bio medical waste management in sirsa (dr.jaideep)
TRANSCRIPT
PRACTICES OF BIO-MEDICAL WASTE MANAGEMENT IN A DISTRICT GOVT.
HOSPITAL IN SIRSA, HARYANA (INDIA)
Dr. Jaideep Kumar BAMS, MPH (Master in public health) , Panjab University,
Chandigarh (INDIA).
Abstract:
Medical waste is now recognized as a major public health hazard. According to World Health
Organization, each year half a million people globally die due to infections such as Hepatitis B,
and C, HIV and hepatocellular cancer transmitted through unsafe healthcare practices. There is
no information as to what component of this figure comprises healthcare workers. There are also
alarming disclosures about used medical devices and other items getting recycled and repacked
by unscrupulous traders in countries such as ours. This happens when the hospitals do not take
adequate steps to disinfect and mutilate the medical waste as required under the law. Despite the
statutory provision of Biomedical Waste Management, practice in Indian Hospitals has not
achieved the desired standard even after ten years of enforcement of the law. Biomedical waste
has become a serious health hazard in many countries, including India. Careless and
indiscriminate disposal of this waste by healthcare establishments and research institutions can
contribute to the spread of serious diseases such as hepatitis and AIDS (HIV) among those who
handle it and also among the general public. In view of this, the present study on Practices of
bio-medical waste management was carried out in a General Hospital Sirsa, a Govt. District
Hospital of Haryana, in North India. This hospital is a 100 bedded hospital with latest facilities.
The Institute has a work force of 15 doctors, 30 nurses,15 sweepers ,24 ward servants and other
support staff. The study is based on interviews of the staff involved in the biomedical waste
management practices and observation of the biomedical waste management practices. The
present study pertains to the biomedical waste management practices at General Hospital. The
study shows that infectious and non-infectious wastes are dumped together within the hospital
premises, resulting in a mixing of the two, some of which are then disposed of with municipal
waste at the dumping sites in the city. All types of wastes are collected in common bins placed
inside and outside the Hospital. For disposal of this waste the hospital depends on the generosity
of the Synergy waste management (P) ltd, whose employees generally collect it from the hospital
daily excluding Sunday. The hospital does not have any treatment facility in working condition
for infectious waste. The laboratory waste materials are disposed of directly into the municipal
sewer without proper disinfection of pathogens. The major part of bio-medical waste is deposited
inside the hospital building in bins for further transportation to BMWM plant Hissar for disposal.
The other small part of bio-medical waste was dumped with municipal waste outside the hospital
building. Some parts of disposable plastic items are segregated by the rag pickers from the
municipal bins and dumps inside the hospital campus. The open dumping of the waste makes it
freely accessible to rag pickers who become exposed to serious health hazards due to injuries and
infections from sharps, needles, other types of material used when giving injections and other
BMW. The results of the study demonstrate the need for strict enforcement of legal provisions
and a better environmental management system for the disposal of biomedical waste in the
General Hospital Sirsa, Haryana(India).
Article Outline
1. Introduction
2. Objective
3. Methodology
4. Key findings
5. Discussion
6. Recommendations
7. Conclusion
8. Acknowledgements
9. References
1.Introduction:-
“Bio Medical Waste”:-
“Bio Medical Waste” means any waste, which is generated during the diagnosis, treatment or
immunization of human beings or animals or in research activities pertaining thereto or in the
production or testing of biological including containers.
Bio-medical waste means “any solid and/or liquid waste including its container and any
intermediate product, which is generated during the diagnosis, treatment or immunization of
human beings or animals.
Components of Bio-medical waste:-
Human anatomical waste (tissues, organs, body parts etc.).
Animal waste (as above, generated during research/experimentation, from veterinary
hospitals etc.).
Microbiology and biotechnology waste, such as, laboratory cultures, micro-organisms,
human and animal cell cultures, toxins etc.
Waste sharps, such as, hypodermic needles, syringes, scalpels, broken glass etc.
Discarded medicines and cyto-toxic drugs.
Soiled waste, such as dressing, bandages, plaster casts, material. contaminated with blood
etc.
Solid waste (disposable items like tubes, catheters etc. excluding sharps).
Liquid waste generated from any of the infected areas.
