INTRODUCTION Hospital Waste Management means the management of waste produced by hospitals using such techniques that will

help to check the spread of diseases through it. The management of waste poses to be a major problem in most of the countries, especially hospital waste. It is an ongoing problem for many countries. In recent years, medical waste disposal has posed even more difficulties with the appearance of disposable needles, syringes, and other similar items. Pakistan is also facing this problem. Around 250,000 tonnes of medical waste is annually produced from all sorts of health care facilities in the country. This type of waste has a bad affect on the environment by contaminating the land, air and water resources. According to a report, 15 tonnes of waste is produced daily in Punjab. The rate of generation is 1.8 kilograms per day per bed. The province houses 250 hospitals with a total capacity of 41,000 beds.

OBJECTIVES OF THE STUDY To study about various steps involved in waste disposal management

To study about how the waste disposal management helpful to organisation

To study about employees opinion in waste disposal management

To study about various drawbacks of waste disposal management system LIMITATIONS

Time is a major limiting factor. During working hours its difficult to collect answers.

REVIEW OF LITERATURE Different Types

Hospital wastes are categorised according to their weight, density and constituents. The World Health Organisation (WHO) has classified medical waste into different categories. These are:

Infectious: material-containing pathogens in sufficient concentrations or quantities that, if exposed, can cause diseases. This includes waste from surgery and autopsies on patients with infectious diseases;

Sharps: disposable needles, syringes, saws, blades, broken glasses, nails or any other item that could cause a cut; Pathological: tissues, organs, body parts, human flesh, fetuses, blood and body fluids; Pharmaceuticals: drugs and chemicals that are returned from wards, spilled, outdated, contaminated, or are no longer required; 3

Radioactive: solids, liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter; and Others: waste from the offices, kitchens, rooms, including bed linen, utensils, paper, etc.

Guidelines There are Guidelines for Hospital Waste Management In Pakistan since 1998 prepared by the Environmental Health Unit, of the Ministry of Health, Government of Pakistan, giving detailed information and covering all aspects of safe hospital waste management in the country, including the risk associated with the waste, formation of a waste management team in hospitals, their responsibilities, plan, collection, segregation,

transportation, storage, disposal methods, containers, and their color coding, waste minimisation techniques, protective clothing, etc. Improper disposal Hospitals and public health care units are supposed to safeguard the health of the community. However, the waste produced by the medical care centers if disposed of improperly, can pose an even greater threat than the original diseases themselves.

There are no systematic approaches to medical waste disposal. Hospital wastes are simply mixed with the municipal waste in collecting bins at roadsides and disposed off similarly. Some waste is simply buried without any appropriate measure. The reality is that while all the equipment necessary to ensure the proper management of hospital waste probably exists, the main problem is that the staff fails to prepare and implement an effective disposable policy. How does hospital waste affect us? If hospital waste is not managed properly it proves to be harmful to the environment. It not only poses a threat to the employees working in the hospital, but also to the people surrounding that area.

Infectious waste can cause diseases like Hepatitis A & B, AIDS, Typhoid, Boils, etc. People pick up used syringes from the hospital waste and sell them. Many drug addicts also reuse the syringes that can cause AIDS and other dangerous and contagious diseases. If a syringe, previously used by an AIDS patient, is reused, it can affect the person using it. So, the hospital staff should dispose off the syringes properly, by cutting the needles of the syringes with the help of a cutter, so that the needle ca not be reused. When waste containing plastics are burnt, Dioxin is produced, which can cause Cancer, birth defects, decreased psychomotor ability, hearing 5

defects, cognitive defects and behavioral alternations in infants. Flies also sit on the uncovered piles of rotting garbage. This promotes mechanical transmissions of fatal diseases like Diarrhea, Dysentery, Typhoid, Hepatitis and Cholera. Under moist conditions, mosquitoes transmit many types of infections, like Malaria and Yellow fever. Similarly, dogs, cats and rats also transmit a variety of diseases, including Plague and Flea born fever, as they mostly live in and around the refuse. A high tendency of contracting intestinal, parasitic and skin diseases is found in workers engaged in collecting refuse. Solution Some steps should be taken for the minimisation of hospital waste. Before any clear improvement can be made in medical waste management, consistent and scientifically based definitions must be established as to what is meant by medical waste and its components, and what the goals are. Plans and policies should be laid down for this purpose. Then the waste should be segregated. Imposing segregated practices within hospitals to separate biological and chemical hazardous waste will result in a clean solid waste stream, which can be recycled easily. If proper segregation is achieved through training, clear standards, and tough enforcement, then resources can be turned to the management of the small portion of the waste stream needing special treatment. 6

New emphasis should be put on the reduction of waste, workers' safety should be ensured through education, training and proper personal protective equipment.

