Approach for the Assessment and Ranking of Hospitals

Based on Waste Management Practices Using RIAM,

Sustainability, and EPI Techniques
Ria Ranjan Srivastava1 and Nekram Rawal2

Abstract: An environmental impact assessment (EIA) tool is used to assess any proposed development activity. It is beneficial for a detailed
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study of large projects, but less feasible for quick assessments of a smaller project. The rapid impact assessment matrix (RIAM) serves the pur-
pose of quick quantitative assessments of any project. In this study, the RIAM technique used to assess waste management practices of various
hospitals in the city of Prayagraj, India. Based on RIAM scores, the level and nature of the sustainability of waste management practices in
hospitals are checked by the model of sustainability. In addition, the environmental performance index (EPI) is applied with RIAM scores
for comparative study. Hospital “A” was ranked as the most promising sustainability option, with sustainability value (S-value) of 0.2815
and EPI of 211.921, indicating good sustainability. Strict abidance to rules and regulations and regular monitoring is needed to substantially
improve waste management in hospitals. DOI: 10.1061/(ASCE)HZ.2153-5515.0000583. © 2020 American Society of Civil Engineers.
Author keywords: RIAM; Environmental performance index; Sustainability analysis; Waste management; Hospitals.

Introduction hazardous but not infectious. Specifically in India, 15%–35% of

Hospitals play a vital role in society’s health and well-being; they
provide healthcare services and give life-saving services to people.
Due to industrialization and a continuing population boom, people
have started migrating toward cities from villages, leading to an in-
crease in pollution (i.e., air, water, solid, and other types of waste)
that causes illness to the people (Rawal et al. 2012, 2017). The mi-
gration of people and increased population density has accelerated
the rate of illness and injury instances among people, leading to in-
creased demand for improved healthcare services. Most hospitals in
a city have facilities such as intensive care, psychiatric, trauma cen-
ters, surgery, specialized hospitals, for serving patients. Huge quan-
tities of waste are generated from various departments in the
hospital, which can be categorized into nonhazardous, hazardous,
and infectious wastes, having the potential to affect environmental
surroundings and living beings (Rao et al. 2004; WHO 2014;
Nichols et al. 2016; World Bank 2016). The US Environmental
Protection Agency (USEPA) reports that on their premises health-
care facilities generate hazardous wastes, such as injections, nee-
dles, discarded dressings, body tissues and parts, disposed blood
samples, expired medicines, pharmaceuticals, and waste from ra-
dioactive departments, along with nonhazardous wastes, such as
packaging waste, medication boxes, and office waste (Aljabre
2002; Abdulla et al. 2008; Ananth et al. 2010). A World Health
Organization report (WHO 2011) states that around 10% of
waste generated from hospitals is infectious, and 5% of waste is
1
Research Scholar, Dept. of Civil Engineering, IIT (BHU), Varanasi
221005, India. Email: ria.srivastava03@gmail.com
2
Associate Professor, Dept. of Civil Engineering, Motilal Nehru
National Institute of Technology, Allahabad, Prayagraj 211004, India
(corresponding author). ORCID: https://orcid.org/0000-0003-1534-7747.
Email: nek_friend@rediffmail.com
Note. This manuscript was submitted on May 19, 2020; approved on
September 25, 2020; published online on November 30, 2020. Discussion
period open until April 30, 2021; separate discussions must be submitted
for individual papers. This paper is part of the Journal of Hazardous,
Toxic, and Radioactive Waste, © ASCE, ISSN 2153-5493.
hospital waste is classified as infectious, 10%–25% are hazardous
wastes, and 40%–60% are nonhazardous wastes (Glenn and
Garwal 1999; Chitnis et al. 2005; Voudrias 2018). Hospitals and
municipal corporations are responsible for the management
and disposal of the waste produced by hospitals. Hospitals follow
the biomedical waste management (amendment) 2018 rules by mu-
nicipal agencies for safe waste collection and their disposal in
India. The hospital management of solid waste generated is one
of the significant strategic works at the hospital level to improve
its quality and hygiene. Benefits, such as reducing costs associated
with hygiene and other services, improvement in service quality,
and, ultimately, a better standard of living for individuals, can be
achieved by practicing safe and sustainable solid waste manage-
ment in hospitals.
Pastakia developed the RIAM technique widely being used by
many researchers in various multiple-criteria decision-making
(MCDM) problems (Pastakia 1998; Pastakia and Jensen 1998;
Cartalis et al. 2000; El-Naqa 2005; Haie 2005; Rawal et al.
2017). Impacts of waste management and their significance can
be evaluated under a broad range of criteria and aspects using the
RIAM technique. RIAM organizes, analyzes, and presents the re-
sult in both quantitative and qualitative forms for assessment. It
can be used for selecting the sustainable waste management prac-
tices and associated requirements, such as the selection of suitable
landfill site for secure disposal of waste (Mohan et al. 2017; Rawal
et al. 2019; Suthar and Sajwan 2014), as well as for checking the
suitability of solid waste dumpsite (Kumar et al. 2019).
Prayagraj is regarded as a holy city. It is a metropolitan city in
the state of Uttar Pradesh, India, and is situated near the confluence
of the Ganga, Yamuna, and Saraswati Rivers, popularly called
SANGAM. The map shown in Fig. 1 represented the study area
located at 25.25° North latitude and 81.58° East longitude. The
Municipal Corporation of Prayagraj is endowed with the responsi-
bility of the management of solid waste generated from hospitals in
this city. Prayagraj has a total area of 70.05 km2 and is divided into
97 wards. As per the census, Prayagraj had a population of 1,087,167
in the year 2011 and its population was 1,294,505 in 2018.

