i

A study on ‘Hospital Waste Management’ of National Institute of Unani Medicine, S.J.I.I.M Hospital (unani) and other Govt. Unani

Dispensaries in Bangalore

By

Ameerulla Khan

Dissertation Submitted to theRajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillmentof the requirements for the degree of

Mahire Tib (M.D.Unani)

In

Hifzane Sehat (Preventive and Social Medicine)

Under the guidance of

Professor Syed Shahabul Haq

Department of Hifzane SehatNational Institute of Unani Medicine

Kottigepalya, Bangalore

2007

ii

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/ thesis entitled “A Study on ‘Hospital Waste

Management’ of National Institute of Unani Medicine, S.J.I.I.M Hospital (Unani)

and other Govt. Unani dispensaries in Bangalore” is a bonafide and genuine

research work carried out by me under the guidance of Prof. Syed Shahabul Haq,

Former Incharge, Dept. of Hifzane Sehat, National Institute of Unani Medicine,

Bangalore.

Date: Dr. Ameerulla KhanPlace: Bangalore

iii

CERTIFICATE BY THE GUIDE

This is to certify that dissertation entitled “A Study on ‘Hospital Waste

Management’ of National Institute of Unani Medicine, S.J.I.I.M Hospital (unani)

and other Govt. Unani dispensaries in Bangalore” is a bonafide research work

done by Ameerulla Khan in partial fulfillment of the requirement for the degree of

Mahire Tib (M.D.Unani).

Date: (Prof. Syed Shahabul Haq)

Place: Former Incharge,Dept. of Hifazne Sehat, NIUM, Bangalore

iv

ENDORSEMENT BY THE HOD & DIRECTOR OF THE INSTITUTION

This is to certify that the dissertation entitled “A Study on ‘Hospital Waste

Management’ of National Institute of Unani Medicine, S.J.I.I.M Hospital (unani)

and other Govt. Unani dispensaries in Bangalore” is a bonafide research work

done by Ameerulla khan under the guidance of Prof. Syed Shahabul Haq, Former

Incharge, Dept. of Hifzane Sehat, National Institute of Unani Medicine,

Bangalore.

HOD Director

Dr. Mohd. Zulkifle Prof. M. A. Jafri, Dept. of Hifzane Sehat, Director, NIUM,NIUM, Bangalore Bangalore

Date: Date:

Place: Bangalore Place: Bangalore

v

COPYRIGHT

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation/ thesis in print

or electronic format for academic/ research purpose.

Date: Place: Bangalore Dr. Ameerulla khan

© Rajiv Gandhi University of Health Sciences, Karnataka

A study on ‘Hospital Waste Management’ of National Institute of Unani Medicine, S.J.I.I.M Hospital (unani) and other

Govt. Unani Dispensaries in Bangalore

By

Dr. Ameerulla Khan

Dissertation Submitted to theRajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillmentof the requirements for the degree of

Mahire Tib (M.D.Unani)

In

Hifzane Sehat (Preventive and Social Medicine)

Department of Hifzane SehatNational Institute of Unani Medicine

Kottigepalya, Bangalore

2007

To my very wonderful childrenwho are the light of my life

the joy of my days the comfort of my lifethe solace in sorrow my light in the dark

and the hope of my heart.No greater joy than you and when u have

children one day,may you be as lucky as i have been

to love and be loved by you

A study on ‘Hospital Waste Management’ of National Institute of Unani Medicine, S.J.I.I.M Hospital (unani) and other

Govt. Unani Dispensaries in Bangalore

By

Dr. Ameerulla Khan

Dissertation Submitted to theRajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillmentof the requirements for the degree of

Mahire Tib (M.D.Unani)

In

Hifzane Sehat (Preventive and Social Medicine)

Department of Hifzane SehatNational Institute of Unani Medicine

Kottigepalya, Bangalore

2007

vi

ACKNOWLEDGMENT

I am indebted and thankful to almighty who is the most beneficent and merciful for

giving me patience and courage for conducting the study and helping me in every

walk of life and blessing me with all that I have got, and without whose blessings the

present work would not have been possible.

I wish to express my sincere respects, regards and deep sense of gratitude to my

guide, Prof. Syed Shahabul Haq, Former Incharge, Dept. of Hifzane Sehat, National

Institute of Unani Medicine, Bangalore, a well versed teacher, experienced in a

plethora of fields, with an inherent rare human quality to listen and to render physical

and mental courage on the onlooker. I sincerely express my boundless reverence for

his excellent guidance, constant courage, encouragement, timely advice, thoughtful

criticism and constructive suggestions that this thesis owes its very existence.

My sincere respect and regards to Prof. M.A. Jafri, Director, National Institute of

Unani Medicine, Bangalore, for his overall supervision, learned guidance, and

providing me the necessary facilities in undertaking this endeavor.

My sincere thanks are due to Dr. Mohd. Zulkifle, HOD, Hifzane Sehat, National

Institute of Unani Medicine, for his moral encouragement and providing me the

necessary facilities that I needed for my research work. I am indebted to him for the

untiring patience, superb scientific judgment; meticulous care and profound interest

that helped this work to finish smoothly.

Once in a lifetime we come across a person who with his knowledge, wisdom,

patience and dedication inspires us, especially if he is our teacher, we can consider

vii

ourselves lucky, I myself is one such lucky student for having worked under my co-

guide Dr. Abdul Haseeb Ansari, Lecturer, Dept. of Hifzane Sehat, National Institute

of Unani Medicine, Bangalore, whose guidance and suggestions greatly inspired me

in completing this work. I wish to express my gratitude, respect and affection to him

who has directed this study with his valuable contribution, dynamic and invaluable

guidance. He came to my rescue in moments of diffidence reducing my confusion to

clarity, rendering confidence and encouragement in each step.

My sincere thanks are due to Dr. Arish M. K. Sharwani and Dr. Zarnigar, Lecturers,

Dept. of Hifzane Sehat, for being supportive and helpful.

No words make articulate to acknowledge constant encouragement and timely advice

rendered by the teachers of NIUM, especially Dr. Mohd. Anwar, Reader, Dr. Abdul

Nasir Ansari, Lecturer, Dept. of Moalijat, Dr. Ghulamuddin Sofi, Lecturer, Dept. of

Ilmul advia.

My sincere thanks to Dr. Haseebunnisa, Principal, Govt. Unani Medical College,

Dr. Mujeebur-Rehman, Professor, Govt. Unani Medical College, Bangalore;

Dr. Gopinath D, Professor; Dr. Pruthvish S, Professor; Dr. Hemanth T, Lecturer;

Department of Community Medicine, M.S Ramaiah Medical College, Bangalore,

Dr. Rama Krishna Goud B, Asst. Professor; St. Johns Medical College, Dr. Riyaz

Basha Asst. Professor; Bangalore Medical College; Dr. Asima banu, Microbiologist,

Bowring and Lady Curzan hospital, Bangalore, for being supportive and helpful.

My sincere thanks are due to Dr. Sheersagar, Principal, S.J.I.I.M and Hospital and its

teaching staff, ministerial staff and hospital staff for their help and cooperation. I

would also extend my sincere thanks to Dr. Nargis Ayesha, Physician, Corporation

Unani Dispensary, Broadway road; Dr. Muqtair, Physician, Govt. Unani Dispensary,

viii

Neelsandra, Bangalore and Dr. Fathima, GUD, Jayamahal, Bangalore, and all their

ministerial and hospital staff for their continue support and help in carrying out my

dissertation work smoothly.

Words are inadequate to express my heartfelt feelings to my friends Dr. Md. Nayab,

Dr. Shaikh Imran, Dr. Mushtaq Naikoo, Dr. Firdose Malik, Dr. Farooque

Dr. Ahmed Hussain, Dr. Abdul Rehman, Dr. Salma banu, Dr. Badrul Hasan,

Dr. Naila, Dr. Chand Usmani, Dr. Sanaulla U, Dr. Noorulla my collogues Dr. Zaki

Anwar, Dr. Ramesh, Dr Md. Farooque, Dr. Shaheena, Dr. Usman and Dr Md.

Saquib for being supportive and helpful.

I am thankful to Mr. Prakash Reddy, Deputy Director and all Ministerial staff,

Dr. Ifthekar Mubeen, RMO, Dr. Shakeel Ansari and Dr. Mohd. Aazam Clinical

Registrars, Staff of Pathology Laboratory, Mrs. Sanjida Tabassum, Mr Md. Hanif,

and Mr Zaki. Pharmacy staff Dr Nafees Khan and Dr Md Fazil. Library staff

Mr. Ehtesham and Mr. Danish. Mrs. Jemima Matron and all the hospital staff for

their cooperation and help during the course of study and conducting of research

work.

I owe a lot more than words can express to my parents, parents in law, my beloved

wife, Dr. Roohi Zaman, my son Faraz Khan, my daughter Nida Farheen, whose

sacrifices and prayers have seen me through these years, nothing would have been

possible without their constant support, encouragement and love. I thank almighty for

blessing me with such wonderful relations and people that has made this life worth

living.

Date:

Place: Bangalore Dr. Ameerulla Khan

ix

LIST OF ABBREVIATIONS USED

(In alphabetical order)

AIDS =Acquired Immunodeficiency Syndrome

BMWMR =Bio Medical Waste Management Rules

e. g. =exempli gratia – for example

et al =et alii or et alia – and others

etc. =etcetra- and the rest

fig =Figure

Ft =Feet

Fr =Friedman Test

GOI =Government of India

HBV =Hepatitis-B Virus

HCIs =Health Care Institutions

HCP =Health Care Personal

HCWM =Health Care Waste Management

HCW =Health Care Waste

HIV =Human Immunodeficiency Virus

HOI =Head of the Institution

i.e. =id est- that is

IP =In Patient

IPD =In Patient Department

Kw =Kruskal-Wallis Test

M/m =meter

M 1 =Month first

x

M 4 =Month fourth

M 6 =Month sixth

n =number

N =Total number

NA =Not applicable

OP =Out Patient

OPD =Out Patient Department

p =Probability

POS =Post Orientation Session

Sec =Seconds

SMHCW =Safe Management of Health Care Waste

Vol. =Volume

WHO =World Health Organisation

WMS =Waste management system

< =less than

> =more than

% =percent

xi

ABSTRACT

The Bio-medical waste management is a global concern, particularly due to constant

rise in blood borne diseases and other related risk factors. The current scenario is that,

the incidence of hospital borne infections is on constant rise. The waste generation in

the hospital and its disposal has always never been given its due importance.

Unani system of medicine has given much emphasis to preventive and health care

aspects and their physicians were well aware of personal hygiene and their concept of

infection. As this system is in the main stream for health care service provider and

also for hospital waste generation source, with more number of patients and health

care personal involved, study was undertaken for the awareness and management of

hospital waste in unani hospitals.

In the present study waste management of unani hospitals in Bangalore, providing

both out patient and in patient facilities and providing only out patient services were

taken up with objectives to assess the existing practices of waste management and to

identify the type of waste, segregation practices, quantification of waste and its

disposal methods. And orientation / sensitisation session was conducted for the health

care personal at interval of first month, fourth month and sixth month of the POS and

the effect of management is noted both in components of the waste and in the

continued interaction of the health care personal.

It is a descriptive research study, which include surveys and fact-finding enquires

with various categories of health care personal. The overall initial assessment of the

studied HCIs shows that none of the studied HCIs managed solid as well as liquid

waste appropriately but there is periodic improvement in the components of HCWM

throughout the POS.

