type of waste T y p e o f B a g / container T r e a t m e n t / Disposal options Chemical solid waste Yellow colored containers/nonchlo rinated plasticbags Incineration or plasma pyrolysis or encapsulation Chemical liquid waste such as discarded disinfectants, infected body fluids and secretions, liquid from house-keeping related activities separatecollection system, which leads to effluent treatment system Pre-treated before mixing with other wastewater YELLOW –Infectious(non plastic wastes)

15. Type of waste T y p e o f B a g/ container Tre a t m e n t / D i spo sa l options Discarded linen Non-chlorinated disinfection followed waste yellow plastic bags by incineration/plasma contaminated with pyrolysis blood/body fluids, mask, cap, gown and shoe cover Microbiology, Autoclave safe Pre-treat followed by other clinical plastic bag/ incineration laboratory waste, container blood bags, live/ attenuated vaccines YELLOW- Infectious(non plastic wastes)

16. Category Type of waste Type of Bag/ container T r e a t m e n t / Disposal options Infectious plastic waste Disposable items tubing, bottles, intravenous tubes and sets, catheters, urine bags, syringes (without needles), vacutainers gloves, plastic apronand goggles Red colored non- chlorinated plastic bags or containers  Autoclaving/ microwaving Mutilation/ shredding Treated waste - recycled RED

17. Category Ty p e o f w a s t e Type of Bag/ container T r e a t m e n t / Disposal options Sharps Waste sharps including metal sharps:Needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades etc. Puncture- proof, leak- proof, tamper-proof containers Autoclaving/dry heat sterilization followed by: Shredding or mutilation or encapsulation Sanitary landfill/ Designated concrete waste sharp pit WHITE

18. Category Type of waste Type of Bag/ container Treatment/ Disposal options Glasswares a)Glasswares : Puncture- Disinfection Soaking the washed glass waste after cleaning with detergent and sodium hypochlorite treatment (1-2%)/ Autoclaving/micro waving/hydroclavi ng and recycled and metallic body implants Broken or discarded and contaminated glass including medicine vialsand proof, leak- proof containers ampoules except those contaminated with cytotoxic wastes b) Metallic body implants: Dental and others BLUE

19. Bag s Waste segregation Method of disposal Y ellow Infectiousnon- plastic waste INCINERATION Red Infectious plastic waste AUTOCLAVING/MICROWA VING Followed by SHREDDINGand RECYCLING White Metal sharp AUTOCLA VING/ MICROW A VING Followed bySHREDDING Blue Broken glassitems and metalimplants DISINFECTION, AUTOCLAVINGOR MICROW A VINGOR HYDROCLAVINGandRECYCLING

20. • Double bags – adequate strength and no leaks • Labelled as Covid19 • The (inner and outer) surface of containers/bins/trolleys should be disinfectedwith 1% sodium hypochlorite solution daily • Separate storage and transportsystem Guidelines for handling of COVID-19 patients wastes.

21. Nurses role in Biomedical Waste Management • It starts from segregation till the treatment of waste. • Ensure that waste bags/containers are properly sealed and labeled. • Bags should not be filled completely, so that bags can be picked up by the neck again for further handling. Hand should not be put under • At a time one should be lifted. • Manual handling of waste bags should be minimized to reduce the risk of needle stick injury.

22. Continued.. • Regular visit to all the wards and high risk units. • Ensuring that all samples (Blood, urine and stool etc.) are collected and disposeproperly. • Monitoring and supervising the staff weather they are doing safe disposal of waste as colour coded. • Prevention of hospital acquired infections byfollowing universal precautions.

23. Continued.. • Avoid needle stick injuries and body fluid exposure. • Collect waste when the bin is3/4th full. • Avoid using common lift to movewaste. • Avoid spillage & Clean spillswith disinfectant. • Immunize self and others time to time andmaintain records. • Report major accidents.

