2. Introduction
• “The very first requirement in a hospital that it should do
the sick no harm" - Florence Nightingale
• Health care associated infections(HCAI)- economic loss
prolonged hospital stay & adverse patient outcomes.
Infection control
Biomedical
waste
management
Standard
precaution
3. Health care associated infections(HCAI)
• Infections that are acquired by the patients
while he is in the hospital either from other
patients, the environment or members of
hospital staff.
4. Health Care Associated Infections
Commonly occurring types
• Urinary tract infections.
• Surgical wound infections.
• Respiratory tract infections.
• Catheter related blood stream infections.
• Meningitis.
• Gastroenteritis.
6. • Low resistance of patient to infections.
• Invasive procedures/interventions.
• Inappropriate anti-microbial usage.
• Drug resistance of endemic microbes.
• Contaminated environment.
Risk due to
10. Measures practiced by health care personnel to
prevent spread, transmission and acquisition of
infection between clients, from health care
providers to clients and from clients to HCP.
Based on
Infection control - definition
Standard precaution
Additional precaution
12. Aseptic practices
• Hand washing.
• Use of barrier nursing –gloves, gown, mask,
goggles etc.
• Adopting universal and standard precautions.
• Care of indwelling devices.
13. Aseptic practices(contd…)
• Proper decontamination, disinfection
and sterilization of equipment.
• Isolation of infected patients.
• Environmental cleaning.
• Proper disposal of hospital waste.
16. Hand washing Vs Hand rub
Hand washing
• Hands visibly soiled.
• Before eating or handling food.
• After handling contaminated linens ,
equipment, organic material.
• Entering and exiting from clinical setting.
17. Hand rub
• Hands not visibly soiled.
• After touching clients intact skin.
• After touching any inanimate objects.
21. Disinfection and Sterilization
Disinfection : Reduce the number of microorganisms
on an object or surface but not the complete
destruction of all microorganisms or spores.
Sterilization : Procedures, which would remove all
microorganisms, including spores, from an object.
24. Changes observed over a period of time
• A switch over to digital thermometers from
clinical thermometers.
• Using distilled H2O ampoules to dissolve
injections rather than using common stock
solutions.
25. Current trends(contd…..)
• Wet mopping over dry sweeping.
• Revised steps of Hand washing.
• No more fumigation with formaldehyde.
• Dry bottles for Cheatle forceps rather
antiseptic solution filled bottles.
27. Standard Precaution
As defined by CDC
“ Set of practices designed to prevent the
transmission of HIV, Hepatitis B and other blood
borne pathogens (bacteria & virus). ”
Blood & other body fluids of all persons are
considered potentially infectious.
28. Body fluids include
• Blood
• Vomit
• Saliva
• Feces
• Drainage
• Secretions from
mucous membrane
• Semen
Sweat and tear mixed with blood
32. Prevention & management of
Sharp injury and Spillage
• Never recap the needles.
• Cannulas with safety needle guards.
• Post exposure prophylaxis treatment.
• Use of PPE.
34. Any waste generated during diagnosis, treatment or
immunization of human beings or animals.
Waste management is the
Collection, transport, processing or disposal, managing
and monitoring of waste material.
BIOMEDICAL WASTE MANAGEMENT
35. Sources-health care waste
Government and Private hospitals
Nursing homes
Physician’s office/clinics
Dispensaries
Primary Health Centers
Medical research and training establishments
Mortuaries
36. Hazards
• Organic portion ferments and attracts fly
breeding.
• Injuries from sharps - health care personnel and
waste handlers.
• Risk of infections to medical, nursing and other
hospital staff.
• Development of resistant strains of
microorganisms.
37. • Increase in risk associated with hazardous
chemicals and drugs to persons handling
wastes.
• Poor waste management encourages
unscrupulous persons to repacking and
reselling.
• Poor infection control - nosocomial infections in
patients (HIV, Hepatitis B & C).
Hazards(contd….)
38. To reduce hazardous nature of waste.
To reduce volume of waste.
To prevent misuse or abuse of waste.
To ensure occupational safety and health.
To consider aesthetics.
Purposes of waste disposal
39. Principles of waste management
• Segregate the waste.
• Disinfect and mutilate sharps.
• Adopt safer technologies as autoclave and
microwave.
• Don’t burn chlorinated plastics.
40. Principles of waste management(contd..)
• Prevent reuse of disposables.
• Motivate and train all hospital personnel.
• Practice universal precaution.
• Follow the biomedical waste rules.
44. Handling & Segregation
Rules and regulations governing the disposal of wastes
The Government of India – The Biomedical Waste
(Management and Handling) Rules 1998.