Keywords

Bio-medical waste; Segregation; Quantification; Waste generation; Unani Medicine,

Hazardous waste; Disposal; Sharp waste; Organic waste, Biodegradable; Composite.

xii

TABLE OF CONTENTS

Sl. No. Contents Pages

1. Introduction 1

2. Objectives 5

3. Review of Literature 6

4. Materials and Methods 36

5. Observation and Results 44

6. Discussion 63

7. Conclusion 74

8. Summary 78

9. Bibliography 82

10. Annexures

Anexure - 1 Instrument for data collection

Anexure - 2 Photographs

87

90

xiii

LIST OF TABLES

Sl. No. Tables Pages

Table 1 Types of services provided by the studied HCIs 44

Table 2 Category of staff and their participation in the studied HCIs 45

Table 3 Percentage of various type of wastes generated in studied HCIs

46

Table 4 Quantity estimation of solid waste generation in Kgs/ bed/ day in studied HCIs having in-patient facility

47

Table 5 Institutional facilities for treatment/ disposal of waste 48

Table 6 Methods of collection of various types of waste items 48

Table 7 Frequency of collection of various types of waste items 49

Table 8 Methods of disposal of various types of waste items 49

Table 9 Activities at point of generation of waste item at studied HCIs

50

Table 10 Treatment and final disposal of wastes in studied HCIs 50

Table 11 Activities at the point of waste generation 51

Table 12 Treatment and final disposal of waste 51

Table 13 Mode of management of liquid waste and infectious body material in the studied HCIs

52

Table 14 HOI, Doctors, Nursing and other staff interest & Participation

57

Table 15 Perceived factors that have helped in sustaining of the system of waste management

57

Table 16 Application of segregation of waste by studied HCIs in their various departments

58

Table 17 Application of disinfection of waste by studied HCIs in their various departments

59

Table 18 Application of containment of waste by studied HCIs in their various departments

60

Table 19 Application of colour coding of waste materials in their various departments

61

Table 20 Application of disposal of waste by studied HCIs in their various departments

62

xiv

LIST OF FIGURES

Sl. No. Figures Pages

Figure1Types of services provided by the studied

HCIs44

Figure 2Category of staff and their participation in

the studied HCIs 45

Figure 3Percentage of various types of wastes

generated in the studied HCIs46

Figure 4 Percentage of quantity of waste generated

in 2 studied HCIs having in-patient facility47

Figure 5Application of segregation of waste by

studied HCIs in their various departments58

Figure 6Application of disinfection of waste by

studied HCIs in their various departments59

Figure 7Application of containment of waste by

studied HCIs in their various departments60

Figure 8

Application of colour coding of waste

materials by studied HCIs in their various

departments

61

Figure 9Application of disposals of waste by studied

HCIs in their various departments.62

1

INTRODUCTION

The bio-medical waste means any solid, liquid waste material, generated during the

process of diagnosis, treatment and immunization of human being. These waste

materials could cause serious hazards to health and environment in case of

indiscriminate management. All the hospital personnel are at a risk to get many fatal

infections and injuries by these infectious materials. To avoid these hazards,

discriminate waste management system should be implemented in hospital

infrastructure. (1)

The concern for Bio-medical waste management has been felt globally with

indiscriminate disposal of health care waste and rise in deadly infections such as

AIDS, Hepatitis-B. The need to educate different health care professionals/ workers

about health care waste management is thus very important. (2)

Hospital is a complex multidisciplinary system, which consumes number of items/

products for delivery of medical care and it is a part of the physical environment. All

these products consumed in hospitals leave some unusable leftovers, which are called

hospital/ clinical wastes as they are generated as a result of some clinical activity.

Bio-medical waste is a broader term applied to waste generated in the diagnosis,

treatment or immunization of human beings, in research or in the production or testing

of biological products.

In every hospital a large amount of waste is generated daily and it has become

necessary to give special attention for the proper treatment and disposal of waste.

Although hospital exists to treat illness, they can act as reservoirs of infection.

Whenever accurate survey have been made it has been found that a substantial

2

proportion of patient acquire infection during stay in the Hospital. Mostly infection

occurs in the hospital, is due to inappropriate cleanliness.

Infectious wastes include all those medical wastes, which have the potential to

transmit viral, bacterial or parasitic diseases. Since the early recovery of the patient

and health of clinical staff directly depends on a clean and hygienic environment, it is

essential that hospital waste is collected, stored and disposed off in a proper and

scientific manner. General hospital hygiene is a prerequisite for good medical waste

management. (3)

Improper management of medical waste may pose health hazards through

transmission of diseases, not only to health workers and their families, but to patients

and their relatives.(4)

The current scenario in India is that, the Hospitals are yet to implement the proper

disposal of health care waste, and are still dumping their waste in municipal garbage

without any segregation. It is unfortunate to note that at many places, it is common to

find large dumps of “biomedical waste” consisting of used needles, syringes, sharps,

blood soaked items, napkins, etc in addition to kitchen waste, plastic, papers and even

human excreta.

These dumping sites are regularly visited by “rag pickers” who scan and sort these

wastes, manually, to pick out plastics, disposables, syringes, needles and other

disposables, merely to resale to the people who ‘recycle’ these, and incur the risk of

accidental infections either by sharps or through non-intact skin. The potentials for

making profit from this recycled material magnify the risks even higher.

In addition to lack of motivation in workers, lack of commitment on the part of the

management, low level of education of sanitary workers, apathy of other staff

3

members and lack of organized training and the human factors further complicate the

present scenario of Bio-medical waste management. It is astonishing to note that

many of the waste generators in hospitals have no knowledge about what was done

with the waste generated in their units or departments, where the dustbins were

located in the hospitals and who was responsible for waste disposal. They were not

aware of new regulations about bio-medical waste management, to overcome this,

various health organizations and WHO has come forward to its safe disposal

programs, and has proposed certain norms and methods of hospital waste

management and safe disposal.(5)

Till July 1998, there was no system for proper hospital waste disposal. Most of the

hospitals were disposing their waste along with general waste. For prevention of these

improper practices, the Government of India had launched a law known as Bio-

medical waste (management and handling) Law 1998.(6)

Unani system of medicine has given much emphasis to preventive and health care

aspects. Unani physicians were well aware with personal hygiene and the concept of

infection. They enjoyed the reputation - the civilizers of the ancient world. They had a

keen sense of knowledge in filth, waste material and sanitation. Public health was

born during their reign. They build sewage systems and established hospitals for the

sick.(7)

Unani system of medicine forms an integral part of national health care delivery

system in India. According to official figures available, there are 43,108 registered

Unani practitioners in the country. There are around 1000 Unani Dispensaries, 312

hospitals besides number of Research centres, diagnostics, Regimenal units etc.

functioning as health care providers.

4

In which there may be number of persons involved in the occupation of health

delivery system, and also these health care facilities are visited by hundreds and

thousands of patients for diagnostic and treatment procedures, in these activities they

generate varieties of health care wastes. These wastes if not managed properly

become a health hazard and spread diseases in the society. Ill managed health care

waste can also be responsible for environmental pollution and degradation.

Proper health care waste management encompasses various processes, such as waste

generation, collection, quantification, handling, storage and final disposal without

causing hazard and risks to society, environment and waste handlers.(8)

The need for the study is to sensitize the Health care workers/ public about hospital

waste and its impact on health and environment, to acquaint about the existing

legislation, knowledge and safe practices regarding health care waste management.(2)

Keeping in mind the above stated problems of waste management, to create

awareness about bio-medical waste and to fulfil the required WHO target, it is

necessary to conduct and start the “Waste Management Studies” from grass root level,

hence the study regarding “Hospital Waste Management” in Unani Hospitals in

Bangalore is initiated. And the study has been undertaken to assess the existing

practice of waste management, to understand the problem and hazards of Bio-medical

waste and to get aware of rules and regulations about Bio-medical health practices.

5

OBJECTIVES OF THE STUDY

•••• To assess the existing practices of hospital waste management in the study

centres, in various components of health care waste, like segregation practices,

type of wastes, quantification of waste and disposal methods.

•••• The orientation / sensitisation session for the health care personnel in safe

management of health care waste.

6

REVIEW OF LITERATURE

Waste is any mater, whether liquid, solid, or gaseous which is discharged, emitted, or

deposited in the environment. The concept of a waste embraces all unwanted and

economically unusable by-products which may be discharged, accidentally or

otherwise, to the environment.(9)

All activities of living thing on earth produce waste in some form or the other.

Normally, aerobic and anaerobic processes in the environment degrade such products.

These wastes, both biodegradable and non-biodegradable hardly had any impact on

the environment until the invention of plastics by the modern man. The process of

natural degradation could not keep pace with the increase in waste generated by the

over increasing population of mankind and its necessities.(10)

Waste and refuse should be properly disposed; otherwise there will be chances of

spreading of diseases. Waste stored temporarily should be in appropriate container

with lid covered. This accumulated huge waste should be transported far away from

populated areas, and buried in the land and cover this area of about one foot height

with mud and later it can even be used as manure after its compositing.(11)

Hospital is a residential establishment which provides short term and long term

medical care consisting of observational, diagnostic, therapeutic and rehabilitative

services for a person suffering or suspected to be suffering from diseases or injury and

during these activities it generate lot of hospital waste of different types.(12)

Unani physicians were aware of the concept, cause and spread of infectious diseases,

through thousands of years. Razi, the famous Unani physician, has mention that the

7

cause of infectious disease is due to aaludgi (pollution), he also observed that the

people were affected with diseases, when they stayed with sick person. Razi has

explained about infection and its causes in his famous book Al-Havi, Volume-23.(13)

Ibn Sina has said that only with admixture of putrefied air and morbid matter,

contamination of air or water is possible. The presence of toxic or putrefying

substances, in the air and water, has been termed as ajsame khabisa.(14)

Hospital waste possesses a serious problem, individual component of the waste which

constitutes a risk to health if inadequately handled. Hospital is facing enormous

problems and difficulties due to mismanagement of waste generated. Large quantities

of waste materials accumulate as a result of the daily activities, if they are not

removed and disposed efficiently, they could soon make any sigh, unpleasant or even

uninhabitable. A special attribute of bio-medical waste is that even though it forms

only a small part of the total solid waste if not taken care of properly, it can pollute

the whole of the solid waste and there by transfer infectivity to the whole of the solid

waste. Once that happens, all the waste must be considered infected and treated as

infectious waste.

Not only this, if the Bio-medical waste finds access to air and water it had the

potential of infecting the ambient environment as well as water sources.(15)

Organic waste becomes a potential place for fly breeding; garbage attracts rodents

like rats and other animals.(16)

(A) Operational Definitions

• Pollutant

• Bio-medical waste

• Hospital waste

8

• Health care waste

• Segregation

• Categories of segregation

• Colour coding systems

• Quantification of health care waste

• Storage

• Transportation

(B) Unani Literature

(C) Public health Act

(D) Categories of the persons exposed to risk of infections

(E) Sources of Health Care Waste

(F) Classification of Health Care Waste

(G) Occupational Health and Safety Precautions/Measures

(H) Treatment and disposal technologies for health-care waste

(I) Key steps of healthcare waste management

(J) Bio-medical wastes (management and handling) Rules, 1998

(A) Operational Definition

Pollutant:

A contaminant whose presence is damaging to the quality of environment or waste

products that have been inadequately disposed or contained.(17)

Bio-Medical Waste:

It is a broader term applied to waste generated during the diagnosis, treatment or

immunization of human beings or in research activities pertaining there to or in the

production or testing of biological products.(6, 13, 14,)

9

Hospital Waste:

It can be defined as any thing that is discarded, unwanted substances which is

generated in process of rendering medical services to a person desiring such services

as a result of sickness or injury. (18)

Health Care Waste:

It is generated as a by-product of health care delivery system. It includes wastes like

sharps, soiled waste, body fluids, discarded medicines, glass slides with blood stains,

infected dressing material etc.(19)

Segregation:

Waste segregation is the key to any waste management scheme. It consists of placing

different types of waste in different containers of colour-coded bags at the site of

generation. This helps in reducing the bulk of infectious waste and contains spread of

infection to general waste. This practice reduces the total treatment cost, the impact of

waste in the community and the risk of infecting workers. Proper segregation should

identify waste according to source and type of disposal. Waste should be segregated

into different categories at the site of generation.(7)

The first step in proper disposal is systematic segregation of the waste. Infectious and

non-infectious wastes are generally not segregated at source and instead the mixed

waste is taken to the incineration plant in a very unhygienic manner. The system of

collection, transportation and disposal of bio-medical waste is thus not scientifically

designed.(20)

Advantage of segregation, is that it prevents mixing of infectious with non-infectious

waste, thus minimizing the high cost and care involved in disposal of infectious

waste. Once such mixture occurs, the total amount has to be treated as infectious.

10

Segregation reduces the chances of accidental infection of health care workers and

waste handlers.(15)

Categories of segregation:

Under Bio-medical waste (management and handling) Rules, 1998; the heart of law is

segregation of waste at the point of origin of waste. Segregating potentially infectious

material from the other waste at the point of generation may reduce both volume and

cost.

The Bio-medical waste (management and handling) Rules, 1998 have categorised the

bio-medical wastes into 10 categories as mentioned in table below. (6)

Sl. No

Waste category Treatment & Disposal options

Colour code

Type of container

1. Human Anatomical waste Incineration / Deep burial Yellow Plastic bag

2. Animal Waste Incineration/ Deep burial Yellow Plastic bag

3. Microbiology &

Biotechnology waste

Autoclaving/ Incineration Yellow /

Red

Plastic bag/

disinfected container

4. Waste sharps Disinfection/Chemical

treatment. Autoclaving

mutilation & shredding

Blue /

white

Plastic bag / Puncture

proof container

(translucent)

5. Discarded Medicines and

cytotoxic drugs

Incineration / destruction

and disposal in secured

landfills

Black Plastic bag

6. Soiled Waste Incineration Yellow /

Red

Disinfected container

/ Plastic bag

7. Solid Waste Disinfection by chemical

treatment/ autoclaving

Red / Blue

/ White

Disinfected container

/ plastic bag

8. Liquid Waste Disinfection by Chemical

treatment & discharge

into drains

NA Not applicable

9. Incineration Ash Disposal in municipal

landfill

Black Plastic bag

10. Chemical Waste Chemical treatment and

discharge into drains for

liquids and secure landfill

for solids.

Black Plastic bag

11

Note:-

1. There will be no chemical pre-treatment before incineration. Chlorinated

plastics shall not be incinerated.

2. Deep burial shall be an option available only in towns with population less

than 5 lakhs and in rural areas.

