CAQs on Biomedical Waste & Disaster Management

      

Que. 1. What do you mean by biomedical wastes?

Ans. 1. Biomedical waste means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining there to or in the production or testing of biologicals or in health camps.

Que. 2. How will you classify waste generated from health care facility?

Ans. 2. Classified as – 

• Biomedical waste (15%)
• General waste (85%)
• Other wastes

Que. 3. How will you categorize the biomedical waste generated from health care facilities?

Ans. 3. Can be categorized into 4 categories depending upon segregation pathway and colour code – 

• Yellow category
• Red Category
• White Category
• Blue category

Que. 4. Which type of biomedical waste are included in yellow category?

Ans. 4. Following type of wastes are included in yellow category – 

• Human anatomical waste
• Animal anatomical waste
• Soiled waste
• Discarded or expired medicines
• Chemical waste
• Chemical liquid waste
• Discarded linen, mattresses, beddings contaminated with blood & body fluids, routine mask & gown
• Pre-treated Microbiology, Biotechnology & other clinical laboratories waste

Que. 5. What do human anatomical wastes include?

Ans. 5. Human tissues, body parts, organs & foetus below viability period (As per current amendment of MTP Act 1971).

Que. 6. What do animal anatomical wastes include?

Ans. 6. Experimental animal carcasses, body parts, organ, tissues including the wastes generated from animals used in experiments or testing in veterinary hospitals/colleges or animal houses.

Que. 7. What do you mean by soiled waste?

Ans. 7. This includes items contaminated with body fluids like dressings, plaster casts, cotton swabs & bags containing residual or discarded blood & blood components.

Que. 8. What do you mean by discarded or expired medicine?

Ans. 8. This includes pharmaceutical wastes like antibiotics, cytotoxic drugs including all items contaminated with cytotoxic drugs along with glass or plastic ampoules, vials etc.

Que. 9. What do you mean by chemical waste?

Ans. 9. This includes chemicals used in production of biological and used or discarded disinfectants.

Que. 10. What do you mean by chemical liquid waste?

Ans. 10. This includes liquid waste generated due to use of chemicals in production of biological & used or discarded disinfectants, silver X-ray film developing liquid, discarded formalin, infected secretions, aspirated body fluids, liquid from laboratories and floor washings, cleaning, house-keeping & disinfecting activities etc. 

Que. 11. What do you mean by Microbiology, Biotechnology & other clinical laboratories waste (Pre- Treated)?

Ans. 11. This includes blood bags, laboratory cultures, stocks or specimens of micro-organisms, live or attenuated vaccines, human 0r animal cell cultures used in research, industrial laboratories, production of biologicals, residual toxins, dishes & devices used for cultures.

Que. 12. Which type of biomedical wastes are included in red category?

Ans. 12. Wastes generated from disposable items such as tubing, bottles, Intravenous tube & sets, Catheter, Urine bags, syringes without needles, fixed needle syringes with their needle cut, vaccutainers & gloves.

Que. 13. Which type of biomedical wastes are included in white category?

Ans. 13. Waste sharps including metals e.g. needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, or any other contaminated sharp object that may cause puncture and cuts. This includes both used, discarded and contaminated metal sharps.

Que. 14. Which type of biomedical wastes are included in blue category?

Ans. 14. Broken or discarded & contaminated glass including medicine vials & ampoules except those contaminated with cytotoxic drugs.

Que. 15. Which items are included in other wastes?

Ans. 15. Batteries, E-waste & Radioactive wastes.

Que. 16. When was chlorinated plastic bags (excluding blood bags) and gloves phased out?

Ans. 16. In March 2019.

Que. 17. What is the suggested guideline for segregation of biomedical waste?

Ans. 17. The suggested guidelines are as follows – 

• Should be segregated at the point of generation by the person who is generating the waste in designated colour coded bins/containers.
• Biomedical wastes & general wastes should not be mixed.
• Only laboratories & highly infectious should be pre-treated onsite before sending for final treatment or disposal.
• Provide bar code levels on all colour coded bags or containers containing segregated biomedical wastes.

Que. 18. What do you mean by General waste?

Ans. 18. General wastes consist of all the waste other than biomedical waste and which has not been in contact with any hazardous or infectious, chemical or biological secretions and does not include any waste sharps e.g. Newspaper, paper & card boxes, plastic waste bottles, cans of soft drinks, food items etc. It consists of 85-90% of wastes generated from the facility.

