Case study Exploration of Biomedical Waste in Multispecialty Hospital in Madurai

International Journal of Applied Environmental Sciences

ISSN 0973-6077 Volume 10, Number 1 (2015), pp. 347-363

© Research India Publications

http://www.ripublication.com

Case study Exploration of Biomedical Waste in

Multispecialty Hospital in Madurai

A.Aravindan1

and Dr.A.M.Vasumathi2

1. Associate Professor, Latha Mathavan Engg.College, Madurai. 2. Dean & Head Of The Department, KLN Colege Of IT, Madurai

Abstract

The objective of this paper is to explore the available scientific data regarding

biomedical waste with respect to the environmental impacts. An important issue of an

environmental protection process is to plan for collecting, transporting, processing

and disposal of hazardous and non-hazardous biomedical wastages and its mandatory

compliance with regulatory notifications of Bio medical waste (management and

handling) rules 1998, the Environment Protecting Act 1986 and Ministry of

Environment and Forestry of India. The paper deals with various methods of

Segregation, Packaging, Labeling, neutralization and final disposal of the Bio Medical

Wastages are analyzed.

Keywords - Biomedical waste, Health care, hospital, Segregation, Disposal, Bio

hazardous waste, Solid waste management system.

1. Introduction

Bio medical wastes are generated during the diagnosis, treatment or immunizations

of human beings or in research activities pertaining to the production or testing of the

categories mentioned in the schedule-I of the Biomedical waste (management &

Handling) Rules, 1998. The disposal falls under two major categories- (i) Non-

hazardous and (ii) Bio-Hazardous wastes. Bio hazardous wastes branch into two

types- Infectious and Non-infectious waste sharps. Infectious waste sharps are plastic

disposables, liquid waste and so on. Non-infectious wastes are radioactive wastes,

discarded glasses, chemical wastes, cytotoxic wastes, incinerate wastes and like. The

Government of India in its Notification, 1998 specifies that Hospital waste

management sector should be the part of hospital which maintains its hygiene. Its

range of activities focus mainly on Engineering functions- such as collection,

transportation, treatment of processing system, and disposal of wastes. However,

initial segregation and storage activities are the direct responsibilities of nursing

348 A.Aravindan and Dr.A.M.Vasumathi

personnel of the hospital. If the infectious components get mixed with the general

non-infectious wastes, the entire mass will become potentially infectious. Before the

notification of Bio-Medical Solid Waste (Management and Handling) Rules,1998, the

treatment of wastes from houses, shops, offices, industries and hospitals is the

responsibility of municipal or governmental authorities, but now it has become

mandatory for hospitals, clinics, veterinary institutions and other medical institutions

to dispose of its Bio-Medical solid wastes as per the law[1].

2. Bio-Medical waste: Management Issues

A major issue related to Bio-Medical waste management is implemented in many

Indian hospitals. In some hospitals, the disposal of wastes is carried out in a

haphazard, improper and indiscriminate manner. Lack of segregation practices results

in mixing of hospital wastes with general wastes that makes the whole waste stream

hazardous. Inappropriate segregation ultimately results in an incorrect method of

waste disposal. A bag that is not securely tied results in scattering of Bio-Medical

wastes in and around hospital and such invites flies, insects, rodents, cats and dogs

which spreads communicable diseases like plague and rabies. Most importantly there

is no mechanism to ensure that all wastes collected and segregated, reaches its final

destination without any discrepancies. Additional hazard includes recycling of

disposables without even being washed [2]. Usage of same wheel barrow for

transportation for all categories of wastes is also a major cause for spreading

infection. The uncontrolled movement of trolley around patient care units poses a

serious health hazard. There is no mechanism to ensure the waste treatment within

prescribed time limits. Bio-Medical wastes that are not handled properly within the

stipulated time will result in fatal infections. In some hospitals the employees are not

properly trained to manage hazardous materials and waste minimization aspects. This

pictures the lack of basic awareness among hospital personnel regarding safe disposal

of Bio-Medical wastes.