24. 1.Metal sharps management : • Needle cutter orburner Prevents reuse/recap Reduces the volume Recycling syringebarrels after disinfection • Handed over to theCBWTF or sharp pits BMW Management in Special Situations

25. 2.Glassware management: • Pretreatment – 1% chlorine solution for 20 mins or Autoclave • Handed over to the CBMWTF for final treatment and disposal/recycling BMW Management in Special Situations

26. 3.Cytotoxic drugs wastes • Highly hazardous • Neverlandfilled or directly discharged into the sewagesystem • Appropriate PPE should beworn • Receiving and transport policies – trained persons • Unpacking – ventilatedarea with negative pressure BMW Management in Special Situations

27. 3.Cytotoxic drugs wastes(Cont..) • Cytotoxic drug preparation room – Class II BSC with HEPA filter ,exhaust fan, emergency eye wash station and cytotoxic spill kit • Drug administration Appropriate PPE Safety engineered needles and needleless administration systems • Collection – Yellow bags labelled with cytotoxic symbol BMW management in special situations

28. Cytotoxic Spill Kit • Cytotoxic container • Cytotoxic bag • Cytotoxic degrading agent • Hypochlorite solution • Water • PPE • Absorbant • Forceps • Scissors • Tape • Marker pen • Dust pan • Shovels • Mops • Securing sinage • App. Disposal bags

29. Cytotoxic wastes disposal techniques: • Return to the supplier • Incineration at higher temperature – 1200 Deg Cel • Chemical degradation -Require expertise -Sodium hypochlorite,hydrogen peroxideand fenton reagent • Newer methods : Encapsulation/inertization BMW management in special situations

30. 4.Liquid waste management • Pretreatment – 1 to 2% sodium hypochlorite solution for 30 mins • Effluent treatment plant – remove thesuspended solids and organicmatter • Prevents direct mixing of hospital drainage system with the municipal drainagesystem BMW management in special situations

31. • Gloves 2 pairs • Apron • Surgical mask • Goggle • Shoe over or plastic bag to cover theshoes • Sodium hypochlorite solution • Absorbent material like newspaper or blottingpaper • Waste collection bag Blood Spill Kit

32. Any spillage, attend immediately,mark the spillage area,put wet floor signage Wearappropriate PPE Remove any broken glass pieces with forceps and discard in Puncture proof and leak proof boxes or containers with blue coloredmarking Confine the spill by placing absorbent cloth or paper to solidify and clean with soap and water Attend to Body Fluid Spill

33. Clean with chlorine based disinfectant Smallspill (<10cm) Largespill (>10 cm) 0.05% sodium hypochlorite solution 0.5% sodium hypochlorite solution Contact time – 10 mins Rinse the area with clean water Discard the PPE and the wastes in appropriate bags and Perform handwash Immediately Attend to Body Fluid Spills!

34. Management of Mercury Spills 1. Mercury spill 2. PlaceCaution board 3.Mercury spill kit 5.WearPPE 6.Aspirate 7.Store in 5 to 10ml water 8.Label and Send to CBWTF 4. Removejewels • 4 to 5 Zip lock covers • Plastic container withlids • Syringe withoutneedles • Flashlight • Powdered sulphur/zinc /copper- vapour suppressing agents •Hydrogen peroxide and cotton swabs for final cleaning

35. Spill Kit

36. • Audit by direct observation • By CCTVcamera • Surveys through structured questionnaires Monitoring of BMW Management

37. BMW Auditor BMWsegregation compliance rate No of wastes disposed appropriately = Totalno of items x100

38. Provides information about. • Colour of the bag • Weight • Occupier information • Operator information •Helps in real time monitoring •Scanning by mobile app/scanner Bar Code System

39. References. • WHO https://www.who.int/news-room/fact- sheets/detail/health-care-waste • CDC https://www.cdc.gov/infectioncontrol/guidelines/envir onmental/background/medical-waste.html • JIPER Puducherry https://jipmer.edu.in/department/biomedical-waste- management/general-info https://www.jipmer.edu.in/sites/default/files/BMWM.pdf • POLLUTION CONTROL BOARD https://cpcb.nic.in/technical-guidelines-2/

40. Thank You

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