Que. 19. How will you do biomedical waste management?

Ans. 19. Following steps are involved – 

• Waste segregation in colour coded & bar code labelled bags/containers at source of generation.
• Pre-treat laboratory & highly infectious waste.
• Intramural transportation of segregated waste to central storage area.
• Temporary storage of biomedical waste in central storage area.
• Treatment & disposal of biomedical waste through central biomedical waste treatment facility and captive facility.

Que. 20. When will you do general waste collection in a health care facility?

Ans. 20. Must be done immediately after the visiting hours of the health care facility.

Que. 21. Whether PPEs should be provided to those collecting biomedical waste?

Ans. 21. Definitely.

Que. 22. What do you mean by Central Waste Collection Room for biomedical waste?

Ans. 22. Each health care facility should have a designated Central Waste Collection Room situated within its premises for storage of biomedical waste, till the waste is picked & transported for treatment & disposal at CBWTF.

Que. 23. What should be the location of Central Waste Collection Room?

Ans. 23. The location of central waste collection room must be away from the public/visitor’s access.

Que. 24. Name the type of wastes collected/segregated in yellow colour non-chlorinated plastic bags or container.

Ans. 24. The types of wastes collected or segregated in yellow colour non-chlorinated bags are – 

• Human anatomical waste
• Animal anatomical waste
• Soiled waste
• Expired or discarded medicines
• Chemical waste
• Discarded linen, mattresses, bedding contaminated with blood or body fluids.

Que. 25. For chemical liquid waste, which method of collection is used?

Ans. 25. Separate collection system leading to effluent treatment system.

Que. 26. For microbiology, biotechnology & other clinical laboratory wastes, which type of container is used?

Ans. 26. Autoclaved safe plastic bags or container.

Que. 27. For which type of waste, cardboard boxes with blue coloured markings are used?

Ans. 27. Glassware & metallic body implants.

Que. 28. For which type of waste, red-coloured non chlorinated plastic bags or containers are used?

Ans. 28. Contaminated and recyclable wastes.

Que. 29. For which type of wastes, puncture proof, leak proof, tamper proof containers are used?

Ans. 29. Waste sharps including metals.

Que. 30. What are the treatment & disposal options of human and anatomical waste and soil wastes in a health care facility without linkage to common biomedical waste treatment facility (CBWTF)?

Ans. 30. Incineration or plasma pyrolysis or deep burial.

Que. 31. Where will you recommend use of deep burial in case of soiled, human & anatomical waste?

Ans. 31. In hospitals located in rural & remote isolated places.

Que. 32. What are the treatment & disposal options for expired & discarded medicines?

Ans. 32. Expired cytotoxic drugs and items contaminated with cytotoxic drugs have to be returned to the manufacturer or supplier for incineration or to a CBWTF for incineration or encapsulation or plasma pyrolysis. All other discarded medicines shall be either sent back to manufacturer or disposed by incineration.

Que. 33. What are the treatment and disposal options for chemical waste?

Ans. 33. Disposed of by incineration or plasma pyrolysis or encapsulation in hazardous waste management, storage & disposal facility.

Que. 34. What are the treatment & disposal options for chemical liquid waste?

Ans. 34. After resource recovery, pre-treated chemical liquid wastes are mixed with other waste water. The combined discharge shall conform to the discharge norms.

Que. 35. What are the treatment & disposal options for contaminated discarded linen, mattresses & bedding?

Ans. 35. Non-chlorinated chemical disinfection followed by incineration or plasma pyrolysis or for energy recovery.

Que. 36. What are the treatment & disposal options for microbiology, biotechnology & other clinical laboratory wastes?

Ans. 36. Pre-treat to sterilize with non-chlorinated chemicals on site as per guidelines thereafter for incineration.

Que. 37. What are the treatment & disposal options for red category wastes?

Ans. 37. Autoclaving or micro-waving / hydroclaving followed by shredding or mutilation or combination of sterilization and shredding. Then sent to recyclers. Plastic wastes should not be sent to landfill sites.

Que. 38. What are the treatment and disposal options for white category wastes (waste sharps including metals)?

Ans. 38. Autoclaving or dry heat sterilization followed by shredding or mutilation or encapsulation in metal container or cement concrete; combinations of autoclaving/shredding; and sent finally for disposal to iron foundries or sanitary landfill or designated concrete waste sharp pit.

Que. 39. What are the treatment & disposal options for glassware wastes?