3. Bio-Medical Waste Rules, 1998

Considering the inappropriate Bio-Medical Waste management, the Ministry of

Environment and Forests implemented the “Bio-Medical Waste (management and

handling) Rules, 1998” in July 1998. In accordance with these Rules (Rule 4), it is the

duty of every “occupier” - a person who has the control over the institution and or its

premises- to take all steps to ensure whether the generated wastes are handled without

any adverse effect to human health and environment. The concern has to ensure if the

vital safety steps such as handling, segregation, mutilation, disinfection, storage,

transportation and final disposal are followed properly[3]. Schedule I of the Bio-

Medical rules contains the categories of Bio-Medical wastes [4] (Refer to Table1).

Schedule II contains the colour coding and the type of container for disposal of

different Bio-Medical waste categories [4]. (Refer to Table2).

Case study Exploration of Biomedical Waste in Multispecialty Hospital 349

Table 1. Schedule I of the Bio-Medical waste Rules

Option Treatment &

Disposal

Waste Category

Cat.

No. 1

Incineration/ deep

burial

Human Anatomical waste (human tissues, organs,

body parts)

Cat.

No. 2

Incineration/ deep

burial

Animal waste, Animal tissues, organs, body parts,

carcasses, bleeding parts, fluid, blood and

experimental animals used in research, waste

generated by veterinary hospitals/ colleges, discharge

from hospitals, animal houses.

Cat.

No. 3

Local autoclaving/

microwaving/ incineration

Microbiology & Biotechnology waste(wastes from

laboratory cultures, stocks or specimen of micro-organisms live or attenuated vaccines, human and

animal cell culture used in research and infections

agents from research and industrial laboratories,

wastes from production of biological, toxins, dishes

and devices )

Cat.

No. 4

Disinfections

(chemical

treatment/ autoclaving/

microwaving and

mutilation shredding)

Waste sharps (needles, syringes, scalpels blades,

glass etc. that may cause puncture and cuts. This

includes both used & unshaped sharps.

Cat

No.5

Incineration/

destruction & drugs

disposal in secured

landfills

Discarded medicines and cytotoxic drugs (wastes

comprising of outdated contaminated and discarded

medicines).

Cat No.

6

Incineration,

autoclaving/

microwaving

Solid waste(Items contaminated with blood and body

fluids including cotton, dressing, soiled plaster casts,

line bleeding , other material contaminated with

blood)

Cat No.7

Disinfections by chemical treatment

autoclaving/ micro

waving & mutilation

shredding

Solid waste(disposable wastes other than sharp wastes).

Cat

No.8

Disinfections by

chemical treatment and

discharge into drain

Liquid waste(waste from laboratory while washing,

cleaning, house-keeping and disinfecting)

Cat No.

9

Disposal in municipal

landfill

Incineration Ash(the remains of incineration of any

bio-medical waste)

Cat No. 10

Chemical treatment & discharge into drain for

liquid & secured

landfill for solids

Chemical waste(chemicals used in production of biological, chemicals, used in disinfection as

insecticides etc).


Table 2 Schedule II of the Bio-Medical waste Rules

Colur coding Type of containers Waste

category

Treatment options as per

schedule 1

Yellow Plastic bag 1,2,3,6 Incineration/ deep burial

Red Disinfected

container/plastic bag

3,6,7 autoclaving/ microwaving/

chemical treatment

Blue/ white

translucent

Plastic bag/puncture

proof container

4,7 autoclaving/ microwaving/

chemical treatment and

destruction/ shredding

Black Plastic bag 5,9, 10

(solid)

Disposal in secured landfill

3. Sources of Biomedical Waste

Hospital waste refers to both biologic or non-biologic that is discarded and not

intended for further use. Medical waste is a subset of hospital wastes and it refers to

the material wastes generated as a result of diagnosis, treatment or immunization of

patients and associated research. Bio-Medical Waste (BMW) refers to the wastage

generated in Hospitals, research institutions, health care teaching institutes, clinics,

laboratories, blood banks, animal houses and veterinary institutes. Though a little

disease get transmitted from medical waste, both the American Dental Association

(ADA) and Center for Disease Control recommend a regulated disposal of medical

wastes.