Incineration ash.
Chemical waste.
Sources of BMW:-
The major sources of health-care waste are hospitals and other health-care establishments,
laboratories and research centres, mortuary and autopsy centres, animal research and testing
laboratories, blood banks and collection services, and nursing homes for the elderly.
Quantity of BMW :-
Health-care activities - for instance, immunizations, diagnostic tests, medical treatments, and
laboratory examinations - protect and restore health and save lives. But what about the wastes
and by-products they generate?
Hospitals and other health care facilities generate lots of waste which can transmit infections,
particularly HIV, Hepatitis B & C and Tetanus, to the people who handle it or come in contact
with it. High-income countries can generate up to 6 kg of hazardous waste per person per year.
In the majority of low-income countries, health-care waste is usually not separated into
hazardous or non-hazardous waste. In these countries, the total health-care waste per person per
year is anywhere from 0.5 to 3 kg.
Composition of BMW
The typical Hospital solid waste composition is as follows (based on CPCB report)
Segregation
Segregation refers to the basic separation of different categories of waste generated at source and
thereby reducing the risks as well as cost of handling and disposal.
Segregation is the most crucial step in bio-medical waste
management. Effective segregation alone can ensure effective
bio-medical waste management. The BMWs must be
segregated accordance to guidelines laid down under schedule
1 of BMW Rules, 1998.
How does segregation help?
Segregation reduces the amount of waste needs special
handling and treatment
Effective segregation process prevents the mixture of medical waste like sharps with the
general municipal waste.
Prevents illegally reuse of certain components of medical waste like used syringes,
needles and other plastics.
Provides an opportunity for recycling certain components of medical waste like plastics
after proper and thorough disinfection.
Recycled plastic material can be used for non-food grade applications.
Of the general waste, the biodegradable waste can be composted within the hospital
premises and can be used for gardening purposes.
Recycling is a good environmental practice, which can also double as a revenue
generating activity.
Reduces the cost of treatment and disposal (80 per cent of a hospital’s waste is general waste,
which does not require special treatment, provided it is not contaminated with other infectious
waste)
People at Risk:-
The main groups at risk are the following:
Doctors, nurses, ambulance staff and hospital sweepers;
Patients in health-care establishments or under home care;
Workers in support services to health-care establishments, such as laundries, waste
handling and transportation, waste disposal facilities including incinerators and other
persons separating and recovering materials from waste;
Inappropriate or inadvertent end-users such as scavengers and customers in secondary
markets for reuse (i.e. households, local medical clinics, etc.)
Health Concern –hazards of Bio-medical waste:-
Biomedical waste poses hazard due to two principal reasons – the first is infectivity and other
toxicity. According to the WHO, the global life expectancy is increasing year after year.
However, deaths due to infectious disease are also increasing. A study conducted by the WHO
reveals that more than 50,000 people die everyday from infectious diseases. One of the causes
for the increase in infectious diseases is improper waste management. Blood, body fluids and
body secretions which are constituents of bio-medical waste harbour most of the viruses, bacteria
and parasites that cause infection. This passes via a number of human contacts, all of whom are
potential ‘recipients’ of the infection. Human Immunodeficiency Virus (HIV) and hepatitis
viruses spearhead an extensive list of infections and diseases documented to have spread through
bio-medical waste. Tuberculosis, pneumonia, diarrhea diseases, tetanus, whooping cough etc.,
are other common diseases spread due to improper waste management.