Ans. 39. Disinfection (by soaking the washed glass waste after cleaning with detergent & sodium hypochlorite treatment) or through autoclaving or micro-waving or hydroclaving & then sent to recyclers.

Que. 40. Which is widely used method for treatment and disposal for most dangerous health care waste?

Ans. 40. Incinerator.

Que. 41. Which are the biomedical wastes, not to be incinerated?

Ans. 41. Biomedical waste not to be incinerated are –

• Pressurized gas containers
• Large amount of reactive chemical wastes 
• Silver salts & photographic or radioactive wastes
• Halogenated plastics such as PVC
• Wastes with high mercury & cadmium content
• Sealed ampules or ampules containing heavy metals.

Que. 42. What are the types of incinerator?

Ans. 42. 4 types – 

• Double chamber pyrolytic incinerators
• Single chamber furnaces with static grate
• Rotatory kins
• Drum or brick incinerator

Que. 43. Which type of incinerator is especially designed to burn infectious health care wastes?

Ans. 43. Double chamber pyrolytic incinerators.

Que. 44. Which type of incinerator is suitable for decomposition of genotoxic substances?

Ans. 44. Rotatory kins.

Que. 45. What is the disadvantages of inertization?

Ans. 45. Not applicable to infectious wastes.

Que. 46. What are the advantages of single chamber incinerator?

Ans. 46. Advantages are as follows – 

• Good disinfection efficiency
• Drastic reduction of weight & volume of waste
• The residues may be disposed off in landfills.
• No need of highly trained operators
• Relatively low investment & operating costs.

Que. 47. Where are the guidelines on BMW management 2020 applicable?

Ans. 47. Applicable in following settings – 

• COVID-19 isolation wards including temporary health care facilities
• Sample collection centres & laboratories for COVID-19 suspected patients
• Quarantine centres/camps/home quarantine or health care facilities.

Que. 48. What are the pre-requisites for segregation of medical wastes for COVID-19?

Ans. 48. The pre-requisites for segregation of medical wastes for COVID-19 are – 

• Foot operated lids and should be closed all the time
• Both liners & bins must have sign of biohazard symbol
• Both liners & bins used in COVID-19 wards must have labels of COVID-19 WASTE – as it helps CWTF to identify the waste for priority treatment.
• Double layer of liners should be used to avoid leaks
• Segregation at source should be encouraged.

Que. 49. Give examples of COVID-19 related wastes to be segregated in yellow category/bins.

Ans. 49. Examples are – 

• All types of used masks
• Disposable linen gown
• Head cover/cap
• Shoe cover
• Any non-plastic or semi-plastic coverall.

Que. 50. Give examples of COVID-19 related wastes to be segregated in red bins/category?

Ans. 50. Examples are – 

• Goggles
• Hazmat suits
• Splash proof gown with plastic cover
• Face shield
• Nitril gloves
• Catheter
• Syringes without needles
• Heavy utility gloves
• Tubing, IV Bottles
• Any recyclable material such as viral transport media, Vacutainers, Pipette tip, testing kits, plastic vials etc.

Que. 51. How will you do faecal management of COVID-19 patients?

Ans. 51. COVID-19 confirmed patient excreta, who is unable to use the toilet should be collected in a diaper which must be treated as a biomedical waste and should be placed in yellow bag or container.

However, if a bedpan is used, the faeces to be washed into toilet and cleaned with neutral detergent & water, disinfected with 0.5% chlorine solution, then rinsed with clean water.

Que. 52. How will you disinfect bins & containers containing biomedical wastes?

Ans. 52. Inner & outer surface of bins & containers containing biomedical waste, should be disinfected with 1% sodium hypochlorite solution daily.

Suggested Further Readings – 

• K. Park; Park’s textbook of Preventive & Social Medicine, 26th edition, 2021
• Government of India; Guidelines for management of health care waste as per Biomedical Waste Management Rules, 2016
• Government of Uttar Pradesh; Manual on Biomedical waste management in health care facilities, Department of Health & Family welfare, Government of UP, February 2019.

                           CAQs on Disaster Management

Que. 1. What do you mean by term disaster?

Ans. 1. Disaster means a catastrophe, mishap, calamity or grave occurrence in any area, arising from natural or manmade causes, or by accident or negligence which results in substantial loss of life or human suffering or damage to, and destruction of property, or damage to, or degradation of, environment, and is of such nature or magnitude as to be beyond the coping capacity of the community of the affected area (Disaster Management Act, 2005, India).