Incinerators: a solution or a threat? Incineration has been the treatment method of choice for medical waste for two important reasons. First, incineration has always been thought to be the best method of eliminating any infectious organisms that are present in medical waste. Second, incineration has been economical for hospitals because it substantially reduces the volume to be disposed of in a landfill. Waste disposal costs have historically been based on the volume to be disposed. Both of these assumptions behind medical waste incineration are no longer able to support objective scrutiny. Waste is burnt at very high temperatures, that produce emissions full of acidic gases, heavy metals, toxic organisms and dioxins. There is a lot of ash produced by an incinerator as well. Incinerators for medical and municipal waste have been linked to severe public health threats and pollution. The combination of intense public 7

opposition to incineration and increasingly strict environmental pollution regulation has forced the closure or cancellation of many incinerators in industrialised countries. Incinerators are fast becoming an obsolete technology in many developed countries as they are moving towards safer and more economical alternative approaches to medical and municipal waste management. As a result, many incinerator companies are targeting overseas markets where people are not yet aware of the serious health and environmental threats associated with incineration or the many advantages of alternatives. Incinerator companies are now targeting Asia, Africa, and Latin America to sell their toxic technology. Researchers came to the conclusion that Dioxin, as well as mercury and other toxic substances, are emitted when waste is burnt in an incinerator. Dioxin and related chlorinated organic compounds are extremely potent toxic substances that produce a remarkable variety of adverse effects in human and animals at extremely low doses. Mercury is also bio-accumulative and is toxic to the kidneys and nervous system. Readily converted to its organic form in the environment, mercury interferes with normal brain development. Techniques to be used

Various alternative technologies for incineration are available at hospitals in many developed countries. As these techniques are either too complicated or very expensive, they are not being used in Pakistan. Though, these techniques should also be applied here,, for proper waste disposal.

Steam Autoclaving Steam Autoclaving is the most widely used and most efficient alternative medical-waste-treatment technology. Most available autoclaves are designed to handle both biohazard and normal hospital wastes simultaneously. However, they cannot treat pathological animal wastes, chemotherapy wastes, and low level radioactive wastes. These wastes have to be treated separately. Medical waste autoclaves usually jointly operate with a shredder, and a compactor(to minimise the waste volume).

In autoclaves, the effects of heat from saturated steam and increased pressure decontaminate medical waste by inactivating and destroying microorganisms. 9

There are two types of autoclaves, gravity displacement and pre-vacuum. Those designed for medical waste are mostly pre-vacuum. Chemical Treatment In chemical treatment systems, an anti-microbial chemical, such as sodium hypochlorite, chlorine dioxide, or peracetic acid, decontaminates the medical waste. Most chemical treatment systems, currently in use, operate at ambient temperature.

Microwave Radiation In Microwave Radiation, medical waste enters the system by batch or continuous mode, where it is wetted with steam or water and heated by microwave radiation at de-contaminating temperatures. Other Thermal Systems Some systems use a combination of infrared radiation and forced hot-air convection to treat the waste. The waste then is compacted, preparing it for landfill. Other systems use gamma radiation to heat the waste to disinfecting temperatures. A portion of the solid residue obtained is recycled, while the remainder is disposed. Several other thermal systems

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currently under development use steam, oil, electricity or some form of radiation as their source of heat. Disposal of Pathological waste As mentioned above, Pathological waste (body parts, research animals, etc.) cannot be disposed off by autoclaving. For disposal of such waste, either Crematoria (burning of the body) or burial should be performed. Training The hospital staff should be trained in such a manner that they help in disposing off the waste properly.

