(With regular inputs from Dr Monica Vasudev)
771: Safe handling and disposal of PPEs, Home Masks etc.
The requirement of PPEs:
To protect health workers from COVID-19, suitable Personal Protective Equipment (PPE) is mandatory, which include goggles, face-shield, mask, gloves, coverall/gowns (with or without aprons), headcover and shoe cover. Coverall/gowns are protect the torso of healthcare providers from exposure to the virus.
The coverall should be impermeable to blood, body fluids, etc. India needs such overalls in a huge quantity.
According to the guidelines of the WHO Disease Commodity Package (Version 4.0), the fabric that clears ‘Synthetic Blood Penetration Resistance Test’ (ISO 16603) and the coverall that passes ‘Resistance to penetration by biologically contaminated solid particles (ISO 22612:2005), may be considered as the benchmark specification to manufacture coveralls. ASTM F 1670/F-1670M-08(2014) may be used to test synthetic blood penetration.
Disposal of PPEs, Masks etc.
In India, safe handling and disposal of PPEs, masks etc., are covered under Bio-medical Waste Management Rules, 2016.
In exercise of the powers conferred by Section 6, 8 and 25 of the Environment (Protection) Act, 1986 (29 of 1986), and in supersession of the Bio-Medical Waste (Management and Handling) Rules, 1998 and further amendments made thereof, the Central Government vide G.S.R. 343(E) dated 28th March 2016 published the Bio-medical Waste Management Rules, 2016. These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio-medical waste in any form including hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories, blood banks, Ayush hospitals, clinical establishments, research or educational institutions, health camps, medical or surgical camps, vaccination camps, blood donation camps, first aid rooms of schools, forensic laboratories and research labs.
The prescribed authority for enforcement of the provisions of these rules in respect of all the health care facilities located in any State/Union Territory is the respective State Pollution Control Board (SPCB)/Pollution Control Committee (PCC) and in case of health care establishments of the Armed Forces under the Ministry of Defence shall be the Director-General, Armed Forces Medical Services (DGAFMS). These rules stipulate duties of the Occupier or Operator of a Common Bio-medical Waste Treatment Facility as well as the identified Authorities. According to these rules, every occupier or operator handling bio-medical waste, irrespective of the quantity is required to obtain authorization from the respective prescribed authority i.e. State Pollution Control Board and Pollution Control Committee, as the case may be. These rules consist of four schedules and five forms. These Rules were further amended in the year 2018 and 2019.
As per Guidelines for Handling, Treatment and Disposal of Waste Generated during Treatment/Diagnosis/ Quarantine of COVID-19 Patients – Revision 2 dated 18/04/2020 issued by CPCB, with regard to COVID-19 Isolation wards: (isolation wards are those where COVID-19 positive patients are being kept for treatment/diagnosis), the following steps are needed to ensure safe handling and disposal of PPEs, used masks, head cover/cap, shoe-cover, disposable linen Gown, non-plastic or semi-plastic coveralls:
- Collect used PPEs such as goggles, face-shield, splash-proof apron, Plastic Coverall, Hazmat suit, nitrile gloves into Red bag;
- Collect used masks (including triple-layer mask, N95 mask, etc.), head cover/cap, shoe-cover, disposable linen gown, non-plastic or semi-plastic coverall in Yellow bags.
These Red bags and Yellow bags are needed to be treated and disposed of as per Part 1 of Schedule I of Bio-medical Waste Management Rules, 2016 as amended to date.
However, as per CPCB Guidelines-Revision 2 dated 18/04/2020, used masks and gloves generated from home quarantine or other households should be kept in a paper bag for a minimum of 72 hours prior to disposal of the same as general waste. It is advisable to cut the masks prior to disposal to prevent reuse.
[Source: Central Pollution Control Board]
Dr KK Aggarwal
President CMAAO, HCFI and Past National President IMA