3. Using at least 1% hypochlorite solution or any other equivalent chemical

reagent. It must be ensured that chemical treatment ensures disinfection.(7)

Colour coding systems:

The bags or containers into which hazardous healthcare waste are collected should

have a distinct colour, so that staff is reminded not to put other wastes into such

containers. Any bags containing hazardous waste that are in the wrong place can be

easily noticed.

It is necessary to have a uniform national colour coding system, so that hazardous and

non hazardous wastes both can be easily recognized. (18)

The WHO recommended methods / guidelines for segregation, colour-coding for wastes are listed below. (21)

TYPE OF WASTE COLOUR OF CONTAINER

TYPE OF CONTAINER AND

MARKINGS Highly infectious waste Yellow, Marked

“ HIGHLY

INFECTIOUS”

Strong, leak-proof

plastic bag or container

autoclaved

Other Infectious waste, pathological

and Anatomical waste

Yellow Leak-proof plastic bag

or container

Sharps Yellow, marked

“SHARPS”

Puncture-proof

container

Chemical and pharma Waste Brown Plastic bag or container

Radioactive waste Labeled Lead box, with

radioactive symbol

General health care waste Black Plastic bag

12

Quantification of health care waste

Helps in:

• Planning infrastructure

• Procuring equipment

• Allocating resources

In middle and low income countries, health care waste generation is usually lower

than in high income countries.

According to a WHO report, 80% general health care waste, which may be dealt with

the normal domestic and urban waste management system.15% pathological and

infectious waste, 3% chemical and pharmaceutical waste, 1% sharps waste and less

than 1% special waste such as radioactive and cytotoxic waste, pressurized containers

or broken thermometers and used batteries.(7)

Storage:

Prime consideration should be given to the proper storage of waste. All segregated

waste should be packed in proper containers and colour-coded bags with labels

mentioning details of biomedical waste and biohazard signs. All containers used for

storage of such waste should be provided with a properly covered lid. (18)

Transportation:

There are two modes of Transportation of health care waste

1. Transportation of waste within the health care institution/ hospital

2. Transportation of waste outside the health care institution/ hospital.(18)

13

Unani Literature

Unani Medicine originated in Greece. Buqrat (Hippocrates) (460-365 BC) a great

Philosopher and Physician was founder of Unani System of Medicine. Modern

medical science was developed on the foundation of Hippocratic philosophy of health

& disease. Hence, Buqrat is known as the “Father of Medicine”. The Greeks enjoyed

the reputation – “The Civilizers of the Ancient World”.

Hippocrates was the first true epidemiologist; he distinguished diseases between

epidemic and endemic. He studied such things as climate, water, clothing, diet, habits

of eating and drinking and the effect they had in producing disease. His book “Kitab-

Al-Ahwia wa Al-Miyah wa Al-Buldan” (“Airs, Waters and Places”) is considered as

true work on social medicine and hygiene. The Hippocratic concept of health and

disease stressed the relation between man and his environment.

The Romans too had a keen sense of knowledge in filth, waste material and sanitation.

Public health was born in Rome, with the development of baths, constructions of fine

roads, building of sewage systems and establishment of hospitals for the sick.

An outstanding figure among Roman medical teachers was Jalinoos (Galen) (130-205

AD) Jalinoos observed that disease is due to three factors- predisposing, exciting and

environmental factors, a truly modern idea. Later, the Arabs translated the Greco-

Roman Medical Literature into Arabic and helped preserve the ancient knowledge.

Borrowing largely from the Greeks and Romans, they developed their own system of

medicine known as the Unani System of Medicine. (7)

Unani System of Medicine has given much emphasis to preventive and health care

aspects. Unani physicians were well aware with personal hygiene and the concept of

infection. Right in its formative stages the influence of the surrounding environment

14

and ecological conditions on the state of health of human beings have been

recognized. There is emphasis on the need for keeping water, food and air free from

pollution. Good and clean air is considered as most necessary for health, Ibn Sina

(Avicenna) (980-1037 AD), the famous Arab physician, noted that the change of

environment relieves the patients of many diseases.(8)

Establishment of Hospitals:

The development of efficient hospitals was an outstanding contribution of Unani

System of Medicine. Hospitals served all citizens free without any regard to their

colour, religion, sex, age or social status. The hospitals were run by the government

and their directors were physicians. It was chiefly towards humanitarian of patient

care that the hospitals of Unani excelled. Near the wards of those afflicted with fever,

fountains cooled the air, the insane were treated with gentleness, and at night music

and storytelling soothed the patients.(22)

The concept of infection and treating the patients in hospitals was noted even during

Greco-Arab period, Abu Bakar Bin Zikaria Razi, (Rhazes) (865-925 AD) the famous

Arab physician, worked hard towards establishment, taking care and maintenance of

Hospitals, for establishing and housing hospitals in clean environment at Baghdad,

Razi hanged over pieces of fresh meat in various places and neighbourhood and later

studied the properties and changes noted in meat, like it colour, odour, taste and

selected the place for constructing hospital in healthy atmosphere where the piece of

meat would rot slower than any of the other places.(23)

The cause of disease in Unani System of Medicine is Asbabe Sittah Zarooriyah,

consisting of external and internal factors. When these asbab are altered in nature,

disease is caused in the body. Experimental proof of the fact came through Raban

15

Tabri, (780-850 AD) who by his pioneering works described asbabe sittah zarooriyah,

especially the morbid air and water which carry mufsidi hawai and mufsidi ardi as the

cause of disease.

Ali Ibn Abbas Majusi (935-994 AD) further elaborates, whenever disequilibrium

occurs in the substance of the air, pollution and putrefaction are produced in both, the

substance (maddah) and quality (Kaifiat), causing plenty of bad symptom aaradd-i

radiyah and thus produces disease in human being.(24)

Even western medicine claims that the diseases are constituted in the human body by

foreign agents (bacteria and viruses) through the media of air, food and water.

The importance of disposal of waste generated by the population has been recognized

by the early civilizations. The Dravidians in 5000 BC incorporated the sewage system

in their town planning for safe and effective disposal of wastes.

The “hospices” or the homes for infirms, travellers, the sick and the old, later became

our hospitals, when the concept shifted from rest houses to treatment and care centres.

With such advent of hospitals, arose the problem of handling and disposal of waste

generated during the care of patients. These were left mostly to sweepers and menial

staff and were supervised by some sanitary inspector.(7)

Hospital and other health care facilities, diagnostic centres, research and medical

institutions, pharmacies are visited by patients for diagnostic and treatment

procedures in the process which generate a variety of wastes. A few examples of

health care wastes are dressing material, plastic disposal items, needles, food waste,

drugs, chemicals, pathological waste - all of which ultimately become part of health

care waste.

16

These wastes if not managed properly become a health hazard and spread diseases in

the society. In addition, ill managed health care waste can also be responsible for

environmental pollution and degradation. Waste generated in health care facilities is

much more complex than the municipal waste as it possesses threat to human health

as well as the environment. With rapid urbanization and population pressure, nature’s

cleansing system, has started breaking down. Improvement of waste management in

health care facilities is urgently needed for safeguarding the population, eliminating

occupational health hazards and protecting the environment.(19)

(B) Public health Act

Hippocrates’ contribution to the field of public health is of importance, as he was the

first recorded “epidemiologist”. The essentials of epidemiology noted by Hippocrates

included observations on how diseases affected populations and how diseases spread.

Hippocrates observations about the cause and spread of disease in populations were in

many ways more accurate than many of his observations about the medical treatment

and illness. The three books which brought him recognition were Epidemic-I

Epidemic- III and On Airs, Waters and Places. (25)

The Industrial revolution of the 18th century while bringing affluence also brought

number of problems – slums, accumulation of refuse and human excreta,

overcrowding and a variety of social problems. Frequent outbreaks of cholera added

to the woes. Chadwick’s report on “The Sanitary Conditions of Labouring population

(1842)”, focused the attention of the people and Government on the urgent need to

improve public health. Filth and garbage were recognized as man’s greatest enemies

and it last to great sanitary awakening bringing Public Health Act of 1848 in England,

in acceptance of the principle that the state is responsible for the health of the people.

17

The act was made more comprehensive in 1875 when Public Health Act 1875 was

enacted. The Indian Public Health Association was formed in 1958.(26)

This early phase of public health (1880-1920) is often called the “disease control

phase”. Efforts were directed entirely towards general cleanliness, garbage and refuse

disposal.(7)

Epidemiology was practiced in hospitals, or most of the times the waste thrown out of

hospitals was to be taken care by the local municipalities. The general public and

social activists were also not much aware of bio-medical waste hazards and were not

concerned about how the Medical waste had to be disposed off.

Since last fifty years or so, a tremendous change has come in disease profile of the

community as the incidence of hospital borne infections is on constant rise. Though

new drugs and technology for management of diseases in health care system are

available, the waste generation and disposal has always not been given its due

importance.

In every hospital a large amount of waste is generated daily and it has become

necessary to give special attention for the proper treatment and disposal of waste.

Although hospital exists to treat illness, they can act as reservoirs of infection.

Whenever accurate survey have been made it has been found that a substantial

proportion of patient acquire infection during stay in the Hospital. Mostly infection

occurs in the hospital, is due to inappropriate cleanliness. Therefore, it is essential to

take precautions in the design and organisation of hospital to minimize the risk of

infection.(25)

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(C) Categories of the persons exposed to risk of infections

The Persons who are exposed to the risk of infection from potentially infectious

wastes are:

i) Patients who attend the hospital and who are at special risk from infections

and other complications if the waste disposal is not properly organized:

• Immunosupressed patients, whose defense mechanisms are altered, e. g.

HIV patients, patients of cancer, patients on immunosuppressive drug

therapy.

• Patients with bleeding or clotting diseases

• Patients in health care establishments or under home care.

ii) All medical and paramedical staff who are involved in medical care:

• The main groups are nurses

• Laboratory technicians

• Sanitation staff involved in collection, segregation and disposal of waste

• Staff working in supportive service areas like kitchen and laundry etc.

iii) All visitors to the hospital including the general public:

iv) Public health risks of hazardous health care waste:

Infections may be transmitted by contact with patient’s body fluids or secretions.

Pathogens may also be distributed by insects and rodents that come in contact with

unsafely stored waste. Nosocomial (hospital acquired) Infection can also occur due to

poor health care waste management.(8)

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(D) Sources of Health Care Waste

Major sources of health care waste:

(a) Hospitals

• University hospital

• General hospital

• District hospital

(b) Other health care establishments

• Health care centres

• Dispensaries

• obstetric and maternity clinics

• Outpatient clinics

• First aid posts

• Long term health care establishments and hospitals

• Primary health centres, sub-centres

(c) Related laboratories and research centres

• Medical and bio-medical laboratories

• Biotechnology laboratories

• Medical research centres

• Animal research and testing centres

• Blood banks and blood collection services

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(d) Minor sources of health care establishments

• Small health care establishments

• Physician offices

• Dental clinics

• Acupuncturists

• Clinics and Dispensaries of Indigenous system of practitioners(7,19)

All these health care establishments generate waste and are therefore covered under

Bio-Medical Waste (management and handling) Rules, 1998.(7)

Though many of the healthcare facilities are small, and do not individually produce

much hazardous waste, the total quantity of hazardous wastes coming from all the

small facilities is likely to be significant. In many cities the wastes from small

healthcare facilities are mixed with general municipal wastes in a large number of

locations, thereby contaminating a very large quantity of waste. (19)

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(E) Classification of Health Care Waste

The WHO classification of hazardous health care waste. (7)

Sl. No. Waste types Description and examples

1. Infectious waste Waste suspected to contain pathogens e.g.

laboratory culture, tissue materials, equipment

that has been in contact with infected patients,

excreta.

2. Pathological waste Human tissue or fluids e.g. body parts, blood

and other body fluids.

3. Sharps Sharp waste e.g. needles, infusion sets,

scalpels, knives, blades, broken glasses etc.

4. Pharmaceutical waste Waste containing pharmaceuticals e.g. expired

drugs.

5. Genotoxic waste Waste containing substances with genotoxic

properties e.g. Cytotoxic drugs.

6. Chemical waste Laboratory reagents, film developers

7. Wastes with high content of

heavy metals

Batteries, broken thermometers and BP

instruments

8. Pressurized containers Gas cylinders, aerosol cans

9. Radioactive waste Waste containing radioactive substances e. g.

unused liquid from radiotherapy units,

packaging or radioactive material.

(F) Occupational Health and Safety Precautions/ Measures

Hospital waste management requires commitment from persons, at all levels in the

health cares facility. According to W.H.O, “The human element is more important

than the technology. Almost any system of treatment and disposal that is operated by

well-trained and well-motivated staff can provide more protection for staff, patients

22

and the community, than an expensive or sophisticated system that is managed by

staff who do not understand the risks and importance of their contrition.”

Appropriate personal hygiene and good laboratory practices are absolutely

fundamental to biological safety and cannot ever be replaced by any fancy chemical

or special equipment.