Most of the Bio-Medical wastes are incinerated and that create many

problems. Medical waste incinerators emit toxic air pollutants and toxic ash residues

which spread major source of dioxins in the environment. The toxic ash residues leach

from the land into groundwater. US Environmental Agency identifies that the Medical

waste is the third largest known source of dioxin air emission and contributor of about

10% of mercury emission to the environment from human activities. The air

emissions affect the environment and may affect the communities widely. Dioxins are

one of the most toxic chemicals known to humankind. Dioxins are the root cause for

cancer, immune system disorders, diabetes, birth defects and disrupted sexual

development. To control the emission of dioxin, no chlorinated compounds should be

introduced into the incinerator. Red bags must not be burnt as red colour contains

cadmium, which causes toxic emissions. If the items contain mercury are put into a

red bag as infectious waste and sent to an incinerator or other waste treatment

technology, mercury will contaminate the environment. Airborne mercury then enters

in to a global distribution cycle of the environment and challenges the survival of fish

and wildlife [5].

4. Classification of biomedical waste

Approximately 75-90% of the biomedical waste is non – hazardous and as harmless

as any other municipal waste. The remaining -% is hazardous and can be injurious to


humans or animals and deleterious to environment. It is important to realize that if

both these types are mixed together then the whole waste becomes harmful.

4.1. Non- hazardous waste

This constitutes about 85% of the waste generated in most healthcare set-ups. This

includes waste comprising of food remnants, fruit peels, wash water, paper, cartons,

packaging material etc.

4.2. Hazardous waste

Biohazard: Biological hazards, also known as biohazards, refer to biological

substances that pose a threat to the health of living organisms, primarily that of

humans. This can include medical waste or samples of a microorganism, virus or

toxin (from a biological source) that can impact human health. It can also include

substances harmful to animals. The term and its associated symbol are generally used

as a warning, so that those potentially exposed to the substances will know to take

precautions.

4.2.1. Levels of biohazard

Immediate disposal of used needles into a sharps container is standard procedure. The

United States centers for disease control and prevention categories various diseases in

levels of biohazard, Level 1 being minimum risk and Level 4 being extreme risk.

Laboratories and other facilities are categorized as BSL (Bio Safety Level) 1-4 or as

P1 through P4 for short (Pathogen or protection Level)

Biohazard Level 1: Bacteria and viruses including bacillus subtilis, canine

hepatitis, Escherichia coli, varicella (chicken pox) as well as some cell cultures and

non-infectious bacteria. At this level precautions against the bio hazardous materials

in question are minimal, most likely involving gloves and some sort of facial

protection. Usually, contaminated materials are left in open (but separately indicated)

waste receptacles. Decontamination procedures for this level are similar in most

respects to modern precautions against everyday viruses (i.e. washing one’s hands

with anti-bacterial soap, washing all exposed surfaces of the lab with disinfectants,

etc). In a lab environment, all materials used for cell and/or bacteria cultures are

decontaminated via autoclave.

Biohazard Level 2: Bacteria and viruses that cause only mild disease to

humans or are difficult to contract via aerosol in a lab setting, such as hepatitis A,B,

and C, influenza A, Lyme disease, salmonella, mumps, measles, scrapie, dengue fever

and HIV. “Routine diagnostic work with clinical specimens can be done safely at

Biosafety Level 2, using Biosafety Level 2 practices and procedures, Research work(

including co-cultivation , virus replication studies, or manipulations involving

concentrated virus)can be done in a BSL-2 (P2) facility, using BSL-3 practices and

procedures .Virus production activities ,including virus concentrations, require a BSL-

3(P3) facility and use of BSL-3 practices and procedures ,see recommended Biosafety

levels for infectious agents. Biohazard level 3: Bacteria and viruses that can cause

severe to fatal disease in humans ,but for which vaccines or other treatments exist


,such as anthrax, West Nile virus, Venezuelan equine encephalitis, SARS virus

variola virus (small box),tuberculosis, typhus, Rift valley fever.

