1. MAJOR (DR) SANJAY DALSANIA
Chief Quality Officer
Apollo Hospitals, Ahmedabad
HEALTHCARE WASTE MANAGEMENT
Stepping Towards Quality Improvement & Safety
“THE APOLLO WAY”

2. HEALTHCARE WASTE HAZARDS
• Infectious & pathological
• Sharp injuries
• Hazardous chemicals
• Radioactive
• Cytotoxic & Genotoxic

3. DISEASE TRANSMISSION
• Air borne
• Direct contact / sharp injuries (through broken skin)
• Diseases:
• Hepatitis-B
• AIDS
• Tetanus
• Diseases of GI tract & respiratory system
• Skin diseases & many more

4. WHO ARE AT RISK?
• Doctors
• Nursing staff
• Ward staff
• Housekeepers
• Patients & visitors
• Community
• Environment

5. HEALTHCARE WASTE MANAGEMENT
• Structure
• Processes
• Outcomes

6. POLICY
• To outline the SoPs to manage various types of
wastes
• To avoid nosocomial infections
• To encourage safe working practices
• To ensure environmental conservation

7. GOLDEN RULES
• Segregation at the source
• No mixing
• No storage beyond 48 hours
• PPE & Universal precautions

8. WASTE CLASSIFICATION
• Clinical waste
• Sharps waste
• Chemical waste
• Pharmaceutical waste
• Laboratory waste
• Radio-active waste
• Cytotoxic /genotoxic waste
• Confidential waste
• Food & domestic (general) waste

9. HEALTHCARE WASTE MANAGEMENT
Step-ISEGREGATION
TRANSPORTATION TO CENTARL
STORAGE SITE
COLLECTION
TREATMENT & DISPOSAL
Step-IV
Step-III
Step-II
LOCAL STORAGE
TRANSPORTATION TO FINAL
DISPOSAL SITE
Step-V
Step-VI
In-houseOutsourced

10. HEALTHCARE WASTE MANAGEMENT
Type of Waste
Non-infectious Waste
(80-85%)
Infectious Waste
(15-20%)

11. SEGREGATION
• Responsibility of all staff.
• At the source of generation itself.
• Clear identification & sorting.
• Display of segregation guidelines.
• Color coding and labeling .

12. SEGREGATION

13. SEGREGATION

14. INFECTION CONTROL
DISPOSAL OF BIOMEDICAL WASTE
RED
CATHETERS, TUBINGS, CANNULAE, SYRINGES, PLASTIC IV
BOTTLES, USED GLOVES, IV SETS, INFECTED PLASTIC WASTE,
SPECIMEN CONTAINERS, WASTE GENERATED FROM
LABORATORY, CULTURE OF MICRO ORGANISMS, USED OR
DISCARDED BAGS OF BLOOD/BLOOD PRODUCTS, VACCINES
INFECTION CONTROL
DISPOSAL OF BIOMEDICAL WASTE
YELLOW
HUMAN TISSUES, ORGANS, BODYPARTS, ITEMS CONTAINING
BLOOD AND BODY FUID (COTTON), SOILED DRESSING, SOILED
PLASTERS CASTS, BEDDINGS, DISCARDED MEDICINE,
DISCRDED CYTOTOXIC DRUGS
INFECTION CONTROL
DISPOSAL OF BIOMEDICAL WASTE
BLUE
GLASS WARE ITEMS, NEEDLES, SYRINGES, SCALPELS, BLADES,
USED AND UNUSED SHARPS
INFECTION CONTROL
DISPOSAL OF BIOMEDICAL WASTE
BLACK
RADIOACTIVE AND CHEMOTHERAPY WASTES

15. SEGREGATION GUIDELINES
COLOUR WASTE DESCRIPTION
YELLOW
Human tissues, organs, body parts, items contaminated by blood/body
fluids, soiled cotton & dressing, soiled plaster casts, discarded medicines,
discarded cytotoxic drugs
RED
Catheters, tubings, cannulae, syringes, plastic IV bottles & sets, used gloves,
infected plastics, specimen containers, lab waste, microbiology cultures,
used or discarded bags of blood/blood products, vaccines
BLUE Glass items, needles, syringes, scalpels, blades, used and unused sharps
BLACK Radioactive and chemotherapy wastage
GREEN
General waste, non-infected plastic materials & papers, disposables,
cardboards, metal containers, office waste, food waste

16. SEGREGATION
• Allow to fill the bag/bin up to 3/4th
level.
• Hub cutters for needles.
• Other sharps: puncture proof auto-locked containers.

