Handling and disposal of infectious Waste materials

Handling and Disposal of Infectious Materials: 

H andling and Disposal of Infectious M aterials Dr.T.V.Rao MD Dr.T.V.Rao MD 1

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The Programme is created for training the Health Care Workers for Accreditation to NABH on Safe Practices Dr.T.V.Rao MD 2

What is Infectious Waste: 

What is Infectious Waste Infectious wastes (also called biomedical waste) include human waste, animal waste and objects and materials contaminated with blood and body fluids containing disease-causing micro-organisms or viruses. Dr.T.V.Rao MD 3

Infectious wastes - Biomedical Waste: 

Infectious wastes - B iomedical Waste Infectious wastes (also called biomedical waste) include human waste, animal waste and objects and materials contaminated with blood and body fluids containing disease-causing micro-organisms or viruses . with any body fluids, which is similar to domestic waste) Dr.T.V.Rao MD 4

Why Infectious Medical Waste is Hazardous: 

Why Infectious Medical Waste is Hazardous Medical waste shall be considered capable of producing an infectious disease if it has been, or is likely to have been, contaminated by an organism likely to be pathogenic to healthy humans, if such organism is not routinely and freely available in the community, AND such organism has a significant probability of being present in sufficient quantities and with sufficient virulence to transmit disease. Dr.T.V.Rao MD 5

Why Infectious Waste is Regulated: 

Why Infectious Waste is Regulated To minimize the potential for the spread of disease from a medical setting to the general public; and To reduce the overall amount of infectious medical waste produced in West Virginia. helps to protect the environment, and reduces medical facilities’ treatment expenditures Dr.T.V.Rao MD 6

What is Infectious Medical Waste: 

What is Infectious Medical Waste Infectious Medical Waste is defined as medical waste capable of producing an infectious disease. Waste is considered Infectious when it is: Contaminated by an organism that is pathogenic to healthy humans; The organism is not routinely available in the environment; and The organism is in significant quantity and virulence to transmit disease. Dr.T.V.Rao MD 7

India to Relook into Safe Practices: 

India to Relook into Safe Practices Bio-medical or infectious waste has not received its due attention in developing countries like India. It is being collected and disposed off along with the municipal solid waste (MSW). Therefore, infectious waste management schemes should be designed carefully by taking in account the correct factors and giving them due weight age. Dr.T.V.Rao MD 8

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9 Cultures and stocks of infectious agents and associated biologicals, including without limitation: specimen cultures cultures & stocks of infectious agents wastes from production of biologicals discarded live & attenuated vaccines Laboratory wastes that were, or are likely to have been, in contact with infectious agents that may present a substantial threat to public health if improperly managed Pathological wastes from humans and animals (provided animals have or are likely to have been exposed to a zoonotic or infectious agent), including without limitation tissues, organs, body parts, body fluids and excreta that are contaminated with or are likely to be contaminated with infectious agents The following items are infectious waste: (Continued) Dr.T.V.Rao MD

The following items are infectious waste:: 

10 Waste materials from the rooms of humans, or the enclosures of animals that have been isolated due to diagnosis of communicable disease that is likely to transmit infectious agents. This includes waste materials from the rooms of patients who have been placed on blood and body fluid precautions under the universal precaution system established by the Centers for Disease Control if the waste presents a substantial threat to human health when improperly managed. Human and animal blood specimens and blood products that are being disposed of, provided that, with regard to blood specimens and blood products from animals, the animals were or are likely to have been exposed to a zoonotic or infectious agent. Note: Blood products does not include patient care waste such as bandages or disposable gowns that are lightly soiled with blood or other body fluids, unless such wastes are soiled to the extent that the generator of the wastes determines that they should be managed as infectious waste. (Continued) The following items are infectious waste : Dr.T.V.Rao MD

The following items are infectious waste:: 

11 Contaminated carcasses, body parts, and bedding of animals that were intentionally exposed to infectious agents associated with zoonotic or human diseases Carcasses and bedding of animals otherwise infected by zoonotic or infectious agents that may present a threat to public health if improperly managed Sharp infectious waste used in the treatment, diagnosis, or inoculation of human beings or animals or that have, or are likely to have, come in contact with infectious agents including, but not limited to: hypodermic needles and syringes scalpel blades glass articles that have been broken The following items are infectious waste: Dr.T.V.Rao MD