Biohazard Level 4: Viruses and bacteria that cause severe to fatal disease in

humans , and for which vaccines or other treatments are not available ,such as

Bolivian and Argentine hemorrhagic fevers,H5N1(bird flu),Dengue hemorrhagic

fever, Marburg virus, Ebola virus, hantaviruses, Lassa fever, crimeancongo

hemorrhagic fever, and other hemorrhagic diseases. When dealing with biological

hazards at this level the use of a Hazmat suit and a self-contained oxygen supply is

mandatory. The entrance and exit of a level Four bio lab will contain multiple

showers, a vacuum room, an ultra violet light room, autonomous detection system,

and other safety precautions designed to destroy all traces of the biohazard. Multiple

airlocks are employed and are electronically secured to prevent both doors opening at

the same time. All air and water service going to and coming from a BiosefetyLevel-

4(P4) lab will undergo similar decontamination procedures to eliminate the possibility

of an accidental release [6].

4.2.1.1 Potentially infectious waste

Over the years different terms for infectious waste have been used in the scientific

literature, in regulation and in the guidance manuals and standards.

These include infectious, infective, medical, biomedical, hazardous, red bag,

and contaminated, medical infectious, regulated and regulated medical waste. All

these terms indicate basically the same type of waste, although the terms used in

regulations are usually defined more specifically. It constitutes 10% of the total waste

which includes:

Dressings and swabs contaminated with blood, pus and body fluids.

Laboratory waste including laboratory culture, stocks of infectious agents.

Potentially infected material: Excised tumours and organs, placents removed

during surgery, extracted teeth etc.

Potentially infected animals used in diagnostic and research studies.

Sharps which include needle, syringes, blades etc.

Blood and blood products.

4.2.1.2. Potentially toxic waste

1. Radioactive waste: It includes waste contaminated with radionuclide; it may

be solid, liquid or gaseous waste. These are generated from in vitro analysis of

body fluids and tissue, in vitro imaging and therapeutic procedures.

2. Chemical waste: It includes disinfectants (hypochlorite, Gluteraldehyde,

iodophors,phenolic derivives and alcohol based preparations), X-ray

processing solutions, monomers and associated reagents, base metal debris.

3. Pharmaceutical waste: It includes anesthetics, sedatives, antibiotics, analgesics

etc.

4.2.1.3 Microorganisms

The concerned medical establishment should constitute a team of its experts,

concerned personnel and workers (doctors, chemists, laboratory technicians, hospital


engineers, nurses, cleaning supervisors/inspectors, cleaning staff etc.) If such

expertise is not available, It may take the help of external experts in the field who can

help them carry out the survey work. A third alternative is possible who carry out the

whole work on contract as a package.

In either case, the medical establishment has to earmark a suitable place where

the qualitative and quantitative tests can be carried out. This place should be an

enclosed space. Depending upon the requirement, it can be a large room or a hall or at

least a covered shade with proper fencing. Unauthorized entry to this space should be

strictly prohibited. It should be well lighted. The place should be washed and

disinfected daily and preferably dry and clean.

The waste generated by all the departments has to be collected according to

the prevailing practices of collection but due care has to be taken to see that no

portion of the total waste generated is missed out from this survey. The waste so

collected has to be sorted out into the different categories according to the schedule 1

of the Biomedical waste (Rules 1998).

If an incinerator is operating within the hospital campus, then the incinerator

ash produced every day has to be weighed. This can be done once a day. At the same

time the total waste incinerated every day has also be recorded.

The liquid waste may be divided into two components: (a) Liquid

reagents/chemicals discarded and (b) the cleaning and washing water channeled into

the drain. A measuring cylinder or other suitable measuring device can easily measure

the first component before discarded each time and keeping suitable records. The

second component can be derived from the total water used in the hospital or by using

appropriate flow meters.

Health care waste is a heterogeneous mixture, which is very difficult to

manage as such. But the problem can be simplified and its dimension reduced

considerably if a proper management system is planned.

The management principles are based on the following aspects: Reduction

/control of waste (by controlling inventory, wastage of consumable items, reagents,

breakage etc).Segregation of the different types of waste into different categories

according to their treatment/disposal options given in schedule 1 of the rules

mentioned above, segregated collection and transportation to final disposal as

indicated in the rules, safety of handling full care /protection against operational

hazard for personnel at each level, proper organization and management.

There are two main issues at present the recent legislation by the Govt. of

India and implementation of the same at individual health care establishments level as

well as whole town /city level. The recent legislation has fulfilled a long -standing

necessity. Now this sector has got clear-cut guidelines, which should be able to

initiate a uniform standard of practice throughout the country [7].