INDUSTRY PROFILE Recently, much has been said about the healthcare industry in India and its growth. And rightly so; the industry has been gathering steam and making people take notice of its massive growth. Last year, Dr. Prathap C. Reddy, Apollo Hospitals group founder-chairman said in Bangalore that the overall industry will show speedy signs of growth mainly because of increase in life expectancy, higher income levels, greater reach of health insurance, and growing lifestyle-related diseases. In fact, it is already a million-dollar industry that is currently undergoing a rapid expansion phase with 12 percent CGPA (cumulative growth per annum) since 2008. By 2020, the 11

sector will accumulate Rs.1.3 trillion (Rs.12,60,000 crore) in revenues. Government initiatives and public-private partnerships will help create better opportunities for nurses, paramedics, emergency medical technicians and specialized doctors across the country, Dr Reddy said. According to the Investment Commission of India, the market size of hospitals and nursing homes will grow at 20% every year & projected to stand at Rs. 54,000 crore. Medical equipment on the other hand will be somewhere close to Rs. 9,000 crore with 15 per cent growth; clinical lab diagnostics with Rs.4,500 crore - a clear 30 per cent increase. In addition to this, imaging diagnostics will be another money-spinning business standing at Rs.4,500 crore (30 per cent growth). Other services including training and education, aesthetics and weight loss, and retail pharmacy will stand at Rs. 9,000 crore. Theres also been an influx of medical tourism, educational services, and leisure tourism in India which is likely to build up in the coming years drawing an additional $6-50 billion in revenue and producing close to 10-48 million direct and indirect jobs by 2020. Investments in Healthcare Global Ratings agency Fitch recently said that "India's healthcare sector will continue to witness investments in 2012 but at a slow pace, driven by a wide gap between the demand for, and supply of, healthcare services," Fitch 12

Ratings said in its annual report '2012 Outlook: India Health Care'. It further added: "This (slow growth) is due to below-par healthcare infrastructure, especially in Tier II and Tier III cities, increasing lifestyle-related health problems, changing demographics, rising disposable income and insurance penetration, and increasing government support and medical tourism." "The sector will continue to offer investment opportunities in increasing bed capacity, ancillary industries like medical technologies and diagnostics in Tier II and Tier III cities, while specialty services like cardiology, neurology, joint replacements etc, are likely to attract most of the investments in bigger cities," the report said. Rise of the Insurance Industry The Insurance segment is worth $3 billion (Rs 15,000 crore) as of now. Health insurance is growing at 20% and will reach around $13 billion by 2020. So, it is growing at a faster rate than the healthcare industry but, even with that growth, you are talking about a funding gap of over $200 billion. The gap in rupees crore is so significant that the Indian government will have a serious issue in terms of financing healthcare says Mr. Antony Jacob, CEO, Apollo Munich Health Insurance. Competing with other Industries The healthcare segment is moving ahead on the same line as the pharmaceutical or the software industries here. Like manufacturing, this 13

segment also has the power to be the engine of the countrys economy. Thanks to this, many foreign companies will continue to invest in it in the years ahead. The Path Ahead Already, Indias economy is flourishing and the middle class is getting stronger with more disposable income to spend on healthcare services. The Government of India too is in the midst of constantly developing all inclusive policies on healthcare that aim to reinforce the sector a high number of infrastructures and advance medical equipment solutions have been infused in the sector. In the years ahead, the sector holds greater potential and promise.

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HOSPITAL PROFILE Hospital information Adarsha Hospital was inaugurated on 12/10/2005 by His Holiness Shri Shri Shri Vibhudesha Theertha Swamiji of Sri Admar Matt, Udupi. Hospital is situated in the heart of the city very near to KSRTC Bus-stand. Hospital situated in cool noiseless and homely environment with ample parking facility. Hospital is an advanced secondary health care centre started with the main intention of providing comprehensive quality health care with compassion to all the sanctions of society and is very economical in all respects. 15

Hospital is having 100 beds with good spacious well ventilated rooms and enjoyable south west breez. Multiple out-patient departments with specious waiting hall and all the diagnostic modalities. India is facing epidemic Diabetes and it is having maximum number of diabetic patients in the world. By the year 2025 India is burdened with more than 60 million diabetics. Thus India is called as the capital city of Diabetis. Hence the cardiac problems also. To face this emerging cardio diabetic epidemic we dedicated this hospital for Cardio diabetes to face this challenge we are planning to train various medical and paramedical peronals conducting numerous free camps across the region with public awareness programs in hospital and through Medias. To give comprehensive quality health care the hospital management has taken utmost care to appoint various staff and resident Doctors who are in the hospital around the clock. Super specialists from different places are visiting the hospital to impart quality health care. Hospital is having an ISO 9001-2008 certification for its standard.

