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Table of Contents
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E.E
Hospital Waste Management
By: Shubhankar Sood
Research Question
To compare the bio-medical waste management practices at private hospital to that of government hospital in a
metropolitan city in India.
Aim
To analyze and compare the bio- medical waste management practices at Hinduja hospital (private ownership)
to that of L.T.M.G. Sion Hospital (governmental ownership).
Hypothesis
Null Hypothesis: there is no comparable difference in the waste management practices followed by both the
hospitals.
Alternative Hypothesis: there is distinctive comparable difference in the bio-medicalwaste management
practices followed by both the hospitals.
There may becomparable difference in the bio-medical waste management practices followed by both
hospitals. Were in, private hospitals waste management practices should be closer to the norms and
government hospitals waste management practices lag behind the standard norms.
Variables:
Independentvariables: management of hospitals (private or government)
Dependent Variables: the method used for segregation and disposing bio-medical waste
Controlled Variables: location of the hospitals (including country and city); morbidity pattern of the city
What is hospital waste?
Hospital waste refers to all waste generated, discarded and not intended for further use in the hospital.
General Classification of hospital waste:
(1) General waste: Largely composed of domestic or house hold type waste. It is non-hazardous to
human beings, e.g. kitchen waste, packaging material, paper, wrappersand plastics.
(2) Pathological waste: Consists of tissue, organ, body part, human foetuses, blood and body fluid. It
is hazardous waste.
(3) Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity
that could cause diseases. It is hazardous e.g. culture and stocks of infectious agents from
laboratories, waste from surgery, waste originating from infectious patients.
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(4) Sharps: Waste materials which could cause the person handling it, a cut or puncture of skin e.g.
needles, broken glass, saws, nail, bladesand scalpels.
(5) Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have
been returned from wards, have been spilled, are out-dated, or contaminated.
(6) Chemical waste: This comprises discarded solid, liquid and gaseous chemicals e.g. cleaning,
housekeeping, and disinfecting product.
(7) Radioactive waste: It includes solid, liquid, and gaseous waste that is contaminated with
radionuclide’s generated from in-vitro analysis of body tissues and fluid, in-vivo body organ
imaging and tumour localization and therapeutic procedures.
Amount and composition of hospital waste generated:
(a) Amount
Country Quantity (kg/bed/day)
U. K. 2.5
U.S.A. 4.5
France 2.5
Spain 3.0
India 1.5
(b) Hazardous/non-hazardous
Hazardous(total) : 15%
a) Hazardous but non- 5%
infective
b)Hazardous and infective 10%
Non-hazardous 85%
(c) Composition
By Weight:
Plastic 14%
Combustible:
Dry cellulosic solid 45%
Wet cellulosic solid 18%
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Non-combustible:
Non-combustible products 20%
[Source: Medical Superintendent at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow]
What is biomedical waste?
Any solid, fluid and liquid or liquid waste, including its container and any intermediate product, which is
generated during the diagnosis, treatment or immunisation of human being or animals, in research pertaining
thereto, or in the production or testing of biological and the animal waste from slaughter houses or any other
similar establishment. All biomedical waste is hazardous. In hospital it comprises of 15% of total hospital waste.
Hospital Waste an Environmental Hazard and Its Management:
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 many 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. Hospital waste is a potential health hazard to the health care
workers, public and flora and fauna of the area. Hospital acquired infection, transfusion transmitted diseases,
rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of
catching many diseases. Air pollution due to emission of hazardous gases by incinerator such as Furan, Dioxin,
Hydrochloric acid etc. have compelled the authorities to think seriously about hospital waste and the diseases
transmitted through improper disposal of hospital waste. This problem has now become a serious threat for
the public health and, ultimately, the Central Government had to intervene for enforcing proper handling and
disposal of hospital waste.
Rationale of hospital waste management:
Hospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15% of
hospital waste i.e. "Biomedical waste" is hazardous, not the complete. But when hazardous waste is not
segregated at the source of generation and mixed with non-hazardous waste, then 100% waste becomes
hazardous. The question then arises that what is the need or rationale for spending so many resources in terms
of money, man power, material and machine for management of hospital waste? The reasons are:
Injuries from sharps leading to infection to all categories of hospital personnel and waste handler.
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.
Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels.
"disposable" being repacked and sold by unscrupulous elements without even being washed.
Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers.
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Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and
ash.
Approach for hospital waste management:
1. Segregation of waste
Segregation is the essence of waste management and should be done at the source of generation of Bio-
medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labour rooms,
treatment rooms etc. The responsibility of segregation should be with the generator of biomedical waste i.e.
doctors, nurses, technicians etc. (medical and paramedical personnel). The biomedical waste should be
segregated as per categories mentioned in the rules.
2. Collection of bio-medical waste
Collection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. At
ordinary room temperature the collected waste should not be stored for more than 24 hours.
Type of container and colour code for collection of bio-medical waste
Category Waste class Type of container Colour
1. Human anatomical waste Plastic Yellow
2. Animal waste -do- -do-
3. Microbiology and Biotechnology -do- Yellow/Red
waste
4. Waste sharp Plastic bag puncture proof Blue/White Translucent
containers
5. Discarded medicines and Plastic bags Black
Cytotoxic waste
6. Solid (biomedical waste) -do- Yellow
7. Solid (plastic) Plastic bag puncture proof Blue/White Translucent
containers
8. Incineration waste Plastic bag Black
9. Chemical waste (solid) -do- -do-
3. Transportation
Within hospital, waste routes must be designated to avoid the passage of waste through patient care areas.
Separate time should be earmarked for transportation of bio-medical waste to reduce chances of it's mixing
with general waste. Desiccated wheeled containers, trolleys or carts should be used to transport the
waste/plastic bags to the site of storage/ treatment.
Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage. The wheeled
containers should be so designed that the waste can be easily loaded, remains secured during transportation,
does not have any sharp edges and is easy to clean and disinfect. Hazardous biomedical waste needing
transport to a long distance should be kept in containers and should have proper labels. The transport is done
through desiccated vehicles specially constructed for the purpose having fully enclosed body, lined internally
with stainless steel or aluminium to provide smooth and impervious surface which can be cleaned. The
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driverscompartment should be separated from the load compartment with a bulkhead. The load compartment
should be provided with roof vents for ventilation.
4. Why treatment of hospital waste?
Treatment of waste is required:
To disinfect the waste so that it is no longer the source of infection.
To reduce the volume of the waste.
Make waste unrecognizable for aesthetic reasons.
Make recycled items unusable.
5.Treatment of general waste:
The 85% of the waste generated in the hospital belongs to this category. The, safe disposal of this waste is the
responsibility of the local authority.
6.Treatment of bio-medical 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.
Autoclave and microwave treatment Standards for the autoclaving and microwaving are also mentioned
in the Biomedical waste (Management and Handling) Rules 1998. All equipment installed/shared should meet
these specifications. The waste under category 3,4,6,7 can be treated by these techniques. Standards for the
autoclaving are also laid down.
Shredding: The plastic (IV bottles, IV sets, syringes, catheters etc.), sharps (needles, blades, 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.
Secured landfill: The incinerator ash, discarded medicines, cytotoxic substances and solid chemical waste
should be treated by this option.
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. In case of small hospitals, facilities can be shared. The waste under category 1,2,3,5,6
can be incinerated depending upon the local policies of the hospital and feasibility. The polythene bags made of
chlorinated plastics should not be incinerated.
It may be noted that there are options available for disposal of certain category of waste. The individual
hospital can choose the best option depending upon the facilities available and its financial resources.
However, it may be noted that depending upon the option chosen, correct colour of the bag needs to be used.
7. Safety measures
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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.
It should be ensured by the hospital and the government that:
Drivers, collectors and other handlers are aware of the nature and risk of the waste.
written instructions, provided regarding the procedures to be adopted in the event of spillage/ accidents.
Protective gears provided and instructions regarding their use are given.
Workers are protected by vaccination against tetanus and hepatitis B.
8. Measures for waste minimization
As far as possible, purchase of reusable items made of glass and metal should be encouraged. Select non PVC
plastic items. Adopt procedures and policies for proper management of waste generated, the mainstay of
which is segregation to reduce the quantity of waste to be treated. Establish effective and sound recycling
policy for plastic recycling and get in touch with authorised manufactures.
