Revised Guidelines Issued For Disposal Of Bio-Medical Waste During The Covid-19 Pandemic

The guidelines have been revised three times. The latest Revision was published on 21^st July 2020, which provides for revised guidance on segregation of general solid waste and bio-medical waste from quarantine centres/home care/healthcare facilities treating COVID-19 patients and recommends disposal of PPE kits.

In addition to existing practices under Bio-Medical Waste Management Rules 2016, the new Guidelines have to be followed by all the stakeholders including isolation wards, quarantine centres, sample collection centres, laboratories, ULBs and common biomedical waste treatment and disposal facilities.

The Revised Guidelines applicable to COVID-19 Isolation wards are set out hereinunder:

1. Separate foot operated lids with colour coded bins/bags/containers to be kept in wards and proper segregation of waste to be maintained.
2. Isolation wards to use double layered bags using 2 bags for collection of such waste.
3. COVID-19 waste to be stored in a dedicated collection bin labelled as COVID-19 and kept separately in temporary storage rooms prior to handing over to authorized staff of CBWTF which may also lift the waste directly from ward into CBWTF collection van.
4. Mandatory labelling of bags/containers used for collecting biomedical waste from COVID-19 wards as "COVID-19 Waste".
5. General solid waste to be collected separately as per Solid Waste Management Rules, 2016.
6. Non-disposable items to be used for serving food in order to minimise waste generation, to be handled with appropriate precautions and cleaned and disinfected as per hospital guidelines. If use of disposable items is inevitable, bio-degradable cutlery to be used. The wet and dry solid waste bags to be tied securely in leak-proof bags, sprayed with sodium hypo-chlorite solution and handed over to authorized waste collectors of ULBs on daily basis. Compostable bags to be used for collecting wet-waste.
7. Separate records of waste generated from COVID-19 isolation wards to be maintained.
8. Dedicated trolleys and collection bins bearing a label "COVID-19 Waste" to be used in COVID-19 isolation wards.
9. The (inner and outer) surface of containers/bins/trolleys used for storage of COVID-19 waste to be disinfected with 1% sodium hypochlorite solution on a daily basis.
10. Opening or operation of COVID-19 ward and COVID-19 ICU ward to be reported to the SPCBs/PCCs and respective CBWTF located in the area.
11. The details of COVID-19 biomedical waste generation to be registered and updated in CPCB mobile application namely 'COVID19 BWM'.
12. Faeces from COVID-19 confirmed patient and excreta collected in diaper, to be treated as biomedical waste and to be placed in yellow bag/container. However, if bed pan used, then faeces to be washed into toilets and cleaned with a neutral detergent and water, disinfected with 0.5% chlorine solution and then rinsed with water.
13. Used PPEs such as goggles, face-shield, splash proof apron, plastic coveralls, hazmet suits, nitrile gloves to be put into red bags for collection by authorized disposal agency.
14. Used masks including triple layered mask, N95 mask, etc., head cover/cap, shoe-cover, disposable linen gown, non-plastic or semi-plastic coverall to be put into yellow bags for collection by authorized disposal agency.
15. Used masks, tissues and toiletries of COVID-19 patient to be segregated into yellow bags as biomedical waste.
16. Segregation of biomedical waste and general solid waste to be done at the point of generation in wards/ isolation rooms. There should be no segregation of biomedical waste and solid waste at temporary waste collection/storage area of Healthcare Facility to ensure occupational safety.

7. Proper training to be provided to waste handlers about infection prevention measures such as Hand hygiene, Respiratory etiquettes, social distancing, use of appropriate PPE, etc. via videos and demonstration in local language. Designated nodal officer for biomedical waste management in hospital to provide the requisite training. Nodal officers, in turn, to be trained by Health Departments / professional agencies in association with SPCB/ PCC of the States/ UTs.

The Revised Guidelines also set out the procedure applicable to sample collection centres and laboratories who are duty bound to report opening and operation of COVID-19 sample collection centres and laboratories. Further, the Revised Guidelines prescribe pre-treatment of viral transport media, plastic vials, vacutainers, eppendorf tubes, plastic cryovials, pipette tips as per BMWM Rules, 2016 which are to be collected in red bags.

Responsibilities of persons operating Quarantine Centres/Camps/ Home Quarantine or Home-Care facilities have been fixed by the Revised Guidelines. Further, exhaustive guidelines and duties of the CBWTF with respect to waste collection and disposal of COVID-19 waste have been prescribed.

Specific responsibilities have been placed on urban local bodies, State Pollution Control Board/ Pollution Control Committees and persons operating in Quarantine Camps/ Quarantine Homes/Home-care units. This revision will also help all stake holders in managing, handling and treating and disposing bio-medical waste.

Although, this is an attempt that has been made by the Government to maintain high standards of sanitation and safety, doctors working in the field feel that the same has become a major challenge because of over-crowded and under-staffed hospitals and also, in rural areas where facilities and equipments are lacking, it would have been advisable for the Government to put in place proper and adequate facilities before enforcing such guidelines