Departments: Internal Medicine Comprehensive Diabetic Care 16

Orthopaedics General Surgery Obstetrics & Gynaecology Paediatrics and Neonatology Ophthalmology ENT Dental Surgery Radio Diagnosis Skin & STD Physiotherapy

Super specialty departments: Interventional Cardiology Neuro Surgery Neurology Gastroenterology

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Urology Medical Oncology Rheumatology Nephrology Endocrinology Plastic Surgery Diabetic Foot care

Facilities In-patient (Platinum, Delux, Special, Semispecial and General wards with A/C & without A/C) Out-patient 3 Well equipped Operation C arm system with Laporoscopic instruments 18

Labour theatre Medical, Surgical and Neonatal Critical Care Units (25 Beds) Microscopic Eye and Ear surgeries Ventilators and Haemodialysis unit Trauma care centre 300MA & 60MA portable X ray with digirtal CR system Treadmill test Thoshiba Spiral CT scan Cardiac Catheterisation Laboratory (Cath Lab) Video Endoscopy and Colonoscopy facility Ultrasound scanning, Echo Cardiography and Doppler studies Fully computerized laboratory with Nano Lab Leica 40 operating Neuro Microscope & ENT micro scopes Feotal Doppler, baby warmer and Phototherapy Multipara monitors, NIBPS, SPO2 monitors, Cardiac monitors, infusion and syringe pumps 24 hours Ambulance service with Cardiac care. 19

RESEARCH METHODOLOGY Research methodology is a way to solve the research problems. It may be understood as a science of studying how research in done scientifically. Primary and secondary data were made use at along with the data collection. Data collections are done through interviews, questionnaire, interview schedule, observation, magazines, booklet and internet. Source of Data Data is coming from primary and secondary data collection methods. Primary data; 20

Primary data those which are freshly collected from the first and their happen to be original in character. Primary datas are collected by using interview schedules, questioners, interview, observation and by conducting interview with the people (customer) Secondary data; Secondary data are which have been already been ready like magazines, booklet, prospectus etc.. The secondary data is collected also through journals, websites etc

Sample frame Sample frame refers to the place from where the sampling has been drawn. Size of sample It refers to the number of items to be selected from the population. Here in the project the size of is 10. Research Design The research design used here is descriptive design. 21

Sampling The sampling technique here is convenient sampling.

TOOLS FOR ANALYSIS The technique used for analysis and interpretation is percentage analysis pictures, graphical representation like bar diagram, pie diagram, columns, graphs, cylinder chart, cone diagram and doughnut. Percentage Analysis The researcher has used percentage analysis No of respondents 22

Percentage =

* 100

Total No of Sample taken Period of Study The study is conducted during the academic year 2012- 2013

DATA ANALYSIS AND INTERPRETATION TABLE NO 1 No of beds in the hospital Criteria Less than 50 50 100 100 200 Above 200 No of Respondents 0 0 100 0 Percentage of Respondents 0 0 100 0 23

Total

100

100

INTERPRETATION From the above table it is clear that the hospital is having 100 to 200 beds.

GRAPH NO 1

24

TABLE NO 2 Number of beds occupied per day 25

Criteria 0 25 25 50 50 75 75 100 Total

No of Respondents 10 10 70 10 100

Percentage of Respondents 10 10 70 10 100

INTERPRETATION From the above table it is clear that the majority have the opinion that there are 50 to 75 patients in a day.

GRAPH NO 2

26

TABLE NO 3 No of staffs in the hospital in a shift 27

Criteria 0 25 25 50 More than 50 Total

No of Respondents 10 10 70 100

Percentage of Respondents 10 10 70 100

INTERPRETATION From the above table it is inferred that there is 25 to 50 staffs are working in the hospital in a shift.

GRAPH NO 3

28

TABLE NO 4 29

Do department generating dangerous wastes have satellite accumulation areas? Criteria Yes No Total No on Respondents 100 0 100 Percentage of Respondents 100 0 100

INTERPRETATION From the above table it is clear that there are satellite accumulation areas for dangerous wastes.