Que. 2. How will you define hazard? 

Ans. 2. Hazard is a dangerous, phenomenon, substance, human activity, or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods & services, social & economic disruption, or environmental damage (UNISDR).

Que. 3. What are the types of disasters?

Ans. 3. The types of disasters are as follows – 

• Natural
• Human-induced
• Incidences of mass trauma

Que. 4. What are the types of natural disasters?

Ans. 4. Types of natural disasters are as follows – 

• Geophysical
• Hydrological
• Meterological
• Climatological
• Biological

Que. 5. What are the examples of geophysical natural disasters?

Ans. 5. Earthquake, Volcano, Tsunami.

Que. 6. What are the examples of hydrological natural disasters?

Ans. 6. Flood, Landslides & wave action.

Que. 7. What are the examples of meteorological natural disasters?

Ans. 7. Examples are Cyclone, Storm surge, tornado, high wind, cold waves, derecho, extreme temperature, heavy rain, lightening, sand/dust storm; snow, ice, winter storm & blizzard.

Que. 8. What are the examples of climatological natural disasters?

Ans. 8. Drought, Extreme hot/cold conditions, Forest wild fire, glacial lake outburst, Subsidence.

Que. 9. What are the examples of biological natural disasters?

Ans. 9. Epidemics & Insect manifestations.

Que. 10. Give few examples of human induced disasters.

Ans. 10. Accidents, chemical, biological, radiological, nuclear hazards etc.

Que. 11. How will you classify morbidities resulting from a disaster?

Ans. 11. Morbidities resulting from a disaster can be classified as – 

• Injuries
• Emotional stress
• Epidemic of the disease & 
• Increase in indigenous diseases

Que. 12. What do you mean by disaster management?

Ans. 12. The body of policy & administrative decisions & operational activities which pertain to the various stages of a disaster at all levels.

Que. 13. What do you mean by vulnerability?

Ans. 13. Degree of loss (e.g. 0-100%) resulting from a potentially damaging phenomenon.

Que. 14. What are the characteristics of a disaster?

Ans. 14. Characteristics of a disaster are – 

• An extra-ordinary event
• Usually occurs because of one of the danger resources, whether caused by nature or human action.
• Seriously & substantially impact the most vulnerable groups
• Results in serious imbalance in the community functions
• Results in significant losses in human lives, materials & environment
• Exceeds the ability of an affected community to cope with using its own resources.

Que. 15. Give examples of incidence of mass trauma.

Ans. 15. Infectious disease outbreaks, incidents of community unrest & other types of traumatic events.

Que. 16. What are the differences between emergencies & disasters?

Ans. 16. A situation in which community is capable of coping is emergency. Emergency situations are generated by a real occurrence of events that require immediate attention of emergency resources.

A situation in which community is incapable of coping is a disaster. Disaster situations are natural or human caused events which causes severe negative impact on community.

Que. 17. How will you deal with emergencies?

Ans. 17. The steps are – 

• Evaluation
• Response
• Speaking on behalf of the affected 
• Distribute Aids
• Supply needs
• Organize works
• Manage resources
• Deal with the media
• Advocate

Que. 18. What do you mean by disaster management life cycle?

Ans. 18. The disaster management cycle illustrates the ongoing process by which government, businesses & civil society plan for & reduce the impact of disasters, react during & immediately following a disaster & take steps to recover after a disaster has occurred.

Que. 19. What are the phases of Disaster Management Life Cycle?

Ans. 19. The disaster management life cycle includes several phases – 

• Mitigation
• Disaster preparedness
• Disaster response
• Disaster recovery

Que. 20. What do you mean by disaster mitigation?

Ans. 20. It involves preventing future emergencies &/or minimizing their negative impacts. It requires hazard risk analysis & application of strategies to reduce the impact of disasters.

Que. 21. What do you mean by disaster preparedness?

Ans. 21. As the term suggests, it includes the plans or preparations made in advance of an emergency situation that prepares individuals or communities for the emergency situation e.g. stocking of foods, water, medicines etc.

Que. 22. What do you mean by disaster response?

Ans. 22. It includes any action taken during or immediately following an emergency situation, which includes efforts to save lives and to further prevent property damage. It is also called disaster relief.

Que. 23. What do you mean by term disaster recovery?

Ans. 23. Disaster recovery takes place after assessment of damages & involves actions to return the affected community to its pre-disaster state or better – and ideally, to make it less vulnerable to future risk.