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Fig. 1. Study area: Prayagraj, India. (Reprinted with permission from Prayagraj Municipal Corporation.)

Table 1. List of hospitals and their details

Kidney Research and
Hospitals No. of beds Maternity OPD Surgery Paediatrics Neonates ICU dialysis Orthopaedic Emergency Lab development
A 250 Y Y Y Y Y Y Y Y Y Y N
B 40 Y Y Y Y Y Y Y Y Y N N
C 50 Y Y Y Y Y Y Y Y Y Y N
D 100 Y Y Y Y Y Y Y Y Y Y Y
E 60 Y Y Y Y Y Y Y Y Y N N
F 100 Y Y Y Y Y Y Y Y Y Y N
G 50 Y Y Y Y Y Y Y Y Y Y N
H 15 N N Y N N Y N Y N N N
I 350 Y Y Y Y Y Y Y Y Y Y N
J 102 Y Y Y Y Y Y Y Y Y Y N
K 100 Y Y Y Y Y Y Y Y Y Y N
L 50 Y Y Y Y Y Y Y Y Y N N
M 199 Y Y Y Y Y Y Y Y Y Y N
Note: Y = yes; and N = no.

Prayagraj has about 30 hospitals; only five hospitals are govern-
ment hospitals and the rest are private hospitals. Most hospitals
have a tie-in with a private agency to manage solid waste, including
biomedical waste. The Ferron Agency collects waste from the hos-
pitals and transfers it to the incineration plant near Naini, Prayagraj.
For this study, 13 hospitals are considered out of which two are
government hospitals and rest (i.e., 11) are private hospitals
(AMC, unpublished data, 2018). As per the confidentiality policy
of the survey, which protects the identities of hospitals under this
study, fictitious names were used for hospitals (e.g., A, B, C).
The list of hospitals and their details is presented in Table 1. In
this paper, the waste management practices in hospitals were
used to rank the hospitals in Prayagraj using the RIAM technique
and EPI. The questionnaire, based on different aspects, was used
for surveying hospitals to assess their solid hazardous waste man-
agement (HWM) practices covered several issues, such as HWM
policy & guidelines, and liquid healthcare waste management prac-
tices. The nature and level of sustainability of hospitals were indi-
cated and hospitals were ranked based on analysis of results
compliance with Bio-Medical Waste Management (Amendment)
Rules (2018) conferred by the Environmental (Protection) Act
(1986), of the Government of India used as the standard.
Methodology
Survey and Baseline Data Collection
The 13 hospitals were surveyed through questionnaires in the city
of Prayagraj. The questionnaire consisted of questions based on
physical, chemical, biological, ecological, sociological, cultural,
economic, and operational aspects of solid HWM practices in hos-
pitals. Several times to visit these hospitals for questionnaire sur-
veys and collected baseline data for study. The list of questions
in questionnaire, as shown in the Appendix, were based on aspects
such as the quality of waste, hygienic condition, storage facility,
hospital follow waste management policy, waste transportation-
related air pollution issues, trained waste handling staff, and treat-
ment cost of waste, for baseline data collection. Approximately 300
respondents, including patients, staff members of hospitals, and
waste collection workers, were approached (about 25 respondents
per hospital). Nearly 245 responded in all 13 hospitals. RIAM an-
alyzed all the 13 hospitals’ responses for the existing waste man-
agement practices and hygienic conditions of hospitals. Suitable
weights were allotted to different components using the analytic
hierarchy process (Pastakia 1998; Pastakia and Jensen 1998).