GRAPH NO 4

30

TABLE NO 5 Are the collection areas properly and clearly identified and labelled 31

Criteria Yes No Total

No on Respondents 100 0 100

Percentage of Respondents 100 0 100

INTERPRETATION From the above table it is clear that the collection areas are clearly and properly labelled and identified.

GRAPH NO 5

32

TABLE NO 6 Does your hospital have a centralized collection area for dangerous wastes? 33

Criteria Yes No Total

No of Respondents 0 100 100

Percentage of Respondents 0 100 100

INTERPRETATION From the above table it is clear that the hospital does not have any centralised collection of dangerous wastes.

GRAPH NO 6

34

TABLE NO 7 35

Is all the waste containers properly labelled with the type of dangerous waste and accumulation start date? Criteria Yes No Sometimes Total No of Respondents 30 30 40 100 Percentage of Respondents 30 30 40 100

INTERPRETATION From the above table it is clear that majority of the respondents have the opinion that the waste containers are not properly labelled.

GRAPH NO 7 36

TABLE NO 8 Are all hazardous waste containers maintained in good condition? 37

Criteria Yes No Sometimes Total

No of Respondents 25 50 25 100

Percentage of Respondents 25 50 25 100

INTERPRETATION From the above table it is clear that the respondents have the opinion that the waste containers are not maintained in good condition.

GRAPH NO 8

38

TABLE NO 9 Do the staffs who handle waste receive hazardous waste management training 39

Criteria Yes No Total

No of Respondents 20 80 100

Percentage of Respondents 20 80 100

INTERPRETATION From the above table it is interpreted that majority of the staff doesnt get any training for handling hazardous waste.

GRAPH NO 9

40

TABLE NO 10

41

Does the hospital keep the log of amounts of dangerous waste generated per month? Criteria Yes No Sometimes Total No of Respondents 20 35 45 100 Percentage of respondents 20 35 45 100

INTERPRETATION From the above table it is clear that the hospital is not maintaining the log of amount of dangerous waste generated per month regularly.

GRAPH NO 10

42

TABLE NO 11 Do you have a contingency plan with a copy filed at your local fire department? 43

Criteria Yes No Total

No of Respondents 0 100 100

Percentage of Respondents 0 100 100

INTERPRETATION From the above table it is clear that the hospital is not maintaining the records of contingency plan.

GRAPH NO 11

44

TABLE NO 12 Do you have emergency response numbers posted near telephone? 45

Criteria Yes No Total

No of Respondents 100 0 100

Percentage of Respondents 100 0 100

GRAPH NO 12

46

TABLE NO 13 Does your management ensure that medical wastes are labelled and managed, properly segregated from dangerous wastes & solid wastes. 47

Criteria Yes No Sometimes Total

No of Respondents 10 50 40 100

Percentage of respondents 10 50 40 100

INTERPRETATION From the above table it is interpreted that the majority have the opinion that management does not ensure that medical wastes are labelled and managed properly segregated from dangerous wastes & solid wastes.

GRAPH NO 13

48

TABLE NO 14 49

Are sharps segregated from other wastes and kept in puncture resistant biomedical waste containers? Criteria Yes No Sometimes Total No of Respondents 18 40 42 100 Percentage of respondents 18 40 42 100

From the above table it is clear that majority of the respondents have the opinion that the sharps are not segregated from other wastes and kept in puncture resistant biomedical waste containers regularly.

GRAPH NO 14 50

TABLE NO 15 51

Are all bio medical waste containers labelled bio medical waste Criteria Yes No Total No of Respondents 0 100 100 Percentage of respondents 0 100 100

INTERPRETATION From the above table it is identified that the bio medical waste containers are not labelled properly.

GRAPH NO 15

52

TABLE NO 16 Does your waste water discharges to 53

Criteria Sewer Septic tank Surface water Total

No of Respondents 0 100 0 100

Percentage of respondents 0 100 0 100

INTERPRETATION From the above table it is clear that the waste water is discharged to septic tank system.

GRAPH NO 16

54

TABLE NO 17 Have you sampled your waste water? 55

Criteria Yes No Sometimes Total

No of Respondents 68 0 32 100

Percentage of respondents 68 0 32 100

INTERPRETATION From the above table it is clear that the hospital has done sampling for the waste water.

