1. Understanding and Simplifying Bio-medical Waste Management A training manual for trainers Who requires training? For: Doctors Administrators Nurses Technicians Ward boys and safai karmcharies

2. Trainers Initially Hospital personnel Outside agency Ongoing training Hospital Infection Control Committee Medical Superintendent Nursing Supervisor Sanitary Supervisor Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

3. Training sessions Teaching Discussion Feedback Ongoing training (once at the time of induction and thereafter once a year) Training module: Vernacular medium Easy to understand Include equipments and slides Demonstration Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

4. Training session one Inputs from trainees: About the present system The need of managing waste Their role and intervention Introducing concepts of waste management Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

5. Sensitisation – the need for managing waste Dangers to the patients Many patients immuno-compromised Dangers to the community Spread of infection through waste Access of waste to the animals Problems due to incinerators Spread of infection through recycling trade Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

6. Dangers to healthcare workers Hours spent at the workplace High rate of needle-stick injuries Exposure to mercury/chemicals Dangers due to improper spill handling Dangers due to on-site incinerators. Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

7. What are sharps? Anything capable of causing cuts and punctures: Needles Blades Scalpels Lancets Sutures I.V. catheters Glass Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

8. Categories of staff exposed to needle-stick Staff prone to needle stick injuries Relative % of injury Staff nurses34.6% Interns15.7% Residents 11.7% Practical nurses8.5% Technical staff 6% Environmental workers19% Others4.5% Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

9. Incidents leading to pricks Type of incident% Blood drawing22.6 Garbage collection12.5 Placing intravenous lines11.3 Recapping11 Needle disposal box10.5 Administering medication8.5 Neglected needle4.8 Cleaning surgical equipment2.8 Others16 Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

10. Sero-conversion following exposure Pathogen Sero-conversionTime of rateconversion HIV 0.3%6 months HBV30%2-6 months HCV 10%7 weeks Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

11. Mercury products in hospitals ProductAlternative ThermometersDigital, expansion or aneroid Sphygmomanometers Electronic vacuum gauge, expansion /aneroid Esophageal Dilators, Products w/Miller Abbott & Cantor tubes Tungsten tubing Dental amalgamsGold, ceramic, porcelain Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

12. Symptoms of mercury poisoning Impairment of peripheral vision Disturbance in sensations Lack of coordination of movements Impairment of speech or hearing Muscle weakness Skin rashes Mood swings, mental disturbance Abnormal brain development; impaired memory, attention and learning Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

13. Mercury effects Damage to the brain, the kidneys and developing foetus. Effects on brain functioning may result in irritability, shyness, tremors, changes in vision or hearing, and memory problems. In addition, short-term exposure to high levels of metallic mercury vapours may cause effects including lung damage, nausea, vomiting, diarrhea, increases in blood pressure or heart rate, skin rashes, and eye irritation. Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

14. Where is glutaraldehyde used? Endoscopy units Theatres ICU Labour wards Infection control Dental units Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

15. Glutaraldehyde and you! Irritates skin, eyes, throat and lungs, causes sensitisation of skin and respiratory tract Can cause allergic reaction, like asthma Skin sensitisation and contact dermatitis Headache, shortness of breath, chest pain, discomfort, cough and fatigue Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

16. Cytotoxic drugs Ability to kill or arrest the growth of living cells Used for treatment of cancerous cells Harmful to normal cells specially the actively dividing cells Exposure happens mainly through inhalation of droplets or dusts. Can be absorbed through the skin, or by swallowing food/beverages contaminated with CDs. Risks for exposure are during the preparation and administration of the drugs, handling of body fluids from patients being treated with cytotoxic drugs Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

17. Cytotoxic drugs-health effects Short term effects: skin injury, lightheadedness, dizziness, nausea, headache, and allergic reactions Long term effects: Some anti-neoplastics can cause cancer, they may also cause birth defect (teratogens) and miscarriages, as well as chromosomal damage (mutagens) Understanding and Simplifying Bio-medical Waste Management A training manual for trainers

18. Other aspects Dangers to ragpickers Sorting of mixed hospital waste Needle-stick injuries Bio-Medical waste Management Rules 2016: Fines and legal implications on non-compliance Implementation is a shared responsibility of the entire staff Understanding and Simplifying Bio-medical Waste Management A training manual for trainers