Field Project Report

HUL 275
“Environment, Development & Society”

Yogesh Kumar
2008ph10643
Group no. 3
 Topic: Bio-Medical Waste disposal in a hospital

“Orthonova Hospital”, SDA, Hauz Khas, New Delhi

Introduction:

In my field project I tried to study about the Bio-Medical waste produced in a hospital and how
the waste is disposed of. I studied the case for a small private hospital named “Orthonova
hospital” which is primarily for orthopedic patients. The hospital is situated in SDA near IIT
Delhi.

Background:

In a hospital there is a variety of wastes and a large amount of waste is produced every day.
The type of waste may vary from hospital to hospital depending upon the type of hospital. Also
all the waste produced in a hospital is not bio-medical waste. Biomedical wastes are dangerous
to both human-being and environment.

Bio-medical waste differs from other hazardous waste in that it has a biological source or it is
used in diagnosis, prevention or treatment of diseases.”1 So all the waste produced at hospital is
not bio-medical waste. “According to a WHO report, around 85% of the hospital wastes are
actually non hazardous, 10 % are infective (hence, hazardous), and the remaining 5% are non-
infectious but hazardous (chemical, pharmaceutical and radioactive). “2

The waste produced in a hospital includes cotton, dressings, scrubs, masks, gloves, urine
catheters, human anatomical parts, blades, slides, IV sets and needles, syringes, drugs,
chemical and radioactive waste (waste which is contaminated during imaging and therapies)
etc. These bio-medical wastes can be very harmful if not managed properly. These wastes can
cause infection to the people in hospital and in the vicinity of hospital. These wastes have been
also found to be the precursor to cancer.

“Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are
vital steps for safe and scientific management of biomedical waste in any establishment.”3 There
is hospital housekeeping in each hospital which takes care of these wastes. They collect these
wastes and store it at a place. They use color coding for packaging different type of waste in
different colored plastic bags.

For the appropriate bio-medical waste management, ministry of environment and forestry gave
the “Biomedical Waste (management and handling) Rules, 1998” in July, 1998. According to
this it is the duty of every “occupier” i.e. the person, who has the control over the institution or its
premises, to take all possible steps to ensure that the waste is handled properly, so that it
doesn’t have any adverse effect on any human being and environment and is segregated into
1
“Biomedical Waste”;Wikipedia; http://en.wikipedia.org/wiki/Biomedical_waste
2
“Mukesh Yadav MD”, Hospital Waste-A Major Problem, Hospital Today, Vol. 8 No. 4 , October-December 2001;
http://www.medind.nic.in/jab/t01/i4/jabt01i4p276.pdf
3
“ Lt Col SKM Rao*, Wg Cdr RK Ranyal+, Lt Col SS Bhatia#, Lt Col VR Sharma**”, Biomedical Waste Management :
An Infrastructural Survey of Hospitals; http://www.bvsde.paho.org/bvsacd/cd48/biomedical.pdf
containers according to Schedule II of Biomedical Waste (management and handling) Rules,
1998.

“Sharps should be collected in puncture proof containers. Bags and containers for infectious
waste should be marked with Biohazard symbol. Highly infectious waste should be sterilized by
autoclaving. Cytotoxic wastes are to be collected in leak proof containers clearly labeled as
cytotoxic waste.”5

The waste is then transported to a plant where this is finally disposed. For e.g. in the given case
the waste is finally taken to Synergy Waste Management Plant. Synergy waste follows the Bio-
medical waste rules, 1998 and also environment protection guidelines and the standards
prescribed by Pollution control authorities. According to these rules they can’t store untreated
bio-medical waste for more than 48 hours under any circumstances. The transport of these
wastes is not permitted according to the “Notwithstanding anything contained in the motor
Vehicle Act, 1988”. So these vehicles must be authorized by the government before using them
for transportation.6

4
“Lt Col SKM Rao*, Wg Cdr RK Ranyal+, Lt Col SS Bhatia#, Lt Col VR Sharma**”, Biomedical Waste Management :
An Infrastructural Survey of Hospitals; http://www.bvsde.paho.org/bvsacd/cd48/biomedical.pdf

5
“Lt Col SKM Rao*, Wg Cdr RK Ranyal+, Lt Col SS Bhatia#, Lt Col VR Sharma**”, Biomedical Waste Management :
An Infrastructural Survey of Hospitals; http://www.bvsde.paho.org/bvsacd/cd48/biomedical.pdf

6
“Synergy Waste Management Pvt. Ltd.”; Laws and Procedures ;
http://www.bio-waste.com/laws_procedures.html
“Every authorized person shall maintain records related to the generation, collection, reception,
storage, transportation, treatment, disposal and/or any form of handling of bio-medical waste in
accordance with these rules and any guidelines issued.”7

