MAJOR (DR) SANJAY DALSANIAChief Quality Officer

Apollo Hospitals, Ahmedabad

HEALTHCARE WASTE MANAGEMENTStepping Towards Quality Improvement & Safety

“THE APOLLO WAY”

HEALTHCARE WASTE HAZARDS• Infectious & pathological• Sharp injuries• Hazardous chemicals• Radioactive• Cytotoxic & Genotoxic

DISEASE TRANSMISSION• Air borne• Direct contact / sharp injuries (through broken skin)• Diseases:

• Hepatitis-B• AIDS• Tetanus• Diseases of GI tract & respiratory system• Skin diseases & many more

WHO ARE AT RISK?

• Doctors • Nursing staff• Ward staff• Housekeepers• Patients & visitors• Community• Environment

HEALTHCARE WASTE MANAGEMENT

• Structure• Processes• Outcomes

POLICY• To outline the SoPs to manage various types of

wastes• To avoid nosocomial infections• To encourage safe working practices• To ensure environmental conservation

GOLDEN RULES• Segregation at the source

• No mixing

• No storage beyond 48 hours

• PPE & Universal precautions

WASTE CLASSIFICATION• Clinical waste• Sharps waste• Chemical waste• Pharmaceutical waste• Laboratory waste• Radio-active waste• Cytotoxic /genotoxic waste • Confidential waste• Food & domestic (general) waste

HEALTHCARE WASTE MANAGEMENTStep-ISEGREGATION

TRANSPORTATION TO CENTARL STORAGE SITE

COLLECTION

TREATMENT & DISPOSAL

Step-IV

Step-III

Step-II

LOCAL STORAGE

TRANSPORTATION TO FINAL DISPOSAL SITE

Step-V

Step-VI

In-h

ouse

Out

sour

ced

HEALTHCARE WASTE MANAGEMENT

Type of Waste

Non-infectious Waste (80-85%)

Infectious Waste (15-20%)

SEGREGATION• Responsibility of all staff.• At the source of generation itself.• Clear identification & sorting.• Display of segregation guidelines. • Color coding and labeling .

SEGREGATION

SEGREGATION

INFECTION CONTROLDISPOSAL OF BIOMEDICAL WASTE

REDCATHETERS, TUBINGS, CANNULAE, SYRINGES, PLASTIC IV

BOTTLES, USED GLOVES, IV SETS, INFECTED PLASTIC WASTE, SPECIMEN CONTAINERS, WASTE GENERATED FROM

LABORATORY, CULTURE OF MICRO ORGANISMS, USED OR DISCARDED BAGS OF BLOOD/BLOOD PRODUCTS, VACCINES

INFECTION CONTROLDISPOSAL OF BIOMEDICAL WASTE

YELLOW

HUMAN TISSUES, ORGANS, BODYPARTS, ITEMS CONTAINING BLOOD AND BODY FUID (COTTON), SOILED DRESSING, SOILED

PLASTERS CASTS, BEDDINGS, DISCARDED MEDICINE, DISCRDED CYTOTOXIC DRUGS

INFECTION CONTROLDISPOSAL OF BIOMEDICAL WASTE

BLUE

GLASS WARE ITEMS, NEEDLES, SYRINGES, SCALPELS, BLADES, USED AND UNUSED SHARPS

INFECTION CONTROLDISPOSAL OF BIOMEDICAL WASTE

BLACK

RADIOACTIVE AND CHEMOTHERAPY WASTES

SEGREGATION GUIDELINESCOLOUR WASTE DESCRIPTION

YELLOWHuman tissues, organs, body parts, items contaminated by blood/body

fluids, soiled cotton & dressing, soiled plaster casts, discarded medicines, discarded cytotoxic drugs

REDCatheters, tubings, cannulae, syringes, plastic IV bottles & sets, used gloves,

infected plastics, specimen containers, lab waste, microbiology cultures, used or discarded bags of blood/blood products, vaccines

BLUE Glass items, needles, syringes, scalpels, blades, used and unused sharps

BLACK Radioactive and chemotherapy wastage

GREEN General waste, non-infected plastic materials & papers, disposables, cardboards, metal containers, office waste, food waste

SEGREGATION• Allow to fill the bag/bin up to 3/4th level.• Hub cutters for needles.• Other sharps: puncture proof auto-locked containers.