Occupational health and safety measures include meticulous practice of universal

precautions at work place, proper use of personal equipment, periodic medical and

health examination, maintenance of records of morbidity, accidents and injury,

typhoid and hepatitis-B. Training, retraining and continued training of personnel,

good house keeping and hygienic practices are complimentary to the Endeavour.(19)

Essentials of the Universal precautions/ standard precautions:

Since medical history and examination can not be reliable identity of patients infected

with HIV or other blood borne pathogens, precautions should be consistently used for

all specimens of blood and body fluid. This approach is known as “Universal

precautions.”

Thus blood and certain body fluids of all patients are considered potentially infectious

for HIV, HBV and blood borne pathogens.

Universal safety precautions are intended to prevent parental, mucous membrane and

non intact skin exposures of health care workers to blood borne pathogens.

Use appropriate barrier precautions to prevent skin and mucous membrane exposure,

when contact with blood or body fluids are anticipated. (19)

23

Few of the other important Safety practices are:

a) Hand washing

• Wash hands after touching blood, secretions, excretions and contaminated

items, whether or not gloves are worn. Wash hands immediately after

gloves are removed, between patients’ contacts.

• Use a plain soap for routine hand washing.

• Use an antimicrobial agent for specific circumstances.

b) Gloves

• Wear gloves when touching blood, body fluids, secretions, excretions and

contaminated items. Put on clean gloves just before touching mucous

membranes and non-intact skin.

c) Mask, eye protection glass, face shield

• Wear a mask and eye protection glass or a face shield during procedures

and patient care activities that are likely to generate splashes or sprays of

blood, body fluids, secretions and excretions.

d) Gown

• Wear a gown during procedures and patient care activities that are likely to

generate splashes or sprays of blood, body fluids, secretions or excretions.

e) Linen

• Handle used linen, soiled with blood, body fluids, secretions and

excretions in a manner that prevents skin and mucous membrane

24

exposures, and that avoids transfer of microorganisms to other patients and

environments.

f) Occupational health and blood-borne pathogens

• Take care to prevent injuries when using needles, scalpels and other sharp

instruments or devices.

• Use ventilation devices as an alternative to mouth to mouth resuscitation

methods.

g) Isolation of Patient

• Place a patient who contaminates the environment or who does not assist

in maintaining appropriate hygiene in an isolated (or separate) room. (27)

Implementation of Bio safety practices

Although guidelines regarding universal precautions and other bio safety practices are

available since long, strict implementation is eventually not in practice in health care

setting in India. With increase in the prevalence of HIV infection, there is a definite

need that the health care workers take bio safety practices seriously. For effective

compliance, the hospital managers should ensure adequate supply of personal

protective equipments, availability of material for hand washing, disinfectants and set

up an effective waste disposal programme for disposal of biomedical waste.(28)

(G) Application, Treatment and Disposal Technologies for Health Care Waste

Application:

The Bio-medical waste (management and handling) Rules, 1998, apply to all persons

who generate, collect, receive, store, transport, treat, dispose or handle Bio-medical

waste in any form.(29)

25

Treatment:

It means any method, technique or process designed to change the biological or

physical character or composition or waste to reduce or eliminate pathogens so that

the waste no longer possesses a hazard to persons who may be exposed to it.

Treatment of waste generated (at source) is the most desirable, since it makes the

handling of waste much safer. The final choice of treatment system should be made

carefully, on the basic of various factors, many of which depend on local

conditions.(30)

Purpose of treatment of waste is:

• Reduce the hazardousness (injuries) of the waste

• Reduce the infectiousness of the waste

• Volume reduction

• Pre-requisite to use certain disposal options (e.g. deep burial of infected

waste)

• Makes the option of recycling of waste a safe and viable one. (30)

Methods of Treatment are as follows:

Disinfection

It is a process of application of a disinfectant for a sufficient length of time in an

adequate quantity and strength so as to kill the specific organisms of infectious

diseases e. g. faeces of an infected person is mixed with an equal volume of phenol

solution 1 in 20 and bleaching powder, stirred with a wooden stick and allowed to

stand for two hours. Urine should be treated with phenol solution 1 in 20 and allowed

to stand for half an hour. Feeding equipment, utensils and crockery should be boiled.

26

Sputum should be received in gauze swabs or paper sputum cups and destroyed by

burning. Clinical thermometer should be kept in a phenol solution of 1 in 20 strength.

Types of Disinfection:

• Concurrent disinfection

It is carried out during course of patient’s illness.

• Terminal disinfection

It is the process of rendering the personal clothing and immediate physical

environment of the patient free from the possibility of conveying infection to others at

the end of illness.

• Prophylactic disinfection

Process of pasteurisation of milk, water purification by chlorination etc.(16)

Disinfectant: A disinfectant or germicide is a substance which destroys harmful

microbes (not usually spores) with the object of preventing transmission of disease.

Disinfectants are suitable for application only to inanimate objects. (7)

A substance/ compounds which kill bacteria (bactericidal) are called disinfectants,

while those which prevent their production (bacteriostatic) are called antiseptics.(17)

Disinfectants may be internal i.e. agents used to kill the micro organisms inside the

body or external i.e. agents used to kill the bacteria outside the body. However the

term disinfectant is usually associated with the external disinfectants.(16)

27

Classification of disinfectants:

The disinfectants are classified as:

• Natural Disinfectants e.g. sunlight and air by process of drying prevent the

growth of microorganisms. The ultra-violet rays present in sunlight are also

germicidal in action.

• Physical Disinfectants:

a) Dry Heat

Burning is the surest method of disinfection and is preferred for items of little value

and disposal. Hot dry air has no penetrating power and does not kill spores.

b) Moist Heat

Boiling is an efficient method. Generally 10-15 minutes boiling kills most of the

microorganisms. For the destruction of spores a longer period of boiling about 30

minutes is necessary. Clothes and utensils etc. can be disinfected by this method.

c) Steam

Current steam: Steam produced at ordinary atmospheric pressure (100ºC) is called

current steam. It is used in many portable disinfectors with the entry of steam at top

and exit below the articles to be disinfected.

Saturated steam: Steam is generated in a closed vessel under pressure, so that higher

temperature is obtained of the compressed steam.

Sterilisation: means destruction of all forms of microbial life including viruses,

fungal and bacterial spores on inanimate surfaces, including the resistant spore forms.

• Chemical Disinfectants: are solids, liquids and gaseous.

28

Chemical Sterilisation includes gas sterilisation with ethylene oxide of other gases

and immersassion in a disinfectant solution with sterilizing properties e.g.

Glutaraldehyde. (16)

Disposal:

It means placing the Bio-medical waste in its final resting place.

Certain Methods of Disposal Technologies of Health Care Waste:

(A) Solid Waste Disposal Methods:

In cities and bigger towns non-contaminated solid waste disposal is usually

undertaken by the Municipalities/ Corporations and such waste is disposed in compost

yards/ burial sites away from living areas. In places where such a systematic facility

for waste disposal is not available, one may need to think of disposal in a site nearer

to the health setting. Such a situation may arise in Primary Health Centre or any other

health setting situated in the countryside or rural area. A similar situation may also

arise when the existing waste disposal facilities are far away or inaccessible. In order

to be equipped to meet this need, it is worthwhile recalling some of the methods of

waste disposal.

Methods of disposal of refuse:

1. Burial

2. Composting

3. Incineration

4. Dumping

5. Manure pits

6. Composting

7. Sanitary land fills.(31)

29

General wastes from the hospital can be disposed off by composting and recycling.

Radioactive waste if persists must be stored until the half life period of the wastes

expire before disposal.(32)

1. Burial:

• It is ideal if the location is 50 m away from any water source. Maintain a

minimum distance of 6 ft between the bottom of the trench and the water label.

• A long trench 6 ft deep and 3 - 4 ft wide is dug. The material is dumped and

covered with one foot of excavated earth each day, this also keep animals away

from digging up the buried refuse.

• Construct a wall or fence around the disposal site with locally available materials

such as stone/ bamboo with cactus or any other thorny plants.

• Chemical, bacteriological and physical changes occur in buried refuse. The

temperature rises to over 60ºC within 7 days, kills all the pathogens and hastens

the decomposition process. It then takes 2 - 3 weeks to cool down. Normally, it

takes 4 - 6 months for complete decomposition of organic matter into an

innocuous mass, which is rich in carbon and nitrogen and is excellent for plant

growth.(31)

2. Composting:

• A biological process in which the organic material in refuse is converted to

manure by the action of microorganisms present in the refuse.(17)

• Garbage, paper, straw and cattle dung are dumped into pits and later covered with

half to one foot of earth after every dumping.

• It is a method of combined disposal of excreta and refuse.

30

• Two such pits will be needed. When one is closed, the other will be in use. In 5 to

6 month’s time, the refuse is converted into innocuous manure.(31)

Waste materials that are organic in nature, such as plant material, food scraps and

paper products are put through a composting or digestion system to control the

biological process to decompose the organic matter and kill pathogens. The resulting

stabilized organic material is then compost for agricultural or landscaping purposes.

There is a large variety of composting and digestion methods or technologies, varying

in complexity from simple window composting of shredded plant material, to

automated enclosed vessel digestion of mixed domestic waste.(33)

The area for compositing is dug and side wall is built with bricks. First the dry waste

is dumped and spread about 6 inch in height, and above that refuse is dumped into

about 2 inches. This process is continued until the pit is filled. Lot of heat emerges

due to chemical changes and pathogens are killed. Thus, matter become precious

manure within three months.(34)

3. Incineration:

Refuse can be disposed off ‘hygienically’ by burning or incineration. Infected hospital

waste and disposables are best disposed off by incineration. Incineration is controlled

burning. For it to be effective and the process innocuous, it is necessary to observe the

following precautions:

• The incinerator should have 2 chambers; one chamber to burn the waste and the

other to burn the volatiles released from the first chamber. Thus, the smoke/ gases

are rendered innocuous and there is no air pollution.

• The temperature maintained in the first chamber (primary chamber) should be

800ºC±50ºC and in the second chamber (secondary chamber) it should be

31

1050ºC±50ºC. Dioxins released while burning plastic material are rendered

innocuous at this temperature.

The standards prescribed by the Central Pollution Control Board and as quoted in the

Bio-medical waste rules, 1998 should be adhered to:

• Install good quality incinerators of standard made

• Monitor closely the temperature reached

• Segregate the waste and feed it selectively into the incinerator

• Provide training to all the staff involved

• Incinerated waste is to be disposed off in secure landfills

• Metal components are not incinerated, hence needles, tops of vials, etc. are to be

disposed off differently.(35)

4. Inertization:

The process of “inertization” involves mixing waste with cement and other substances

before disposal in order to minimize the risk of toxic substances contained in waste

migrating into surface water or groundwater. It is especially suitable for

pharmaceuticals and for incineration ashes with a high metal content (in this case the

process is also called “stabilization”).

For the inertization of pharmaceutical waste the packaging should be removed, the

pharmaceuticals are grinded and a mixture of water, lime and cement added. A

homogenous mass if formed and cubes or pellets are produced of equal size and then

can be transported to a suitable storage site. Alternatively the homogenous mixture

can be transported in liquid state to a landfill and poured into municipal waste.

The following are typical proportions for the mixture:

65% pharmaceutical waste, 15% lime, 15% cement, 5% water.(36)

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(B) Liquid Waste Disposal Methods:

Liquid wastes of hospitals and health care settings consists of waste water from

bathrooms, wash basins etc. In cities and bigger towns where an underground

drainage system exists, all these liquid wastes and decontaminated liquid waste from

laboratory/ blood bank can be led into the underground drainage system. Blood,

serum and all other body fluids left over in the laboratory, spillage during / after

diagnostic or treatment procedures has to first decontaminate with suitable

disinfectant like 0.5 – 1% sodium hypochlorite with a contact time of 30 minutes. (35)

In semi-urban and rural health care settings, where there is no underground drainage

system, the following methods of disposal can be considered.

a. Soak Pit

• A soak pit allows waste water to drain into the soil

• A soak pit cannot be used in areas where earth is made of heavy clay or rock or

near a ground water source.

• The size recommended for a soak pit depends on the amount of waste water and

the percolation rate. In a wide range of soils, a soak pit 5 - 6 feet deep and 3 ft in

diameter could drain out 50 - 70 litres of liquid waste per day.

• Soak pits should not be constructed near the wells, for fear of contaminating the

sub soil water.(37)

b. Evapo-transpiration Mound

• This is useful especially where soil conditions do not allow the liquids in soak pits

to soak into the ground (e.g. in heavy clay and rock) or where ground water can

get contaminated.

33

• Waste water is led into a mound where fast growing grasses take up water and

release it into the atmosphere through transpiration and evaporation. It is better to

locate the mound on a site, which is not subject to flooding.

• The mound must be well constructed and managed properly.(35)

(H) Key steps of health care waste management

Minimization, separation, identification, handling, treatment and final disposal of

waste: technical specifications for the implementation of each step should be

described in separate technical guidelines:

• Record-keeping requirements

• Rules governing the protection of workers’ health and safety

• Safe practices for waste minimization

• Separation, handling, storage and transport of health care waste.(38)

The persons most at risk are the staff of hospitals, particularly nurses and other health

care providers, waste handlers both within and outside the health care establishment.