GRAPH NO 17

56

TABLE NO 18 What will be the interval for sampling waste water? 57

Criteria Once in a month Quarterly Half yearly Yearly Total

No of Respondents 0 28 46 26 100

Percentage of respondents 0 28 46 26 100

INTERPRETATION From the above table it is clear that majority have the opinion that the interval for sampling is half yearly.

GRAPH NO 18

58

TABLE NO 19 Is there periodic maintenance of treatment plant? 59

Criteria Yes No Total

No of Respondents 100 0 100

Percentage of respondents 100 0 100

GRAPH NO 19

60

FINDINGS 1. There are 100 to 200 beds in the hospital 61

2. There is satellite accumulation centre for dangerous wastes 3. The collection areas are clearly and properly labelled 4. Majority have the opinion that the hospital does not have a centralised collection area 5. Majority have the opinion that the waste containers are not labelled properly 6. Majority said that hazardous waste containers are not maintained in good condition 7. About 80% of the respondents does not received the training 8. The hospital does not have a contingency plan 9. The emergency response information is posted near telephone 10.The management ensures the collection and segregation of waste only to a limit. 11.Sharps are not separated regularly 12.Biomedical waste containers are not labelled properly 13.The waste water is discharged to septic tank system 14.The sampling of waste water is done half yearly 15.There is periodic maintenance of treatment plant

SUGGESTIONS 1. Try to provide centralised collection area for hazardous waste 2. Try to maintain the labelling of waste containers in good condition 62

3. Try to maintain the hazardous waste containers in good condition 4. Provide training for handling of hazardous waste management to all employees 5. Try to keep a log of amount of waste generated per day 6. Try to maintain a contingency plan 7. Label all biomedical waste containers properly 8. Separate and keep sharps in puncture resistant bags

CONCLUSION

If the overall goal of waste management is to prevent disease transmission 63

from waste products, therefore the emphasis should be placed on the "Management" aspect of the process and not on the "technological fix" which is expensive diversion rather than an effective solution. Technology should fit the situation and work in the management system to achieve the final goal as part of the overall system, not as a replacement for the system. Technology choices should be made to meet local needs and conditions. National standards for operating acceptable treatment technologies should be set which should match the international standards practiced in the developed countries.

BIBLIOGRAPHY
Books
Shishir Basarkar, Hospital waste management Mohd. Faizal Khan, Medical waste managemnt

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 C. R. Kothari, Research Methodology

Websites
www.google.com www.who.int/topics/medical_waste/en. https://fortress.wa.gov/ecy/publications

APPENDIX 1. Number of beds? 65

Less than 50 50 to 100 100 to 200 Above 200 2. Average number of beds occupied per day? 0 to 25 25 to 50 50 to 75 75 to 100 3. Number of staff 0 to 25 25 to 50 More than 50 4. Do departments generating dangerous wastes have satellite accumulation areas? Yes No 5. Are the collection/satellite areas properly and clearly identified and labelled? Yes No 6. Does your hospital have a centralized collection area for dangerous waste? Yes No 7. Are all waste containers properly labelled with the type of dangerous waste and accumulation start date? Yes No Sometimes 8. Are all hazardous waste containers maintained in good condition? Yes No Sometimes 9. Do staff who handle waste receive hazardous waste management training? Yes No 10.Does your department keep a log of the amounts of dangerous waste generated per month? Yes No Sometimes 11.Do you have a contingency plan with a copy filed at your local fire department? Yes No 12.Do you have emergency response information posted near a telephone? Yes No

13.Does your management ensure that medical wastes are labelled and managed properly, segregated from dangerous wastes and solid wastes? 66

Yes No Sometimes 14.Are sharps segregated from other wastes and kept in punctureresistant biomedical waste containers? Yes No Sometimes 15.Are all biomedical waste containers labelled biomedical waste? Yes No 16.Does your wastewater discharge to: Sewer Septic system Surface water 17.Have you sampled your wastewater discharge? Yes No Sometimes 18.What will be the interval for sampling waste water? Once in a month Quarterly Half Yearly Yearly 19. Is there periodic maintenance of treatment plant? Yes No

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