Question

Imagine you are a seasoned healthcare employee inducting new coworkers into an environment that needs to remain clean and sterile. Write a minimum 250-word procedure instructing new employees on the proper method for disposing of medical waste

Answer 1

Cleaning in the health care system refers to the removal of visible dirt, dust, and debris. Cleaning alone results in large reductions in environmental contamination, including the removal of many pathogens. and help in the control of infection and many hospital-borne infections.

the different areas in a hospital need different frequency of cleaning like healthcare facilities will require at least daily cleaning. Other specialized clinical areas require twice daily or more frequent cleaning in operation theater

cleaning equipment required are

• Cleaning cloths: these should ideally be color-coded to distinguish cloths used for ‘clean’ areas from those used for highly contaminated areas, e.g. toilets, baths, and isolation areas. Where a color-coding system is used, it is important to ensure that all staff is aware of which equipment may be used for cleaning which areas.
• Cleaning buckets/carts: should be cleaned daily or whenever heavily soiled.
• Mops: flat mops are preferred to the ‘spaghetti’ mop type. Mopping water and detergent solution should be changed frequently. Proper storage of mops is important so that they can be allowed to dry thoroughly and without cross-contamination of the mop heads.
• Floor polishers: where these are used the machines should be emptied and cleaned daily.
• Storage area: each clinical area should have a dedicated cleaning store/closet. It is important to ensure that all equipment is stored dry, and inspected for damage prior to use.

Personal protective used by cleaning staff

• Domestic rubber gloves that reach to at least mid-arm to protect the workers from exposure to chemicals and organic material.
• Plastic aprons should be worn during any activity that may result in splashes.
• If entering a room where transmission-based precautions are in place, the domestic staff should be made aware of the risk and instructed to put on the required personal protective equipment.
• Ideally, all domestic staff should also be immunized against tetanus and hepatitis B as they are frequently exposed to sharps

BIOMEDICAL WASTE MANAGEMENT

Waste management is the handling and safe disposal of infectious and non-infectious waste. The aims of waste management are to ensure safe and environmentally friendly destruction or reprocessing of healthcare waste.

Health cae waste should be seggregated at point of source

category	color	example
Anatomical tissues and clinical waste, any material which is visibly contaminated with blood or body fluid or infectious agents	red clinical waste	Placentae, human limbs and tissue, excision products, used bandages and dressings, urinary catheter and drainage bags*, intravenous administration sets, abdominal swabs, theatre dressings, Infectious disease isolation area: gloves and aprons, linen savers with blood or body fluids
Sharps, sharp objects that are contaminated with blood or body fluid	yellow sharp object	Hypodermic needles, stylets, vials, syringes containing blood or body fluids, insertion ends of intravenous administration sets, trochars, cannulae, rigid guidewires
Non-clinical waste generated by patients but not contaminated with blood or body fluids, paper and packaging, packaging or wrapping, office and administration	black non clinical	Items used by patients but not contaminated with blood or body fluids, e.g. used gloves, linen savers, tissues, paper towels, packaging or wrapping from sterile items or processed items, babies' nappies, sanitary towels, Office paper, wrapping paper from SSD, surgical masks, overshoes, surgical disposable caps and gowns
SSD equipment, used single items sent to SSD for sterilization or high-level disinfection	clear for sterilization	Surgical instruments, vaginal speculae, respiratory equipment, masks, etc.
Storage of patient articles	clear for sterilization	storage of patient article

BIO MEDICAL WASTE COLLECTION

1. TIME OF COLLECTION

• Bio-medical waste should be collected on daily basis from each ward of the hospital at a fixed interval of tIME
•  HCF should ensure collection, transportation, treatment and disposal of bio-medical waste within 48 hours.
•  Collection times should be fixed and appropriate to the quantity of waste produced in each area of the health-care facility
• .  General waste should not be collected at the same time or in the same trolley in which biomedical waste is collected.
•  Collection should be daily for most wastes, with collection timed to match the pattern of waste generation during the day.
•  General waste collection, must be done immediately after the visiting hours of the HCFs, as visitors coming to the facility generate a lot of general waste and in order to avoid the accumulation of such general waste in the HCF.
• .  Bio-medical waste collected by the staff should be provided with PPEs.

2.PACKAGING

• Bio-medical waste bags and sharps containers should be filled to no more than three-quarters full. Once this level is reached, they should be sealed ready for collection.
•  Plastic bags should never be stapled but may be tied or sealed with a plastic tag or tie.
•  Replacement bags or containers should be available at each waste-collection location so that full ones can immediately be replaced.
•  Color-coded waste bags and containers should be printed with the bio-hazard symbol, labeled with details such as date, type of waste, waste quantity, senders name and receivers details as well as a barcoded label to allow them to be tracked till final disposal
• .  Ensure that Barcoded stickers are pasted on each bag as per the guidelines issued bY CPCB

3 LABELLING

• Date of Generation
• Type of waste category
• Waste Quantity in kg
• Name and Address of the hospital
• Contact Person Name and Phone Number
• Contact Details in case of any Emergency
• Receivers contact details i.e Name, Address and Contact Details

4 INTERIM STORAGE

• Interim storage of bio medical waste is discouraged in the wards / different departments of HCF.
•  If waste is needed to be stored on interim basis in the departments it must be stored in the dirty utility/sections.
•  No waste should be stored in patient care area and procedures areas such as Operation Theatre. All infectious waste should be immediately removed from such areas.
•  In absence of dirty utilities/ sections such BMW must be stored in a designated places away from patient and visitor traffic or low traffic area.

5 INHOUSE TRANSPORT

• Transportation does not occur through high-risk areas
•  Supplies and waste are transported through separate routes
• .  Waste is not transported through areas having high traffic of patients and visitors
•  Central Waste collection area can be easily accessed through this route
•  Safe transportation of waste is undertaken to avoid spillage and scattering of waste

6 STORAGE OF WASTE

Each Healthcare facility should ensure that there is a designated waste collection center situated within its premises for storage of bio-medical waste, till the waste is transported for treatment and disposal to CBMWTF. Such a center is manned and is under lock and key under the responsibility of a designated person. During construction, it is to be ensured that the center is kept ventilated through the use of exhaust fan or by providing guarded space for proper VENTILATION

HANDING OVER WASTE

All the BMW waste should be collected in the colour coded bags/ bins/ containers and should not be mixed with the general waste generated by the health care facility.  All the bags or containers containing bio- medical waste, to be sent out of the premises must also be labeled as per BMWM Rules and also with the unique bar code.  Collect or receive a receipt generated from bar-code scanning system.  The HCFs must ensure that there is no secondary handling of the waste i.e. the waste is handed over to the CBWTF directly from HCFs‟ central waste collection center.