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 Environmental scores (ES) for each component were obtained by
using the RIAM tool. The EPI values were also obtained for all
the hospitals. The sustainability analysis was also undertaken to
rank the hospitals by comparing the environmental conditions
under consideration.
Rapid Environmental Impact Assessment (RIAM) Method
Appropriate literature, environmental experts, and officials from
the hospital’s management were consulted while preparing and
framing the questionnaire. The questionnaire consisted of criteria
based on different aspects concerning the hospital’s solid waste
management practices, such as physical, chemical, biological, eco-
logical, sociological, cultural, economic, and operational. The
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questionnaire included eight questions on physical/chemical (PC)
aspects; six questions on biological/ecological (BE) aspects; five
questions on sociological/cultural (SC), including human aspects;
and five questions on identifying the economic/operational (EO)
aspects. An exhaustive survey was conducted at the hospitals or
their nearby vicinity to get information about their HWM practices.
The responses obtained from the patients, staff members of hospi-
tals, and waste collection workers of the hospitals were analyzed
using the RIAM method.
The RIAM method is based on a grading system. The quantita-
tive numerical values are assigned to each qualitative question for
each aspect. Thereby, solid waste management practices were as-
sessed to obtain a final environmental score by analyzing their
values in different aspects. The important assessment criteria
were as follows:
Criterion A: Magnitude of the condition, they can independently
affect the score obtained, and;
Criterion B: Significance of the situation, they cannot indepen-
dently change the score obtained.
The questionnaire helps to find the value as mentioned in each cri-
terion (Pastakia 1998). The scores for each aspect are computed by
four evaluation criteria as given by Pastakia and Jensen (1998). It
includes the importance of impact (A1), magnitude (A2), permanence
(B1), reversibility (B2), and cumulatively (B3). The score “AT” in
Eq. (1) depends on impact (A1), magnitude (A2) scores mentioned
in criterion A, and the score “BT” in Eq. (2) depends on permanence
(B1), reversibility (B2), and cumulatively (B3) scores mentioned in cri-
terion B. The ES is computed by Eq. (3) for knowing the condition of
waste management in hospitals:
(A1 ) × (A2 ) = AT
(B1 ) + (B2 ) + (B3 ) = BT
(AT ) × (BT ) = ES
The Eqs. (1)–(3) are used to compute and obtain the ES. The
overall assessment of each aspect in a questionnaire is made as
per the given criteria. The individual ES of each aspect for the hos-
pital’s waste management conditions are categorized under differ-
ent banded ranges given by Pastakia (1998), and their assessment
criteria represent the inference. The ranges define the positive or
negative impact of hospitals’ waste management conditions and
acts as the qualitative indicator of the conditions.
Sustainability Analysis
The concept of sustainable analyses is based on qualitative analyses
of the aspects, such as environment, social, and institutional well-
being of the hospital. The four aspects are considered in the
RIAM method and their obtained results are used for sustainable
© ASCE
J. Hazard. Toxic Radioact. Waste, 2021, 25(2): 04020076
analysis. In this study, each hospital’s waste management condition
is evaluated by applying a sustainable analysis approach for rank-
ing of the hospitals to know which is more sustainable in terms of
waste management condition. The sustainability (S) of the hospitals
concerning the environment (E) with human need and interest
(HNI) are calculated by



