IPC Webinar

BMWM in HCFs in context

of COVID-19:
Implementation
Dr Malini R Capoor
Professor, Microbiology
VMMC & Safdarjung Hospital, New Delhi

Strengthening Infection Prevention & Control for COVID-19 in Healthcare Facilities – focus on Private Sector | 4 May 2020
Introduction
• COVID-19 pandemic – GoI isolation wards/ICUs, sample collection centres,
laboratories, quarantine camp/centres, home-care
• Biomedical waste generated during diagnosis, treatment or immunization of human
beings or animals or in research activities or in production or testing of biologicals or in
health camps, BMWM Rules, 2016
• BMWM rules 2016, amendments 2018, 2019, CPCB guidelines for implementation
2018
• CPCB guidelines for COVID-19 waste, 2020
• Colour categories: Yellow, Red, White, Blue
Stakeholders
• MoEFCC • Occupier (lab director)
• Central Pollution Control Board – sample collection centres
(CPCB) • Occupier (lab director)
– laboratories
• State Pollution Control Board
• Occupier – quarantine centres/camps
(SPCB)
• Urban local bodies (ULBs)
• MoHFW
• Common Biomedical Waste
• Occupier HCFs for COVID-19
Treatment Facility (CBWTF)
– isolation wards/ICUs
BMWM rules, 2016, 2018, 2019
CPCB BMWM guidelines for COVID,
2020
Guidelines for 18 March 2020 25 March 2020 18 April 2020
management of
waste generated
during diagnostics
and treatment of
COVID-19
suspected/confirmed
patients, are required
to be followed by
stakeholders in
addition to existing
practices under BMW
Management Rules,
2016
CPCB BMWM guidelines for COVID,
2020
• 18 March 2020: Handling, treatment, disposal: HCFs, quarantine
camps/home-care, sample collection centres, labs, SPCBs, ULBs, CBWTFs
• Rev 1, 25 March 2020: + specific duties of quarantine camps/homes, home-
care, ULBs, states without CBWTF – treatment storage and disposal facility
(TSDFs)
• Rev 2, 18 April 2020: requirements and responsibilities of persons operating
STP at HCFs, PPE disposal, lab waste and to clarify on management of
general waste from quarantine homes and masks/gloves from households
CPCB BMWM guidelines for COVID,
2020
• Based on current knowledge on COVID-19 and existing practices in
management of infectious waste generated in HCFs while treating
viral and other contagious diseases like HIV, H1N1, etc
• These guidelines will be updated if needed
• Guidelines brought out by WHO, MoH&FW, ICMR, CDC and other
concerned agencies from time to time may also be referred
Labelling and double bag
• Collect and store BMW: Use a dedicated collection
bin labelled as “COVID-19” to store and keep
separately in storage room prior to handing over to
staff of CBWTF OR be lifted directly from ward into
CBWTF collection van
• Mandatory labelling, BMW bags/containers from
COVID-19 wards: labelled as “COVID-19 Waste”
CBWTFs to identify for priority treatment and
disposal upon receipt
COVID-19 isolation wards
• Separate colour coded bins/bags/containers in wards and
maintain proper segregation of waste as per BMWM Rules and
CPCB guidelines –all four categories (yellow, red, white, blue)
• Double layered bags (2 bags)
used for collection of BMW
so as to ensure adequate
strength and no-leaks
COVID-19 isolation wards
• Use dedicated trolleys and collection bins with label “COVID-19
waste” to be pasted on these items also
• Inner and outer surface of containers/bins/trolleys used for COVID-
19 BMW – disinfect with 1% sodium hypochlorite solution daily
Isolation ward – nursing station, patient
area
All colour coded trolleys – designated route
Report opening or operation of COVID-19 ward and COVID
ICU ward, lab, collection centre to SPCBs and respective
CBWTF in the area: SPCC letter
Maintain separate record of waste
generated from COVID-19 wards
General waste
• General waste not having
contamination should be disposed as
solid waste as per SWM Rules, 2016
• Depute dedicated sanitation workers
separately for BMW, SW so that
waste can be collected and
transferred timely to temporary waste
storage area
Samples
• Feces from COVID-19 confirmed patient, who
is unable to use toilets and excreta is
collected in diaper, must be treated as BMW
and should be placed in yellow bag/container
• If a bedpan is used, then faeces to be washed
into toilet and cleaned with a neutral detergent
and water, disinfected with a 0.5% chlorine
solution, then rinsed with clean water
BMW disposal – red bag
• PPEs: goggles, face-shield, splash proof apron, plastic coverall, Hazmat
suit, nitrile gloves
BMW disposal – yellow bags
• Collect used masks (triple layer
mask & N95 mask), head
cover/cap, shoe-cover, disposable
linen gown, non-plastic or semi-
plastic coverall
Sample collection centres and laboratories