In countries like India, scavengers and rag pickers are at serious risk. It is necessary in

such a situation that attention is paid to:

i. Keeping the waste secured and preventing the access to unauthorized persons at

every stage.

ii. Initiate awareness within the health care establishment and the community about

the potential hazard of medical waste.

iii. Decontaminate or disinfect the infectious component of the waste at site of

generation.

iv. Disfigure the single/ limited use items to prevent the reuse.(3)

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(I) Bio-Medical Wastes (management and handling) Rules, 1998

The Government of India under the provision of the Environment Act - 1986, notified

the Bio-medical waste (management and handling) rules on 20th July 1998.

The following are the guidelines:

• The Rules regulate the disposal of Bio-medical waste.

• The objective is to take all steps to ensure safety of health and environment.

• Article 21 of the constitution of India guarantees the right of life and personal

liberty. The expansive interpretation given to it by the judiciary includes the

fundamental right to clean environment and health and medical care within its

ambit.

The central legislations on this subject are:

• The water (prevention and control of pollution) Act, 1974

• The Air (Prevention and control of pollution) Act, 1981

• The Environment (Protection) Act, 1986

• The Hazardous Wastes (Management and Handling) Rules, 1998

• The Bio-Medical Wastes (Management and Handling) Rules, 1998

• Municipal Solid Wastes (Management and Handling) Rules, 2000 for municipal

waste.(15)

The law and rules should be complemented by a policy document, and by technical

guidelines developed for implementation of the law. This legal “package” should

specify regulations on treatment for different waste categories, segregation, collection,

storage, disposal, and transport of waste, responsibilities and training requirements; it

35

should taken into account the resources and facilities available in the country

concerned any cultural aspects of waste-handling. Gradual implementation of the law

is recommended in preference to any attempt to introduce all measures

simultaneously, particularly where existing practices are inadequate.(6)

36

MATERIALS AND METHODS

The HCIs (unani hospitals and dispensaries) in Bangalore were sorted out as

providing OP services only and those providing both OP and IP services for the

purpose of analysis and discussion. The collected data is analysed by using tables and

graphs, the research design used for this study is a descriptive research study, which

includes surveys and fact finding inquires.

1. Through observational checklist (Annexure-1) for assessment of both Pre and Post

orientation/ Sensitisation session.

2. Interaction with various categories of health care personal (like doctors, nurses,

technicians, ward boys and other waste handlers).

3. Type of waste, Quantity of waste, Waste segregation and method of disposal

recorded.

4. The purpose of the study was explained to respondents (Department heads,

administrative heads of the institutions, physicians, nursing heads, house keeping

and cleaning personnel) to get their full cooperation and prompt answers.

5. The observational checklist (Annexure-1) for assessment of the existing systems is

based on the Bio-medical waste (management and handling) Rules, 1988, Govt. of

India, and Interaction with various categories of health care personal and waste

handlers.

RESEARCH APPROACH:

The research design used for this study is a descriptive research study. Descriptive

research includes surveys and fact finding inquires, to assess the existing practices of

37

waste management and to identify the type of waste, segregation practices,

quantification of waste and its disposal methods. And orientation / sensitisation

sessions were conducted for the health care personnel at interval of first month, fourth

month and sixth month of the POS at various departments / sections of the studied

HCIs and the effect of management is noted both in components of the waste and in

the continued interaction of the health care personnel, as mentioned below.

(1) Through observational checklist (Annexure-1) for assessment of the existing

system and post orientation / sensitization session, the components which

includes source of waste, type of waste, collection of waste, storage of waste and

disposal methods were observed.

(2) Interaction with various categories of health care personnel, like doctors, nurses,

paramedical staff, technicians, ward boys, ayahs, housekeeping staff and other

waste handlers will be done.

PLACE AND DURATION OF THE STUDY:

This study was undertaken in 02 Govt. Unani Hospitals and 03 Govt. Unani

Dispensaries in Bangalore urban limit area, during the period October 2006 and June

2007.

The types of the hospitals included in the study are as follows:

•••• Those providing In-patient and Out-patient services

•••• Those providing only Out-patient service

SAMPLE SIZE:

The Bangalore urban limit area has 02 Govt. Unani Hospitals and 03 Dispensaries.

These hospitals and dispensaries have been included in the study.

38

Table showing the types and number of Hospitals studied

Type of Hospitals Hospitals where

practice documented

Those providing both IP and OP Services (n=2)

National Institute of Unani Medicine, Bangalore Yes

Sri Jayachamarajendra Institute of Indian Medcine

and Hospital

Yes

Those providing only OPD services (n=3)

Government Unani Dispensary, Neelsandra,

Bangalore

Yes

Government Unani Dispensary, Jayamahal extension,

Bangalore

Yes

Corporation Unani Dispensary, Broadway road,

Bangalore

Yes

The studied institutions/ hospitals have been categorised whether providing OP

services or both OP and IP services.

Table Showing Profile of the Studied Institutions

Services Provided

Total Beds

Total Bed Occupancy

Average OPD

Strength /Day

Average IPD

Strength /Day

Average No. of Pathological Cases/Month

Average No. of Regimenal

Cases/Month

OPD and IPD n=2

200 120 200 30 2400 1500

OPD

n=3

NA NA 150 NA - -

Total

n=5

200 120 350 30 2400 1500

Note:

NA=Not Applicable, n = number of institution/ hospital

39

SAMPLING:

It was a purposive sample and effort was made to include health institutions,

rendering out-patient services and both out-patient as well as in-patient services for

documenting practices.

Statistical analysis was carried out for two sources of data, as mentioned below.

1. Staff interest and participation

• HOI, doctors, nursing and other staff interest and participation.

• Perceived factors that have helped in sustaining of the system of waste

management (training and retraining to the staff, recording of injuries/

accidents, periodic monitoring of the waste management facility, occupational

safety measures).

Statistical Analysis: The statistical calculation was carried out using instant G-paid

version 3.

Test applied: Kruskal–Wallis Test

Description: Kruskal-Wallis Test is the most efficient non parametric test for

independent samples. (data replaced by scores or by their ranks) It is named after

William Kruskal and W. Allen Wallis. (39)

The perceived factors were assessed before and at intervals of 1st, 4th, and 6th

months after orientation session with the help of Checklist, they are independent

samples and the samples are classified by the ranking. This test is most appropriate in

this case.

Purpose: Applicable for independent samples with a hypothesis that the treatment

effects are different hence this technique could be used in this study.

40

2. Assessment of the sub-systems of the health care waste management

• Segregation

• Disinfection

• Containment

• Colour coding

• Disposal

The Test that is applied for the assessment during the monitoring of both pre and post

orientation sessions of the sub-system are as follows:

Statistical Analysis: The statistical calculation was carried out using instant G-paid

version 3.

Test applied: Friedman Test

Description: The Friedman test is a non-parametric statistical test use to compare

observations on the related subjects in a sample, the procedures involves ranking. (40)

. The sub-systems were assessed before and at intervals of 1st, 4th, and 6th months after

orientation session with the help of Checklist. They are related subjects and are

classified by the ranking. This test is most appropriate in this case.

Purpose: This test is used with a hypothesis that the treatment effects are different.

This is applicable for related subjects in a sample; hence this technique could be used

in this study.

PILOT STUDY:

A Pilot study was carried out to find out the type of waste generated from the

institutions/ hospitals (providing out-patient services only and those providing both

out-patients as well as in-patient services), quantity of waste, waste segregation and

41

method of disposal is recorded. The purpose of the study was explained to

respondents (department heads, administrative heads of the institution, physicians,

nursing heads, house keeping and cleaning personnel) to get their full cooperation and

prompt answers.

The tool was found to be feasible and practicable and there was no necessity to make

further changes after the pilot study. Therefore, the investigator decided to carry out

the actual study process.

METHODS OF COLLECTION OF DATA:

Initial interaction discussion was held with:

(i) Head of the Department

(ii) Administrative heads of the institution

Data were gathered through observational checklist (Annexure-1), interaction with the

health care personnel and also by direct observation.

The following was the process adopted for building the systems:

a) Interaction with the head of the institutions, to understand their perceptions

about the whole issue of safe management of hospital waste.

b) The initial survey of the institution to learn about the existing systems for safe

management of hospital waste.

c) Orientation and training session, that was interactive, participatory and task

oriented.

d) Identification of roles of each of the health care personnel in safe management

of hospital waste.

42

The standard method used for quantification is as follows:

• Segregated waste was weighed.

• Whenever waste was not segregated, it was physically segregated using

appropriate protective measures.

• In each of the institution, waste was weighed for a minimum period of seven

days.

• The total amount of waste was calculated by taking the average for the period

of weighing.

Regular monitoring of the systems was undertaken using the checklist. The

monitoring was done at 1st month, 4th month and 6th month after the initial orientation.

Few of the key factors that played a great role in establishing the systems health

care units were:

Monitoring

• Monitoring was undertaken with the help of checklist

• Problem identification and problem solving and not a fault finding mission.

• Persuasive and encouraging

Empowering

• Discourage waste generation staff to depend on cleaning staff for segregating

waste.

Incentive for good practices

• A small token monitory benefit

43

Disincentive

• Token monitory fine

• No increments

Head of the institutions

• A participant in the endeavour

• Facilitating continued interaction

• Helps systems to evolve and improving the systems by procuring appropriate

equipment.

44

OBSERVATION AND RESULTS

This chapter is based on collected data, which was analysed by using Tables and

Graphs.

Table 1

Types of services provided by the studied HCIs

Services Provided IPD/OPD

n =2 (40%) OPD

n =3 (60%) Total N =5

Total Beds 200 NA 200

Total Bed Occupancy 120 NA 120

Avg. OPD Strength/day 200 65 265

Avg. IPD strength/day 30 NA 30

Average Pathological Investigation/month

6215 0 6215

Figure 1

Types of services provided by the studied HCIs

OPDn = 3(60%)

IPD/OPDn = 2(40%)

IPD/OPD n = 2 OPD n = 3

Figure 1 shows that number of studied HCIs providing OP service was 60% and those

providing both IP/ OP services were 40%

45

Table 2

Category of Staff and their Participation in the Studied HCIs

Category of Staff Number (%)

Number of Doctors 56 (46.66)

Nursing staff 14(11.66)

Laboratory technicians 8(6.66)

Pharmacy staff 16(13.33)

Ward boys/ Ayahs 22 (18.33)

Others 4(3.33)

Total Health Care Personnel 120(100)

Figure 2

Category of Staff and their participation in the studied HCIs

56 (46.66%)

14 (11.66%)

8 (6.66%)

16 (13.33%)

22 (18.33%)

4 (3.33%)

0 20 40 60

Cat

ego

ry

Number (Percentage)

Others

Ward boys/ Ayahs

Pharmacy staff

Laboratory technicians

Nursing staff

Doctors

Figure 2 shows the numbers and percentage of various HCP participated in studied

HCIs throughout pre and post orientation/ sensitisation session

46

Table 3

Percentage of Various Types of Waste Generated in Studied HCIs

Types of Waste Waste items Quantity (Kg)

%

General Waste Paper, plastic, food waste, sweeping from hospital premises, packing material, herbal remains from pharmacy etc.

123 81.45

Sharps Needles, syringes, broken ampoules and glass, used scalpel, blades, etc.

1.87 1.23

Pathological Waste

Human tissues and fluids e.g. body parts, blood and other body fluids, remains of blood sample, blood soaked swab, etc.

5.90 3.90

Infectious Waste Used dressing material, soiled surgical dressing, swab material in contact with persons suffering from infectious diseases, disposable gowns, gloves, towels, etc.

20.25 13.41

Figure 3

Percentage of various types of wastes generated in studied HCIs

81.45%

1.23%

3.90%13.41%

General waste

Sharps

Pathlogical waste

Infectious waste

47

Table 4

Quantity Estimation of Solid Waste Generation in kgs/ bed/ day in studied HCIs

having In-Patient Facility

Observation No. of Beds

Total Weight (Kg)

Weight (Kg)/ bed/ day

Weight (Kg)/ bed/ year

%

HCI 1 100 78 0.78 284.7 53.42

HCI 2 100 68 0.68 248.2 46.58

Total 200 146±7.07 1.46±0.07 532.9±25.80 100

Figure 4

Percentage of quantity of waste generated in 2 studied HCIs having in-patient facility

53%

47%HCI No. 1

HCI No. 2

48

Table 5

Institutional Facilities for Treatment/ Disposal of waste

Services Provided

(%)

Burial Burning Incineration Autoclave

IP/OPD

n=2 (40%) 0 2 (40%) 0 0

OP

n=3 (60%) 0 2 (40%) 0 0

Total

N=5 (100%) 0 4 (80%) 0 0

Table 5: shows that 4 studied units two were having the facility of OPD and other two

having facility of OPD & IPD were burning the waste.