PG + BE
E= (4)
PCmax + BEmax



(SCmax − SC) + (EOmax − EO)
HNI = (5)
SCmax + EOmax
S = E − HNI (6)
The system is sustainable if E > HNI then S > 0. The value of S
defines the level and nature of sustainable development. The
value of S ranges from 0.751 to 1 refer to as very strong; from
0.501 to 0.75 refer as strong; from 0.251 to 0.5 refer as weak;
and from 0.001 to 0.25 refer to as very weak sustainable develop-
ment. If E < HNI, then S ≤ 0 and the system is not sustainable
(Phillips 2009, 2010).
Environmental Performance Index (EPI)
The EPI method is used to find out the best hospital from among the
city’s alternative options. The results obtained from the RIAM
analysis are used for computation of EPI score. The EPI score re-
flects the quantitative comparison of alternative options and hospi-
tals’ suitability is compared, as mentioned by Pastakia (1998).
Rawal et al. (2017) suggested calculating EPI score by
EPI = ηP1 + βP2 + γP3 + δP4 (7)
where η, β, γ, and δ are the ES obtained from the RIAM method for
each aspect (i.e., PC, BE, SC, and EO aspects, respectively). The
P1, P2, P3, and P4 are the priority vectors of the PC, BE, SC, and
EO aspects, respectively. Saaty (1980) in the analytic hierarchy
process (AHP) suggested a paired comparison matrix to get the pri-
ority vectors between the four aspects used in RIAM method.
Results and Discussions
(1) The responses contained in the questionnaires obtained from the
patients, staff members of hospitals, and waste collection workers
(2) of various hospitals were analyzed to draw inferences. The discrep-
ancies in the waste management practices and hygienic conditions
(3) of all 13 hospitals were juxtaposed. The outcome of the analysis of
hospitals indicates the positive as well as negative impacts on dif-
ferent aspects of the RIAM. The ES of an individual matrix of
RIAM analysis of all 13 hospitals and their details are represented
in Table 2. The summary of the ES of all the components is illus-
trated in Figs. 2(a and b) for A Hospital to M Hospital.
ES obtained for A Hospital is the strongest and is, therefore, the
most sustainable hospital among the surveyed hospitals in Prayagraj.
It has very high BE and PC positive impacts. Figs. 2(a and b) sug-
gests the all the concerned aspects PC, BE, SC, and EO are on the
positive side and, hence, have no negative impacts, thereby satisfying
the biomedical waste management rules. Fig. 3(a) represents the
comparison of RIAM-based ES obtained for different hospitals for
each criterion. The ES obtained for B Hospital has a negative
value in all the four aspects (i.e., 25% PC, 50% BE, 40% SC, respec-
tively). Positive values in some criteria under PC and EO are also ob-
tained due to hygienic conditions in hospitals. B Hospital must check
04020076-3 J. Hazard. Toxic Radioact. Waste
 Table 2. RIAM analysis for hospitals
Hospitals A B C D E F G H I J K L M
PC1 63 42 63 18 21 21 −42 21 63 63 42 21 63
PC2 54 −27 36 −27 −27 −18 −54 −18 36 36 18 18 36
PC3 28 −14 28 7 −7 −14 −14 −14 28 28 −14 14 28
PC4 81 9 0 0 0 54 0 0 54 0 54 0 54
PC5 12 12 −12 12 12 6 −12 6 18 12 12 12 18
PC6 18 12 12 12 12 6 6 −6 12 12 18 12 18
PC7 21 28 14 14 28 7 −14 7 21 14 14 14 21
PC8 18 12 −6 12 12 12 6 6 12 12 12 12 18
BE1 12 12 6 12 12 6 12 6 12 12 12 12 6
BE2 18 6 −6 12 6 12 6 6 18 12 12 12 12
BE3 54 −18 18 −18 −18 −18 −36 −18 18 36 −18 −18 36
BE4 36 −27 18 27 −27 −18 27 18 36 18 −18 −18 18
−9 −9 −9 −9 −9 −18 −9 −9
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BE5 18 18 18 18 9
BE6 81 54 81 81 27 −27 −54 54 54 54 27 27 54
SC1 18 9 27 18 18 9 −9 −9 27 18 18 9 18
SC2 12 6 −12 12 6 6 6 6 18 12 12 12 12
SC3 12 6 12 12 6 12 −6 −6 12 12 12 12 12
SC4 18 −18 18 36 −18 18 −36 −9 18 9 9 −9 18
SC5 54 −27 27 54 −27 −27 −27 −27 54 27 −27 −27 54
E01 27 27 18 27 27 9 27 9 18 9 9 9 18
E02 54 18 36 18 18 18 18 18 36 18 18 18 36
E03 24 8 16 8 8 8 8 8 16 8 8 8 16
E04 16 32 24 32 16 8 16 8 16 16 8 8 24
E05 6 0 0 0 0 0 0 0 12 12 0 0 12
Sn-value (%) 28.15 5.86 15.72 15.10 3.88 3.48 −6.32 1.85 23.73 16.44 9.35 6.34 23.41
EPI 215.16 40.28 109.77 88.57 24.89 4.00 −59.55 29.71 168.45 123.98 67.83 50.55 168.45

