Blood Bags Disposal as per prevailing guidelines

1. DISPOSAL OF
BLOOD BAGS
Dr. Ruchi Kushwaha
Hospital Administrator

2. Here is How I Propose to Go. . .
Introduction
Need/Importance
Statutory Provisions
Administrative Responsibilities
Operational Management
• Preparing for treatment
• Loading the blood bags in the autoclave
• Discarding autoclaved blood
• Disposal of Expired Blood Bags
Hazards and Safety Concerns
Reporting and Recordkeeping

3. Introduction
Blood-
Blood is a body fluid in humans and other animals that delivers necessary
substances such as nutrients and oxygen to the cells and transports
metabolic waste products away from those same cells
Blood Products-
Blood products are the elements of blood, such as red blood cells, white
blood cells, platelets, plasma and biochemical substances contained in the
plasma that are obtained from blood processing

4. Blood & Blood products to be discarded
• Include bags of blood that have been donated, but are unusable because- they are expired
• They have been found to contain HIV or other pathogens, or
• They have failed a blood bank’s quality control procedures for any reason
eg-
• Blood from open wounds, wound draining, cleaning and spill response, transfusions and
other activities, excluding pathological waste
• Body fluids, including secretions, but excluding excreta, unless from patients in isolation.
• Waste materials contaminated with free-flowing blood
• Laboratory samples containing blood or body fluids

5. Need of disposal of Blood Bag
•All bulk blood and blood products, unless tested and found to be free of
pathogens, should be considered as highly infectious waste and need to
be managed to minimize risk in the health care setting
•The main risk is from the potential for harboring pathogenic organisms,
which may cause the spread of infectious diseases
•Infectious waste has the potential to harm anyone who comes into contact
with it, so it is vital that it is stored, handled and disinfected correctly
before being discarded to the environment

6. Statutory Provisions
Disposal of Blood Bags Should comply with requirements of Biomedical
Wastes Management Rules (Amendments) 2018, which states that “pre-
treat the laboratory waste, microbiological waste, blood samples and blood
bags through disinfection or sterilisation on-site in the manner as
prescribed by the World Health Organisation (WHO) guidelines on Safe
management of wastes from health care activities and WHO Blue Book,
2014 and then sent to the common bio-medical waste treatment facility for
final disposal”

7. Responsibilities
The administrator shall ensure that all relevant personnel are-
• Adequately trained on the hazards of and safe handling, storage, treatment and
disposal of wastes containing free-flowing blood and blood products, including spill
incident response
• Donning of PPE as per need, which is clean and maintained in a good state
• Following procedures correctly where blood and blood products require treatment
and disposal and addressing any non-conformances to avoid harm to people and the
environment

8. Responsibilities
• Ensuring that any non-conformances are addressed to avoid harm to people
and the environment
• Recording any incidents relating to the disposal of blood products, with the root
cause established, reported and actions taken to prevent a recurrence
• Reviewing, within a reasonable period, the effectiveness of any actions taken
following an incident to prevent a recurrence
• Reporting in full and on time to the waste management committee and/or
relevant regulatory authorities in terms of legal requirements

9. Responsibilities
• The person authorized to accept waste blood bags for treatment prior to
disposal must ensure that:
Where present, the needle has been removed – any incidents of non conformance are
immediately communicated to the department manager for action, to prevent a
recurrence.
Only residual liquid remains in the bag, unless the blood has been considered infectious,
requiring disinfection in the bag prior to disposal
All blood bags (empty or full) are autoclaved and not incinerated
The autoclave cycle used has sufficient exposure time to disinfect dense liquids like
blood

10. Materials and Equipment needed
1. PPE-
• Gloves
• Masks
• Goggles or a face shield
• Strong and closed shoes
• Overalls/ Lab coat
2. Disinfectants-
• Sodium or calcium hypochlorite
• Hydrogen peroxide based disinfectants
• Phenol-based disinfectants
• Quaternary ammonium disinfectants

11. Equipment needed
• Sharp pair of scissors – to cut the needle off the tubing on a waste blood bag
• Access to the drain for disposal of any residual or expired, clean blood
• Autoclave – for disinfecting waste blood in bags
• Labelled containers for storing waste blood bags at the place where they are
used
• Reusable autoclave containers in which to place blood bags or packs, to contain
any liquid that may leak from ruptured bags

12. Methods of Disposal of Blood Bags
•Chemical decontamination
•Autoclaving of blood bags
•Incineration of blood bags
•Disposal to sanitary sewer
•Legal and other requirements

13. Method of Disposal of Blood Bags
• Blood bags once rejected for use (contaminated, incorrect typing, in excess of
requirements or expired), the bags and any blood will need to be treated prior to disposal
to reduce any potential for infection
• Donated blood that has been checked for infectious agents prior to issue and found safe
can be considered safe for discard to closed sewer for subsequent treatment, such as
provided in a wastewater treatment works, a septic tank or bio digester
• If blood is known to be contaminated, it will require disinfection prior to disposal and
autoclaving is the recommended treatment method