HEALTH IMPACTS:-
Health-care waste is a reservoir of potentially harmful micro-organisms which can infect hospital
patients, health-care workers and the general public. Other potential infectious risks include the
spread of, sometimes resistant, micro-organisms from health-care establishments into the
environment. These risks have so far been only poorly investigated. Wastes and by-products can
also cause injuries, for example radiation burns or sharps-inflicted injuries; poisoning and
pollution, whether through the release of pharmaceutical products, in particular, antibiotics and
cytotoxic drugs, through the waste water or by toxic elements or compounds such as mercury or
dioxins.Some of these are given below:-
Cytotoxic Waste:-Cytotoxic drugs have the ability to stop the growth of certain living cells and
are used as chemo-therapeutic agents. They are carcinogens and can also be mutagenic. Any
material used to handle these products and contaminated in due course would also need to be
disposed off in the same manner.Adverse health effects from both acute and chronic exposures to
cytotoxic drugs have been demonstrated in healthcare personnel.Over a long term, almost all of
these drugs have the potential of damaging cells or adversely affecting cellular growth and
reproduction. The drugs bind directly to genetic material in the cell nucleus, or affect cellular
protein synthesis. In-vivo, in-vitro and human studies have implicated anti-neoplastic drugs in
chromosomal damage, teratogenesis, and carcinogenesis.Testicular and ovarian dysfunction,
including permanent sterility, have been demonstrated in male and female patients, respectively,
who have received these drugs singly, or in combination. Studies in Finland have shown an
increased incidence of foetal loss among nurses routinely working with anti-neoplastic agents
than among those who do not. Other studies have suggested a correlation between exposure to
anti-neoplastic agents and foetal malformation in pregnant nurses. Additionally, organ damage
has been associated with exposure to some anti-neoplastic agents. Liver damage has been
reported in oncology employees, and appears to be related to the duration and the concentration
of the exposure. The risks to workers handling anti-neoplastic agents are a result of the inherent
toxicity of the drugs themselves, and the actual dose that a worker receives. The dose is
dependent on the concentration of the drug, the duration of the exposure, and the route of entry.
The adverse health effects as a result of exposure to a particular drug may depend on whether the
drug enters the body through inhalation, through the skin, or ingestion.
Sharps:-Anything that can cause a cut or a puncture wound is classified as ‘sharps’. These
include needles, hypodermic needles, scalpel and other blades, knives, infusion sets, saws,
broken glass, and nails. Whether or not they are infected, sharps are usually considered highly
hazardous healthcare waste because they have the potential to cross the passive and primary
immunology barrier of the body the skin and thus establish contact with blood. Because of this
double risk of injury and disease transmission sharps are considered very hazardous. The
principal concerns are infections that may be transmitted by subcutaneous introduction of the
causative agent, for example, viral blood infections. Hypodermic needles constitute an important
part of the sharps waste category and are particularly hazardous because they are often
contaminated with blood .Throughout the world every year an estimated 12 000 million
injections are administered. And not all needles and syringes are properly disposed of, generating
a considerable risk for injury and infection and opportunities for re-use.
Worldwide, 8-16 million hepatitis B, 2.3 to 4.7 million hepatitis C and 80 000 to 160 000
HIV infections are estimated to occur yearly from re-use of syringe needles without
sterilization2. Many of these infections could be avoided if syringes were disposed of
safely. The re-use of disposable syringes and needles for injections is particularly
common in certain African, Asian and Central and Eastern European countries.
Regarding injection practices, public health authorities in West Bengal, India, have
recommended a shift to re-usable glass syringes, as the disposal requirements for
disposable syringes could not be enforced.
In developing countries, additional hazards occur from scavenging on waste disposal sites
and manual sorting of the waste recuperated at the back doors of health-care
establishments. These practices are common in many regions of the world. The waste
handlers are at immediate risk of needle-stick injuries and other exposures to toxic or
infectious materials.
Mercury:- Mercury is the only heavy metal that can exist in all three states of matter: it readily
changes from solid to liquid to gaseous form and is a persistent bio-accumulative toxin. It
circulates constantly in the environment. Three major forms of chemical mercury circulate in the
atmosphere: mercury (0), mercury (II) and methyl mercury. Methyl mercury can accumulate in
muscle tissue and bio-magnify via the food chain. Mercury is a neurotoxicant and affects the
brain and the nervous system. Other vital organs like kidneys and lungs are also affected.
Mercury poisoning can be difficult to diagnose since the symptoms are common to other
afflictions. Pregnant women and children are most vulnerable to the effects of mercury. A foetus
exposed to mercury shows nervous system damage.
Vaccine waste:-In June 2000, six children were diagnosed with a mild form of smallpox
(vaccinia virus) after having played with glass ampoules containing expired smallpox vaccine at
a garbage dump in Vladivostok (Russia). Although the infections were not life-threatening, the
vaccine ampoules should have been treated before being discarded.
