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Training component of the project
“Environmentally Sound Management of Medical Wastes in India”
Endeavour of GEF, UNIDO, MoEFCC and
State Governments of Gujarat, Karnataka, Maharashtra, Odisha & Punjab
STANDARD OPERATIVE PROCEDURES FOR
BIO-MEDICAL WASTE MANAGEMENT Acknowledgment:
‘This document has been prepared for the United Nations industrial Development Organization (UNIDO) on behalf of the taining
‘component ofthe project “Environmentally Sound Management of Medical Wastes in India by the Department of Community Medicine,
Romaich Medical College, Bangalore. This document has been reviewed and approved by the Technical Working Group (TWG), the
Ministry of Environment, Forest and Climate Changee(MoEFCC), Government of India.
Contributions were provided by Lalitha krishnappa, Shalini Pradeep and Babitha Rajan, Ramaiah Medical College, Bangalore to prepare
this document. C. Shivaram, Shalini Chandrathekar Nooyi and Suman Gadicherla, Ramaiah Medical College, Bangalore have reviewed
the document
Contributions and inputs were provided by the Ministry of Environment, Forest and Climate Change, Government of India; the Centra
Pollution Control Board the State Pollution Control Boards, the Health and Family Welfare Departments and participating health care
facilities ofthe Five project states Gujarat, Karnataka, Maharashtra, Odishaand Punjab = to develop this document
Disclaimer:
‘This document has been produced without formal United Nations aditing. The designations employed and the presentation of the
‘material in this document do not imply the expression of any opinion whatsoever an the part of the secretariat ofthe United Nations
Industrial Development Organization (UNIO) concerning the legal status of any country, tarritary, city, oF area or ts authoritles, or
Concerning the delimitation of its frontiers or boundaries or Its economic system or degree of development. Designations such as
developed, “Industrialized” and “developing” are Intended for statistical convenience and do not necessarily express @ judgment
‘about the stage reached by aparticularcountry or area in the develooment pracess, Mention of fem names or commercial products
doesnot constitutean endorsement by UNIDO.
Copyright © 2018 by the United Netions industrial Development Organization
Edition: First published in Ini, 2018 About the Project
With Inia becoming « party to the Stockholm Convention on Persistent Organic Pllatonts (POP) in May 2002 end raiyng itn
January 2006, the country wes obliged to comply withthe recirements ofthe Stockholm Convention tis inthis context thet. the
proect on Environmentally Sound Management of Medial WesteiningieCESMW) hes been approved by Globel Environment Fecity
{GEF) whore the Ministry of Envienmentand Forest and Clmatechenge, Government of india sth national executing agency and the
United Nations Industrial Development Organization (UNIO) stheimplomenting agency.
‘The overall objective ofthe projects to reduce the release of unintentionally produced POPs and other globally harmful pollutants into
the environment,
Objectives of SOP
Biomedical Waste Management Is process dependent and not person dependent. The Standard Operative Procedure willhelp inuniform
Implementation of the Bio-Medical Waste Management Rules, 2016, Standard Operative Procedure Is defined as a method for
sccompllshing a policy, Hence, SOPs represent the action plan for achieving the policy
1, Itisa means to standardize the practices by all health care professionels in health care facilites,
2. Itisa step by step guideline
5. Itisbriefandto the point.
4. Itisa ready reckoner Introduction
‘Waste management rues in India are founded on the principles of “sustsinsble development’, “precautionary” and "polluter pays"
Under the Environment Protection) Act, 1986, Bio-Medical Waste Management Rules, 2016, came into force from 28th March, 2016 in
supersession ofthe Bio-Meical Waste (Management and Handling) Rules, 1998. Under the nev rules, the coverage hes increased and
‘also provides for pre-treatment of lab waste, blood samples, ee. It mandates bar code system for proper control, It has simplified
‘categorisation and authorisation which makes the implementation more easier
Salient features of BMW Management Rules, 2016:
1. The ambit of the rules has been expanded to include vaccination camps. blood donation camps, surgical camps or any other
hneattncare activity
2. To phase-out the use of chlorinated plastic bags, gloves by 27th March, 2019,
3. Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags through disinfection or
sterlisation on-site
44, Provide training to alls health care workers and immunise all health workers regularly
5. Establish a Bar-Code System for bags or containers containing bio-medical waste for disposal
6. Report major accidents.
7. Bio-medical waste has been classified in to 4 categories instead 10 to improve the segregation of waste at source
Procedure to get authorisation simplified. Automatle authorisation for bedded hospitals. The validity af authorization
synchronised with validity of consent orders for Bedded HCFS. One time Authorisation for Non-bedded HCFs.