The following items are infectious waste:: 

12 Any other waste materials generated in the diagnosis, treatment, or immunization of human beings or animals, in research pertaining thereto, or in the production of or testing of biologicals, that presents a substantial threat to human health when improperly managed because of contamination with, or the likelihood of contamination with, infectious agents. Infectious waste also includes any other waste materials that the generator designates as infectious waste. A generator of infectious waste may designate and manage other waste materials as infectious waste when the generator deems it is appropriate because the waste is, or is likely to be, contaminated with infectious agents. However, non-infectious materials that a generator places in an infectious waste container (e.g. biohazard bag & burn box), must be handled and disposed of as infectious waste. The following items are infectious waste: Dr.T.V.Rao MD

Diseases Caused by Blood borne Pathogens: 

Diseases Caused by Blood borne Pathogens Malaria Rabies Syphilis Tularemia Viral Hemorrhagic Fevers Arbovirus infections Brucellosis Creutzfeldt-Jakob Disease Hepatitis C Leptospirosis HIV / AIDS Hepatitis B Dr.T.V.Rao MD 13

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Dr.T.V.Rao MD 14

Universal (Standard) Precautions: 

Universal (Standard) Precautions “Precautions to protect against exposure must be taken when there is any potential for exposure to bodily fluids. It is assumed that all bodily fluids have the potential to transmit disease” The Universal Precaution Rule: Treat all human blood, bodily fluids and other potentially infectious materials as if they are infectious. Dr.T.V.Rao MD 15

Risk Group 1: 

Risk Group 1 Unlikely to cause animal or human disease Non pathogenic agent Dr.T.V.Rao MD 16

Risk Group 2: 

Risk Group 2 Pathogenic for humans Unlikely a serious hazard Treatment and preventive measures available Limited risk of spread of infection CDC, Yersinia pestis laboratory

Risk Group 3: 

Risk Group 3 Pathogenic, cause serious disease Effective treatment and preventive measures usually available Little person-to-person spread Laboratory in Lyon France

Risk Group 4: 

Risk Group 4 Lethal, pathogenic agent Readily transmittable direct, indirect Effective treatment and preventive measures not usually available National Institute for Infectious Diseases, Rome, Italy

Disinfection with household bleach: 

Disinfection with household bleach Work areas disinfect with 0.5% bleach after every procedure Contaminated supplies soak with 0.5 % household bleach for 30 minutes wash in soapy water sterilize as necessary Photo: WHO

Activity spectrum of select detergents and disinfectants : 

Activity spectrum of select detergents and disinfectants BG+ BG- MycoB Spores Yeast Virus Prions Alcohol 70° ++ ++ ++ 0 + + 0 Aldehydes +++ +++ ++ + +++ ++ 0 Ammonium IV +++ + 0 0 + + 0 Anilides + 0 NP NP 0 NP 0 Chlorhexidine +++ ++ 0 0 + + 0 Cl compounds +++ +++ ++ ++ ++ ++ + (a) Iodine (+ der.) +++ +++ ++ ++ ++ ++ 0 Hg compounds ++ ++ 0 0 + 0 ou + 0 Phenols : Variable activity depending on components (b) Hexachlorophene +++ + 0 0 + 0 0 (a) Bleach (6%) during 60 min at 20°C ; (b) discussion on efficacy of phenol on prions

Infectious Laboratory Wastes: 

Infectious Laboratory Wastes Cultures Etiological agents Specimens Stocks Related contaminated wastes Vaccine vials Dr.T.V.Rao MD 22

Can we handle ???: 

Can we handle ??? Dr.T.V.Rao MD 23

Highly Infectious Isolation Wastes: 