17. SEGREGATION

18. SEGREGATION
• Thumb Rule: Mutilate disposable and plastic items
and empty the glass vials & bottles before throwing
in waste bins.
• Proper segregation:
• Facilitates further collection, handling, storage &
disposal of waste.
• Minimizes the cost of handling and disposal of
waste.

19. COLLECTION
• Scheduled collection by Housekeeping Staff.
• 2 hourly in ICUs
• 4 hourly in wards/other clinical areas
• Thumb Rule: Tie on the top. Do not compress the
bag. Lift the bag from the top. Do not support the
bottom of the bag with the other hand.
• Regular washing & disinfection. Checklist for
washing/disinfection.
• Use of PPE while collecting waste.

20. COLLECTION

21. LOCAL STORAGE
• Temporary storage:
• Colour coded containers / big polythene bags
• Labelling
• Local collection points (closed dirty utility rooms)
• Away from patient areas
• No mixing of infectious and non-infectious waste.
• Thumb Rule: Waste from local storage must be
transported to central collection site within two
hours of collection.

22. LOCAL STORAGE

23. TRANSPORTATION TO CENTRAL
STORAGE SITE
• From local storage areas to central storage area:
• Closed air-tight color-coded container trolleys
• Scheduled time interval
• Pre-defined waste route
• Well demarcated dirty utility lift
• Thumb Rule: No crossing over with food trolleys or
sterile areas.

24. TRANSPORTATION TO CENTRAL
STORAGE SITE
• Scheduling & separate routes for waste trolleys &
food trolleys.
• Regular washing & disinfection of container trolleys.
Checklist for washing/disinfection.
• Use of PPE while transporting waste.

31. CENTRAL STORAGE AREA
• Away from clinical areas, kitchen, stores & public routes.
• Restricted entry.
• Adequately lit & ventilated rooms with impervious floor.
• Color-coded self-closing doors.
• Facility of washing area.
• Provision of First Aid Kit.
• Availability of PPE.
• Fire extinguishers.
• Regular washing and disinfection. Checklist.

32. CENTRAL STORAGE AREA

33. TRANSPORTATION TO FINAL
DISPOSAL SITE
• Daily.
• Outsourced to Government authorized CBWTF
(Common Biomedical Waste Treatment Facility).
• In a closed cart/vehicle with smooth & impermeable
surfaces.
• Thumb Rule: No waste should be kept stored in the
hospital beyond the period of 48 hours.

34. TRANSPORTATION TO FINAL
DISPOSAL SITE
• Weighing of waste to monitor the waste
volume/bed.
• PPE while handling the waste. Immunized
personnel.
• Once a month, visit by Infection Control Coordinator
to the disposal site.
• General/food waste – municipal vehicle.

35. TREATMENT & DISPOSAL
Waste
Category
Waste Category Type
Treatment & Disposal
Option
Category-1
Human Anatomical Waste
(human tissues, organs, body parts )
Incineration/deep burial
Category-2
Animal Waste
(animal tissues, organs, body parts carcasses,
bleeding parts, fluid, blood and experimental
animals used in research, waste generated by
veterinary hospitals, colleges, discharge from
hospitals, animal houses)
Incineration/deep burial
Category-3
Microbiology & Biotechnology Wastes
(Wastes from laboratory cultures, stocks or
specimens of micro-organisms live or
attenuated vaccines, human and animal cell
culture used in research and infectious agents
from research and industrial laboratories,
wastes from production of biologicals, toxins,
dishes and devices used for transfer of
cultures)
local autoclaving/micro-
waving/incineration

36. TREATMENT & DISPOSAL
Waste
Category
Waste Category Type
Treatment & Disposal
Option
Category-4
Waste sharps
(needles, syringes, scalpels, blades, glass etc.
that may cause puncture and cuts. This
includes both used and unused sharps)
disinfection (chemical
treatment)/autoclaving/
microwaving and mutilation
/shredding
Category-5
Discarded Medicines and Cytotoxic drugs
(wastes comprising of outdated, contaminated
and discarded medicines)
incineration/destruction and
drugs disposal in secured landfills
Category-6
Soiled Waste
(Items contaminated with blood, and body
fluids including cotton, dressings, soiled
plaster casts, lines beddings, other material
contaminated with blood)
Incineration/autoclaving/micro-
waving
Category-7
Solid Waste
(wastes generated from disposable items
other than the waste [sharps] such as tubing,
catheters, intravenous sets etc.)
disinfection by chemical
treatment/autoclaving/
microwaving and
mutilation/shredding