The gases released due to burning of these bio-medical wastes causes air pollution and contain
many hazardous gases like Furan, Dioxin, Hydrochloric acid etc. So these gases must be
prevented to go to the atmosphere. For this purpose, there are specially designed BMW
incinerators for bio-medical waste. Central Pollution Control Board has given the guidelines for
manufacture, installation and working of these incinerators. These guidelines will apply to all
new installation. And existing incinerators must be equipped with Air Pollution Control Device
(APCD). These incinerators can only be installed at Common Bio-Medical Waste Treatment
Facility (CBWTF). All incinerators must be equipped with APCD. Only skilled persons would be
allowed to operate these incinerators. And all workers must use the protective gears for safety
purposes. The ash shall be disposed in a secured landfill. The waste water produced from
APCD must be handled properly. The ash analysis as per requirement of Bio-medical Waste
(Management and Handling) Rules, 1998 shall be done quarterly i.e. once in three months and
record shall be maintained by facility operator.8

Generally state pollution control board is the prescribed authority for the enforcement of these
rules. It has right to cancel the authorization of the operator if operator fails to comply with any
provision of these rules. But no authorization can be cancelled without giving a reasonable
opportunity to the operator of being heard. Every operator has to submit an annual report each
year by 31st January. The prescribed authority will send this information in a compiled form to
the Central Pollution Control Board by 31st March.

List of Actors:

A lot of actors like patients, doctors, hospital housekeeping, transporters, canteen, synergy
waste management etc are involved in this whole process. I chose following three actors to
interview…

1. Hospital-Housekeeping: - I met Mr.Raj Singh, Mr.Sonu and Mr.Tapan(he comes for only
limited time). They are the head of housekeeping. I talked to them and found them quite
friendly. So I thought I can interview them. Also they are a very important part of this
whole process. So I have chosen them.

2. The Truck guys:-As told by Mr.Sonu, I came to know that generally two people come
with truck. One drives the truck and other one fills the waste into truck. They transports
waste from hospital to Synergy Waste Management plant where it is finally disposed.

7
“Synergy Waste Management Pvt. Ltd.”; Laws and Procedures ;
http://www.bio-waste.com/laws_procedures.html

8
Central Pollution Control Board; “Design and construction of BMW incinerator”; http://cpcb.nic.in/oldwebsite/Bio
%20Medical%20%20Waste/Design_construction_BMW_incinerator.html
 3. Synergy Waste Management :- The waste is finally brought here. Their role is most
important. Because the waste is finally treated here. If the waste is not treated properly
then it might be very dangerous to the environment. They play the most important role in
this whole process as they finally decide that how the waste will be disposed.

Conducting Interviews:

First of all I visited the hospital and asked for the hospital housekeeping. I was lucky that I found
Mr. Sonu who is one of the head of the sweepers in the hospital. I told him about my project. Mr.
Sonu is quite friendly and told me a lot about the whole process. He also told that when can I
meet Mr.Tapan who is the head of the hospital housekeeping. He also introduced me with the
truck guys Mr. Arun and Mr. Dalbir. Mr. Sonu was very helpful in this interview process.

Mr. Sonu answered most of the questions but he refused to answer some of the questions
which he thought might be harmful to him and reputation of the hospital. Also they are scared of
losing their jobs and they couldn’t find any of their personal profit in this. That’s why they only
gave limited information. I could only manage a small talk with Mr. Tapan as he comes only for
one hour each day and have a quite busy schedule. Also the hospital was near the college so it
was easy to visit it.

The truck comes daily around 2.00 p.m. to collect the waste from the hospital and take it to the
synergy waste plant. I mainly interviewed Mr. Dalbir who uses to carry the plastic bags
containing the hospital waste to the truck. The truck driver stays in the truck. Interview with Mr.
Dalbir went quite well expect some questions like about their health and suggestions about this
problem. They wanted to avoid these type questions because they were afraid that it may harm
their jobs. Also he was not using any kind of precaution while carrying the polythene bags.

Finally I had to interview the Synergy Waste Management. It is situated quite far from IIT Delhi. I
used Google map to go there. After reaching the given place in Google map, I asked people
about it. But no one could tell me about the plant. Actually the plant wasn’t there. The position
given on Google maps is wrong. And the actual position is somewhere very different from that
position. So I came back as it was getting late in the evening. Finally I look for their address on
their website and followed it and found it. There is also a municipal composite plant near the
Synergy plant. The area was full of bad smell coming out of the aeration plant unit and from the
huge quantity of general waste. When I went there I met Mr. Chandra Jeet who is the manager
of Synergy Waste since last three years. When I tried to tell him about my project he seemed in
no interest to hear it. He right away said he can’t tell me anything about the plant as it is private.
When I insisted and convinced him very hard, then he just gave very basic information about the
plant. So interview with Mr. Chandra Jeet wasn’t the way as I was expecting.