Table 6

Methods of Collection of Various Types of Waste Items

Types of Waste Waste items Methods of

collection

General Waste Paper, plastic, food waste, sweeping from hospital premises, packing material, herbal remains from pharmacy etc.

In baskets and containers (open lid)

Sharps Needles, syringes, broken ampoules and glass, used scalpel, blades, etc.

Transparent bottles

Pathological Waste

Human tissues and fluids e .g. body parts, blood and other body fluids, remains of blood sample, blood soaked swab etc.

Polythene covers/ containers (lidded)

Infectious Waste Used dressing material, soiled surgical dressing, swab material in contact with persons suffering from infectious diseases, disposable gowns, gloves, towels etc.

Polythene covers/ containers with lid

Table 6: shows that open containers were used to collect the non-infectious general

waste and lidded containers were used to collect the infectious waste

49

Table 7

Frequency of Collection of Various Types of Waste Items

Types of Waste Waste items Frequency of

collection

General Waste Paper, plastic, food waste, sweeping from hospital premises, packing material, herbal remains from pharmacy etc.

daily

Sharps Needles, syringes, broken ampoules and glass, used scalpel, blades, etc.

Once in a week

Pathological Waste

Human tissues and fluids e .g. body parts, blood and other body fluids, remains of blood sample, blood soaked swab etc.

daily

Infectious Waste Used dressing material, soiled surgical dressing, swab material in contact with persons suffering from infectious diseases, disposable gowns, gloves, towels etc.

Twice a day

Table 7 shows General waste is collected daily and infectious waste is collected twice a day

Table 8

Methods of disposal of various types of waste Items

Types of Waste Waste items Methods of

disposal of waste

General Waste Paper, plastic, food waste, sweeping from hospital premises, packing material, herbal remains from pharmacy etc.

Burning/ handing over to corporation municipal system

Sharps Needles, syringes, broken ampoules and glass, used scalpel, blades

burning

Pathological Waste Human tissues and fluids e .g. body parts, blood and other body fluids, remains of blood sample, blood soaked swab etc.

burning

Infectious Waste Used dressing material, soiled surgical dressing, swab material in contact with persons suffering from infectiousdiseases, disposable gowns, gloves, towels, etc.

burning

50

MODE OF MANAGEMENT OF SOLID AND LIQUID INFECTIOUS W ASTE

IN THE STUDIED HCIs

• Mode of Management of Solid Infectious Waste in the Studied HCIs

Table 9

(a) Activities at Point of Generation of Waste Item at Studied HCIs

Waste item Segregation Disinfection Containment

Cotton 2 (40%) 0 2 (40%)

Contaminated linen 2 (40%) 0 2 (40%)

Bandage cloth 2 (40%) 0 2 (40%)

Table 9 shows that segregation and containment of waste was done in 40% of the

studied HCIs

Table 10

(b) Treatment and Final Disposal of Wastes in Studied HCIs

Waste item Transportation Colour

Coding

Final

Disposal

Overall Approximate

Management

Cotton 2 (40%) 0 1 (20%) 0

Contaminated

linen 1 (20%) 1 (20%) 0 0

Bandage cloth

1 (20%) 1 (20%) 0 0

Table 10 shows transportation of waste was done in 40% of the studied HCIs

51

(c) Method of Management of Recyclables/ Waste Sharps in the Studied HCIs

Table 11

(i) Activities at the Point of Waste Generation

Waste item Segregation Disinfection Disfigurement Containment

Disposable Syringes

2 (40%) 1 (20%) 0 2 (40%

Needle/ Scalpel

Blade 2 (40%) 2 (40%) 1 (20%) 2 (40%)

Intact glass ware

2 (40%) 0 0 1 (20%)

Plastic

Material 5 (100%) 0 0 5 (100%)

Table 11 shows that segregation and containment of plastic material was done in all

the studied HCIs

Table 12

(ii) Treatment and Final Disposal of Waste

Waste Item Transportation Color coding Final disposal

Overall

Appropriate

Management

Disposable Syringe

4 (80%) 3 (60%) 2 (40%) 0

Needle/Scalpel

Blade 2 (40%) 2 (40%) 2 (40%) 0

Intact Glass ware

2 (40%) 2 (40%) 2 (40%) 0

Plastic material

2 (40%) 2 (40%) 2 (40%) 0

Table 12 shows that overall management of treatment and final disposal is not

satisfactory

52

Table 13

• Mode of Management of Liquid Waste and Infectious Body Material in the

Studied HCIs

Waste Item Disinfection Containment Final disposal Overall

Appropriate

Management

Stool 0 0 0 0

Urine 0 0 0 0

Sputum 0 0 0 0

Blood 0 0 0 0

Table 13 shows that overall management is nil

53

RESULTS OF INITIAL ASSESSMENT IN STUDIED HCIs

Overall Assessment:

• None of the studied units managed Soiled infectious waste appropriately

• One of the studied units providing both IPD/ OPD had needle destroyer for

disfigurement of needles, but final disposal was not appropriate.

• None of the studied institutions managed liquid infectious waste appropriately.

From the above results, it could be inferred that the type, size or the profile of

institutions has not influenced the systems for safe management of HCW.

Assessment of the Subsystems:

1) Soiled infectious waste: Bandage cloth

• Segregation of this waste item was seen in 40% of the studied units and its

containment was satisfactory in similar number of the studied institutions

• However, there is an operational constraint, if chemical decontamination of this

waste is to be considered, it requires huge amounts of water and chemicals. This

also increases the weight of the waste item. There is a possibility that this

practice if adopted, would leave the whole of its containment, collection, storage

and transportation subsystems in a mess and further, if there is no appropriate

concentration of the disinfecting agent used, then there is a possibility of spread

of the spill area.

• The other alternative that could be considered is Autoclaving or Microwaving,

which again are cost intensive and need trained HCP for operation.

54

2) Waste sharp management: Needles

• The management of this waste is a big concern. There is segregation in only 40%

of the HCIs. This could be probably because of the thrust that is give to the waste

sharp destructors, so if there is no destructor the system can not start, this myth

among the HCIs needs to be quelled.

• A puncture proof container would achieve the objective of the waste sharp

management.

• This coupled with disinfection could achieve the objective of management of this

category of waste.

3) Plastic recyclables: Syringes

• This waste item was segregated in 40% of the studied HCIs

• The problems with this waste item are its Re-use potential, and in many of the

HCIs this has been left as an incentive to the Cleaners.

4) Body fluids:

• The appropriate management of this infectious waste is very much feasible

operationally. HCI could be oriented to the hazards of untreated liquid infectious

waste could pose to General community/ sanitary workers.

• It is not much difficult to orient people to disinfect at least the laboratory samples

of the body fluid before they let in to sewage system.

The assessment of the sub-systems reveals that though the current existing systems do

not fulfil the requirements of the BMW Rules, there were definitely attempts at

managing the waste in the studied HCIs.

55

Assessment of the Systems and Subsystems for SMHCW

Description of the process observed for building systems for SMHCW in all the 5

HCIs selected for orientation sensitization:

Monitoring the Systems at 1st, 4th And 6th Months

The status of the subsystem at Monthly interval after the Orientation session was

assessed based on checklist. The subsystems are Segregation, Disinfection and

Containment.

Assessment of the systems was in terms of whether it is satisfactory or not

satisfactory. Similarly, Head of institute interest, Nursing staff participation, House

keeping staff, Doctors interest, Continues interaction, support of HOI, was looked for

there presence or absence.

Assessment of Waste Management System in the HCIs, Pre and Post

Orientation/ Sensitisation

(A) Staff interest and Participation

1. HOI, Doctors, Nursing and other Staff Interest and Participation

2. Perceived factors that have helped in sustaining of the System of Waste

Management (Training to the staff, Recording of injuries/ accidents, Periodic

monitoring of the waste management facility, Occupational safety measures).

(B) Assessment of the Sub-systems of the SMHCW

The status of Subsystems of SMHCW, as mentioned below, was recorded in 6

Departments/ sections (Pathology, IPD, OPD, Pharmacy, Kitchen and Dressing

Sections) of studied HCIs having both IP and OP facilities and 3 Departments/

sections (OPD, Pharmacy and Dressing Sections) of studied HCIs having only OP

56

facility, where Orientation session was conducted. The assessment during the

monitoring of both pre and post Orientation session was done based on the Checklist.

•••• Segregation

•••• Disinfection

•••• Containment

•••• Colour-coding

•••• Disposal

57

(A) Staff Interest and Participation

Table 14

1. HOI, Doctors, Nursing and other Staff Interest and Participation

Post- Orientation Session HCIs

N = 5

Pre-Orientation

Status Month 1 Month 4 Month 6

Head of the Institution interest

1 2 3 5

Doctors participation 1 3 4 5

Support of the Head of the Institution

1 2 3 5

Continued Interaction

- 3 4 5

Nursing Staff Participation

1 2 3 5

kw=17.841 p<0.001, considered extremely significant

Table 15

2. Perceived Factors that have helped in Sustaining of the System of Waste

Management:

Post-Orientation Session HCIs

N = 5

Pre-Orientation

status Month - 1 Month - 2 Month - 3

Trainingand retraining to the staff

0 1 4 5

Recordingof Injuries/ accidents

0 1 3 5

Reportingof injuries/ accidents

0 1 3 4

Periodic monitoring of the Waste managementfacilities

0 2 2 4

Occupational safety policy

0 0 1 2

kw=15.555 p<0.001, considered extremely significant

58

(B) Assessment of the Sub systems of the SMHCW

Table 16

Application of Segregation of Waste by Studied HCIs in their various

departments

Post – Orientation Session HCIs

N = 5

Pre – Orientation

Status Month - 1 Month - 4 Month - 6

1 0 1 4 6

2 0 1 3 6

3 0 1 2 3

4 0 1 2 3

5 0 1 2 3

fr=15 p=0.0001 considered extremely significant

Figure 5

Application of Segregation of waste by studied HCIs in their various departments

0 0 0 0 0

1 1 1 1 1

4

3

2 2 2

6 6

3 3 3

0

1

2

3

4

5

6

7

HCI 1 HCI 2 HCI 3 HCI 4 HCI 5

No

. o

f D

epar

tmen

ts

Pre-Orient Status Month 1 Month 4 Month 6

59

Table 17

Application of Disinfection of waste by studied HCIs in their various

departments

Post – Orientation Session HCIs

N = 5

Pre – Orientation

status Month 1 Month 4 Month 6

1 0 1 2 4

2 0 1 2 4

3 0 1 2 2

4 0 1 2 2

5 0 1 2 2

fr=14.617 p<0.001, considered extremely significant

Figure 6

Application of Disinfection of waste by studied HCIs in their various departments

0 0 0 0 0

1 1 1 1 1

2 2 2 2 2

4 4

2 2 2

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

HCI 1 HCI 2 HCI 3 HCI 4 HCI 5

No

. o

f D

epar

tmen

ts

Pre-Orientation Status Month 1 Month 4 Month 6

60

Table 18

Application of containment of waste by studied HCIs in their various

departments

Post – Orientation Session HCIs

N = 5

Pre – Orientation

status Month - 1 Month - 4 Month - 6

1 2 3 4 6

2 0 1 4 6

3 0 1 2 3

4 0 1 3 3

5 0 1 3 3

fr=14.625 p<0.002, considered extremely significant

Figure 7

Application of containment of waste by studied HCIs in their various departments

2

0 0 0 0

3

1 1 1 1

4 4

2

3 3

6 6

3 3 3

0

1

2

3

4

5

6

7

HCI 1 HCI 2 HCI 3 HCI 4 HCI 5

No

. o

f D

epar

tmen

ts

Pre-Orientation Status Month 1 Month 4 Month 6

61

Table 19

Application of Colour coding of waste materials by studied HCIs in their various

departments

Post – Orientation Session HCIs

N = 5

Pre – Orientation

status Month - 1 Month - 4 Month - 6

1 0 1 2 4

2 0 1 3 5

3 0 1 2 3

4 0 1 2 3

5 0 1 2 2

fr=14.755 p<0.001, considered extremely significant

Figure 8

Application of Colour coding of waste materials by studied HCIs in their various departments

0 0 0 0 0

1 1 1 1 1

2

3

2 2 2

4

5

3 3

2

0

1

2

3

4

5

6

HCI 1 HCI 2 HCI 3 HCI 4 HCI 5

No

. o

f D

epar

tmen

ts

Pre-Orientation Status Month 1 Month 4 Month 6

62

Table 20

Application of Disposal of waste by studied HCIs in their various departments

Post – Orientation Session HCIs

N = 5

Pre – Orientation

status Month - 1 Month - 4 Month - 6

1 0 2 3 6

2 0 2 3 6

3 0 1 2 3

4 0 0 1 3

5 0 1 2 3

fr=14.755 p<0.001, considered extremely significant

Figure 9

Application of Disposal of waste by studied HCIs in their various departments

0 0 0 0 0

2 2

1

0

1

3 3

2

1

2

6 6

3 3 3

0

1

2

3

4

5

6

7

HCI 1 HCI 2 HCI 3 HCI 4 HCI 5

No

. o

f D

epar

tmen

ts

Pre-Orientation Status Month 1 Month 4 Month 6

63

DISCUSSION

Types of services provided by the studied HCIs

Table 1, shows that total number of studied HCIs providing OP service is 3 (60%) and

those providing both IP/ OP services were 2 (40%). Total number of beds available

was reported to be 200. The total bed occupancy was reported to be 120, average bed

occupancy of about 60%. The average OPD strength per day in studied HCIs

providing only OP service was 65. Average out patient strength per day in studied

hospitals providing both IP/ OP services were 200. The average in-patient strength in

the studied HCIs providing IP/ OP services was reported to be 30 per day. Average

number of Pathological Investigation in studied hospitals providing both IP/ OP

services were 6215 per month.