5. Biomedical waste Generation

According to the European legislation, each hospital or health care establishment has

to achieve a programme[8] for qualitative as well as quantitative survey of the

biomedical waste generated, depending on the medical activities and procedures


followed by it .The concerned medical establishment should constitute a team of its

experts, concerned personnel and workers: doctors, chemists, laboratory technicians,

hospital engineers, nurses, cleaning inspectors, cleaning staff. Also, the medical

establishment has to earmark a suitable place where the qualitative and quantitative

tests can be carried out. The biomedical waste generated by all the departments has to

be collected according to the prevailing practices of collections[9] and then it has to

be sorted out into the different categories according to the rules of biomedical waste

legislation[10] .

It must be also said that, according to the legislation [8],[9] if an incinerator is

operating within the hospital campus, then the incinerator ash produced every day has

to be weighed. Regarding the liquid waste, it may be divided into liquid

reagents/chemical discarded and the cleaning and washing water channeled into the

drain. Hence the category-wise survey of medical waste generation are; human

anatomical waste, animal waste, microbiology and biotechnology waste, sharps waste,

medicines and cyto-toxic drugs, soiled waste, solid waste, chemical waste,

incineration ash, liquid waste.

6. Biomedical waste segregation and storage

The segregation of biomedical waste should be examined because facility standard

operating procedures for biomedical waste segregation have a direct impact on type

and cost of biomedical waste treatment [11].Each category of waste has to be kept

segregated in a proper container or bag as the case may be such container or bag

should have certain properties; it should be without any leakage; it must be able to

contain the designed volume and weight of the waste without any damage; the

container should have a cover, preferably operated by foot; when a bag or container is

filled at 3/4th

capacity, it must be sealed and an appropriate label has to be

attached.Taking into account the European and national legislation[8],[9], an adequate

symbol must be pictured for all type of biomedical waste, according to their code:

1) infectious waste; 2) pathological waste 3] sharps; 4) pharmaceutical waste; 5)

genotoxic waste; 6) chemical waste; 7) waste with high content of heavy metals; 8)

radioactive waste.

Arrangement for separate receptacles in the storage area with prominent

display of colour code has been made in accordance with the legislation, yellow for

hazardous biomedical waste and black for the non-hazardous waste[9],[10].

7. Biomedical waste Handling and Transportation

This activity has three components:

(i) collection of different kinds of waste storage bags and containers inside the

hospital,

(ii) Transportation and intermediate storage of segregated waste inside the

premises and

(iii) Transportation to the treatment or final disposal. The biomedical waste has to

be transported to the treatment or disposal facility site in a safe manner. The


vehicle should have certain specifications [9]; it should be covered and

secured against accidental opening door, leakage etc, and the interior of the

container without sharp edges or corners in the aim to be easily washed and

disinfected; there should be adequate arrangement for drainage and collection

of any leakage.

8. Biomedical waste Treatment and Disposal

Different methods have been developed for rendering biomedical waste

environmentally innocuous and aesthetically acceptable [11],[12].The biomedical

waste legislation [8],[9] has elaborately mentioned the recommended treatment and

disposal options according to the different categorized waste generated in hospitals.

Different methods and treatment technologies have been developed [13],[14] stating

from the chemical composition and hazardous traits of biomedical waste:

a) Incineration;

b) Autoclave treatment;

c) hydroclave treatment

d) microwave treatment;

e) chemical disinfecting;

f) sanitary and secured land filling

g) General waste.

a) Incineration is a high temperature thermal process involving combustion of the

waste under controlled condition for converting them into inert material and

gases. Incineration of medical waste remains a prevalent treatment method

around the world. The advantages of incinerating medical waste or those

associated with incineration of any type of waste: Significant volume

reduction (by about 90%), assured destruction, sterilization, wait reduction,

and the ability to manage most types of wastes with little processing before

treatment [13],[15]. The disadvantages include potential pollution risks

associated with incineration processes and increased costs associated with

controlling pollution emission. In some European countries, regional off-site

incineration facilities have been encouraged to optimize the economical

application of advanced pollution control technologies. In Romania,

incineration continues to occur on-site in health care unit, most of which

having few or no pollution controls.