Highly Infectious Isolation Wastes Wastes generated from the care of a patient who has or is suspected of having a disease caused by a CDC Class 4 agent, listed below CLASS 4 VIRAL AGENTS: Alastrim, Smallpox, Monkey pox, and White pox. Hemorrhagic fever agents, including Crimean hemorrhagic fever (Congo), Junin, and Machupo viruses Herpes virus simiae (Monkey B virus) Lassa virus Marburg virus Tick-borne encephalitis virus complex, including Russian spring-summer encephalitis, Kyasanur forest disease, Omsk hemorrhagic fever, and Central European encephalitis viruses Venezuelan equine encephalitis virus Yellow fever virus Dr.T.V.Rao MD 24

What about OSHA: 

What about OSHA Ensure that all employees can safely perform their normal duties without undue health risks Bloodborne Pathogen (BBP) Standard developed to protect employees with occupational exposure to bloodborne pathogens HIV HbV Employers required to evaluate engineering controls to reduce or eliminate employee exposure risks adoption of a needleless system Dr.T.V.Rao MD 25

Blood borne Pathogen Standard: 

Blood borne Pathogen Standard Employers must: Ensure that Universal Precautions are observed Provide free Hepatitis-B vaccination series Provide all necessary PPE and ensure that is it used Provide BBP training at hire, and annually thereafter Maintain records of all training Maintain an Exposure Control Plan, update annually Record exposure incidents and follow-up activities Dr.T.V.Rao MD 26

Blood borne Pathogen Standard: 

Blood borne Pathogen Standard Defines Infectious Medical Waste as: Liquid or semi-liquid blood or other potentially infectious materials (OPIM), Contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed, Items caked with dried blood or OPIM that would dislodge during handling, Contaminated sharps, and Pathological and microbial wastes containing blood or OPIM Dr.T.V.Rao MD 27

Other Potentially Infectious Material OPIM: 

Other Potentially Infectious Material OPIM Any body fluid with visible blood Amniotic fluid Cerebrospinal fluid Pericardial fluid Peritoneal fluid Pleural fluid Saliva in dental procedures Semen/vaginal secretions Synovial fluid Anywhere body fluids are indistinguishable Dr.T.V.Rao MD 28

Transmission of Blood and Fluid Borne Pathogens: 

Transmission of Blood and Fluid Borne Pathogens An exposure incident does not guarantee disease transmission. Several factors affect transmission: Infected Source – the disease stage of the source Means of Entry - severity or depth of the: puncture wound, broken skin, or direct contact with mucus membrane Infective Dose - the amount and type of fluid, as well as the amount of infectious agent in the fluid Blood is the fluid of greatest concern Susceptible Host - immunocompromised Dr.T.V.Rao MD 29

Disposal of Isolation Wastes: 

Disposal of Isolation Wastes Isolation wastes that do not meet the definition of infectious medical waste should be separated and disposed in the general waste stream disposable gowns face masks shoe covers All waste from an isolation room should be treated with caution and the appropriate Personal Protective Equipment (PPE) must be worn during handling and disposal. Dr.T.V.Rao MD 30

Blood-borne Pathogens (BBP): 

Blood-borne Pathogens (BBP) Blood-borne pathogens (BBP) are specific microorganisms transmitted in human blood or bodily fluids, which can cause disease in people. There are three major BBPs: Hepatitis B (HBV) causes inflammation of the liver that might lead to liver failure completely preventable by a vaccine Hepatitis C (HCV) also causes inflammation of the liver, no vaccine to prevent infection Human Immunodeficiency Virus (HIV) HIV is a human retrovirus that causes AIDS (Acquired Immune Deficiency Syndrome). There is no vaccine to prevent HIV infection. Dr.T.V.Rao MD 31

Routes of exposure: 

Routes of exposure Blood-borne Pathogens such as HBV, HCV and HIV are transmitted through contact with human blood and bodily fluids. Contacts include: “sharps” exposures in occupational settings sexual activity sharing of needles mother-to-child exposures at birth HIV is passed from one person to another through blood-to-blood and sexual contact. Infected pregnant women can pass HIV to their babies during pregnancy, delivery, and breast feeding . Dr.T.V.Rao MD 32

Prevention of Exposure: 