Category of staff and their participation in the studied HCIs

As evident in Table 2, the total Health care personnel that took part in the continued

interaction, through out pre and post orientation/ sensitisation session were about 120.

Doctors’ participation was 56 (46.66%), Nursing staff participation was about 14

(11.66%), Laboratory technicians were about 8 (6.66%), Pharmacy staff participation

was 16 (13.33%), Ward boys/ Ayahs were 22 (18.33%), others like House keeping

staff were 4 (3.33%) .

Percentage of various types of wastes generated in studied HCIs

As evident in Table 3, out of total quantity of waste generated from studied HCIs,

81.45% is General waste like Paper, plastic, food waste, sweeping from hospital

premises, packing material, herbal remains from pharmacy, etc. Sharp wastes about

64

1.23% consisting of Needles, syringes, broken ampoules and glass, used scalpel,

blades etc. Pathological waste about 3.90% consisting of human tissues and fluids e.g.

body parts, blood and other body fluids, remains of blood sample, blood soaked swab

etc. And Infectious waste is 13.41% consisting of used dressing material, soiled

surgical dressing, swab material in contact with persons suffering from infectious

diseases, disposable gowns, gloves, towels etc.

All hospital waste has the potential to transmit infection. It is estimated that 80- 85%

is noninfectious general waste, 10% is infectious waste and 5% is other hazardous

waste.(3)

Quantity estimation of solid waste generation in kgs/ bed/ day in studied HCIs

having in-patient facility

Quantity of waste generation in studied HCIs having in-patient facility along with the

standard deviations is calculated in kgs/ bed/ day and/ bed/ year. In observation HCI-

1, the quantity of waste /bed/ day is 0.78kg and/ bed/ year is 284.7kgs. In observation

HCI-2, the quantity of waste /bed /day is 0.68kg and /bed/year is 248.2kgs.

Observations are summarized in Table 4.

The results of the waste survey of the hospitals, polyclinics, clinics and Health centers

indicated that the total amount of waste produced is about 0.26 kg/ bed/ day, the

survey also confirmed that hospitals generate more medical waste than polyclinics,

clinics and health centres.(41)

The hospital waste generation from a 400 bed Brazilian hospital which generates

about 386 kg per day that means that generated waste was about 1 kg/ bed/ day.(42)

It is estimated that the quantity of waste generated from hospitals in India ranges

between 0.5 and 2.0 kg/bed/day and annually about 0.33 million tones.(43)

65

Institutional facilities for Treatment/ Disposal of waste

As evident in Table 5, that 4 studied units two having the facilities of both IP/ OP

Services and the other two having the facility of only OP services, were burning the

waste; no study units had Autoclave for the purpose of treating waste. No incineration

facility was available in any of the studied HCIs for treatment/ disposal of waste.

Burial as an option for disposal of waste was not adopted by any of the studied units.

None of the studied institutions had Microwave for treatment of waste. All the studied

institutions were dependent on corporation/ Municipal facility for lifting and

disposing of waste. There was no landfill facility in the studied area. The remains of

the burning were either dumped in corporation bin or were handed over to the BMP

personnel. It could be observed that there is an overall deficiency of the treatment and

disposal facilities.

Methods of collection of various types of waste items

General waste like paper, plastic, food waste, sweeping from hospital premises,

packing material, herbal remains from pharmacy etc. are collected in baskets and

other containers without lid. Transparent bottles are used for collecting sharp waste

like needles, syringes, broken ampoules and glasses, used scalpel, blades etc.

Pathological waste like human tissues and fluids e.g. body parts, blood and other body

fluids, remains of blood sample, blood soaked swab etc. are collected in polythene

covers and containers with lids. Infectious waste like used dressing material, soiled

surgical dressing, swab material in contact with persons suffering from infectious

diseases, disposable gowns, gloves, towels etc. collected in polythene covers and

containers with lid. Observations are summarised in Table 6.

66

Frequency of collection of various types of waste products

General waste like paper, plastic, food waste, sweeping from hospital premises,

packing material, herbal remains from pharmacy etc. and pathological waste like

human tissues and fluids e.g. body parts, blood and other body fluids etc. are collected

daily. Sharps waste like needles, syringes, broken ampoules and glasses, used scalpel,

blades etc. are collected once in a week. And infectious waste like used dressing

material, soiled surgical dressing, swab material in contact with persons suffering

from infectious diseases, disposable gowns, gloves, towels etc. are collected twice

daily. Observations are summarised in Table 7.

Methods of disposal of various types of waste product

Disposal of general waste like paper, plastic, food waste, sweeping from hospital

premises, packing material, herbal remains from pharmacy etc, are subjected to

burning/ handing over to corporation municipal system. Sharp waste, like needles,

syringes, broken ampoules and glasses etc are also burnt, in one of the studied HCI

needles were destroyed in needle burner and later disposed. Infectious waste like used

dressing material, soiled surgical dressing, swab material in contact with persons

suffering from infectious diseases, disposable gowns, gloves, towels etc, and

pathological waste like human tissues and fluids e.g. body parts, blood and other body

fluids, remains of blood samples, blood soaked swab etc. are also subjected to

burning. Observations are summarised in Table 8.

Method of management of solid infectious waste in the studied HCIs

As revealed in Table 9 and 10, that 40% of the studied HCIs were segregating and

containing waste items in this category, and similarly more than 40% of the

67

institutions were transporting this waste safely, however, the steps that gave away the

system were colour-coding and final treatment/ disposal options adopted.

As evident in Table 11 & 12 that, segregation of disposable syringes, needles and

intact glasses were noted in 2 studied HCIs, plastic materials were segregated in

almost all the studied HCIs. Appropriate disinfection procedure for syringes was

noted in 1 of the studied HCI and for needles in 2 HCIs. Disfigurement of needles was

noted in 1 of the studied HCIs. Appropriate containment for plastic material was

noted in almost all the studied HCIs. But overall management of all waste material in

this category was not satisfactory.

Mode of management of liquid waste and infectious body material in the studied

HCIs

As evident in Table 13, that in the studied HCIs, the system of Disinfection and

Containment for this category of waste was nil. This practice has the potential to

contaminate surface and ground water in addition to exposing the city sanitary

workers to the risk of infections. There was no formal colour-coding system used for

this category of waste.

Assessment of waste management system in the HCIs, pre and post orientation/

sensitization session

A. Staff interest and participation

1. HOI, Doctors, Nursing and other Staff Interest and Participation

As evident in Table 14, the status of the sub systems in all 5 HCIs, was noted

in the Pre-orientation status. In 1 (20%) of the HCI, the HOI showed interest in

establishing system for SMHCW. In 1 (20%) of the unit Doctors was very keen for

establishing the system for SMCHW. In 1(20%) of the HCI, the HOI said he would

68

support the endeavor of establishing the systems, by making appropriate provisions in

terms of resources. In 1 (20%) of the HCI, Nursing staffs were keen on establishing

the system. Continued Interaction was not ascertained in any of the HCIs, because, it

has to be started from here onwards.

The Status of the systems at the end of 1 month of orientation was as follows

The keenness of the HOI and his support were noticed in 2 (40%) of HCIs, Doctors

participation was noticed in 3 (60%) of the HCIs. Nursing staff participation was

noted in 2 (40%), Continued participation i.e. 3 (60%) of the HCIs were in constant

touch with the investigator for suggestions and inputs, regarding waste management.

Nursing staff interest and participation was seen in 2 (40%) of the studied HCIs.

The status of the systems during the second monitoring that is 4 months after the

orientation was as follows

3 (60%) of the HOIs showed keen interest in the efforts at building systems,

continued participation and support was also noted in 3 (60%) of the HCIs. In 4 (80%)

of the HCIs, Doctors were reported to have taken interest and participated in efforts

towards building system for SMHCW. In 3 (60%) of the HCIs, nursing staff made

efforts to make the systems work, and 4 (80%) of the HCIs were in continuous touch

with the investigator for advice and the needful.

Third monitoring of the systems at the end of 6 months of POS, the system were

noted as follows:

All the 5 HOIs had continued to take keen interest in the systems and their

development, in similar number of HCIs Doctors, Nursing Staff, took interest in

building the system and staff from all the HCIs was in continuous touch with

investigator for advice and the needful. The statistical calculation was carried out with

69

the help of Kruskal–Wallis Test (kw) =17.841, p<0.001, considered extremely

significant. Observations are summarised in Table 14

2. Perceived factors that have helped in sustaining of the system of Waste

Management

The following status was observed in the Pre-orientation session, training was not

given to any staff, regarding the safety practices of HCWMS. There was no system of

recording and reporting of injuries/ or any kind of accidents with reference to

mismanagement of Health Care Waste and there was no knowledge about safe

policies of occupation and health care personnel in any of the studied HCIs.

Observations are summarized in Table 15.

The Status of the systems at the end of 1 month of orientation was as follows

Training to the staff, recording and reporting of injuries were noted in 1 (20%) of

studied HCI, monitoring of the system was noted in 1 (20%) of the studied HCI and

Occupational safety measures were not noted in any of the studied HCIs.

The status of the systems during the second monitoring that is 4 months after the

orientation was:

In 4 (80%) of the studied HCIs, Training and Retraining to the staff was conducted

regarding SMHCW. Recording and Reporting of injuries was noted in 3 (60%) of the

studied HCIs. Monitoring of the waste management facility was seen in 2 (40%) of

the HCIs, and 1 (20%) HCI adapted the occupational safety policy.

70

Third monitoring of the systems at the end of 6 months of POS, the system were

noted as follows:

Training and retraining to the staff and Recording of injuries/ accidents were seen in

all the 5 studied HCIs. Reporting of injuries and periodic monitoring of the waste

management facility were noticed in 4 (80% of the studied HCIs. Safety regarding

occupational measures was noticed in 2 (40%) of the HCIs.

The statistical calculation was carried out with the help of Kruskal–Wallis Test (kw) =

15.555, p<0.001, considered extremely significant. Observation are summarized in

Table 15

This indicates that the assessment of various independent factors mentioned in Table

14 & 15 had a gradual and incremental improvement during regular monitoring of the

systems with the help of checklist both at pre and post orientation session.

Notification of the Biomedical waste management (m & h) Rules, 1998, Govt. of

India is the appropriate authority for implementation of rules as well as monitoring of

the systems could be the other contributing factors for improvement.

(B) Assessment of the Subsystems of the SMHCW

The status of Subsystems of SMHCW, as mentioned below was recorded in 6

Departments (Pathology, IPD, OPD, Pharmacy, Kitchen and Dressing sections of all

the studied HCIs, where Orientation session was conducted. The assessment during

the monitoring of both pre and post Orientation session was done based on the

Checklist.

Segregation Colour-coding Disinfection

Disposal Containment

71

Application of Segregation of Waste by studied HCIs in their various

departments

The statistical calculation was carried out with the help of Friedman Test (fr)= 15.000,

p<0.0001, considered extremely significant. The above test indicates that there is a

gradual and perceptible rise during regular monitoring of the systems with the help of

the checklist in all the departments of studied HCIs in the component of segregation.

Observations are summarized in Table 16.

Application of Disinfection of Waste by studied HCIs in their various

departments

The statistical calculation was carried out with the help of Friedman Test (fr)= 14.617,

p<0.001, considered extremely significant.

The above test for the component, for Disinfection of waste, showed gradual and

incremental rise during the monitoring of the systems with the help of the checklist in

all the department of the studied HCIs. .Observations are summarized in Table 17

Application of containment of waste by studied HCIs in their various

departments

The statistical calculation was carried out with the help of Friedman Test (fr) =14.625,

p<0.002, considered extremely significant.

The above test for the component, Containment of waste, showed gradual and

incremental rise during the monitoring of the systems with the help of the checklist in

all the department of the studied HCIs. Observations are summarized in Table 18

72

Application of Colour Coding of Waste Materials by studied HCIs in their

various departments

The statistical calculation was carried out with the help of Friedman Test (fr) =14.755,

p<0.001, considered extremely significant.

The above test for the component, of Colour coding of waste material, showed

gradual and incremental rise during the monitoring of the systems with the help of the

checklist, in all the department of the studied HCIs. Observations are summarized in

Table 19.

Application of Disposal of Waste by studied HCIs in their various departments

The statistical calculation was carried out with the help of Friedman Test (fr) =14.755,

p<0.001, considered extremely significant.