Incinerators [16],[17]] can be oil fired or electrically powered or a

combination thereof. On a broader front, three types of incinerators are used for

hospital waste [14],[18]viz., multiple hearth type, rotary kiln and controlled air types.

All the types can have primary and secondary combustion chambers to ensure optimal

combustion. In the multiple hearth incinerators, solid phase combustion takes place in

the primary chamber whereas the secondary chamber is for gas phase combustion.

There are referred to as excess air incinerators because excess air is present in both

the chambers. The rotary kiln is a cylindrical refectory lined shell that is mounted at a


slight tilt to facilitate mixing and movement of the waste inside. It has provision of air

circulation. The kiln acts as the primary solid phase chamber, which is followed by

the secondary chamber for the gaseous combustion. In the third type, the first

chamber is operated at low air levels in the primary chamber i. due to low oxygen

levels in the primary chamber I, there is better control of particulate matter in the flue

gas. According to the legislation [8],[9], incineration it is recommended for human

anatomical waste, animal waste, cytotoxic drugs, discarded medicines and solid

waste.

b) Autoclave Treatment is a process of steam sterilization under pressure. It is a

low help process in which steam is brought into direct contact with the waste

material for duration sufficient to disinfect the material. There are also of three

types: gravity type, pre-vacuum type and retort type. In the gravity type, air

is evacuated with the help of gravity alone. The system operates at a

temperature of 121oC and a steam pressure of 15 psi for 60-90 minutes. In the

pre-vacuum type, vacuum pumps are used to evacuate air from the pre-

vacuum autoclave system so that the time cycle is reduced to 30-60 minutes. It

operates at about 132oC. The retort type autoclaves are designed to handle

much larger volumes and operation at much higher steam temperature and

pressure. Autoclave treatment is recommended [9],[14] for microbiology and

biotechnology waste, waste sharps, soiled and solid waste.

c) Hydroclave treatment is based on innovative equipment named hydroclave, for

steam sterilization process (like autoclave) [14]. Hydroclave is a double

walled container in which the steam is injected into the outer jacket to heat the

inner chamber containing the waste. Moisture contained in the waste

evaporates as steam and builds up the requisite steam pressure (35-36 psi).

Sturdy paddles slowly rotated by a strong shaft inside the chamber tumble the

waste continuously against the hot wall thus mixing as well as fragmenting the

same. In the absence of enough moisture, additional steam is injected. The

system operates at 132 o

C. and 36 psi steam pressure for sterilization time of

20 minutes. The total time for a cycle is about 50 minutes, which includes

start-up, heat-up, sterilization, venting and depressurization and dehydration.

The treated material can further be shredded before disposal. The expected

volume and weight reductions are up to 85% and 70% respectively. The

treatment of hydroclave is similar to that of the autoclave in addition to the

waste sharps. This technology has certain benefits, such as, absence of harmful

emissions, absence of liquid discharges, non-requirement of chemicals,

reduced volume and weight of waste etc.

d) Microwave treatment is again a wet thermal disinfection technology but unlike

other thermal treatment systems, which heat the waste externally, microwave

heats the targeted material from inside out, providing a high level of

disinfection. Microwave technology has certain benefits such as condensed

volume of waste, absence of harmful air emissions and chemical. However

the investment costs are high at present. According to Biomedical Waste


(management and handling) rules 1998, the microbiology and biotechnology

solid waste are permitted to be micro waved.

e) Chemical disinfecting is a treatment recommended for waste sharps, solid and

liquid waste as well as chemical wastes. Chemical treatment involves use of at

least 1% hypochlorite solution with a minimum contact period of 30 minutes

or other equivalent chemical reagents, such as phenolic compounds, iodine,

hexachlorophene, and iodine-alcohol or formaldehyde alcohol combination.

f) Sanitary and secured landfilling is necessary under certain circumstances [19]

o Deep burial of human anatomical waste, when the facility of proper

incineration is not available – secured landfill;

o Animal waste under similar conditions as above – secured landfill;

o Disposal of autoclaved/ hydroclaved/ microclaved waste – sanitary landfill;

o Disposal of incineration ash – sanitary landfill;

o Disposal of sharps – secured landfill;

General waste includes the waste material generated from the office, kitchen, garden,

store etc. which are non-hazards and non-toxic.

