Quantum of Biomedical waste (BMW) before and during COVID, and the challenges it presented

Abstract

Aims and Objectives:
1. To find out the quanta of BMW before and during Covid 19, and the challenges presented during its
management.
2. To assess the knowledge, attitude and practices of health care workers (HCW) related to infection
control practices (ICP) during scientific management of bio medical waste (BMW) to overcome the
challenges of Covid BMW (CBMW).

Material and Methods:
Records for Non Covid BMW(NBMW) generated in the healthcare facility HCF) ware analysed. Covid BMW
(CBMW) was added from 23rd March 2020 & records pertaining to it were also analysed. Questionnaires
were administered to HCWs regarding ICP for NBMW & CBMW management, and the challenges faced
in this regard. Their responses were scored. Random audits of ICP by the HCW were conducted by direct
observation also. Records of Hepatitis B & Covid vaccination were obtained for ICP scoring.
Results and observations: Yellow bag NBMW generation showed an anticipated slight increase in 2020, compared to 2019. Red bag
non NBMW showed a slight decrease. Covid BMW was added on 23 March 2020. Separate records were
maintained for this. Both yellow & red bag CBMW showed variations in different months of the year 2020 &
2021. CBMW showed an increase in June & July of 2020, & again in November & December of 2020. In 2021,
a single peak of CBMW was seen in April & May.

Discussion: The CBMW needed a system of segregation and disposal separate from NBMW, as per CPCB rules. This posed
an additional burden on the existing system. The demand for Personal Protective Equipment (PPE), increased
multi folds. Plastic micro waste generation also increased. Changes were made in the shifts and working hours
of BMW waste handlers. Double work of separate register entries for NBMW & CBMW, and urgent handing
of waste to CBWTF, in double bags placed an additional load on all HCWs. Some HCWs, were not vaccinated
for Hepatitis B. Re training sessions had to be carried out for the vaccination drive and to strengthen various
other ICP like six steps of hand hygiene as per World Health Organization (WHO), donning and doffing of PPE,
& Covid specific BMW management. Laboratory BMW management program was strengthened. Specimens
from suspected/ confirmed Covid patients were appropriately disposed of as CBMW.

Conclusion: The rapidly spreading Covid pandemic increased the receptivity of HCWs to better ICP & BMW management.
The increased micro plastic and other biomedical waste led to more frequent removal of waste from the site
and motivated HCW to improve techniques for balling up PPE during doffing to reduce the volume of waste.
The laboratory also devised safety norms for handling Covid & later fungal suspect/ confirmed samples and
appropriate BMW disposal of such samples.