The above test for the component, Disposal of waste, showed gradual and incremental

rise during the monitoring of the systems with the help of the checklist. Observations

are summarized in Table 20.

As evident in Table 16-20, the status of the sub-systems (Segregation, Disinfection,

Containment, Colour coding and Disposal) in all 5 of the HCIs, where Pre and Post

Orientation session was assessed based on the Checklist

The Pre-orientation status of the systems as shown in the Tables from 7 – 12 revealed

that only 2 Departments of HCIs had appropriate containment. However, none of the

Department of the 5 HCIs has Segregation, Disinfection, Colour coding or appropriate

Final Disposal procedures.

The status of the Subsystems at the end of 1 month of orientation was as follows:

73

Efforts at Segregation, Disinfection and Colour Coding were noted in 5 Departments

of HCIs, Containment of waste was practiced in 7 Departments and Appropriate

Disposal was attempted in 6 Departments of the HCIs.

The status of the systems during the second monitoring that is 4 months after the

orientation was that Segregation attempted in 13 Departments, disinfection was noted

in 10 Departments of the HCIs, appropriate Containment of waste was noted in 16

Departments of the HCIs, Colour Coding and appropriate Disposal were attempted

each in 11 Departments of studied HCIs.

Third Monitoring of the Subsystems, i.e. 6 months after POS were noted as follows,

Segregation, appropriate Containment and Disposal were attempted in 21

Departments of the HCIs. Disinfection was noted in 14 Departments and 17

Departments attempted instituting a Colour Coding system.

It could be seen from the Tables 16-20 that there was a gradual and incremental

improvement in all the components of the systems for SMHCW. The components like

Segregation, Disinfection and Treatment of waste noted a gradual and perceptible rise

during regular monitoring of the systems with the help of the checklist.

74

CONCLUSION

In the present study the existing practices of waste management in Unani hospitals,

and to identify the type of waste, segregation practices, quantification of waste and

its disposal methods were identified with an observational checklist (Annexure–1).

And orientation/ sensitisation sessions were conducted for the health care personnel

at interval of first month, fourth month and sixth month of the POS at various

departments / sections of the studied HCIs and the effect of management is noted

both in components of the waste and in the continued interaction of the health care

personnel.

The study revealed that there is no system of hospital waste management, there is lack

of necessary supplies (colour coding container, protective devices etc), facilities and

knowledge among health workers.

Quantity of HCW generated in studied HCIs, is 0.78 kg and 0.68 kg/ bed/day in two

studied HCIs providing IP&OP services. The types of wastes generated in the studied

HCIs are General waste (81.45%), Pathological waste (3.90%), Infectious waste

(13.41%) and Sharp waste (1.23%) Waste collected at regular interval and transported

manually.

Lidded containers were used for transporting infectious and pathological waste during

containment of wastes. General waste (81.45%) is non infectious and it is the major

part of the categories of waste, which even includes waste from herbal unani

pharmacy containing remains of dry leaves, twigs, powder of herbs which are all

organic matter and hence bio-degradable. Proper segregation of this waste is

recommended and the biodegradable share can be composite, and later can be used as

75

natural manure for growing plants and maintaining herbal garden. Sharp waste and

hazardous waste is very less in this study compared to other studies, if this is mixed

with non-infectious general waste, the whole waste turns to be infectious and it will

be a burden in management of waste, both cost wise and also in terms of manual

labour. It could be seen from the study that there was a gradual and incremental

improvement in all the components of the systems for SMHCW. The components like

Segregation, Disinfection and Treatment of waste noted a gradual and perceptible rise

during regular monitoring of the systems with the help of the checklist.

It could be concluded from the above, that:

• The most vital component of the waste management plan is to bring about a

transformation in the mind sets and develop a system and culture through

education, training and persistent motivation of the health care staff.

• It should involve the coordinated working of several departments in health

care establishments, like medical, surgical, laboratory, house keeping, kitchen,

pharmacy and even administrative departments.

• The Segregation of hospital waste plays the key role in the safe and efficient

management of health care waste, especially infectious wastes from the non-

infectious waste resulting in defining and limiting expenditures.

• As the major share of the waste is non-infectious, the biodegradable part can

be composite, and later can be used as natural manure for growing plants and

maintaining herbal gardens.

• Lack of treatment and disposal options possess a constraint to the sustenance

of the systems.

76

• Head of the Institution interest, a key for early establishment and efficient

functioning of the systems.

• Paramedical staff and other waste handlers are the key HCP for the

development and evolving of the system.

• Compositing of the non-infectious, biodegradable waste can be taken up as

primary issue in treatment and management of this system

Recommendations

• Intensive training programme at regular time interval for all the staff with

special importance to the new comers.

• The entire waste management practices should be part of total hygiene

practice of the society, rather than confining to hospital and health facilities.

• Establishment of an authorised person responsible for all aspects of medical

waste management. Its main function should be the creation of a national

programme containing uniform requirements for medical waste handling and

disposal.

• Provision of health education, not only for health workers but for all the

community, about hazards of medical waste and how to minimize them.

• Provision of adequate supplies and facilities needed for medical waste

handling, such as colour-coded bags, puncture-proof boxes and protective

devices.

• Encouragement of studies on different aspects of medical waste, such as the

creation of database information in different sectors, risk analysis and disposal

methods.

77

• Only one department can be taken and thorough process of waste management

can be studied

• A specific Colour Coding system for the various wastes can be introduced to

identify the types of wastes and make the job easier for collection of waste.

78

SUMMARY

The summary may be presented under the following headings:

• Background

• Aims and Objectives

• Materials and Methods

• Results

• Conclusion

• Recommendations

Background

The Bio-medical waste management is a global concern, particularly due to constant

rise in blood borne diseases like AIDS, Hepatitis-B etc. Subsequently the environment

and the pollution board, GOI, 1998, framed rule called the Bio-medical waste (m & h)

Rules, which is the authority for any default.

The current scenario is that, the incidence of hospital borne infections is on constant

rise. The waste generation in the hospital and its disposal are not given its due

importance. Most of the areas the waste thrown out of hospitals were to be taken care

by the local municipal cleaners with ignorance of biomedical health hazard, to

overcome this, various health organization, WHO, Environment and pollution control

board has come forward for its safe guard, and has proposed specific norms, rules and

guidelines for its safe disposal.

79

As Unani system of medicine is also in the main stream for health care service

provider and also the source for hospital waste generation with more number of

patients and health care personnel involved, hence study was undertaken for the

awareness and management of hospital waste in Unani hospitals in Bangalore.

Aims and Objectives

The objectives of the study is to assess the existing practices of waste management

and to identify the type of waste, segregation practices, quantification of waste and its

disposal methods.

Materials and Methods

The research design used in this study is a descriptive research type. Descriptive

research includes surveys and inquires based fact findings are as follows:

(1) Through observational checklist (Annexure-1) for assessment of the existing

system and post orientation/ sensitisation session, the components which

includes sources of waste, type of wastes, collection of waste, storage of

waste and disposal methods were observed and recorded in a checklist.

(2) Interaction with various categories of health care personal (like doctors,

nurses, paramedical staff, technicians ward boys, ayahs, housekeeping staff

and other waste handlers.

Results

Overall assessment:

• The overall initial assessment of the studied HCIs show that none of the

studied HCIs managed solid as well as liquid waste appropriately.

• None of the studied HCIs managed soiled infectious waste appropriately.

80

• One of the studied HCIs providing both IPD/ OPD had needle destroyer for

disfigurement of needles, but final disposable was not appropriate.

• None of the studied institutions managed liquid infectious waste appropriately.

From the above results, it could be inferred that the type, size or the profile of

institutions has not influenced the systems for safe management of HCW.

Assessment of the Subsystems

The assessment of the sub-systems, like soiled infectious waste (bandage cloth), waste

sharp management (Needles, broken ampoules), plastic recyclables (syringes) and

body fluids, reveals that though the current existing systems do not fulfil the

requirements of the Bio-medical waste (m & h) Rules 1998, but there were definite

attempts at managing the waste in the studied HCIs.

Conclusion

In the present study the existing practices of waste management in Unani hospitals,

and to identify the type of waste, segregation practices, quantification of waste and its

disposal methods were identified with an observational checklist (Annexure–1).

Quantity of HCW generated in studied HCIs, is 0.78 kg and 0.68 kg/ bed/day in two

studied HCIs Providing IP/OP services. The types of wastes generated in the studied

HCIs are General waste (81.45%), Pathological waste (3.90%), Infectious waste

(13.41%), and Sharp waste (1.23%).

General waste (81.45%) is non-infectious and it is the major part of the categories of

waste, which even includes waste from herbal Unani pharmacy containing remains of

dry leaves, twigs, powder of herbs which are all organic matter and hence bio-

degradable. Proper segregation of this waste is recommended and the biodegradable

81

share can be composite, and later can be used as natural manure for growing plants

and maintaining herbal garden. Sharp waste and hazardous waste is very less in this

study compared to other studies, hence infectious waste like sharps and other

pathological waste if mixed with this non-infectious general waste, the whole waste

turns to be infectious and it will be a burden in management of waste, both cost wise

and also in terms of manual labour.

Recommendations

Intensive training programme should be held, at regular time interval, for all the staff.

Health education should be given for all the community, about hazards of medical as

well as general wastes and how to minimize them. There should be adequate facilities

needed for medical waste handling, such as colour-coded bags, puncture-proof boxes

and protective devices etc.

82

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87

Annexure - 1

Instrument for data collection

Safe management of health care waste The checklist for health care settings

Name of the Health Care Setting: Address: Telephone / Fax / E-mail: Name of the respondent with designation: Services provided (encircle): Only OPD / OPD + IP / Others (specify) Staff position (number): Duty Doctors Consultants

Doctors Nursing Staff Ward Boys /

Ayahs X-Ray technicians Lab Technicians Pharmacy Staff Others Total Number of Staff

Number of Beds: Average In Patient admission / Day: Out patient strength in the last One year: In patient Strength in the last One year: Pathological investigation strength in last one year: Average Bed Occupancy: Average Out patients / Day: Tick if the following is present:

• Infection Control Committee • Waste Management Committee • Disinfection Policy • Waste Management Policy • Waste Sharps Management Policy • HIV Infection Control Policy • Occupational Safety Policy

88

Tick the Facilities available for Waste Management: Segregation / containment / Burial / Deep Burial / Burning / Incineration Micro waving / Autoclave / Others (Specify) / Others (Specify) REMARKS

1. Authorisation obtained: Yes / No 2. System of recording of illness / injuries / accidents: Yes / No 3. System of reporting of illness / injuries / accidents: Yes / No 4. Periodic monitoring of the waste management facility undertaken: Yes / No 5. Training / Retraining to the staff provided Yes / No

Record if the following is happening regarding handling of Health Care Waste:

Waste materials

Segre- gation

Dis-infection

Disfigurement

Containment

Transportation

Colour coding

Final Disposal

Plastic Material

Paper / card board

Banana leaves / Fruit peels etc.

Discarded glassware / vials / ampoules / bottles

Left over food

Disposal needles & syringes

Cotton / bandage cloth

Contaminated linen

Urine remains / Stool samples

Blood / serum samples

Please note: NA = Not Applicable; C = Complete; IC = Incomplete; S = Satisfactory; NS = Not Satisfactory; A = Appropriate; IA = Inappropriate

89

OCCUPATIONAL SAFETY OF THE HEALTH CARE PERSONAL Indicate YES, if being provided and used, NO if not being used.

HCP Uniform Apron Boots Mask Goggles Gloves Vaccination Given

Duty Doctors

Nurses

Consultants

Laboratory Technicians

Ward boy

Ayah

Was

te

hand

lers

Helper

WASTE CONTAINERS (Sample in a representative fashion) 1 2 3 4 5

Location of Container Size (in Litres.) Shape Lid present Yes/no Yes/no Yes/no Yes/no Yes/no Material of the container Collection Frequency/day

List the suggestion by the staff for the improvement of the Solid Waste Management mechanism regarding the following. Containers Frequency of collection Frequency of disposal Use of protective devices Transportation of the waste Any others------

90

Annexure - 2

Photographs

1. Generation of Unani pharmacy waste in one of the studied health care institutions

2. Generation of highly infectious liquid waste from semi auto processor in

pathology laboratory in one of the studied health care institutions.

3. Generation of kitchen waste in one of the studied health care institutions

4. Containment of waste in one of the studied health care institutions

5. Weighing of waste in one of the studied health care institutions

6. Use of needle destructor in one of the studied health care institutions

7. Orientation/ training sessions in studied health care institutions

91

Generation of Unani pharmacy waste in one of the studied health care institutions (1)

92

Generation of highly infectious liquid waste from semi auto processor in pathology laboratory in one of the studied HCIs (2)

93

Generation of kitchen waste in one of the studied HCIs (3)

94

Containment of Waste in one of the studied HCIs (4)

95

Weighing of waste in one of the studied HCIs (5)

96

Use of needle destructor in one of the studied HCIs (6)

97

Orientation/ training sessions in studied HCIs (7)