Prevention of Exposure Guidelines to reduce the risk of exposure: Frequent hand washing Use of standard barrier precautions Regular cleaning and decontamination of work surfaces with a cleaning agent labeled as effective against Mycobacterium/TB Vaccination against Hepatitis-B Proper infectious waste disposal Dr.T.V.Rao MD 33

Exposure control: 

Exposure control Exposure Controls consist of those policies and practices that prevent occupational exposures to infectious materials, including: Administrative Controls Exposure control plan (ECP) Individual Laboratory Risk assessments Universal (Standard) Precautions Personal Protective Equipment (PPE) Engineering Controls (HVAC, bio-safety cabinets, self-sheathing needles, safer medical devices, and  needleless systems) Dr.T.V.Rao MD 34

Exposure control plan (ECP): 

Exposure control plan (ECP) The OSHA BBP Standard requires employers to develop written documents to explain how they will implement the standard, provide training to employees, and to eliminate or minimize occupational exposure to blood-borne pathogens to protect the health and safety of their workers. The ECP must be tailored to the specific requirements of the institution; plans must be accessible to all employees, either on-line or in an area where they are available for review on all shifts. Dr.T.V.Rao MD 35

Exposure control plan (ECP): 

Exposure control plan (ECP) The ECP includes: Determination of employee exposure and Implementation of various methods of exposure control, including: Universal (Standard) precautions Engineering and work practice controls Personal protective equipment Waste segregation, treatment and disposal, including sharps Hepatitis B vaccination Post-exposure evaluation and follow-up Communication of hazards to employees and training Recordkeeping:  Training records, employee health records, exposure/incident records Procedures for evaluating circumstances surrounding exposure incidents Dr.T.V.Rao MD 36

Exposure control plan (ECP) cont.…: 

Exposure control plan (ECP) cont.… Administrative Controls: Administrative controls, including risk assessments, are steps taken by supervisors and individual employees, including: Conducting a risk assessment of the materials in use Adhering to vaccination schedules and training schedules Training personnel to handle specific infectious materials and their hazards Promoting individual awareness of personal protective equipment use and engineering controls (sample containers) to minimize or eliminate potential exposure Dr.T.V.Rao MD 37

Exposure control plan (ECP) cont.…: 

Exposure control plan (ECP) cont.… Sharps Precautions You must exercise care when using needles, scalpels, glass pipettes and other sharp instruments or devices.   Follow these rules of thumb when handling sharps: Do not recap, bend, break, or otherwise manipulate used needles by hand. Do not remove used needles from disposable syringes. Place used sharps in labeled or color-coded puncture-resistant, leak-proof, closable, sharps containers for disposal. Do not overfill sharps containers. Consider the use of alternative, non-sharps equipment whenever possible. Dr.T.V.Rao MD 38

Exposure control plan (ECP) cont.…: 

Exposure control plan (ECP) cont.… Personal Protective Equipment (PPE) Whenever you may be exposed to infectious materials you must wear the appropriate personal protective equipment. PPE places a barrier between you and potentially infectious material. Here are some basic rules to follow: PPE should be readily accessible Always wear PPE in exposure situations-Wear a lab coat, gloves and eye protection whenever splashing is imminent Remove and replace PPE that is torn or punctured, or that loses its ability to function as a barrier to potentially infectious materials Remove PPE before leaving the work area Dispose of contaminated PPE properly-in biohazard containers Dr.T.V.Rao MD 39

Exposure control plan (ECP) cont.…: 

Exposure control plan (ECP) cont.… Types of Personal Protective Equipment (PPE): Gloves Protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments Eye protection devices, such as masks, goggles or glasses with solid side shields, or chin-length face shields Dr.T.V.Rao MD 40

Exposure control plan (ECP) cont.…: 

Exposure control plan (ECP) cont.… Hand Hygiene Most common mode of transmission of pathogens is via hands! Often infections acquired in healthcare and research settings are due to not washing your hands. Employees must wash their hands with soap and water: immediately, or as soon as feasible, after removal of gloves or other PPE. whenever they leave the work area, go on break, or before eating. following contact with blood or other potentially infectious materials. Dr.T.V.Rao MD 41

Exposure control plan (ECP) cont…: 

