Ch 22: Biomedical Waste Management at DMC

The National TB Elimination Programme (NTEP) utilizes different coloured bags for the segregation of waste generated in TB laboratory settings as shown in the table below.

All these bags are to be labelled with the Biohazard logo (figure below) on them. 

Figure: Biohazard Logo

• Waste generated in the Culture Drug Susceptibility Testing (CDST) laboratories is autoclaved prior to segregation in colour-coded bags.
• The biohazard materials are collected and handed over to handlers authorized by the pollution control board.
• Personnel handling/segregating biomedical wastes must use appropriate Personal Protective Equipment (PPE) and should be trained in spill management.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, 2021.
• Guidelines for Management of Healthcare Waste as per Biomedical Waste Management Rules, 2016.

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The Laboratory Technician (LT) must safely discard contaminated, biohazard waste generated by tuberculosis (TB) laboratories. This waste must be discarded along with the overall waste of the health facility in which TB services are provided.

There are 2 types of waste generated from DMC laboratory settings:

1. Sputum containers with specimen and wooden sticks
2. Stained slides

Disposal of Sputum Cups with Left-over Specimen, Lids and Wooden Sticks

Figure 1: Steps for disposal of sputum cups with specimen, lids and wooden sticks

Important Points to Remember

• If autoclaving is not possible, boil in a pressure cooker of 7 litre capacity with water and submerge the contents for at least 20 minutes
• LTs and support staff handling biological waste need to wear gloves
• The red bag used for autoclaving must:  
  • Have a biohazard symbol  
  • Have adequate strength to withstand the load of the waste material 
  • Be made of non-PVC plastic material  

Disposal of Stained Slides

Figure 2: Steps for disposal of stained slides

Resources

• Training Module (1-4) for Program Managers and Medical Officer, NTEP, MoHFW, 2020.

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Disinfectants used in lab settings include:

1% Sodium Hypochlorite

• Broad spectrum antimicrobial action
• Used to disinfect surfaces
• Used to disinfect infectious material and disposal of used Truenat consumables (reagent bottles, cartridges, tips, chips) 
• Hazardous and corrosive, to be used with care
• Is highly alkaline so can corrode metal
• Waste soaked in Sodium Hypochlorite should not be discarded by autoclaving. 

70% Alcohol

• Bactericidal action
• Used for surface decontamination only
• Highly inflammable; keep away from fire
• Used to disinfect biosafety cabinets, laboratory benches and surface of instruments.

5% Phenol

• Used for decontaminating Cartridge-based Nucleic Acid Amplification Testing (CBNAAT) equipment and single-use items like CBNAAT cartridges prior to disposal
• Highly irritating to the skin, eyes and mucous membranes.

Preparation of these disinfectants is described below.

Preparation of 1% Sodium Hypochlorite

• Use commercially available 4% sodium hypochlorite solution.
• Dilute with distilled water to prepare required amount of 1% sodium hypochlorite
  • E.g.: To prepare 100 ml of 1% sodium hypochlorite: 75 ml distilled water plus 25 ml 4% sodium hypochlorite solution.
• Sodium hypochlorite solutions (domestic bleach) contain 50 g/l available chlorine, and should therefore be diluted to 1:50 or 1:10 in water to obtain the final concentrations of 1 g/l or 5 g/l when used as a general-purpose disinfectant for TB laboratories.
• To be prepared fresh.

Preparation of 70% Alcohol

• Use commercially available absolute alcohol.
• Dilute with distilled water to prepare the required amount of 70% alcohol
  • E.g.: To prepare 100 ml of 70% alcohol: 70 ml absolute alcohol plus 30 ml distilled water.

Preparation of 5% Phenol

• Melt 5 g of phenol by heating it.
• Dissolve in 100 ml distilled water.

Video : Preparation of TB Lab Disinfectants

Resources

• Tuberculosis Laboratory Biosafety Manual

Commitment at national, state and district level are required to support and facilitate the implementation of Infection Prevention and Control (IPC) measures.

The important stakeholders in IPC include:

National Airborne Infection Control Committee (NAICC) has been constituted to provide for a multi-lateral national level coordinating body, to develop national guidelines on IPC, and provide technical guidance for their implementation, evaluation, and revisions.

Composition of NAICC

NAICC has representatives from Central TB Division, Medical college, State TB Programme representatives, Directorate General of Health Services, Central Design Bureau, National Institutes, Civil society representatives and other relevant agencies

A State Airborne Infection Control Committee (SAICC) should be established for adoption and integration of the national guidelines on airborne infection control in health care and other settings in the hospital infection control plans of various health care facilities in the states

Composition of SAICC

SAICC has representatives from Mission Director, National Rural Health Mission, Director Health Services (Nodal Officer), Director Medical Education and Research, State TB Officer, Project Director-SACS, State Task Force for Medical Colleges, Representative of IMA (State Body), Architects and Engineers from State PWD, Representative of State Pollution Control Board, NGO / CBO

The airborne infection control activities at the district level should be coordinated and undertaken by the Sub-Committee on Biomedical Waste Management / Infection Control (SC-BMW/IC) under the District Health Society (DHS). They should function under guidance and close coordination with the SAICC, State Health Society and with the TB Sub-Committee under DHS (NRHM).

Composition of SC-BMW/IC

SC-BMW/IC has representatives from Medical College / District Hospital, Representative of Pollution Control Board Office at the district, Director, Nursing Administration and Training or equivalent, Representative of IMA (Local Body) / NGO / CBO

The Hospital infection control committee (HICC) is an integral component of the IPC programme of the health care facility.

The main functions of HICC include:

1. Establish the IPC programme in the health care facility, develop action plan for strengthening IPC measures for the facility and individual units within the facility with priorities based on the risk assessment

2. Constitute an infection control team to oversee IPC implementation in the facility

3. Review and revise annually infection control guidelines with policies, recommendations and working protocols with standard precautions, hand hygiene, cleaning and decontamination, disinfection and sterilization as key components

4. Organize training programmes on recommendations of the guidelines and IPC practices for staff

5. Develop an antibiotic policy and antibiotic stewardship programme

6. Conduct surveillance of antimicrobial resistance, monitor trends in hospital acquired infections (HAI), investigate outbreaks of HAIs

7. Evaluate the effectiveness of interventions for IPC, analyze the surveillance data and identify at-risk patients. Take appropriate action and implement recommendations where necessary

8. Conduct audits and quality control of IPC activities, ensure compliance with recommendations

9. Help control environmental risks for infection by liaising with appropriate departments such as healthcare waste management, provision of safe water (testing of water sources), pharmacy, housekeeping services, laundry and kitchen services

Resources

Guidelines on Airborne Infection Control in Healthcare and Other Settings.

National Guidelines for Infection Prevention and Control in Healthcare Facilities (https://www.mohfw.gov.in/pdf/National%20Guidelines%20for%20IPC%20in%20H…)