• Report opening or operation of COVID-19 sample
collection centres and laboratories to SPCB
• Guidelines for isolation wards should be applied
suitably in centres, lab
• Pre-treat viral transport media, plastic vials,
vacutainers, Eppendorf tubes, plastic cryovials, pipette
tips as per BMWM Rules and collect in red bags
Pretreatment – lab waste, blood bags –
sterilization log6
• Waste – autoclave horizontal vs vertical vs microwave
• Specifications graphic or computer recording devices: monitor and record
dates, time of day, load ID, and operating parameters autoclave cycle
• Safety standards of ISI/BIS/ISO/EN in NABL/NABH accredited facilities
• Validation test – records
 Chemical control
• Browne's tubes
• Bowie Dick test: each batch, >1sr
 Microbiological control – spore test
• B. stearothermophilus1w (autoclave 1x106)
• B. atropheus 1x104 (Microwave)
 Physical control – temp & pressure record
Responsibilities of persons operating quarantine
camps/homes or home-care facilities (1)
• SW generated from quarantine centres or camps: handed over to
waste collector identified by ULB
• BMW from quarantine centres/camps – collected separately in yellow
bags provided by ULBs in bins
• Persons operating quarantine camps/centres – operator to collect
BMW
• Contact details of CBWTFs – local authorities – all colour categories,
BMWM Rules, 2016
Responsibilities of persons operating quarantine
camps/homes or home-care facilities (2)
Persons in quarantine home/home-care
• Hand over yellow bags with BMW to authorized waste collectors at door
steps by local bodies; or
• Deposit BMW in yellow bags at designated deposition centres of ULBs
• Handover BMW to waste collector engaged by CBWTF operator at doorstep
• Persons operating – report to ULBs – difficulty in getting the services for
disposal of SW/BMW
Clarifications
• BMW at quarantine camps/home-care – syringes, date expired or discarded medicines,
used masks/gloves, drain bags, urine bags, body fluid or blood soaked tissues/cotton,
empty ampules etc. ‘domestic hazardous waste’ as defined under Solid Waste
Management (SWM) Rules, 2016 and disposed as per BMWM rules 2016 guidelines
• General waste (if not infected) as per provisions under SWM Rules, 2016
• Used masks and gloves – home quarantine or other households – paper bag for
minimum of 72 hours prior to disposal; then disposed as solid waste (cut the masks prior
to disposal to prevent reuse)
Duties of CBWTF
• Report to SPCBs/PCCs: receiving COVID-19 waste
• Dedicated vehicle to collect COVID-19 waste; sanitize with sodium hypochlorite after every trip
• COVID-19 waste – disposed-off promptly on receipt
• May operate for extra hours – inform SPCBs/PCCs
• Maintain separate record: collection, treatment disposal
• Workers
 Ensure training – handling and collection
 PPEs – triple-layer masks, splash proof aprons/gowns, nitrile gloves, gum boots, safety goggles
 Do not allow any worker showing signs/symptoms to work – send on leave with pay protection
Duties of SPCBs/PCCs
• Records of COVID-19 treatment wards/quarantine centres/home
• Proper collection and disposal of BMW as per BMW Rules, 2016 and SOPs/guidance document
• Allow CBWTFs to operate for extra hours as per requirement
• Authorisation of quarantine camps (not required; does not qualify as HCF) – allow CBWTFs to
collect BMW as and when required
• States (no CBWTFs), rural or remote areas; existing captive facilities of HCFs; disposal of COVID-
19 waste as per BMWM Rules, 2016 and use of deep burial pits; disposal of yellow
• Coordinate with CBWTFs, ULBs for disposal COVID-19 waste
• Large volume of yellow colour coded (incinerable) COVID-19 waste, permit HW incinerators at
existing TSDFs to incinerate
Duties of urban local bodies (ULB)
• ULBs: ensuring safe collection and disposal of BMW quarantine camps/ quarantine
homes/home care for COVID-19 suspected persons
• Information on each above facility – available with local administration & updated list to
SPCBs from time to time
• Quarantine camps: BMW is collected directly by CBWTFs identified by ULB
• Provide necessary support, security, authorisation to staff of CBWTFs
• ULB: engage CBWTF operator for disposal of BMW collected from quarantine
home/home care or waste deposition centres or from door steps – agreement with
CBWTF
Duties of urban local bodies (ULB) (1)
• ULBs envisage disposal of BMW – quarantined homes/home care
a) Engage authorized waste collectors for door steps collection of BMW –
transfer to collection points for further pick-up by CBWTF; and/or
b) ULBs engage services of CBWTFs to collect waste directly from door-steps