Exposure control plan (ECP) cont… Engineering controls Containment is the concept of managing materials to reduce or eliminate potential exposures to personnel, the general public and the outside environment. Primary containment consists of good microbiological techniques, appropriate vaccinations or immunizations, appropriate PPE and safety equipment. Dr.T.V.Rao MD 42

Exposure control plan (ECP) cont…: 

Exposure control plan (ECP) cont… Engineering Controls Needle stick Prevention: Sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems are used to isolate or remove certain blood-borne pathogens hazards from the workplace. Dr.T.V.Rao MD 43

Accidents and Injuries : 

Accidents and Injuries If you are exposed to blood or other potentially infectious or hazardous materials, follow these steps: If you experience a needle stick or sharps injury, immediately wash needle sticks or cuts with soap and water. Splashes to the nose, mouth, or skin should be flushed with water. Irrigate eyes using eyewash, for 10 to 15 minutes. Report the incident to your supervisor. Colorado State law requires you to notify your supervisor in writing within 4 days of an accident, injury or exposure. Immediately seek medical treatment . Dr.T.V.Rao MD 44

Exposure Incident Response: 

Exposure Incident Response Wash exposed area with soap and water Flush splashes to nose, mouth or skin with water Irrigate eyes with water or saline Report the exposure to supervisor Follow your facility’s exposure response plan Report all exposures, regardless of severity, for your safety Dr.T.V.Rao MD 45

Responsibilities of Infectious Waste Generators: 

Responsibilities of Infectious Waste Generators Identify and segregate infectious waste from non-infectious waste at the point of generation. Properly package infectious waste at the generation site. Do not transport infectious waste on roadways. Infectious waste will be picked up at the site of generation and transported by the Office of Environmental Health & Safety (EHS). Train personnel Prepare & implement spill and containment plans Dr.T.V.Rao MD 46

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Collection of Infectious Waste: 

Collection of Infectious Waste Infectious medical wastes must be collected at the point of generation in the appropriate color coded bags Orange bags for autoclaved waste, Red bags for all other treatment methods Biohazard bags must be labeled with the international biohazard symbol and appropriate wording; “biohazard,” “biomedical waste,” “infectious medical waste,” or “regulated medical waste” Dr.T.V.Rao MD 48

Source Separation is the Key!: 

Source Separation is the Key! Everyone needs to consider which waste stream an item goes in every time wastes are disposed We realize that you are busy, but it only takes a few seconds to separate waste items into the proper waste stream By properly segregating medical wastes, the weight of infectious waste can be drastically reduced in every facility Dr.T.V.Rao MD 49

Sharps: 

Sharps Must be collected at the point of generation, in a leak-proof and puncture-resistant container Containers must bear the international biohazard symbol and appropriate wording Containers should never be completely filled, nor filled above the full line indicated on box. Dr.T.V.Rao MD 50

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51 Sharp infectious waste is sharp waste used in the treatment, diagnosis, or inoculation of human beings or animals or that have, or are likely to have, come in contact with infectious agents. Sharp infectious waste includes, but is not limited to: hypodermic needles and syringes scalpel blades glass articles that have been broken Sharp infectious waste must be placed in a sharps disposal container that is: Rigid, puncture-resistant, leak-resistant, and closed tightly to prevent loss of contents Containers specifically designed and manufactured for the management and/or disposal of “sharps” Labeled as “sharps” Labeled with the universal biohazard symbol Sharp Infectious Waste Dr.T.V.Rao MD

Tips for handling and using sharps: 

Tips for handling and using sharps To help reduce the risk of sharps injuries, heed the following work practices: Organize your work space so that all materials for the experiment are ready and available before accessing the sharp device. This helps reduce the chance of having to set an exposed needle down on the lab bench in order to retrieve other necessary supplies, for example. Be prepared to use the device the moment the sharp is exposed (e.g., when the needle is uncapped, the razor blade removed from its wrapper) Make sure you have adequate lighting to perform the task involving the sharp. Locate your sharps container in your workspace. 52 Dr.T.V.Rao MD

Tips for handling and using sharps (cont.): 

