Handling and Disposal of Infectious Materials

Dr.T.V.Rao MD

Dr.T.V.Rao MD

 The Programme is created for training the Health Care Workers for Accreditation to NABH on Safe Practices
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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 microorganisms or viruses.
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Infectious wastes - Biomedical Waste

Infectious wastes (also called biomedical waste) include human waste, animal waste and objects and materials contaminated with blood and body fluids containing diseasecausing micro-organisms or viruses. with any body fluids, which is similar to domestic waste)
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Why Infectious Medical Waste is Hazardous

Medical waste shall be considered capable of producing an infectious disease if (1) it has been, or is likely to have been, contaminated by an organism likely to be pathogenic to healthy humans, (2) if such organism is not routinely and freely available in the community, AND (3) such organism has a significant probability of being present in sufficient quantities and with sufficient virulence to transmit disease.
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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
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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.
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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.
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The following items are infectious waste:

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 (Continued) with infectious agents
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The following items are infectious waste:

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)
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The following items are infectious waste:

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: o hypodermic needles and syringes o scalpel blades Dr.T.V.Rao MD 11 o glass articles that have been broken

The following items are infectious waste:

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.
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Diseases Caused by Blood borne Pathogens

HIV / AIDS Hepatitis B

Arbovirus infections Brucellosis Creutzfeldt-Jakob Disease Hepatitis C Leptospirosis

Malaria Rabies Syphilis Tularemia Viral Hemorrhagic Fevers

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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.

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Risk Group 1
Unlikely to cause animal or human disease Non pathogenic agent
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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
Pathogenic, cause serious disease Effective treatment and preventive measures usually available Little person-toperson spread

Laboratory in Lyon France

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

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

BG+ Alcohol 70 Aldehydes Ammonium IV Anilides Chlorhexidine Cl compounds Iodine (+ der.) Hg compounds Phenols : ++ +++ +++ + +++ +++ +++ ++ BG++ +++ + 0 ++ +++ +++ ++ Myco B ++ ++ 0 NP 0 ++ ++ 0 Spores 0 + 0 NP 0 ++ ++ 0 Yeast + +++ + 0 + ++ ++ + Virus + ++ + NP + ++ ++ 0 ou + Prions 0 0 0 0 0 + (a) 0 0

Variable activity depending on components (b)

Hexachlorophene +++
(a) Bleach

(6%) during 60 min at 20C ; (b) discussion on efficacy of phenol on prions

Infectious Laboratory Wastes

Cultures Etiological agents Specimens Stocks Related contaminated wastes Vaccine vials
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Can we handle ???

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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
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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
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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
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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

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 areMD Dr.T.V.Rao indistinguishable

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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
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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.
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Blood-borne Pathogens (BBP) microorganisms Blood-borne pathogens (BBP) are specific

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 also causes inflammation of the liver, no vaccine to prevent infection HIV is a human retrovirus that causes AIDS (Acquired Immune Deficiency Syndrome).

Hepatitis C (HCV)

Human Immunodeficiency Virus (HIV)

There is no vaccine to prevent HIV infection.
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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.
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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
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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, selfsheathing needles, safer medical devices, and needleless systems)
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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.

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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

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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

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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.

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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

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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

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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.

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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.

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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 bloodborne pathogens hazards from the workplace.
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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.
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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 facilitys exposure response plan Report all exposures, regardless of severity, for your safety
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Responsibilities of Infectious Waste Generators

Identify and segregate infectious waste from noninfectious 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
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Dr.T.V.Rao MD

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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
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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
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Sharps

Must be collected at the point of generation, in a leak-proof and punctureresistant 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.
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Sharp Infectious Waste

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

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

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.

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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
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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

BSL
1

Laboratory type
Basic teaching, research Primary health services; diagnostic services, research

Laboratory practices
Good microbiological techniques Good microbiological techniques, protective clothing, biohazard sign None

Safety equipment

Open bench work Open bench PLUS biological safety cabinet for potential aerosols

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

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

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
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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
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Laboratory Biosafety

The Laboratory Biosafety Manual is an important WHO publication used worldwide

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A Simple Hand Wash Can Play Miracles

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References for Creating a Better world

OSHA guidelines References of CDC Atlanta USA WHO Laboratory Safety Manual

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WE NEED YOUR FEEDBACK AND SUPPORT

THE WASTE MANAGEMENT SYSTEM IS NEW (= NOT PERFECT) YOUR QUESTIONS, COMMENTS AND SUGGESTIONS ARE WELCOME DONT FORGET YOUR Responsibilities
Dr.T.V.Rao MD
[email protected]

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

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 The Programme Created by Dr.T.V.Rao MD for Medical and Health care Workers in the Developing World
Email [email protected]
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