water pollution and prevent leakage of hospital liquid waste
and waste exposure to rodents. It should pay more attention to proper
waste management and follow the HWM policy and guidelines and
liquid healthcare waste management practices as given by the
Government of India.
C Hospital has 25% PC, 20% SC, and 33.33% BE impacts, in
the negative range. It must improve the hospital and hazardous
waste storage facility to prevent waste exposure to insects/rodents.
It must improve its aesthetic impact and check odor problems. D
Hospital has 33.33% BE and 12.5% PC impacts, in the negative
range. It must check leakage of waste, pay more attention to
water pollution, and check the exposure of waste to insects/rodents.
E Hospital has 25% PC, 50% BE, and 50% SC, in the negative
range, respectively. It must check water pollution and prevent leak-
age of waste. It must check the exposure of waste to rodents and
address air pollution issues due to waste transportation. It should
pay more attention to the prevention of the spread of diseases.
F Hospital has 25% PC, 66.67% BE, and 20% SC impacts, in the
negative range. It needs to check the mixing of infectious waste in
any form with general waste, prevent water pollution, and leakage.
It should prevent exposure to rodents and address air pollution issues.
G Hospital has 80% SC, 50% BE, and 82.5% PC, in the negative
range. It has high, unsustainable values. It must strictly follow
waste management policies and work toward protecting the public
and environment by maintaining hygienic conditions and having tie-
ups with proper waste disposal agencies. It must check the leakage of
waste and water pollution. It has high negative SC impacts and must
immunize and train waste-handling staff, and do careful management
of hazardous substances to prevent the spread of disease and keep
hygienic conditions. H Hospital has 50% PC, 33.33% BE, and
80% SC impacts, in the negative range. It must check the leakage
of waste and water pollution. It has high negative SC impacts. It
must train staff in proper waste handling and do careful management
of hazardous substances, prevent disease spread, and keep hygienic
conditions.
I Hospital is healthy and sustainable in all the four compo-
nents. The ES obtained for I Hospital has significant positive
values in all the four aspects. The existing solid waste manage-
ment practices in I Hospital is better than most of the surveyed
hospitals. J Hospital is sustainable in all but one BE component.
The ES of J Hospital shows a positive impact on physical, eco-
logical, and social components. It must check the exposure of
waste to insects and rodents. K Hospital has 12.5% PC,
33.33% BE, and 20% SC impact, in the negative range. It
must prevent leakage of hospital liquid waste and check odor
and air pollution issues; it must focus on storage and exposure
to rodents.
The ES of L Hospital has a profoundly negative impact (i.e.,
40% and 33.33% in SC and BE aspects, respectively). Few positive
values also noted in the PC and EO components due to contracts
with Ferron Agency to collects waste from the hospitals. It needs
improvement in the safe management of hazardous substances
and, thus, preventing the risk of diseases.
M Hospital is healthy and sustainable in all four components.
The ES of M Hospital shows a highly positive impact on physical,
biological, and ecological and social components compared with
other hospitals.
The sustainability waste management condition of hospitals is
evaluated by the sustainability model for ranking of the hospitals.
The sustainability (S) of the hospitals concerning the environment
(E) with human need and interest (HNI) are calculated by the sus-
tainability model, as mention in Eqs. (4)–(6). Fig. 3(b) represents
the Sn values (%) of different hospitals.
Calculation of max ES totals:
PCmax = 8 × 216 = 1,728
SCmax = 5 × 216 = 1,080
BEmax = 6 × 216 = 1,296
EOmax = 5 × 216 = 1,080

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(a) (b)

(c) (d)

(e) (f)

Fig. 2. RIAM analysis of hospitals: (a) A Hospital; (b) B Hospital; (c) C Hospital; (d) D Hospital; (e) E Hospital; (f) F Hospital; (g) G Hospital; (h) H
Hospital; (i) I Hospital; (j) J Hospital; (k) K Hospital; (l) L Hospital; and (m) M Hospital.