• Provide yellow coloured bags to operator of quarantine camp or home-

care: bags may be provided through CBWTF
• Ensure workers – door step waste collection at waste deposition centres
or at quarantine homes or home care (by designated staff)
Duties of urban local bodies (ULB) (2)
• Training – sanitization, collection, precautions – CBWTF
• Authorised waste collector – adequate PPE (three layer masks, splash proof
aprons/gowns, heavy-duty gloves, gum boots, safety goggles) – required to be
worn all the time – collecting from quarantine centre/quarantine homes/home
care/waste deposition
• Use dedicated carts/trolleys/vehicles for transport of BMW
• Ensure sanitization of vehicles with 1% hypochlorite after each trip
• Waste collectors – spray 1% hypochlorite on bin used
Duties of urban local bodies (ULB) (3)
• Common waste deposition centres/existing “dhalaos”
• SW: quarantine homes/home care: SWM Rules, 2016
• Services of CBWTFs and its staff – essential service as part of
health infrastructure
• Facilitate smooth operations of CBWTFs
• Additional measures as per guidelines
Management of wastewater from HCFs
• Risk of transmission COVID-19 through sewage is low (CDC); operators treatment of STPs
• Agencies: HCFs/isolation wards/operators of terminal sewage treatment plants (PHED/Jal
Board/etc.)
• Agencies to ensure disinfection of treated wastewater as per prevailing practices to inactivate
coronaviruses
• Operators of ETPs/STPs – standard operational practices, practice basic hygiene precautions,
and wear PPEs (goggles, face mask , liquid repellent coveralls, waterproof gloves and rubber
boots)
• COVID-19 pandemic – utilization of treated wastewater in utilities within HCFs may be avoided
ETP/STP
NGT order
• Safe disposal of BMW & solid waste during
COVID-19 pandemic
 Sanitation worker safety: PPEs
 Online monitoring by SPCBs, online
awareness programmes, online trainings LBs,
HCFs
• Coordination with media, GoI, State Govt.
• SPCB, CPCB – essential health services
Summary
• BMWM: duty of all stakeholders HCF, labs,
collection centres, home care, quarantine centres
• BMWM with social distancing, hand hygiene,
PPEs, respiratory etiquette, IPC practices
• BMWM rules, 2016, amendment 2018, 2019,
CPCB guidelines for implementation, 2018
• CPCB guidelines for COVID -19 waste, 18 April
2020
• NGT: BMWM: CPCB, SPCB – essential health
service