Priti Razdan, Amarjeet Singh Cheema

Bio-Medical Waste Management System

Priti Razdan, Amarjeet Singh Cheema

Abstract : Hospitals produce waste, which is increasing over the years in its amount and type. The hospital waste, in addition to the risk for patients and personnel who handle them also poses a threat to public health and environment. The main functions of the Bio-Medical Waste Management (BMWM) system (one of the modules of a Hospital Management Information System) is to ensure proper handling, segregation, mutilation, disinfection, storage, transportation and final disposal of Bio-Medical waste. This paper presents the design of the BMWM within the overall scheme of a Hospital Management Information System. The BMWM system generates alerts under exceptional conditions such as violation of segregation guidelines, waste not treated with in a defined period, violation of trolley route for waste collection, etc. It ensures the segregation and transportation of waste bags at the point of generation according to bag colour and trolley mapping so that mixing of bags can be avoided. A digital weighing machine with direct interface to the system takes the weight of the waste bags. It also provides various crosscheck mechanisms for reducing theft/ pilferage occurrences, at the time of storage of the waste in the Department area. This proposed module will be implemented in Government of National Capital Territory of Delhi (GNCTD) hospitals, Post Graduate Institute of Medical Education & Research, Chandigarh (PGIMER) and Sawai Maan Singh Hospital (SMS), Jaipur as part of HMIS system being developed for them. Keywords: Bio-Medical waste, segregation, disposal, waste handler, Bio hazardous waste, Radio Frequency Identification. 1. Introduction Bio-Medical Waste is any waste generated during the diagnosis, treatment or immunization of human beings or in research activity [1]. The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste [2]. Bio-Medical waste generated in the hospital falls under two major Categories - Non Hazardous and Bio Hazardous. Constituents of Non Hazardous waste are Non-infected plastic, cardboard, packaging material, paper etc. Bio hazardous waste again falls into two types (a) Infectious waste- sharps, non sharps, plastics disposables, liquid waste, etc. (b) Non infectious waste-radioactive waste, discarded glass, chemical waste, cytotoxic waste, incinerated waste etc Approximately 75-90% of the Bio-Medical waste is non-hazardous and as harmless as any other municipal waste. The remaining 10-25% is hazardous and can be injurious to humans or animals and deleterious to environment. It is important to realise that if both these types are mixed together then the whole waste becomes harmful.[3] Major hospitals contribute substantially to the quantum of Bio-Medical waste generated. Smaller hospitals, nursing homes, clinics, pathological laboratories, blood banks, etc also contribute a major chunk.
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Bio-Medical Waste Management System

This paper presents various aspects of Bio-Medical waste System which has been designed by us. It is divided into following sections. Section 2 elaborates major issues in the BioMedical waste management. Section 3 describes the Bio-Medical Waste (management and handling) Rules, 1998 of the Ministry of Environment and Forests. Section 4 discusses the salient features of the BMWM system developed. 2. Bio-Medical Waste: Management Issues A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard, improper and indiscriminate manner. Lack of segregation practices, results in mixing of hospital wastes with general waste making the whole waste stream hazardous. Inappropriate segregation ultimately results in an incorrect method of waste disposal. A bag not securely tied results in scattering of Bio-Medical waste. Bio-Medical waste scattered in and around hospitals invites flies, insects, rodents, cats and dogs that are responsible for spread of communicable diseases like plague and rabies. Most importantly there is no mechanism to ensure that all waste collected and segregated, reaches its final destination without any pilferage. Additional hazard includes recycling of disposables without even being washed. [5]. Usage of same wheel barrow for transportation of all categories of waste is also a cause of infection spreading. Most of the times there is no monitoring of trolley routes, resulting in trolley movement around patient care units posing a serious health hazard. There is no mechanism for ensuring waste treatment within prescribed time limits. Note that, Bio-Medical waste if not handled properly and within the stipulated time period could strike in the form of fatal infections. In some hospitals there is no proper training of the employees in hazardous materials management and waste minimization aspects. This indicates the lack of even basic awareness among hospital personnel regarding safe disposal of Bio-Medical waste. 3. Bio-Medical Waste Rules, 1998 Keeping in view inappropriate Bio-Medical waste management, the Ministry of Environment and Forests notified the Bio-Medical Waste (management and handling) Rules, 1998 in July 1998. In accordance with these Rules (Rule 4), it is the duty of every occupier i.e. a person who has the control over the institution and or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment. Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are vital steps for safe and scientific management of BMW in any establishment [3]. Schedule I of the Bio-Medical rules contains the categories of Bio-Medical Waste [4] (Refer to Table1). Schedule II contains the Colour coding and the type of container for disposal of different Bio Medical waste categories [4]. (Refer to Table2).