SEGREGATION

SEGREGATION

• Thumb Rule: Mutilate disposable and plastic items and empty the glass vials & bottles before throwing in waste bins.

• Proper segregation:• Facilitates further collection, handling, storage &

disposal of waste.• Minimizes the cost of handling and disposal of

waste.

COLLECTION• Scheduled collection by Housekeeping Staff.

• 2 hourly in ICUs• 4 hourly in wards/other clinical areas

• Thumb Rule: Tie on the top. Do not compress the bag. Lift the bag from the top. Do not support the bottom of the bag with the other hand.

• Regular washing & disinfection. Checklist for washing/disinfection.

• Use of PPE while collecting waste.

COLLECTION

LOCAL STORAGE• Temporary storage:

• Colour coded containers / big polythene bags• Labelling • Local collection points (closed dirty utility rooms)• Away from patient areas

• No mixing of infectious and non-infectious waste.• Thumb Rule: Waste from local storage must be

transported to central collection site within two hours of collection.

LOCAL STORAGE

TRANSPORTATION TO CENTRAL STORAGE SITE• From local storage areas to central storage area:

• Closed air-tight color-coded container trolleys• Scheduled time interval• Pre-defined waste route• Well demarcated dirty utility lift

• Thumb Rule: No crossing over with food trolleys or sterile areas.

TRANSPORTATION TO CENTRAL STORAGE SITE• Scheduling & separate routes for waste trolleys &

food trolleys.

• Regular washing & disinfection of container trolleys. Checklist for washing/disinfection.

• Use of PPE while transporting waste.

CENTRAL STORAGE AREA• Away from clinical areas, kitchen, stores & public routes.• Restricted entry.• Adequately lit & ventilated rooms with impervious floor.• Color-coded self-closing doors.• Facility of washing area.• Provision of First Aid Kit.• Availability of PPE.• Fire extinguishers.• Regular washing and disinfection. Checklist.

CENTRAL STORAGE AREA

TRANSPORTATION TO FINAL DISPOSAL SITE• Daily. • Outsourced to Government authorized CBWTF

(Common Biomedical Waste Treatment Facility).• In a closed cart/vehicle with smooth & impermeable

surfaces.• Thumb Rule: No waste should be kept stored in the

hospital beyond the period of 48 hours.

TRANSPORTATION TO FINAL DISPOSAL SITE

• Weighing of waste to monitor the waste volume/bed.

• PPE while handling the waste. Immunized personnel.

• Once a month, visit by Infection Control Coordinator to the disposal site.

• General/food waste – municipal vehicle.

TREATMENT & DISPOSALWaste

Category Waste Category Type Treatment & Disposal Option

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, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals, colleges, discharge from

hospitals, animal houses)

Incineration/deep burial

Category-3

Microbiology & Biotechnology Wastes(Wastes from laboratory cultures, stocks or

specimens of micro-organisms live or attenuated vaccines, human and animal cell

culture used in research and infectious agents from research and industrial laboratories,

wastes from production of biologicals, toxins, dishes and devices used for transfer of

cultures)

local autoclaving/micro- waving/incineration

TREATMENT & DISPOSALWaste

Category Waste Category Type Treatment & Disposal Option

Category-4

Waste sharps (needles, syringes, scalpels, blades, glass etc.

that may cause puncture and cuts. This includes both used and unused sharps)

disinfection (chemical treatment)/autoclaving/

microwaving and mutilation /shredding

Category-5Discarded Medicines and Cytotoxic drugs

(wastes comprising of outdated, contaminated and discarded medicines)

incineration/destruction and drugs disposal in secured landfills

Category-6

Soiled Waste(Items contaminated with blood, and body

fluids including cotton, dressings, soiled plaster casts, lines beddings, other material

contaminated with blood)