‘9. The new rulas prescribe more stringent standards for Incinerator to reduce the emission of pollutants In environment
10. No aceupler shal establish ar-site treatment and dieposalfaclty, a service of ‘commen bio-medical waste treatment faclity
ic avaliable at a distance of seventy-five klometer.
1. Operator of a common bio-medical waste treatment and disposal faclity to ensure the timaly collection of bio-medical waste
{rom the HCFs and assist the HCFS In conduct of training Segregation - Yellow Bin (Infectious Waste)
tyes
* LA Mom ||
Bice
ey fre sks
‘Human & ani =s gases SO, iscar¢ inen
waste nee
anatomical wastes, Placenta bvconcar| cciartroe,, | & beddings
cotour cove ns 4
=e
‘Treatment ‘Common Bio-Medical Waste Treatment Facility - Incineration/plasma pyrolysis
Bbipasel Fissipedia mans
+ Disinfection with Non- Chorinated chemical disinfectant ~ 5% phenol 5% cresol, 23% formaldehyde, 2% formalin, 3% hydrogen peroxide,
"70% ethy| alcohol followed by cutting & shreding
err Segregation - Yellow Bin
ripest c ro 2 .
pena
we rab, Cea boar
tanves/ scans | cytoueangs | SetEMOCN Wate Reng Boo nes
ee [Pre treat in autoclave safe plastic bag /
sit eta ena
‘tage | amg a
oon! | iS =
i oI
= a =
reo | Seen | orem, en)
ae) Sresees |S | cements Damecn Segregation -Liquid Waste
Types of
Biomedical
Waste
Sllver X ray flm
developing liquid
Liquid Waste
Liquid chemical waste from lab
(reagents, normal saline), floor washing
Lab, Operation
Infected secretions
= sputum / faeces /
urine / serum
theater, ‘Aspirated body fluids
casualty, ~ pleural/eeritoneal /
Labour room CSF/ synovial fluid 2
Pre-treatment with Neutralisation=
Sent to registered | chemical disinfection | serene sscanSraniaed tae wees
ene receiea Ge veanihation | fscsncmcsancma meses,
for silver recovery a ”s
effluent
Disposal Effluent Treatment Plant
Weston D205, Aesae Hom UL ach. /coten o/cb
smancicommbierschemebatetyeuesin efor chem! a eons
er Types of ‘“ 7
Biomedical
Waste es a)
=
Bo cin Wirt REDON CHLORINATED
Colour Code |
eS PLASTIC BAGS 50 microns
Common Bio-Medical Waste Treatment Facity -
Autoclave /Mcrowave/Chemicsl disinfection fellowed by shredaing
Treatment
CFs where there no access to CBWTF within 75 kms - re treat ith chemical disinfection /
stelzetion (Autoclave/Mcrowave) and then hand it over to registered recyclers * esate
Types of
Biomodical S a
Waste =a —_
Colour Code Puncture prof, leak proof container with blue marking
‘Common Bio-Medical Waste Treatment Facility - Autoclave
ae = Hand it over to registered recycler
& Disposal
At HCFs where there is no access to CBWTF within 75 km
= Disinfection & Hand it over to registered recycler Segregation of Contaminated (Recyclable) Wastes
Types of
ae Saad eB. m™ oA |e!
Wonte : fyingew)————Lmrnichre Na ra
en,
colour Coa =) white translucent Puncture Proof, Leak Poot and
jolour Code \ & ‘Tamper Proof Container
COMMON BIO-MEDICAL WASTE TREATMENT FACILITY - Autoclave - Shredding
Treatment
& Disposal
*HCCFs where no access to CBWTF - Chemically disinfect and then contain in SHARPS PIT
Pry Collection & Transportation of Biomedical Medical waste
within the Health Care Facility (HCF)
Collection & transportation of waste to be done preferably during non-peak hours of the hospital or every shift.
Frequency of collection of waste to be detormined based on the requirement of the HCF-(dally /ence in every shift)
Personal Protection Equipment (PPE) to be worn during collection & transportation,
Pstic beg should only be %th filled and tightly tied ond tagged (trom where it was collected: ea ward/OPD/OT).
Predefined route chert should be followed for on-site transportation
‘Closed troleys with bio-hazard symbol should be used.