General waste may be taken care of:

i) Composting of green waste,

ii) Recycling of packaging material.

In both cases, certificate indication origin and non-contamination, issued by

the concerned medical authorities of the health care establishment is essential from

the point of safety.

9. A Multispecialty Hospital in Madurai –

A Case study:

The concern hospital is 700 bedded multi discipline super specialty health care

destination located in the Temple Town, Madurai, Tamil Nadu, India.

Following:

Andrology and Urology, Cardiology, cardiothoracic and vascular surgery,

dermatology and venecology, Dental and maxillofacial surgery, Diabetology, E.N.T

,General medicine, medical oncology, Nephrology, Neurology, Obstetrics and

gynecology, Opthalmology, Orthopaedics and Traumatology, Paediatriconcology,

Paediatric and Neonatology, Plastic surgery, Radiation oncology, Reproduction

medicine, Surgery and surgical gastroenterology, Surgical oncology are the specialties

available in the hospital. The Biomedical waste is collected from this hospital in the

following wards: Paediatrics, Gynacology, casuality, orthoot, ortho POW,

IRCU,POW I & II, IMCU I & II, RICU, Nephrology, Dialysis, medicine, Cath lab,

SOT, MOT, Urology ,Surgery, 5th

SPL, Neuro surgery, Eye ward, CTS, OT, ICU, Eye

ward ramp, Eye OT ramp, RT ward, CICU ramp, Blood bank, Cardiology and so on.

Table 1 presents the survey result of average daily Biomedical waste

generated and waste handling on a month of August -2014.


Table 1: Average Daily Biomedical waste generated in the concern hospital on

August 2014

DATE RED kg YELLOW kg BLUE kg BLACK kg 01.08.2012 186.49 162.78 68.2 158.3

02.08.2012 215.84 235.96 77.78 174.92

03.08.2012 206.48 203.66 93.68 183.86 04.08.2012 202.52 178.28 76.06 183.86

05.08.2012 196.9 174.22 93.94 165.1 06.08.2012 192.96 179.3 88.24 182.5

07.08.2012 179.45 166.92 96.78 169.3

08.08.2012 166.34 172.04 78.3 154.46 09.08.2012 216.98 198.5 88.1 166.32

10.08.2012 206.66 183.39 74.64 164.7

11.08.2012 202.07 186.5 83.5 156.24

12.08.2012 186.28 190.2 84.2 143.2

13.08.2012 216.26 199.98 91.26 149.86 14.08.2012 194.49 197.26 78.6 160.08

15.08.2012 171.92 169.93 73.84 152.4 16.08.2012 198.43 203.26 80.24 174.04

17.08.2012 222.9 202.76 76 169.4

18.08.2012 214.33 216.54 103.12 184.57

19.08.2012 187.52 144.12 90.14 148.72

20.08.2012 205.74 197.06 102.86 156.1 21.08.2012 172.2 136.29 96.11 131.8

22.08.2012 189.46 179.9 81.73 145.4

23.08.2012 202.12 173.78 86.14 159.78

24.08.2022 199.06 179.14 93.38 170.96

25.08.2012 186.8 172.24 101.76 155.02 26.08.2012 208.46 188.22 78.98 167.46

27.08.2012 197.64 186.2 88.89 142.8 28.08.2012 191.89 199.51 92.7 143.8

29.08.2012 182.36 174.1 78.52 153.35

30.08.2012 220.83 205.6 70.68 172.2 31.08.2012 211.34 205.32 78.66 173.78

Total 6132.7 5763 2647 5014.3


Figure No: 3 Comparison of Average Red bag waste calculated for the month of

August 2014

Figure No: 4 Comparison of Average Yellow bag waste calculated for the month of

August 2012

Figure No: 5 Comparison of Average Blue bag waste calculated for the month of

August 2014


Figure No: 6 Comparison of Average Black bag waste calculated for the month of

August 2014

Figure No: 7 Comparison of Average Biomedical waste for the month of August

2014.