INDIAN BIO-MEDICAL WASTE RULES1998:
Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment
Protection Act by the Ministry of Environment and Forest (Government of India) bio-medical waste has to be
segregated according to the following 10 categories:
Option Waste Category Treatment & Disposal
Category No. 1 Human Anatomical Waste incineration /deep burial
(human tissues, organs, body parts)
Category No. 2 Animal Waste incineration/deep burial
(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)
Category No. 3 Microbiology & Biotechnology Waste local autoclaving/micro-
(Wastes from laboratory cultures, stocks or micro- waving/incineration
organisms live or 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)
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Category No. 4 Waste Sharps disinfection (chemical
(needles, syringes, scalpels, blade, glass, etc. that treatment) /auto
may cause puncture and cuts. This includes both claving/microwaving and
used and unused sharps) mutilation/shredding
Category No. 5 Discarded Medicines and Cytotoxic drugs incineration/destruction and
(Waste comprising of outdated, contaminated and drugs disposal in secured
discarded medicines) landfills
Category No. 6 Soiled Waste incineration/autoclaving/m
(items contaminated with blood, and body fluids icrowaving
including cotton, dressings, soiled plaster casts,
linen, bedding, other material contaminated with
blood)
Category No. 7 Solid Waste disinfection by chemical
(Waste generated from disposal items other than treatment/autoclaving/mic
the sharps such a tubing’s, catheters, intravenous rowaving and
sets etc.) mutilation/shredding
Category No. 8 Liquid Waste disinfection by chemical
(Waste generated from laboratory and washing, treatment and discharge
cleaning, housekeeping and disinfecting activities) into drains
Category No. 9 Incineration Ash disposal in municipal
Ash from incineration of any bio-medical waste) landfill
Category No. 10 Chemical Waste chemical treatment and
(Chemicals used in production of biological, discharge into drains for
chemicals used in disinfection, as insecticides, liquids and secured landfill
etc.) for solids
W.H.O REGULATIONS
Definition according to W.H.O:
Health-care waste includes all the waste generated by health-care establishments, research facilities, and
laboratories. In addition, it includesthe waste originating from ‘minor’ or ‘scattered’ sourcessuch as
thatproduced in the course of health care undertaken in the home (dialysis,insulin injections, etc.)
W.H.O Classification:
As per W.H.Othe biomedical wastes could be classified into eight categories on the basis of the type of waste
and the risk of transmission of infectious material in them.
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1. General waste (domestic)
2. Pathological
3.Radioactive
4. Chemical
5. Infectious
6. Pharmaceutical wastes
7. Sharps
8. Pressurised containers
Data Collection and Processing
I had visited two different hospitals, in different localities and with different ownerships for my research work.
Collecting information and data through interviews, cross-sectional study, and observational study; pertaining
to the waste generated by the hospital and its subsequent management and disposal.
The two hospitals visited are:
1] P. D. Hinduja National Hospital and Medical Research Centre: private ownership
2] L.T.M.G. Sion Hospital: governmental ownership
P. D. Hinduja National Hospital and Medical Research Centre
Also popularly known as Hinduja Hospital, is a private hospital located at Mahim in Mumbai, India.The hospital
was established in 1951 byParmanandDeepchandHinduja.The hospital is a modern multi-speciality tertiary care
hospital with a medical research centre set up in collaboration with Massachusetts General Hospital (MGH),
Boston. The hospital has an inpatient capacity of 381 beds including of 53 critical care beds in different
specialities. As a tertiary care hospital, it offers services covering investigations & diagnosis to therapy, surgery,
and post-operative care. It is the first tertiary care hospital to have received ISO 9002 certification from KEMA,
Netherlands, for Quality management systems, and was awarded the "Golden Peacock Global Award" for
philanthropy in emerging economies (2006).
P. D. Hinduja National Hospital has many departments and wards like:
1. Trauma centre
2. Burn unit
3. Main OT
4. Urology dept.
5. Neurology dept.
6. ENT dept.
7. Minor OT
8. Emergency Dept.
9. Eye Dept.
10. Pediatric Dept.
11. Dermatology Dept.
12. Gynecology Dept.
13. Diagnostic Labs
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14. Pharmacy
15. Etc...
Note: Due to time constrain and for sake of comparison only some main target departments have been studied
for data.
All the waste generated in the hospital is segregated, collected and disposed according to the categories of
waste defined by ‘INDIAN BIO-MEDICAL WASTE RULES 1998’. Hence the below mentioned data is in terms of
these categories
NOTE: the ‘INDIAN BIO-MEDICAL WASTE RULES 1998’ categories have been listed in tabular form earlier in the
report. Hence it is advisable to keep in mind the ‘waste categories’ while referring to the data given below.