‘The biomedical waste is to be weighed, bar coded and the number of bags and the corresponding weight should be
documented in a record.
8, ‘Trolleys snould be cleaned daly. Collection & Transportation of Biomedical Medical waste
within the Health Care Facility (HCF)
6
ee a)
Be nea wats Us mapa toe rola % .
ae ee eee
‘and off-site transportation of Bio-Medical Wastes
from Health Care Facility Temporary Waste Storage Room in the Health Care Facility
‘The temporary waste storage room should be designed in the following way
+ Display board at the entrance -Name of the CBWTF and adress, validity of authorisation and bio-hazard lego
+ Be located such that itis accessible for easy transportation of waste to common bio-medical waste treatment vehicle
+ Be secured with lock and key with proper signage
It should be away from patient care
+ Have four big partitions with colour coding & biohazard symbol
Have non porous for that is easy to clean
+ Be protected from rain and sunlight
+ Have good lighting and ventilation
+ Should be inaccessible to stray animals and unauthorized person
+ Should have adequate water supply to clean the room
+ Should have adequate drainage facility for washing and cleaning purposes
+The outlet ofthe floor washing of room shall have discharge into ETP
+ Should have provision for clesning of the equipment”
protective clothing, waste bins
+ Should have a weighing scale to weigh the waste
+ Transporting trolleys should be located conveniently close to the storage room
+ CAUTION - BIOMEDICAL WASTE STORAGE AREAS - NO ENTRY WITHOUT PERMISSION DEEP BURIAL
1. The site should be relatively impermeable and no shallow well should be close
tothe site
2. The ground water table level should be a minimum of 6-7 metres below the
‘ground level
5. Should be at a distance of atleast 15 metres from habitation so as to ensure
thot ne contamination of any surface water oF ground water occurs
4. ‘The area should not be prone to flooding or erosion
5. Should not be accessible to stray animals or unauthorised person and covers,
Cf galvanised iron/wire meshes may be used
6, Should be dug about 2 m deep below the sround level
7, Burial must be performed under clase and dedicated supervision
18. Every time the wastes is added to the pt, a layer of 10cm of soll should be
‘added to cover the wastes
3. The pit should be half filed with waste, then covered with ime within 50cm of
the surface before filing the rest of the pit with sei,
10. The HCFs should maintain record of al pits for deen burl
Note : As pr CBWTF , Deep burial is permitted only in places where there is no
CBWTF within 75kms,
DEEP BURIAL PIT
= e200 Needle stick injury /
Blood & body fluid exposure
+ Post exposure propia for Hepatitis
Maintenance of Records
ME es 2006 ater
te.socors manu
OCCUPATIONAL SAFETY
— Immunization —=
esti
Use of PPE #
— I | — ‘hanna ao co ms
Training Health check ups
baring natn / ety no Preplacment Heath checeup an
measures Recorrendatins ofthe hrarazton Paces Avior Carte ACIP. IAW Personal Protective Equipment (PPE) for Waste Handlers
4.Goggles——
6 Hoary auty |
Ronee Face shield
Apron ——
——5.Gum Boots
Order of wearing the PPE
Apron
. Mask
. Head cover
. Goggles / Face Shield
. Gum boots
. Heavy Duty Gloves
oan
Note :
Gum boots - for the waste handler
Face shield - during splash of
body fluids, chemicals and aerosols
"Note Detals a th mater ofthe loves given nthe tnformation book on biomedical waste for adminstratos/doctors and nurses PERSONAL PROTECTIVE EQUIPMENT - WHEN TO USE ?