Tips for handling and using sharps (cont.) Safe work practices (cont.) Keep exposed sharps pointed away from yourself and others. Never directly hand an exposed sharp to another person. Instead, designate a “sharps passing zone” where exposed sharps are set down prior to being picked up by another person. Be accountable for the sharps you use. Look around after you complete your work and make sure that all sharps have been disposed of properly. 53 Dr.T.V.Rao MD

Disposal of Blood, Blood Products, Body Fluids, & Excreta: 

54 Generators of infectious waste may discharge untreated liquid or semi-liquid infectious waste that consists of blood, blood products, body fluids, and excreta into a public waste waster system -- provided these materials do NOT contain hazardous materials (such as, but not limited to formaldehyde or bleach) or radioactive materials. Generators may also package blood, blood products, body fluids and excreta in biohazard bags and burn boxes for pick-up by EHS. All liquid/semi-liquid wastes must be packaged in containers that will prevent leakage prior to placement in biohazard bags and boxes. Disposal of Blood, Blood Products, Body Fluids, & Excreta Dr.T.V.Rao MD

Liquid Infectious Medical Wastes: 

Liquid Infectious Medical Wastes Liquid Infectious Medical Waste, i.e., the contents of suction canisters, may be disposed of in several ways: Placed directly in the Bio hazardous waste, Poured down a sanitary sewer, Solidified using an approved disinfectant solidifier and discarded in the solid waste Dr.T.V.Rao MD 55

Personal Protection: Hand hygiene: 

Personal Protection: Hand hygiene Alcohol based hand rubs are gold standard in health care settings (if hands not visibly soiled) Must complement with hand washing with normal soap Photos: WHO

Risk groups, biosafety levels, practices and equipment: 

Risk groups, biosafety levels, practices and equipment BSL Laboratory type Laboratory practices Safety equipment 1 Basic teaching, research Good microbiological techniques None Open bench work 2 Primary health services; diagnostic services, research Good microbiological techniques, protective clothing, biohazard sign Open bench PLUS biological safety cabinet for potential aerosols 3 Special diagnostic services, research As BSL 2 PLUS special clothing, controlled access, directional airflow Biological safety cabinet and/or other primary devices for all activities 4 Dangerous pathogen units As BSL 3 PLUS airlock entry, shower exit, special waste Class III biological safety cabinet, positive pressure suits, double ended autoclave (through the wall), filtered air

Preventing Disease Transmission: 

Preventing Disease Transmission The single most effective measure to control the transmission of Blood borne Pathogens is: Universal Precautions Treat all human blood and other potentially infectious materials like they are infectious for Hepatitis B and HIV Dr.T.V.Rao MD 58

Never Forget what are Hazardous: 

Never Forget what are Hazardous Treat all human blood, bodily fluids and other potentially infectious materials as if they are infectious There are 3 major Blood-borne pathogens: Hepatitis B, Hepatitis C and HIV. The most common mode of transmission of pathogens is the hands Wear proper PPE in exposure situations Dr.T.V.Rao MD 59

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A Simple Hand Wash Can Play Miracles : 

A Simple Hand Wash Can Play Miracles Dr.T.V.Rao MD 61

References for Creating a Better world: 

References for Creating a Better world OSHA guidelines References of CDC Atlanta USA WHO Laboratory Safety Manual Dr.T.V.Rao MD 62

WE NEED YOUR FEEDBACK AND SUPPORT : 

WE NEED YOUR FEEDBACK AND SUPPORT THE WASTE MANAGEMENT SYSTEM IS NEW (= NOT PERFECT) YOUR QUESTIONS, COMMENTS AND SUGGESTIONS ARE WELCOME DON’T FORGET YOUR Responsibilities Dr.T.V.Rao MD doctortvrao@gmail.com Dr.T.V.Rao MD 63

For Articles of Interest on Infectious diseases and Microbiology follow me on: 

Dr.T.V.Rao MD 64 For Articles of Interest on Infectious diseases and M icrobiology follow me on

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The Programme C reated by Dr.T.V.Rao MD for Medical and Health care Workers in the Developing World Email doctortvrao@gmail.com Dr.T.V.Rao MD 65