Pharmaceutical waste:- includes expired, unused, spilt and contaminated pharmaceutical
products, drugs, vaccines and sera that are no longer useful.
Chemicals:- are generally used in diagnostic and experimental work, and in cleaning,
housekeeping and disinfecting procedures. Many chemicals and pharmaceuticals used in
hospitals are hazardous. They are termed hazardous if they have any one of the following
properties: toxic, corrosive, flammable, reactive, genotoxic. Examples of such waste are
formaldehyde, glutaraldehyde and photographic chemicals. They may cause injuries, including
burns. Disinfectants are particularly important members of this group as they are used in large
quantities and are generally corrosive.
Hazards of Bio-medical waste:-
Injury from sharps to staff and waste handlers associated with the health care
establishment.
Hospital Acquired Infection(HAI)(Nosocomial) of patients due to spread of infection and
disease through vectors (fly, mosquito, insects etc.).
Risk of infection outside the hospital for waste handlers/scavengers and eventually
general public.
Occupational risk associated with hazardous chemicals, drugs etc. Reaction due to use of
discarded medicines
Unauthorized repackaging and sale of disposable items and unused / date expired drugs
Toxic emissions from defective/inefficient incinerators.
Indiscriminate disposal of incinerator ash / residues.
Occupational health hazards :-
The health hazards due to improper waste management
can affect
The occupants in institutions and spread in the
vicinity of the institutions
People happened to be in contact with the
institution like laundry workers, nurses,
emergency medical personnel, and refuse workers.
Risks of infections outside hospital for waste handlers, scavengers and (eventually) the
general public
Risks associated with hazardous chemicals, drugs, being handled by persons handling
wastes at all levels
Injuries from sharps and exposure to harmful chemical waste and radioactive waste also
cause health hazards to employees.
Hazards to the general public:-
The general public’s health can also be adversely affected by bio-medical waste.
Improper practices such as dumping of bio-medical waste in municipal dustbins, open
spaces, water bodies etc., leads to the spread of diseases.
Emissions from incinerators and open burning also lead to exposure to harmful gases
which can cause cancer and respiratory diseases.
Exposure to radioactive waste in the waste stream can also cause serious health hazards.
An often-ignored area is the increase of in-home healthcare activities. An increase in the
number of diabetics who inject themselves with insulin, home nurses taking care of
terminally ill patients etc., all generate bio-medical waste, which can cause health hazards.
RISKS ASSOCIATED WITH WASTE DISPOSAL:-
Although treatment and disposal of health-care wastes aim at reducing risks, indirect health risks
may occur through the release of toxic pollutants into the environment through treatment or
disposal.
Landfilling can potentially result in contamination of drinking water. Occupational risks
may be associated with the operation of certain disposal facilities. Inadequate
incineration, or incineration of materials unsuitable for incineration can result in the
release of pollutants into the air. The incineration of materials containing chlorine can
generate dioxins and furanse, which are classified as possible human carcinogens and
have been associated with a range of adverse effects. Incineration of heavy metals or
materials with high metal contents (in particular lead, mercury and cadmium) can lead to
the spread of heavy metals in the environment. Dioxins, furans and metals are persistent
and accumulate in the environment. Materials containing chlorine or metal should
therefore not be incinerated.
Only modern incinerators are able to work at 800-1000 °C, with special emission-
cleaning equipment, can ensure that no dioxins and furans (or only insignificant amounts)
are produced. Smaller devices built with local materials and capable of operating at these
high temperatures are currently being field-tested and implemented in a number of
countries.
At present, there are practically no environmentally-friendly, low-cost options for safe
disposal of infectious wastes. Incineration of wastes has been widely practised, but
alternatives are becoming available, such as autoclaving, chemical treatment and
microwaving, and may be preferable under certain circumstances. Landfilling may also
be a viable solution for parts of the waste stream if practised safely. However, action is
necessary to prevent the important disease burden currently created by these wastes. In
addition, perceived risks related to health-care waste management may be significant. In
most cultures, disposal of health-care wastes is a sensitive issue and also has ethical
dimensions.
Bio-medical waste can cause health hazards to animals and birds too:-
Plastic waste can choke animals, which scavenge on open dumps.
Injuries from sharps are common feature affecting animals.