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Priti Razdan, Amarjeet Singh Cheema Table1. Schedule I of the Bio- Medical Waste Rules Option Cat. No. 1 Cat. No. 2 Treatment & Disposal Incineration /deep burial Incineration /deep burial Waste Category Human Anatomical Waste (human tissues, organs, body parts) Animal Waste Animal tissues, organs, Body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by veterinary hospitals/ colleges, discharge from hospitals, animal houses) Microbiology & Biotechnology waste (wastes from laboratory cultures, stocks or specimens of micro-organisms live or attenuated vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biological, toxins, dishes and devices used for transfer of cultures) Waste Sharps (needles, syringes, scalpels blades, glass etc. that may cause puncture and cuts. This includes both used & unused sharps)

Cat. No. 3

Local autoclaving/ micro waving/ incineration

Cat. No. 4

Cat. No. 5

Cat. No. 6

Disinfections (chemical treatment /autoclaving/micro waving and mutilation shredding Incineration / destruction & drugs disposal in secured landfills Incineration, autoclaving/micro waving Disinfections by chemical treatment autoclaving/micro waving& mutilation shredding. Disinfections by chemical treatment and discharge into drain Disposal in municipal landfill Chemical treatment & discharge into drain for liquid & secured landfill for solids

Cat. No. 7

Discarded Medicines and Cytotoxic drugs (wastes comprising of outdated, contaminated and discarded medicines) Solid Waste (Items contaminated with blood and body fluids including cotton, dressings, soiled plaster casts, line beddings, other material contaminated with blood) Solid Waste (waste generated from disposable items other than the waste sharps such as tubing, catheters, intravenous sets etc.)

Cat. No. 8

Cat. No. 9 Cat. No. 10

Liquid Waste (waste generated from laboratory & washing, cleaning , house-keeping and disinfecting activities) Incineration Ash (ash from incineration of any bio-medical waste) Chemical Waste (chemicals used in production of biological, chemicals, used in disinfect ion, as insecticides, etc)

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Bio-Medical Waste Management System

Table2. Schedule II of the Bio-Medical Waste Rules Colour Coding Yellow Red Blue/ White translucent Black Type of Containers Plastic bag Disinfected Container/ Plastic bag Plastic bag/ puncture proof container Plastic bag Waste Category 1,2,3,6 3,6,7 4,7 Treatment Options as per Schedule 1 Incineration/deep burial Autoclaving/Micro waving/ Chemical Treatment Autoclaving/Micro waving/ chemical treatment and destruction/shredding Disposal in secured landfill

5,9,10 (Solid)

4. The Bio-Medical Waste Management System of e-Sushrut e-Sushrut, the hospital management Information system developed by C-DAC is a web based system developed using J2EE architecture (Figure 1). It consists of various modules which broadly belong to three main groups Patient Care, Support Services and Back Office. Bio-Medical Waste Management (BMWM) system is one of the important modules of the support services group of HMIS.

Fig.1 HMIS Architecture BMWM module aims to track the hospital waste within the hospital, right from its generation, segregation, transportation and disposal, as required under the provisions of the Bio-Medical Waste (Management and Handling) Act 1998 and rules framed there under. The module makes the record keeping and tracking of waste easy along with generating reports for perusal of the hospital management and any designated monitoring agency like Delhi Pollution Control Committee (D.P.C.C.). The major components are described in the following subsections. 4.1 Segregation The segregation of Bio-Medical waste is the key to successful Bio- Medical waste management. This aspect is taken care in the BMWM by capturing information regarding