During the study it is observed that the hospital has been properly managing

their biomedical waste. Regularly the hospital segregates the biomedical waste

according to the specified categories and colour coding. The hospital maintains the

practice of decontamination of biomedical waste before disposal or storing of the

waste for 48 hours.

Regarding the capabilities and risks of biomedical treatment alternatives, it

must be emphasized that the only treatment technologies that are usually used to treat

pathological waste are the incineration and mechanical/chemical disinfection systems.

Depending on the type of incinerator and the nature of its control, incineration is the

one treatment alternative that could manage the biomedical waste .An important issue

concerning the incineration of biomedical waste is to identify the combustion

pollutants. It includes dioxins and furans, pathogens, metal(as KDM) , acid

gases(Hydrogen chloride, Nydrogen oxides and sulphor dioxide which can cause acid

rain and may enhance the toxic effects of heavy metals. It is also responsible for the

chronic health and acute effects (such as eye and respiratory irritation). It must be


notified that the average emission of concentrated hydrogen chloride (HCL) in

biomedical waste incinerator compared with MSW incinerator may be due to the

higher levels of polyvinyl chloride (PVC) plastics in medical waste. Almost all of the

chlorine in these waste is converted to HCL during the combustion process(Assume a

high combustion efficiency).In this way , chlorinated plastics contribute to the high

emission rates of HCL and possibly the formation of dioxins(particularly if

combustion is low).

Incineration technology continues to evolve and more sophisticated pollution

control equipment is available. Still, a source of concern is the potentially hazardous

nature of incinerator ash. A trend may be emerging for medical waste to recover

energy and include front- end waste separation and recycling efforts.

From other perspectives, non-incineration alternatives may have advantages

over incineration. On one hand, there are more serious emissions concerns associates

with incineration than most alternatives. But, on the other hand since incineration has

become a more established technology, emissions concerned have been clearly

identified.

Valid comparison of various treatment alternatives for biomedical waste are

problematic because different types of treatment goals are served by different

technologies (Example the goal can be treatment to render waste non- infectious, or

non- infections and non -toxic).That is the different techniques may be appropriate for

different waste types. Alternative Treatments will differ in the nature of the emission

that warrant test protocols, control measure and operating parameters specific to each

technology. The costs and risks associated with the alternative will vary. Comparison

between off-sight and on-sight applications of various alternatives can be problematic.

Considering these differences clearly, comparison of the treatment technologies has

been made carefully.

In health center around the world, a concerning issue of biomedical waste

management is that whatever treatment alternative is used, some form of additional

solid waste disposal must occur. In all cases, ultimately, some degree of dependency

on landfills remains. In the biomedical waste incineration, the ash becomes a waste

product which requires land filling. For Autoclaving, microwaving and irradiation

either incineration or landfilling is necessary. The residue from the chemical and

mechanical treatment alternative has to be discharged to the sewer or landfilled.

10. Conclusion:

Some suggestions are recommended to the hospital staffs, which are well taken and

appreciated. The key challenges need to be resolved for biomedical waste

management is:

- Enhanced defining hazardous waste,

- Improving the segregation of medical waste and

- Identifying appropriate treatment alternatives.


However, the achievements of reduction and recycling efforts will continue

for effective treatment and disposal of wastes that can’t be recycled. A number of

other treatment alternatives are available for incineration remains.

One of the most critical issues regarding biomedical waste management is

selecting an appropriate treatment. The availability of permitted landfill space and the

demographic and geographic factors need to be considered when selecting the most

appropriate management strategy. Safety, reliability and costs of alternative treatment

methods also affect selection of treatment alternatives.

Regarding the people and environmental issues, a correct Health Care Waste

Management (HCWM) will avoid the negative long-term health effects, viz.,

releasing the toxic substances such as dioxin, mercury and others in the environment.

From perspectives of both volume and toxin, the use of plastics in society is a focus of

waste management concern. The type of plastic used and its impact on waste

treatment is one example of how waste reduction efforts must be focused on reducing

certain emissions can link pretreatment and treatment management efforts.

Further, on achieving the HCWN strategy, the applicable regulatory

requirements must be known first and then the assessment of the capabilities, costs

and associated health and environmental risks of various treatment technologies.

REFERENCES

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Case study Exploration of Biomedical Waste in Multispecialty Hospital in Madurai

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