Calculation of relative ES totals: Calculate HNI totals:

HNI = ((SCmax − SC) + (EOmax − EO))/(SCmax + EOmax)
PC = 8 × 108 + 295 = 1,159 HNI = ((1,080 − 654) × (1,080 − 667))/(1,296 + 1,080)
SC = 6 × 108 + 114 = 654 HNI = 0.388426
BE = 5 × 108 + 219 = 867 Determine S value:
EO = 5 × 108 + 127 = 667
S = E –HNI
= 0.669974 − 0.388426 = 0.281548
Calculate E totals:
Since S > 0, the hospital under consideration is sustainable.

E = (PC + BE)/(PCmax + BEmax) Environmental Performance Index (EPI)

= (1,159 + 867)/(1,728 + 1,296) To determine the environmental significance of each hospital, the
E = 0.669974 EPI was evaluated using the results obtained in the RIAM analysis.

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 (g) (h)
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(i) (j)

(k) (l)

(m)

Fig. 2. (Continued.)

The pair-wise comparisons are performed systematically using relationships, as mention in Table 3. The comparison matrix re-
the concept of analytic hierarchy process. This includes all sults for finding the weight or priority vector of each aspect are
the combinations of physical/chemical, biological/ecological, given in Table 4. It was using all the values in Eq. (7) for finding
social/cultural, and economical/operational components the EPI. It helps in the exact identification of the environmental

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(a)

(b)

Fig. 3. (a) The relative representation of RIAM based environmental scores (ES); and (b) Sn values (%) and EPI values of different hospitals.

condition of hospitals. where SPC = summation of ES of PC component; SBE = summation

of ES of BE component; SSC = summation of ES of SC component;
and SEO = summation of ES of EO component.
EPI = (0.277 × SPC) + (0.465 × SBE) Based on the applied sustainability model and EPI models,
+ (0.095 × SSC) + (0.161 × SEO) the considered hospitals are ranked and Table 5 represents the

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 Table 3. Developing reciprocal matrix by paired comparison not immunized by the hospital authorities. The hospital maintains
Criteria PC BE SC EO
just-qualifying hygienic conditions.

PC 1 0.5 3 2
BE 2 1 4 3
SC 0.34 0.25 1 0.5 Appendix. Questionnaire on Waste Management
EO 0.5 0.34 2 1 Practices in Hospitals
Sum 3.83 2.08 10 6.5
The questionnaire consisted of criteria based on physical/chemical
(PC), biological/ecological (BE), sociological/cultural (SC) and
Table 4. Normalized relative weight and priority vector economic/operational (EO) aspects concerning the hospital's
Standardized criteria PC BE SC EO Weights solid waste management practices.
PC 0.26 0.24 0.3 0.30 0.277
BE 0.52 0.48 0.4 0.46 0.465 Questionnaire on Waste Management Practices
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SC 0.08 0.12 0.1 0.07 0.095 in Hospitals