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Priti Razdan, Amarjeet Singh Cheema the waste material like solid waste, sharp waste, chemical waste etc, collected from various locations in the hospital at the waste generation point itself. Weighing machines are made available to the staff to weigh the waste bags properly for correctness of data.. A digital weighing machine with direct interface to the system is also used for this. A trend analysis of the waste generation based on the reports generated by the BMWM module helps the hospitals in arriving at an approximate amount of waste, category wise at various points. This approximation is then used to ascertain the correctness of the quantity of actual waste collected (category wise) in different areas and entering it into the online BMWM system. The weight approximation trends also help in gradually developing the judgement of the hospital staff and guides them to tie the bags once they are filled of its capacity. The system ensures the segregation of waste bags at the point of generation in accordance with Schedule I of Bio-Medical Waste rules. 4.2 Transportation For monitoring malpractice of waste, BMWM modules cross-checks the waste information gathered from each point and ensures total handover of the waste at the storage area. The system has the provision to implement at least two checking-barriers between sources of waste to its destination. Here bags are weighed and checked to ensure that the waste is not re-circulated nor deviates from its designated path of movement. The BMWM module also contains a mechanism to define and enforce the trolley schedule and route. Each trolley can be dedicated to collect only a particular type of waste from the bins. Bins are located at a stationery location where as trolley is moving from department to department for collection of waste. The trolleys are attached with Radio Frequency Identification (RFID) tags for monitoring the trolley movement. Complete Trolley routes as well as Zero Tolerance Area routes are installed with RFID readers. This is to ensure that the transportation of waste is as per its defined path and also enforce the transportation of waste away from patient care units. 4.3 Disposal Every hospital generating Bio-Medical waste needs to set up requisite Bio-Medical waste treatment facilities to ensure proper treatment of waste. As per the guidelines no untreated Bio-Medical waste is to be kept stored beyond a period of 48 hours. The BMWM module handles all aspects related to fuel filling, complaints lodging, etc of the Waste disposal equipments for ensuring smooth functioning of the Bio-Medical waste treatment facilities. The module is also able to generate alerts under exceptional conditions such as waste not treated with in stipulated time. Additionally online help will be available that gives exact references to the guidelines from Bio-Medical Waste (management and handling) Rules, 1998. This will help the users in proper waste generation, segregation, transportation, handling, disposal, etc. 5. Conclusion Bio-Medical waste management system is closely coupled with User Management for role permissions, Alert Management, Material Management for items, Equipment Maintenance etc. It ensures strict adherence to schedules of the Environment (Protection) Act by the

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Bio-Medical Waste Management System

Ministry of Environment & Forest, Govt. of India. It ensures that, as far as possible staff adheres to the governmental guidelines related to Bio-Medical Waste Management for doing their routine activities. The BMWM module is ready for implementation at Guru Gobind Singh Hospital, Raghubir Nagar, Delhi (pilot hospital of the GNCTD project). Acknowledgment This work was part of the HMIS project development. We express our gratitude to the Health and Family Welfare Department of Delhi Government for awarding the HMIS project of GNCTD hospitals to C-DAC Noida. We are thankful to the GNCTD project module committee members Dr.Vijay Rai, Nodal Officer(IT), H&FW Department, Delhi Government, Dr.Vandana Bagga, Guru Gobind Singh Hospital, Delhi and Dr Ravinder Agrawal, Nodal Officer(IT), G.B.Pant Hospital, Delhi for helping us understand the complete domain of waste Management. References [1] Govt of India, Ministry of Environment and Forests Gazette notification No 460 dated July 27, New Delhi:1998:10-20 [2] Park K. Hospital Waste Management. Parks Textbook of Preventive and Social Medicine. M/s Banarasidas Bhanot Publications, New elhi. 18th Edn, 2005: 595-598. [3] Biomedical Waste Management - An Emerging Concern in Indian Hospitals. Author(s): Virendar Pal Singh, Gautam Biswas, Jag Jiv Sharma Vol. 1, No. 1 (200707 - 2007-12). http://www.indmedica.com/journals.php?journalid=11&issueid=98&articleid=1324&a ction=article. Last accessed on 6th February 2009. [4] http://envfor.nic.in/legis/hsm/biomed.html - Website of the MINISTRY OF ENVIRONMENT & FORESTS. Last accessed on 6th February 2009. [5] National AIDS Control Organisation. Manual of Hospital infection control, New Delhi, 1998;50-66 About Authors
Ms. Priti Razdan has graduated in Electronics Engineering from Pune University in the year 1994. She has also done a Diploma in Advanced Computing from C-DAC, Delhi. Since 1997, she has been associated with the Health Informatics Group of C-DAC. In her career span of more than a decade she has had the opportunity to be exposed to the in depth workflow of Government as well as Super speciality Indian hospitals. Mr. Amarjeet Singh Cheema, is an Electrical & Electronics Engineer. He has done his Post Graduation Diploma in Software Design from Electronics Research & Development Centre, Noida. He started his career with C-DAC Noida in the year 2001. He has trained himself as a Functional Analyst in health domain and has done a number of successful implementations in the same area. He has worked on various technologies C/C++, Pro C, Power Builder, JavaJ2EE (Struts Framework), Visual Basic, Oracle.

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