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HOSPITAL WASTE

MANAGEMENT
By
Wirsal Hasan

• Hospital is a place of almighty, a
place to serve the patient. Since
beginning, the hospitals are known
for the treatment of sick persons but
we are unaware about the adverse
effects of the garbage and filth
generated by them on human body
and environment.

• Now it is a well established fact that
there are many adverse and harmful
effects to the environment including
human beings which are caused by
the "Hospital waste" generated
during the patient care.

. have compelled the authorities to think seriously about hospital waste and the diseases transmitted through improper disposal of hospital waste. • Hospital acquired infection. rising incidence of Hepatitis B. public and flora and fauna of the area. and HIV. transfusion transmitted diseases. increasing land and water pollution lead to increasing possibility of catching many diseases. Hydrochloric acid etc.• Hospital waste is a potential health hazard to the health care workers. Dioxin. • Air pollution due to emission of hazardous gases by incinerator such as Furan.

• This problem has now become a serious threat for the public health and. the Central Government had to intervene for enforcing proper handling and disposal of hospital waste and an act was passed in July 1996 and a bio-medical waste (handling and management) rule was introduced in 1998. ultimately. .

e. • The last century witnessed the rapid mushrooming of hospital in the public and private sector.• A modern hospital is a complex. • All these products consumed in the hospital leave some unusable leftovers i. . hospital waste. dictated by the needs of expanding population. • The advent and acceptance of "disposable" has made the generation of hospital waste a significant factor in current scenario. multidisciplinary system which consumes thousands of items for delivery of medical care and is a part of physical environment.

• What is hospital waste • Hospital waste refers to all waste generated. discarded and not intended for further use in the hospital .

body part.g. culture and stocks of infectious agents from laboratories. It is hazardous e. paper. It is hazardous waste. blood and body fluid. e. • (3)        Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that could cause diseases.g. • (2)        Pathological waste: Consists of tissue. human foetuses. kitchen waste. packaging material. It is nonhazardous to human beings. organ. waste from surgery. wrappers. plastics. .• Classification of hospital waste • (1)        General waste: Largely composed of domestic or house hold type waste. waste originating from infectious patients.

g. blades. house keeping. have been spilled. or contaminated. and gaseous waste that is contaminated with radionucleides generated from in-vitro analysis of body tissues and fluid. liquid and gaseous chemicals e.g. drugs. • (5)        Pharmaceutical waste: This includes pharmaceutical products. cleaning. . scalpels. broken glass. saws. nail. in-vivo body organ imaging and tumour localization and therapeutic procedures. a cut or puncture of skin e. • (7)        Radioactive waste: It includes solid. liquid. are outdated. needles. • (6)        Chemical waste: This comprises discarded solid. and chemicals that have been returned from wards. and disinfecting product.• (4)        Sharps: Waste materials which could cause the person handling it.

4.S.A.5 • U.• Amount and composition of hospital waste generated • (a) Amount • CountryQuantity (kg/bed/day) • U.K.5 • France2.2.0 • India1.5 • Spain3.5 .

• • • • • • • • • • • (b) Hazardous/non-hazardous Hazardous15% a) Hazardous but non-infective5% b) Hazardous and infective10% Non-hazardous85% (c) Composition By weight    Plastic14% Combustible   Dry cellublostic solid45%  Wet cellublostic solid18% Non-combustible 20% .

• Biomedical waste • Any solid. including it's container and any intermediate product. . fluid and liquid or liquid waste. treatment or immunisation of human being or animals. or in the production or testing of biological and the animal waste from slaughter houses or any other similar establishment. All biomedical waste are hazardous. which is generated during the diagnosis. in research pertaining thereto. In hospital it comprises of 15% of total hospital waste.

• Rationale of hospital waste management • Hospital waste management is a part of hospital hygiene and maintenance activities. "Biomedical waste" is hazardous. material and machine for management of hospital waste ? . man power. then 100% waste becomes hazardous. In fact only 15% of hospital waste i.e. • But when hazardous waste is not segregated at the source of generation and mixed with nonhazardous waste. not the complete. • The question then arises that what is the need or rationale for spending so much resources in terms of money.

ll categories of hospital personnel and waste handler.The reasons are: • ·         injuries from sharps leading to infection to a. . • ·        nosocomial infections in patients from poor infection control practices and poor waste management. • ·         risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals.

treatment rooms etc. labour rooms. The biomedical waste should be segregated as per categories mentioned in the rules. diagnostic services areas. operation theaters. notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India). (medical and paramedical personnel). all patient care activity areas.e.g. nurses. • 1. technicians etc. doctors. The responsibility of segregation should be with the generator of biomedical waste i. . Segregation of waste • Segregation is the essence of waste management and should be done at the source of generation of Bio-medical waste e.• Approach for hospital waste management • Based on Bio-medical Waste (Management and Handling) Rules 1998.

At ordinary room temperature the collected waste should not be stored for more than 24 hours.• 2. . Collection of bio-medical waste • Collection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules.

Microbiology and Biotechnology waste-do-Yellow/Red • 4.Waste sharpPlastic bag puncture proof containersBlue/White Translucent . • CategoryWaste classType of containerColour • 1.• Type of container and colour code for collection of bio-medical waste.Animal waste-do--do• 3.Human anatomical wastePlasticYellow • 2.

Incineration wastePlastic bagBlack • 9.Discarded medicines and Cytotoxic wastePlastic bagsBlack • 6.Solid (biomedical waste)-do-Yellow • 7.• 5.Solid (plastic)Plastic bag puncture proof containersBlue/White Translucent • 8.Chemical waste (solid)-do--do- .