EO 0.13 0.16 0.2 0.15 0.161
1. Physical/Chemical Components:
a. No. of beds…………………………
Table 5. Ranking of hospitals based on sustainability model and EPI b. No. of in/outpatients……………………
Rank based on
c. Waste generated per bed per day ……………..
sustainability model S (%) Rank based on EPI EPI d. Waste Segregation Yes/No
e. Waste recycling rate per day…………….
1 A Hospital 28.15 1 A Hospital 215.16 f. Waste collection frequency………………..
2 I Hospital 23.73 2 I Hospital 168.45
g. Waste storage period…………………
3 M Hospital 23.41 3 M Hospital 166.04
4 J Hospital 16.44 4 J Hospital 123.98 h. Waste disposal frequency……………….
5 C Hospital 15.72 5 C Hospital 109.77 i. Waste incinerated per day…………….
6 D Hospital 15.10 6 D Hospital 75.17 j. Mixing with infectious waste Yes/No
7 K Hospital 9.35 7 K Hospital 67.83 k. Packaging of sharps Yes/No
8 L Hospital 6.34 8 L Hospital 50.55 l. Quality of waste bags/sacks employed Bad/Good/Very
9 B Hospital 5.86 9 B Hospital 40.28 Good
10 E Hospital 3.88 10 H Hospital 29.71 m. Radioactive/Carcinogenic waste generated Yes/No
11 F Hospital 3.48 11 E Hospital 24.89 n. No. of cleaning personnel employed ………………
12 H Hospital 1.85 12 F Hospital 4.00 2. Biological/Ecological components:
13 G Hospital −6.32 13 G Hospital −59.55
a. Open/closed storage……………
b. Means of waste collection (Special/General)…………….
c. Disposal Area Vicinity……………….
hospital ranking on the basis score obtained in the sustainability d. Storage Area Vicinity………………..
model and EPI. e. Fly Control Yes/No
f. Odor Control Yes/No
g. Exposure to insects/animals Yes/No
Conclusion h. Risk of mixing with nearby water source or leaching Low/
High
In this study, 13 hospitals were surveyed in Prayagraj for ranking i. Risk of leakage while collection/handling Low/High
j. Risk from sharps, chemicals, drug Low/High
them based on their efficient, stable waste management systems.
3. Economical/Cultural Components:
G Hospital ranks lowest, while A Hospital is on top. These ranks
a. Cost of safety materials/measures……………….
are found using two models, namely the sustainability analysis
b. Cost of sacks/bags……………..
model and the EPI model. The sustainability model consists of
c. Cost of employing personnel for cleaning……………….
two parameters that take PC/BE and SC/EO values separately
d. Cost of treatment provided (if any)/sterilizing
and compare them. The EPI model assigns priority vectors to dif- waste…………………..
ferent components by applying AHP. A Hospital is ranked highest e. Cost of waste collection/disposal…………………….
due to its exceptionally efficient solid HWM practices. It is one of f. Cost of installing control devices……………………
the biggest hospitals in Prayagraj and not only plays a vital role for g. Cost of transportation involved………………………….
its patients but, by taking proper measures, it also plays a crucial h. Cost of infrastructure for storage………………………….
role in the entire city. It has installed a water treatment plant, has i. Cost for radioactive waste handling-encapsulation, etc.
excellent aesthetics, and has very safe storage and handling facili- ……………………
ties. It has highly efficient and careful waste segregation sections, j. Financial viability of recycling……………………..
in which the waste is segregated at source and the waste is sprayed k. Cost of incineration………………………………
with chemicals to prevent the breeding of insects. The waste is 4. Social/Cultural Components:
taken to the disposal site twice a day in closed dumpsters, and spe- a. Aesthetic problem Yes/No
cial attention is given to the cleanliness and hygienic conditions b. Exposure to public health Bad/Very Bad
that prevent the risk of any disease. G Hospital is ranked lowest c. Regular cleaning of storage area Yes/No
among the surveyed hospitals. It lacks basic facilities, such as d. Safe transportation Yes/No
proper storage or a proper waste disposal tie-ups facility. The gen- e. Proper packaging to limit vectors and rodents Yes/No
erated waste is treated carelessly by untrained employees who are f. Gas and ash emission from incinerator Yes/No

© ASCE 04020076-8 J. Hazard. Toxic Radioact. Waste

J. Hazard. Toxic Radioact. Waste, 2021, 25(2): 04020076

 g. Control devices with incinerator Yes/No
h. Compliance with state and central authority regulations
Yes/No
i. Outsourcing to larger treatment facility (if any) Yes/No
j. Immunization of cleaning personnel against hepatitis B
Yes/No
k. Training for waste handling Yes/No
l. Safety measures for personnel like gloves, mask Yes/No
m. Emergency procedures…………………..
n. Waste reduction/recovery procedures………………
o. Biological hazard symbol……………………….
p. Color-coded bag Yes/No
Downloaded from ascelibrary.org by Carleton University on 11/30/20. Copyright ASCE. For personal use only; all rights reserved.
Data Availability Statement
All data generated during the study appear in the published article.
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