Incineration/autoclaving/micro-waving

Category-7

Solid Waste(wastes generated from disposable items

other than the waste [sharps] such as tubing, catheters, intravenous sets etc.)

disinfection by chemical treatment/autoclaving/

microwaving and mutilation/shredding

TREATMENT & DISPOSALWaste

Category Waste Category Type Treatment & Disposal Option

Category-8

Liquid Waste(waste generated from laboratory and washing, cleaning, house-keeping and

disinfecting activities)

disinfection by chemical treatment and discharge into

drains

Category-9Incineration Ash

(ash from incineration of any bio-medical waste)

disposal in municipal landfill

Category-10

Chemical Waste(chemicals used in production of biologicals, chemicals used in disinfection, as insecticides

etc.)

Chemical treatment and discharge into drains for liquids and secured landfill for solids

• Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection.• Mutilation/shredding must be such so as to prevent unauthorized reuse.

TREATMENT & DISPOSAL• Thumb Rule: Disinfect and mutilate the waste

before its final disposal.• Syringes: cut, disinfected & disposal into sharps pit.• Infected plastics: disinfected/autoclaved, shredded

and sent for final disposal into municipal dumps.• General waste: disposal to municipal waste dumps

without any treatment.

ACCIDENTS & INCIDENTS• Structured procedures for risk management.• Immediate first-aid measures & post-exposure

prophylaxis.• Reporting to Emergency Department or Staff Clinic

at earliest.

ACCIDENTS & INCIDENTS• Prompt reporting to Quality/Infection Control Dept:

• Inappropriate segregation• Leakage & spillage• Damaged containers• Splashes & Sharp Injuries• Mixing of general waste with biomedical waste• Excessive accumulation

ACCIDENTS & INCIDENTS

• Retention of the item and identification of possible infection.

• Investigation and RCA• CAPA to prevent recurrences.

PERSONAL PROTECTION• Disposable gloves & heavy-duty gloves• Industrial apron / leg protectors• Face shields & protective glasses• Sturdy industrial boots• Helmets & strong industrial PPE in high risk areas.• Masks & respiratory protectors for protection

against toxic dust.• Standard PPE (approved by BARC) for protection

against radioactive wastes.

PERSONAL PROTECTION

PERSONAL PROTECTION• Protective equipment - cleaning & maintenance.• Periodic/surprise checking.• Hepatitis-B and tetanus vaccination.• Washing facilities at storage & disposal areas.• Insistence on hand washing practices.

STAFF SAFETY• Pre-employment & annual health check• Vaccination & online monitoring of immune status • Training on occupational safety• Display of SoPs at all working areas• Provision of required PPE and periodic inspection• Spillage Kits, Mercury Kits• HAZMAT Kits• First Aid Kits• Fire Fighting Equipment

EDUCATION & TRAINING• Training on induction, a part of orientation program.• Focused group training at regular intervals by

Infection Control Dept.• Training on colour coding, labelling, route marking

etc.• Training on special problems related to sharp

disposal.• Awareness about the occupational risks.• Re-training on revision of policies & procedures.

EDUCATION & TRAINING• Training on personal safety, safe procedures, use of

protective clothing/equipment and how-to-deal-with spillage and other incidents at work area.

• Training on appropriate cleaning and disinfection procedures.

• Hand Hygiene, First Aid, BLS & Fire Safety Training.• Post-training assessment & competency evaluation.• Mock Drills.

QUALITY ASSURANCE• Process Audits

• Planned & surprise• Cross-departmental

• Waste Audits• Segregation• Labeling• Departmental Waste Volume/Day

QUALITY ASSURANCE• Biomedical Waste Management – permanent

agenda in monthly Infection Control Committee Meetings.

• “Quality Watch”• Adherence to cleaning checklists• Needle Stick Injuries• Incident Reports• Hospital Acquired Infection Rates• Hand Hygiene Compliance

END