Interview Results:

Generally there is a “Hospital-Housekeeping” in every hospital which takes care of all the waste
inside the hospital. They collect all the waste from the hospital and store it at a place. Later a
truck comes every day and takes this waste to a bio-chemical plant called “Synergy Waste
Management”. The waste is finally disposed here.
Orthonova hospital is a small hospital, so waste produced here is comparatively in small
amount. But in big hospital a large amount of bio-medical waste is produced every day. In
Orthonova hospital on an average 13 Kg of waste is produced every day. The waste mainly
contains cotton, dressings, plaster, blood, urine catheter, glucose bottles, glass bottles, tube,
syringes, needles, drugs and general waste. They collect all the waste and after segregation,
store it in a corner of the building outside the hospital. They usually use two types of polythene
bags viz. yellow and red. Red bags mainly contain plastic waste while yellow bag contains non-
plastic wastes. And needles are kept in a separate plastic box. The workers working for the
hospital housekeeping are usually aware that the waste may be harmful for them, so they use
safety precautions. They use gloves, scrubs, masks, disinfectants etc.

The waste in polythene bags is then transported to Synergy Waste Management Plant for
burning. A truck comes everyday to hospital and carries them in their truck to the plant. These
truck guys go to approximately 100 places to collect the bio-medical waste. So they do a lot of
hard work daily. But still their pay scale is quite low. Also they were not using any kind of
precautions. When I asked him, “why are you not using gloves/masks”, he answered that “it is
time consuming to use these precautions. And he can earn more money if he goes to more
places.” He added that, “it is very difficult to bear the smell from these wastes during summer
and then it is must to use the masks.” Headache is one of the most common problems they
have due to smell of these wastes. This transportation is done by Synergy Waste Management
Pvt. Ltd.

The waste is finally brought to Synergy Waste Plant where it is stored and then burnt in
specially designed BMW incinerators. These incinerators are designed and installed according
to the guidelines given by Central Pollution Control Board. First of all, they separate non bio-
medical waste (general waste) from bio-medical waste and send it to the municipal dump
wastes. The waste is incinerated in two stages, in first stage the waste is decomposed in
scarcity of air and then these volatile gases are driven to second stage where they are mixed
with additional air and burnt at 1100/1400 K. Some of the wastes burn at 1100K while for some
of the waste, they use 1400K. The workers in this plant follow the precautions which has been
given Bio-Medical Waste (Management and Handling) Rules, 1998. “All the staff at the
incinerator plant shall put on protective gears such as gumboots, gloves, eye glasses, etc. for
safety reasons.” 9 The ash produced after is then sent for safe land-fill. Also the gases produced
due to burning of these bio-medical wastes are hazardous, so steps are taken to minimize the
air pollution. For this Air Pollution Control Device (APCD), high pressure venture scrubber
systems are used. This is then followed by centrifugal type droplet separator to remove water
droplets from flue gas.

Suggestions for Improvement:

Some of the suggestions which can be used for the improvement of this problem …

 If waste is segregated properly then its hazardous effects can be decreased.

9
Central Pollution Control Board; “Design and construction of BMW incinerator”; http://cpcb.nic.in/oldwebsite/Bio
%20Medical%20%20Waste/Design_construction_BMW_incinerator.html
 All the actors which are involved in this process must be informed about its hazardous
effect, so that they use appropriate precautions and try to minimize the production of
these wastes.
 People and particularly people around the vicinity of these wastes must be aware about
the ill-effects of these wastes.
 .A regular checkup of the workers involved in this process should be done and
appropriate steps should be taken.
 Small health care centre generally don’t register to any of the operator and mix their bio-
medical waste in the municipal waste, they should be encouraged to register.
 Some instruments should be development which can be used, so that direct contact to
these wastes could be avoided.
 The polythene bags should be strong and such that they can prevent the smell coming
outside.
 Good quality preventive gears should be provided.

Conclusion:
Bio-medical waste is being a serious problem and a proper disposal of these wastes is a
must. Incineration of these wastes produces hazardous gases and causes air pollution.
The actors involved in this process are at a high risk to their health. Very few of them
use the precautions every time and it might be very harmful to them in longer period of
time. The workers involved in this process are generally poor and are bound to do this
work for their living. They are scared of taking any step against their masters. Some
efforts are needed to be taken towards it.