14. Blood Bags should not be incinerated.
Why???
•Because blood bags are usually made from the chlorinated plastic PVC
(polyvinyl chloride), they should not be incinerated, due to the generation
of dioxins and furans during the burning process
•These toxic compounds cause cancers even in low concentrations
•In addition, where the incineration devices are basic, the burning bags
may leak, which will create a hazard in the vicinity of the incinerator

15. Procedure to autoclave the Blood Bag
Preparing for treatment
Loading the blood bags in the autoclave
Discarding autoclaved blood

16. Preparing for treatment
• For blood bags with contaminated contents or those considered potentially
infectious, ensure all the liquid and the containers are sent for autoclaving to
disinfect them prior to disposal
• For blood bags with an attached needle, once the blood bag is ready to be
discarded:
Tie a knot in the tubing above the needle
 Drain the blood in the tube back into the bag, using a pen or other suitable
device, rolling it along the tube to move the blood
Cut the needle off the pack and dispose of it in the waste sharps container

17. Loading the blood bags in the autoclave
• Load the blood bags in single layers in reusable, leak-proof secondary containers to
ensure the steam is able to heat the liquids effectively, and to contain any material that
leaks from the bags, which often burst during autoclaving
• Where only a few bags (fewer than five) are required to be autoclaved at any one time,
these may be loaded with other infectious waste for treatment
• It is best to use a “liquid cycle,” which is usually one of the program options on
electronically controlled autoclaves
 This has an extended exhaust stage to prevent liquids from bubbling out of containers as the
pressure reduces
 This slow exhaust stage will provide sufficient time to allow the bags to hold the required
temperature long enough for disinfection

18. Contd…
•For situations where routinely many blood bags at a time require
autoclaving, such as for blood banks, where contaminated bags have
been returned for disinfection, then
Undertake a full validation for this waste stream to determine the correct parameters
required for disinfection of the blood
If the majority of the waste to be autoclaved comprises filled bags, then the
autoclave cycle will have to be validated for this waste prior to being treated for the
first time

19. Contd…
•When a lot of blood bags are to be autoclaved, but where this will not be
a routine operation, spread the bags out over many loads to prevent too
many from being autoclaved together. Blood bags generally need a
longer holding time at the target temperature (121°C) required to
effectively disinfect the dense liquids. This can be achieved by:
Using a liquid cycle as the longer cooling down period will allow more time for the
blood bags to be effectively disinfected and to minimize liquid boiling over due to
rapid pressure drops
Not venting for at least 20 minutes after the usual disinfection time has elapsed

20. Discarding autoclaved blood
•Blood usually congeals in the bags, which burst during autoclaving, so do
not discard autoclaved blood to drain, as this semi-solid or gelatinous
material may cause blockages by forming a plug in the pipes and u-bends
•Autoclaved blood can either be:
Discarded with other solid waste or directly into a placenta pit, septic tank or
biodigester (not if accessed via drains or pipes) or
Macerated and discharged to a closed drain connected to a treatment system

21. Disposal of Expired Blood Bags
• Blood can be emptied into a septic or sewerage system if safety measures are followed
(e.g. PPE and precautions against spatter)
• Other options for expired blood bags include
Disposal at a controlled land-disposal site or
High-temperature incinerator (1100 °C) or
Autoclave that has a special liquid treatment programme cycle
• If no other disposal option is available, expired blood bags may be isolated from patients
and staff by placing unopened into a protected pit excavated within the grounds of the
health-care facility or at another secure location

22. Hazards and Safety Concerns
•A risk assessment should be undertaken to find ways to identify hazards,
assess the risks and minimize the potential for harm to people and the
environment
•It is critical that blood bags are made noninfectious as close to the point of
generation as possible
•Blood saturated wastes must never be discarded to the sewer system as
they can cause blockages and pose a risk to staff who then have to clear
the pipes

23. Hazards and Safety Concerns contd…
•To prevent leakage during transportation, wastes should be placed in
a leak-proof container with a sealable lid and labeled appropriately
•Due to the organic nature of this waste stream, which will biologically
decay, especially in warm temperatures, storage should be avoided if
possible or the duration minimized
•Sticks or cuts from needles
•Exposure to blood and blood-borne pathogens

24. Reporting and Recordkeeping
•The number or mass of blood bags autoclaved should be included in the
autoclave operation log
•Any incidents, including needles remaining on waste blood bags must be
reported to the department manager for action
•Report any incidents or accidents, such as spills and needle stick injuries,
according to standard institutional procedures
•Where prescribed by local legal requirements, the relevant authorities
must be notified of any incidents, such as needle stick injuries

25. Thank You for your attention…

26. Speaker Contact Information
drruchi21@gmail.com
Your feedback and comments will be appreciated !