Extra precautions to be taken by sanitation workers, healthcare facilities and COVID-19 isolation wards are also described
Concerns over biomedical waste generated by treating novel coronavirus disease (COVID-19) patients, sanitation workers who handle this waste and extra care to be taken by isolation wards were stressed by revised guidelines published by the Central Pollution Control Board (CPCB) on June 10, 2020.
This was the third revision made to the guidelines that were first published on April 18. The new guidelines were formulated on current knowledge and practices in the management of other infectious waste generated in hospitals while treating viral and contagious diseases.
These guidelines must be followed by all stakeholders including isolation wards, quarantine centres, sample collection centres, laboratories, Urban Local Bodies (ULBs) and common biomedical waste treatment and disposal facilities (CBWTFs).
The guidelines add to existing practices under the Biomedical Waste Management Rules, 2016.
The revision incorporates guidance on segregation of general solid waste and biomedical waste generated by ULBs, CBWTFs, quarantine centres and healthcare facilities treating COVID-19 patients.
Safety of sanitation workers
They also address the safety of waste handlers and sanitation workers associated with such healthcare facilities.
The guidelines emphasise extra care to be taken at COVID-19 isolation wards. Foot-operated lids in colour-coded bins must be introduced to avoid contact, according to the guidelines.
General solid waste like medicine wrappers and cartons, syringes, fruit peels, empty bottles, discarded paper and other items not contaminated by patients’ secretions and body fluids must be collected separately, according to Solid Waste Management Rules, 2016.
Wet and dry solid waste bags must be securely tied and handed over to waste collectors authorised by ULBs daily.
Non-disposable items must not be disposed of as much as possible and should, instead, be cleaned and disinfected keeping hospital rules in mind, the guidelines said.
Waste segregation
The segregation of waste material was described by Arvind Bhardwaj, Manager at Hoswin Incinerator Pvt Ltd, a biomedical waste treatment facility.
Left-over food, disposable plates, glasses, used masks, tissues, toiletries, etc used by COVID-19 patients were classified as biomedical waste and should be put in yellow-coloured bags, while used gloves should be put in red bags, he said.
“This demarcates the type of COVID-19 waste that needs to be incinerated and the kind that can be disinfected, autoclaved (a process that kills bacteria, viruses, etc) and disposed,” Bhardwaj said. “This helps in reducing the quantity of COVID-19 waste generated and reduces unnecessary burden on CBWTFs for incineration as well,” he added.
Designated nodal officers for biomedical waste management in hospitals must be made responsible for training waste handlers about infection prevention measures, according to the guidelines.
The measures — that include hand hygiene, respiratory etiquettes, social-distancing and use of appropriate personal protective equipment — must be demonstrated through videos and in local languages.
Nodal officers, in turn, need to be trained by health departments and professional agencies in association with the state pollution control boards (SPCBs) or pollution control committees (PCCs).
It is the responsibility of people operating quarantine camps, homes or homecare facilities to hand over general municipal solid waste to waste collectors identified by ULBs.
Waste generated from kitchens, packing material for groceries, food material, waste papers, waste plastic, floor cleaning dust, etc, handled by patient caretakers or suspected quarantined individuals should be treated as general waste, the guidelines said.
Waste contaminated with blood or body fluids of COVID-19 patients must be collected in yellow bags. The storage of general waste in yellow bags is strictly not allowed.
Role of nodal officers
The guidelines authorise ULBs to hire services of professional waste management agencies for timely collection of solid and biomedical waste if collection and transportation operations are inadequate due to existing staff conditions.
Quantification and tracking the movement of COVID-19 needed to be carried out by all quarantine centres though the CPCB’s biomedical waste-tracking mobile application called COVID19BWM.
The daily generation of COVID-19 waste must be updated by nodal officers of quarantine centres every day.
The same application can also be used to enter data by CBWTF and SPCBs and PCCs to develop a cross-checking mechanism at each stakeholder level to avoid data discrepancies.
The SPCBs and PCCs of Union territories are authorised to permit hazardous waste incinerators at existing treatment, storage and disposal facilities or captive industrial incinerators. This is to be done if the generation of yellow colour-coded (incinerable) COVID-19 waste is beyond the capacity of existing CBWTFs and captive BMW incinerators.
Waste feeding for incinerators, however, needs to be separate for COVID-19 and hazardous waste.
“Prior to the revised guidelines, we received all kinds of mixed waste from containment zones and quarantine households in a yellow bag,” said a Gurgaon-based CBWTF operator. “Bottom ash content from the mixed waste after incineration is very high,” the operator added.
The revisions in the guidelines aim to reduce the burden on CBWTFs and simultaneously do not compromise on safe disposal of COVID-19 waste, according to the operator.
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