DATA COLLECTION:Table 1
Wards or Hospital Waste Collected[kg/Bed/week] (03/09/11-09/09/11)
Dept.
Category Category Category Category Category Category Category Category Category Category
No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10
OPD area - - - 0.08 0.01 0.08 0.04 0.08 - 0.01
Causality 0.12 - 0.02 0.15 0.02 0.22 0.24 0.15 - 0.02
ICU’s 0.04 - 0.01 0.19 0.03 0.27 0.29 0.21 - 0.03
OT area 0.59 - 0.03 0.21 - 0.32 0.37 0.32 - 0.05
Diagnosti - - 0.46 0.09 0.03 0.04 0.08 0.20 - 0.42
c Labs
Radiology - - - 0.02 0.02 0.02 0.03 0.18 - 0.08
Dept.
Pharmacy - - - 0.01 0.18 0.02 0.01 0.07 - 0.01
Table 2
Wards or Hospital Waste Collected[kg/Bed/week] (10/09/11-16/09/11)
Dept. Category Category Category Category Category Category Category Category Category Category
No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10
OPD area - - - 0.09 0.01 0.11 0.03 0.14 - 0.02
Causality 0.14 - 0.03 0.23 0.03 0.28 0.42 0.23 - 0.03
ICU’s 0.08 - 0.02 0.31 0.03 0.35 0.51 0.36 - 0.05
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Hinduja Hospital has its own Hospital Infection Control Team (HICT), which carries out
surveillance/inspection of different areas of hospital.
HICT comprises of: -
1. Medical Superintendent
2. Nursing Superintendent
3. H.O.D. Microbiology
4. Casualty Medical Officer (CMO)
5. Ward Medical Officers
L.T.M.G. Sion Hospital
LTMGH, (LokmanyaTilak Municipal General Hospital), locally known as "Sion Hospital", is a general municipal
hospital situated in Sion, a suburb of Mumbai, India. It was started in 1947 with 10 beds initially, which has now
grown into multi-specialty hospital with 1,416 beds. In the same campus, it is attached to LTMMC
(LokmanyaTilak Municipal Medical College) which is a teaching institute for undergraduate and post graduate
studies in medical sciences. It is named after LokmanyaTilak, an eminent Maharashtra freedom fighter in pre-
independence India.
L.T.M.G. Sion Hospital has many departments and wards like:
1. Trauma centre
2. Burn unit
3. Main OT
4. Urology dept.
5. Neurology dept.
6. ENT dept.
7. Minor OT (Ward 4)
8. Emergency Dept.
9. Eye Dept.
10. Pediatric Dept.
11. Dermatology Dept.
12. Gynecology Dept.
13. Diagnostic Labs
14. Pharmacy
15. Etc...
Note: Due to time constrain and for sake of comparison only some main target departments have been studied
for data. The hospital did not maintain perfect data according to the categories provided by ‘INDIAN BIO-
MEDICAL WASTE RULES 1998’; hence I had do that so as to make data comparison easier and clearer.
Data Collection:
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Causality - -
ICU’s - -
OT area - -
Diagnostic - -
Labs
Radiology - -
Dept.
Pharmacy - -
METHOD OF WASTE DISPOSAL ADOPTED BY L.T.M.G. SION HOSPITAL:
Colour Coding Waste Category Method of Disposal Adopted by
Hospital
Yellow Category 1,2,3 &6 Deep burial / Collected by BMC and
[Human & Animal anatomical waste / dumped at Deonar(near Chembur)
Micro-biology waste and soiled
cotton/dressings/linen/beddings etc.]
Red Category 7 Autoclaving / Microwaving /
[Tubing’s, Catheters, IV sets.] Chemical treatment/Collected by
BMC and dumped at Deonar
Blue/White Category 4 Autoclaving / Microwaving /
[Waste sharps like Chemical treatment /
Needles, Syringes, Scalpels, blades Shredding/Collected by BMC and
etc.] dumped at Deonar
Black Category 5,8,9 &10 Chemical treatment/Collected by
[Discarded medicines/cytotoxic drugs, BMC and dumped at Deonar
Incineration ash, Chemical waste.]
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