45. Category Types Management
Category
1
Human Anatomical Waste Incineration/Deep Burial
Category
2
Animal waste Incineration/Deep Burial
Category
3
Microbiology and
biotechnology waste
Local Autoclaving
Hospital waste categories
46. Hospital waste categories(contd..)
Category Types Management
Category
4
Waste Sharps Chemical Disinfection
Autoclaving/ Microwaving,
Mutilation and Shredding
Category
5
Discarded medicines and
cytotoxic drugs
Incineration/Destruction
and
disposal in land fills
Category
6
Soiled waste (contaminated
with blood and body fluids
including cotton, dressings,
soiled plasters)
Autoclaving/ Microwaving/
Incineration
47. Hospital waste categories(contd..)
Category types management
Category
7
Solid waste (tubes,
catheters, IV sets)
Chemical
Disinfection/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
48. Colour codes
Color
coding
Waste Category Treatment
options
Red Human and animal wastes Incineration/
Deep Burial
Yellow Highly infectious
waste biodegradable wastes.
Incineration/
Deep Burial
49. Colour codes(contd..)
Color
coding
Waste Category Treatment
options
Blue Infected plastics
( Cat 4 in puncture proof
container & Cat 7)
Autoclave/Microwave/
Chemical Treatment
Destruction/Recycling
and Shredding
Black General waste (food waste,
garden waste, Discarded
medicines, Cytotoxic drugs,
Incineration ash and chemical
waste)
(Cat 5,9 & 10)
Disposal in
secured land
fills
51. Waste storage
Storage facility should have sufficient capacity.
location - within hospital premises.
Radioactive waste must be stored separately.
Untreated biomedical waste not to be kept beyond 48
hrs (Permission required for >48 hrs).
Protect human health & environment.
52. Waste transportation
Points to be remembered:
Before taking the bags it should be tied and
labeled.
Waste handlers should not touch any other
articles.
A covered cart with biohazard symbol to carry
the waste to the central area of collection.
53. Waste Treatment and Disposal
Available Treatment and Disposal Methods
Chemical Technology
Thermal Technology
Autoclave
Hydroclave
Incinerator
Microwave
54. Waste Treatment and Disposal(contd..)
Mechanical Technology
Compaction
Grinding/ Shredding
Plasma torch Technology
Deep burial
55. Waste Treatment and Disposal(contd..)
Biological Method
Land filling
Open dumps
Sanitary land fill
Worm composting
56. Final disposal
Black bags
Disposed along with other municipal waste.
Yellow bags
Incinerated & resultant ash collected to be
used in land fills.
Blue bags
Autoclaved, shredded & finally dispensed.
57. Specific wastes
• Dead fetus
• Mutilated organs
• Placenta
• Dead bodies
• Cytotoxic drugs
• Radio active substances
• Expired countable drugs & sutures
• Immunization vials
58. Staff safety considerations
Separate trolleys for transporting waste within the
hospital.
All workers involved in the work are aware of the
hazardous nature of the work.
Provided with all protective equipment.
Immunized against tetanus and hepatitis B.
59. Training on biomedical waste management
Overall aim of training:
• To develop awareness of health, safety and
environmental issues relating to health care waste.
• Roles & responsibilities of health care personnel in
overall management program should be
highlighted.
60. Four main categories for which separate
training activities are designed
Hospital managers & administrative staff
Medical doctors
Nurses
Cleaners, porters, auxiliary staff &waste handlers
61. Biomedical waste management issues
Implementation of bio-medical waste regulation -
unsatisfactory.
Lack of segregation practices.
Incorrect methods of waste disposal.
Dumping of waste in river and sea.
Recycling of disposables without even being washed.
62. Biomedical waste management issues..
Using same wheel barrow for all categories of waste.
Trolley movement around patient care units.
No mechanism for ensuring waste treatment
within prescribed time limits.
No proper training of employees in some hospitals.
63. Responsibilities of health care Institutions
• Set up biomedical waste treatment facilities -
incinerators, autoclave and microwave system.
• Make an application to the concerned authorities
for grant of authorization.
• Report immediately any accident to the prescribed
authority.
64. Responsibilities of health care
Institutions (contd…)
• Maintain records about the generation, collection
reception, storage, transportation, treatment, disposal
and/or any form of handling bio medical waste.
• Submit a report during the preceding year by 31 Jan
every year.
65. Role of infection control nurses
• Visits all wards and high risk units.
• Checking nursing supervisor’s register and
records for cases suggestive of infection.
• Collection of sample from different areas of the
hospitals & sending them to the lab.
66. Role of infection control nurses(contd..)
• Daily visit to microbiology lab to ascertain results
of sample collected.
• Monitoring & supervision of infection among
hospital staffs.
• Training of nursing & paramedical personnel on
correct hygiene practices & aseptic technique.
Editor's Notes
Disinfection and sterilization are important procedures in biosafety.
H2O2 3%
sweat
Biodegradable and non biodegradable wastes
recycle disposables and disposed drugs for
(hospitals, nursing homes, clinics, dispensaries,
veterinary institutions, animal houses, pathological
laboratories and blood banks)
Applicable to all persons who generate, collect, receive, store, transport, treat, dispose or handle biomedical wastes.
.(regarding categories and quantities of biomedical wastes handled).