Que. 24. What do you understand by risk identification?

Ans. 24. Risk identification includes understanding the nature of hazards as well as understanding the nature of vulnerabilities.

Que. 25. How will you manage mass causalities?

Ans. 25. This can be divided into search & rescue, first aid, triage, stabilization of the victims, hospital treatment & redistribution of patients to other hospitals if necessary.

Que. 26. What is the management sequence of a sudden onset disaster?

Ans. 26. After disaster impact, manage by –

• Response
• Rehabilitation
• Reconstruction
• Mitigation
• Preparedness.

Que. 27. When will you use triage?

Ans. 27. When the quantity & severity of injuries overwhelm the operative capacity of health facilities.

Que. 28. What is triage in disaster management?

Ans. 28. It consists of rapidly classifying the injured on the basis of severity of their injuries, expected chance of survival with prompt medical interventions.

Que. 29. Which is the only approach that can provide maximum benefits to the greatest number of injured in a major disaster?

Ans. 29. Triage.

Que. 30. Which is the internationally accepted, most commonly used triage system?

Ans. 30. Four colour code system triage.

Que. 31. What does the different colours in a four colour code system triage indicate?

Ans. 31.  Colours indicate as per following –

Red colour – high priority treatment or transfer

Yellow colour – Medium priority

Green Colour – Ambulatory or low priority

Black Colour – Dead or moribund patients.

Que. 32. What will you do with high priority patients?

Ans. 32. Should be transported to hospitals with specialized treatment facilities.

Que. 33. Why persons with minor or moderate injuries should be treated at their own homes?

Ans. 33. To avoid social dislocation& added drain of the resources of transporting them to the central facilities.

Que. 34. How will you care of dead man in disaster management?

Ans. 34. Steps of care of dead man are as follows – 

• Removal of dead body from the disaster site
• Shifting to the mortuary
• Identification of the body
• Reception of the body by the relatives

Proper management for the dead is the central aim of care of dead.

Que. 35. What are the hazards associated with cadavers?

Ans. 35. Hazards associated with cadavers are as follows – 

• Nuisance/foul smell
• Contamination of water resulting in outbreak of water borne diseases
• Social problems

Que. 36. What are the aims of disaster management?

Ans. 36. The aims of disaster management are – 

• Reduce/avoid the potential losses from hazards
• Assure prompt & appropriate assistance to victims when necessary.
• Achieve rapid & durable recovery.

Que. 37. What we generally do in primary mitigation?

Ans. 37. Reducing the presence of hazard & reducing vulnerability.

Que. 38. What is generally done in secondary mitigation?

Ans. 38. Reducing the effect of the hazard.

Que. 39. What are the objectives of disaster response?

Ans. 39. The objectives of disaster response are – 

• Assess the needs
• Reduce the suffering 
• Limit the spread & consequences of the disaster
• Open the way to rehabilitation

Que. 40. What is the hierarchy of control for the hazards?

Ans. 40. In order of most effective to least effective action – 

• Elimination – Physically remove the hazard
• Substitution – Replace the hazard
• Engineering Controls – Isolate people from the hazard
• Administrative controls – change the way people work
• PPE – Protect the worker with personal protective equipment.

Que. 41. Which is the best approach to hazard mitigation?

Ans. 41. Substitution.

Que. 42. What do you mean by Risk?

Ans. 42. Risk can also be defined as the probability of a loss. Risk depends on 3 elements – 

• Hazard
• Vulnerability
• Exposure

Que. 43. What are the types of vulnerability?

Ans. 43. The types of vulnerability are as follows – 

• Physical Vulnerability
• Social Vulnerability
• Economic Vulnerability
• Environmental Vulnerability

Que. 44. How can one calculate risk?

Ans. 44. Risk= Probability of hazard * Degree of vulnerability

Que. 45. What are the different types of dealing with risk?

Ans. 45. Different types of dealing with risk are – 

• Risk acceptance
• Risk avoidance
• Risk reduction
• Risk Transfer

Que. 46. Which are the types of disaster management resources?

Ans. 46. Different categories are – 

• People
• Facilities
• Systems
• Equipment
• Materials
• Supplies
• Funding
• Information 

Suggested Further Readings – 

• K. Park; Park’s textbook of Preventive & Social Medicine, 26th edition, 2021
• Benard Lango; Disaster Management compiled notes for unit lecture, June 2020
• Uday Singh; Disaster Management, Ukal University, Bhubaneshwar, Odisha, 2021