• 3. • Desiccated wheeled containers. trolleys or carts should be used to transport the waste/plastic bags to the site of storage/ treatment. Transportation • Within hospital. • Separate time should be earmarked for transportation of bio-medical waste to reduce chances of it's mixing with general waste. . waste routes must be designated to avoid the passage of waste through patient care areas.

• ·         risk of air. or due to defective incineration emissions and ash.• ·         risk associated with hazardous chemicals. being repacked and sold off to unsuspecting buyers. • ·         "disposable" being repacked and sold by unscrupulous elements without even being washed. • ·         drugs which have been disposed of. drugs to persons handling wastes at all levels. water and soil pollution directly due to waste. .

. does not have any sharp edges and is easy to clean and disinfect. remains secured during transportation. • Hazardous biomedical waste needing transport to a long distance should be kept in containers and should have proper labels. • The wheeled containers should be so designed that the waste can be easily loaded.• Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage.

lined internally with stainless steel or aluminium to provide smooth and impervious surface which can be cleaned. The load compartment should be provided with roof vents for ventilation.• The transport is done through desiccated vehicles specially constructed for the purpose having fully enclosed body. . • The drivers compartment should be separated from the load compartment with a bulkhead.

Treatment of hospital waste Treatment of waste is required: • to disinfect the waste so that it is no longer the source of infection. • make waste unrecognizable for aesthetic reasons. • make recycled items unusable. . • to reduce the volume of the waste.• 4.

1 General waste • The 85% of the waste generated in the hospital belongs to this category. safe disposal of this waste is the responsibility of the local authority.• 4. . The.

2 bio-medical waste: 15% of hospital waste • ·         Deep burial: The waste under category 1 and 2 only can be accorded deep burial and only in cities having less than 5 lakh population.• 4. • ·         .

       .• Autoclave and microwave treatment Standards for the autoclaving and microwaving are also mentioned in the Biomedical waste (Management and Handling) Rules 1998.6. • The waste under category 3.4. • All equipment installed/shared should meet these specifications.7 can be treated by these techniques. Standards for the autoclaving are also laid down.

sharps (needles.• Shredding: The plastic (IV bottles. syringes. catheters etc. . blades. IV sets. glass etc) should be shredded but only after chemical treatment/microwaving/autoclaving. Needle destroyers can be used for disposal of needles directly without chemical treatment.).

6 can be incinerated depending upon the local policies of the hospital and feasibility. facilities can be shared. • Incineration: The incinerator should be installed and made operational as per specification under the BMW rules 1998 and a certificate may be taken from CPCB/State Pollution Control Board and emission levels etc should be defined. .5. discarded medicines.2. The waste under category 1. cytotoxic substances and solid chemical waste should be treated by this option. The polythene bags made of chlorinated plastics should not be incinerated.3. In case of small hospitals.• Secured landfill:: The incinerator ash.

The individual hospital can choose the best option depending upon the facilities available and its financial resources. . However.• It may be noted that there are options available for disposal of certain category of waste. it may be noted that depending upon the option chosen. correct colour of the bag needs to be used.

1   All the generators of bio-medical waste should adopt universal precautions and appropriate safety measures while doing therapeutic and diagnostic activities and also while handling the bio-medical waste. Safety measures • 5. .• 5.

2   It should be ensured that: • ·         drivers.• 5. • ·         written instructions. . • ·         protective gears provided and instructions regarding their use are given. provided regarding the procedures to be adopted in the event of spillage/ accidents. • ·         workers are protected by vaccination against tetanus and hepatitis B. collectors and other handlers are aware of the nature and risk of the waste.

Training • ·         each and every hospital must have well planned awareness and training programme for all category of personnel including administrators (medical. • ·         all the medical professionals must be made aware of Bio-medical Waste (Management and Handling) Rules 1998. • ·         training should be conducted to all categories of staff in appropriate language/medium and in an acceptable manner.• 6. paramedical and administrative). • ·         to institute awards for safe hospital waste management and universal precaution practices. .

well in time and to get it renewed as per time schedule laid down in the rules. .T. • Each hospital should constitute a hospital waste management committee. chaired by the head of the Institute and having wide representation from all major departments. Government. Management and administration • Heads of each hospital will have to take authorization for generation of waste from appropriate authorities as notified by the concerned State/U.• 7.

accident reports. • The annual reports. . monitoring and implementation. as required under BMW rules should be submitted to the concerned authorities as per BMW rules format.• This committee should be responsible for making Hospital specific action plan for hospital waste management and its supervision.

Select non PVC plastic items. . Establish effective and sound recycling policy for plastic recycling and get in touch with authorised manufactures. the mainstay of which is segregation to reduce the quantity of waste to be treated.• 8. Measures for waste minimization • As far as possible. Adopt procedures and policies for proper management of waste generated. purchase of reusable items made of glass and metal should be encouraged.

• 9. • ·         . generated in Indian hospitals. belong to general category (non-toxic and non-hazardous). Coordination between. hospital should have constant interaction with municipal authorities so that this category of waste is regularly taken out of the hospital premises for land fill or other treatment. hospital and outside agencies • ·         Municipal authority : As quite a large percentage of waste (in India upto 85%).

• Development of non-PVC plastics as a substitute for plastic which is used in the manufacture of disposable items. to search for suitable materials to be used as containers for bio-medical waste requiring incineration/autoclaving/ microwaving. provision of facilities for testing. approval of certain models for hospital use in conformity with standards 'aid down.• Co-ordination with Pollution Control Boards: Search for better methods technology. • To search for cost effective and environmental friendly technology for treatment of biomedical and hazardous waste. Also. .