Bmw management by dr.malini

1. IPC Webinar
Strengthening Infection Prevention & Control for COVID-19 in Healthcare Facilities – focus on Private Sector | 4 May 2020
BMWM in HCFs in context of
COVID-19: Implementation
Dr Malini R Capoor
Professor, Microbiology
VMMC & Safdarjung Hospital, New Delhi

2. 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

3. Stakeholders
• MoEFCC
• Central Pollution Control Board
(CPCB)
• State Pollution Control Board
(SPCB)
• MoHFW
• Occupier HCFs for COVID-19
– isolation wards/ICUs
• Occupier (lab director)
– sample collection centres
• Occupier (lab director)
– laboratories
• Occupier – quarantine
centres/camps
• Urban local bodies (ULBs)
• Common Biomedical Waste
Treatment Facility (CBWTF)

4. BMWM rules, 2016, 2018, 2019

5. CPCB BMWM guidelines for COVID, 2020
Guidelines for
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
18 March 2020 25 March 2020 18 April 2020

6. 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

7. 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

8. 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

9. 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

10. 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

11. Isolation ward – nursing station, patient area

12. All colour coded trolleys – designated route

14. 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

15. Maintain separate record of waste generated
from COVID-19 wards

16. 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

17. 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

18. BMW disposal – red bag
• PPEs: goggles, face-shield, splash proof apron, plastic coverall, Hazmat
suit, nitrile gloves

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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)

25. 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

26. 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

27. 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

28. 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)

29. 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

30. 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

31. 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

32. ETP/STP

33. 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

34. 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