37. TREATMENT & DISPOSAL
Waste
Category
Waste Category Type
Treatment & Disposal
Option
Category-8
Liquid Waste
(waste generated from laboratory and
washing, cleaning, house-keeping and
disinfecting activities)
disinfection by chemical
treatment and discharge into
drains
Category-9
Incineration Ash
(ash from incineration of any bio-medical
waste)
disposal in municipal landfill
Category-10
Chemical Waste
(chemicals used in production of biologicals,
chemicals used in disinfection, as insecticides
etc.)
Chemical treatment and
discharge into drains for liquids
and secured landfill for solids
• Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical
reagent. It must be ensured that chemical treatment ensures disinfection.
• Mutilation/shredding must be such so as to prevent unauthorized reuse.

38. TREATMENT & DISPOSAL
• Thumb Rule: Disinfect and mutilate the waste
before its final disposal.
• Syringes: cut, disinfected & disposal into sharps pit.
• Infected plastics: disinfected/autoclaved, shredded
and sent for final disposal into municipal dumps.
• General waste: disposal to municipal waste dumps
without any treatment.

39. ACCIDENTS & INCIDENTS
• Structured procedures for risk management.
• Immediate first-aid measures & post-exposure
prophylaxis.
• Reporting to Emergency Department or Staff Clinic
at earliest.

40. ACCIDENTS & INCIDENTS
• Prompt reporting to Quality/Infection Control Dept:
• Inappropriate segregation
• Leakage & spillage
• Damaged containers
• Splashes & Sharp Injuries
• Mixing of general waste with biomedical waste
• Excessive accumulation

41. ACCIDENTS & INCIDENTS
• Retention of the item and identification of possible
infection.
• Investigation and RCA
• CAPA to prevent recurrences.

42. PERSONAL PROTECTION
• Disposable gloves & heavy-duty gloves
• Industrial apron / leg protectors
• Face shields & protective glasses
• Sturdy industrial boots
• Helmets & strong industrial PPE in high risk areas.
• Masks & respiratory protectors for protection
against toxic dust.
• Standard PPE (approved by BARC) for protection
against radioactive wastes.

43. PERSONAL PROTECTION

44. PERSONAL PROTECTION
• Protective equipment - cleaning & maintenance.
• Periodic/surprise checking.
• Hepatitis-B and tetanus vaccination.
• Washing facilities at storage & disposal areas.
• Insistence on hand washing practices.

45. STAFF SAFETY
• Pre-employment & annual health check
• Vaccination & online monitoring of immune status
• Training on occupational safety
• Display of SoPs at all working areas
• Provision of required PPE and periodic inspection
• Spillage Kits, Mercury Kits
• HAZMAT Kits
• First Aid Kits
• Fire Fighting Equipment

46. EDUCATION & TRAINING
• Training on induction, a part of orientation program.
• Focused group training at regular intervals by
Infection Control Dept.
• Training on colour coding, labelling, route marking
etc.
• Training on special problems related to sharp
disposal.
• Awareness about the occupational risks.
• Re-training on revision of policies & procedures.

47. EDUCATION & TRAINING
• Training on personal safety, safe procedures, use of
protective clothing/equipment and how-to-deal-with
spillage and other incidents at work area.
• Training on appropriate cleaning and disinfection
procedures.
• Hand Hygiene, First Aid, BLS & Fire Safety Training.
• Post-training assessment & competency evaluation.
• Mock Drills.

48. QUALITY ASSURANCE
• Process Audits
• Planned & surprise
• Cross-departmental
• Waste Audits
• Segregation
• Labeling
• Departmental Waste Volume/Day

49. QUALITY ASSURANCE
• Biomedical Waste Management – permanent
agenda in monthly Infection Control Committee
Meetings.
• “Quality Watch”
• Adherence to cleaning checklists
• Needle Stick Injuries
• Incident Reports
• Hospital Acquired Infection Rates
• Hand Hygiene Compliance

51. END