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).
350 A.Aravindan and Dr.A.M.Vasumathi
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
Case study Exploration of Biomedical Waste in Multispecialty Hospital 351
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
352 A.Aravindan and Dr.A.M.Vasumathi
,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
Case study Exploration of Biomedical Waste in Multispecialty Hospital 353
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
354 A.Aravindan and Dr.A.M.Vasumathi
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
Case study Exploration of Biomedical Waste in Multispecialty Hospital 355
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
356 A.Aravindan and Dr.A.M.Vasumathi
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
Case study Exploration of Biomedical Waste in Multispecialty Hospital 357
(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.
358 A.Aravindan and Dr.A.M.Vasumathi
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
Case study Exploration of Biomedical Waste in Multispecialty Hospital 359
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
360 A.Aravindan and Dr.A.M.Vasumathi
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
Case study Exploration of Biomedical Waste in Multispecialty Hospital 361
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.
362 A.Aravindan and Dr.A.M.Vasumathi
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
[1] Notification: Bio-medical waste (Management and Handling) Rules, 1998.
Ministry of Environment and forests, GOI(E) , part 3(ii), New Delhi,
27.07.1998.
[2] National AIDS Control Organization. Manual of Hospital infection control,
New Delhi, 1998; 50-66.
[3] Biomedical Waste management – An Emerging concern in Indian Hospitals,
Author(s): Virendar Pal Singh, gautam Biswas, jag Jiv Sharma Vol.1,No.1
(2007-07-2007-12).
[4] http://envfor.nic.in/ legis/hsm/biomed.html – website of the MINISTRY OF
ENVIRONMENT & FORESTS.
[5] Singh IB, Sarma RK. Hospital Waste Disposal System and Technology
Journal of Academy of Hospital Administration, 1996;
[6] Acharya DB. The Book of Hospital Waste Management 2000;1:92-96.
[7] Srivastava JN. Hospital waste Management project at Command Hospital,
Airforce, Bangalore, National Seminar on Hospital waste management :a
report.
[8] The Directive on Harmonisation of good Laboratory Practice 87/18/EEC and
its related Directive on Inspection and Verification of Good Laboratory
Practice 88/320/EE.
[9] Ordinul Ministrului Sanatatii si fmiliei din Romania nr. 219/2002 pentru
aprobarea Normelor tehnice privind gestionarea deseurilor rezultate din
activitatila medicale si a metodologilor de culegere a datelor pendru baza
national de date privind deseurile rezultate din activitatile medicale.
Case study Exploration of Biomedical Waste in Multispecialty Hospital 363
[10] Hotaarea Guvernului Romaniei nr.856/2002 privind evidenta gestiunii
deseurilor si pentru aprobarea listeicuprinzand deseurile, inclusive deseurile
periculoase, cepot fi supuse tratamentelor de neutralizare prin sterilizare
termica.
[11] Research Triangle Institute, Review and Evaluation of Existing Literature on
Generation, Management and Potential Health Effects of Medical waste,
Health Assessment Section, Technical Assessment Branch, Office of Solid
Waste, U.S. Environmental Protection Agency, November, 1988.
[12] Doucet L.G., Infectious Waste Treatment and Disposal Alternatives, Peekskill,
NY: Doucet & Mainka , P.C.,1989.
[13] OTA Special report on Medical Waste Treatment Methods, Finding the Rx for
Managing Medical wastes, NTIS order #PB91-106203, October, 1990.
[14] Ram Charitra Sah, Bio-Medical waste management Practice and POPs in
Kathmandu, Nepal, Centre for Public Health and Environmental Development
of Kathmandu, Nepal, http//www.noharm.org/details.cfm july 2007.
[15] Cross F., The Case for Regional Incineration of Hospital Waste, Proceedings
of the First National Symposium on Incineration of Infectious Waste,
Washington , DC, May, 1988.
[16] Hagenmaier H., kraft M., Brunner H., and Haag R., Cataytic Effects of Fly
Ash from waste Incineration facilities to the Formation and Decomposition of
Polychlorinated Dibenzo-p-dioxins and Polyclorinated Dibenzofurans,
Environ. Sci.Technol.21911): 1080-1084, 1987.
[17] Curtis F., Testing for Medical Waste Incinerator Destruction Efficiency for
Surrogate Indigator Organisms, The 83rd
Air and waste Management
Association Annual Meeting, Pittsburg, PA, June 24- 29, 1990.
[18] Glasse H., and Chang D., Analysis of the state of California’s Biomedical
Waste Incinerator Base, The 83rd
Air and waste Management Association
Annual Meeting, Pittsburg, PA, June 24 - 29, 1990.
[19] Brill D., Allen E.W., Lutzkar L., Disposal of Low Level Radioactive Waste:
Impact on the Medical Profession, Journal of the American Medical
Association 254(172): 2449-2451.
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