Emi co
Taking 8 - -
Temperature, pulse, Counting respiration - - - -
IMinjection - - - -
Starting V line oF taking blood oF IV injection y a a
Controlling minor bleeding Y . E 5
Cleaning an incontinent patient with diarrhoea 1 q - -
Handling sollec laundry y y q
Cleaning contaminated instruments 1 4 y -
Controlling massive bleeding y q y 4
lrrigating a wound y y y
Conducting Delivery Y y y v
Intubation Y Y y v
Suctioning Y ’ Y y
Liguis spi management \ q y y
Mercury spill management 4 1 y J
Handling waste(support staff) Y Y y y
‘Gum boots -for the waste handler | #Face shield - during splash of body fluids, chemicals and aerosols Spill Management (Blood or Body fluids)
(Spill management should be done by /under close supervision of trained person)
Contents of Spill kit
1
NOTE: Spill kit should be placed at all necessary locations
Porsenal Protective Equipment (PPE) -
2. Rubber gloves
b, Safety goggles / Faco shiold
Mask
d. Apron
©. Disposable shoe cover
(Old news paper / blotting paper / absorbant material
A labeled bottle of chemical disinfectant
Mop cloth
Yellow and Red plastic bags with bio - hazard logo for waste
collection
‘eg: Nursing stations, OT, Labour ward, Casualty Spills Management (Blood or Body Fluids)
Steps in management of spills:
‘Step 1: Use stop/cautian board. Cordon the area
‘Step 2: Open the spill kit
‘Step &: Wear gloves and other PPE as appropriate
Step 4; Place an old news paper or blotting paper to absorb the spill
and ciscard itinto yellow bin
‘Step $: Cover the spill area with equal volume of disinfectant and
leave it for 20 minutes.
Step 6: Clean tho spill area with paper towels / old newspaper and
discard itinto yelow bin
‘Step 7: After the decontamination procedure. Wash / clean the area
with detergent
‘Step 8: Remove the gloves and alscard into Red bin. Discard the
Gown, mask and shoe cover into Yellow bin
‘Step 9: Wash the hands with soap and water
‘Step 10:Re arrange the spl kit with required contents for next use, MANAGEMENT OF MERCURY SPILL
Management of Mercury spill to be done by a trained person
Mercury hazardous chemical used in eiferent instruments like thermometers and ephygmomanometer within health facilties, is 2
reurotoxin and can contaminate air ane water in minute quantities,
Note: Mercury spillage collection kit should be kept at all nursing stations of wards in HCFs to allow rapid access to use the same
in the event of mercury spillage.
Don'ts during management of mercury spill
1. Dornot touch the mercury with bare hands
2, Do not throw the mercury in waste bins or drain.
4. Do not use a broom or a vacuum cleaner for
loaning of Mercury.
CONTENTS OF MERCURY SPILL KIT Procedure of management of mercury spill
stopt
stop2:
stop 6
ut a cation boord and cordon ofthe area
Remove al jwallry from hands and wrist so that morcury dees not react withthe precious metals
‘Wear personal protective gears - Gown, Cap, Mask, Gogol and loves in that order
Collect mereury droplets together by using two eardoard piecas/ Xray fms/using afl / duct tape/sringe
ron the cclacted mereury into a ott half fled with water and ight cove the dof the bottle
Label the contents ofthe battle with date
Send the bote containing morcury back to manufacturer for recovery send to Hazardous Treatment, Storage and Disposal Facility
‘Cove the spl area with 10% soalum thiosulbhate solution and clean the area wih mop
Fesnave al the personal protection equipment and pace itn separate plastic bag NEEDLE STICK INJURY/ACCIDENTAL EXPOSURE TO BODY FLUIDS
FOR THEEVE FOR MOUTH TO UNBROKEN SKIN
‘spit the fluid immediately 1. Wash the exposed area
1 Tehaets etensed oye Immediately with running water
immediately with water or saline Rinse the mouth thorough,
ing water or saline snd spit 2. Do nat put finger into the mouth
2, Sit in chair tit the head back asain
Do not sau
‘and ask colleague to gently ‘Repeat this process several times
our water or normal saline o not use antispetics
‘Do not use soap or alsinfectant in
3. If wearing contact lens leave the mouth
them in place while irrigating, os
they form a barrier over the eye
‘and will elp protect it
4. Once the eve is cleaned, remove Report the incident to the area supervisar/infection contol nurse.
the contact lens and clean them
in the normal manner. This wil
make them safe te wear again.
Supervisor/ infection control nurse should document the injuy/incident in
the injury register
Pennies IFinjury is due to unused syringe, no further action needs to be taken
contact lens. It its due to used syringe/sharp instruments, samples from Health core
‘worker and algo from the source for HIV, HBEAg and anti HEAD should be
6. Do not use soap or disinfectant teen Sate)
tor the eves.
55. Refer to the Nodal person for counselling and action ta be taken for PEP. POST EXPOSURE PROPHYLAXIS FOR HEPATITIS B EVENT IN AN ACCIDENTAL EXPOSURE
(Percutaneous and mucosal exposure to blood and body fluids)
Post-exgosur testing Post exposure prophyinis ae
ee ea sane oc | Pca bs aie vecntin eee
estrehnisons