Harmful chemicals such as dioxins and furans can cause serious health hazards to
animals and birds.
Heavy metals can even affect the reproductive health of the animals
Change in microbial ecology, spread of antibiotic resistance
Situation of BMWM in India:-
Most countries of the world, especially the developing nations, are facing the grim situation
arising out of environmental pollution due to pathological waste arising from increasing
populations and the consequent rapid growth in the number of health care centres. India is no
exception to this and it is estimated that there are more than 15,000 small and private hospitals
and nursing homes in the country. This is apart from clinics and pathological labs, which also
generate sizeable amounts of medical waste.
India generates around three million tonnes of medical wastes every year and the amount is
expected to grow at eight per cent annually.
Barring a few large private hospitals in metros, none of the other smaller hospitals and nursing
homes have any effective system to safely dispose of their wastes. With no care or caution, these
health establishments have been dumping waste in local municipal bins or even worse, out in
the open. Such irresponsible dumping has been promoting unauthorized reuse of medical
waste by the rag pickers for some years now.
Legal aspect of BMWM in India:-
The Central Government, to perform its functions effectively as contemplated under sections 6,
8, and 25 of the Environment Protection Act, 1986, has made various Rules, Notifications and
Orders including the Bio-medical wastes (Management & Handling) Rules, 1998.A brief
summary of the provisions in Bio-medical wastes (Management & Handling) Rules, 1998 is
given below.
Section 3 establishes the authority of the government to undertake various steps for
protection and improvement of the environment.
Section 5 provides for issuance of directions in writing.
Section 6 empowers the government to make rules.
Section 8 permits the education of individuals dealing with hazardous wastes regarding
various safety measures.
Section 10 bestows authority to enter the premises and inspect.
Section 15 allows the government to take punitive steps against defaulters. This
involves imprisonment up to five years or penalty of upto rupees one lakh or both.
In case the default continues, it would then attract a penalty of rupees five thousand
per day up to one year and thereafter imprisonment up to seven years.
Section 17 provides for punishment in case of violations by government departments.
Even after the June, 2000 deadline most of the large hospitals have not complied with these
Rules, as there is no specified authority to monitor the implementation of these Rules. But, the
fact is that in most of the states, the pollution control boards that are connected with waste in
general do not have adequate powers or commitment to enforce the Rules.
Applicability of BMW Rules, 1998
The BMW Rules are applicable to every occupier of an institution generating biomedical waste
which includes a hospital, nursing homes, clinic, dispensary, veterinary institutions, animal
houses, pathological lab, blood bank by whatever name called, the rules are applicable to even
handlers.
Common Biomedical wastes treatment facility [CBWTFs]
The Common Biomedical wastes treatment facility, (see rules 14, amended in June 2000, which
cast the responsibilities on municipal bodies to collect biomedical wastes/treated biomedical
wastes and also provide sites for setting up of incinerator.) The owner of CBWTFs are service
providers, who are providing services to health care units for collection of BMWs for its final
disposal to their site.
CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I
WASTE
CATEGORY TYPE OF WASTE
TREATMENT AND
DISPOSAL OPTION
Category No. 1 Human Anatomical Waste (Human tissues, organs, body parts) Incineration@ / deep burial*
Category No. 2
Animal Waste
(Animal tissues, organs, body parts, carcasses, bleeding parts,
fluid, blood and experimental animals used in research, waste
generated by veterinary hospitals and colleges, discharge from
hospitals, animal houses)
Incineration@ / deep burial*
Category No. 3 Microbiology & Biotechnology Waste (Wastes from laboratory
cultures, stocks or specimen of live micro organisms or
attenuated vaccines, human and animal cell cultures used in
research and infectious agents from research and industrial
laboratories, wastes from production of biologicals, toxins and
Local autoclaving/
microwaving /
incineration@
devices used for transfer of cultures)
Category No. 4
Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that
may cause puncture and cuts. This includes both used and
unused sharps)
Disinfecting (chemical
treatment@@ / autoclaving /
microwaving and
mutilation / shredding##
Category No. 5Discarded Medicine and Cytotoxic drugs (Wastes comprising of
outdated, contaminated and discarded medicines)
Incineration@ / destruction
and drugs disposal in
secured landfills
Category No. 6
Soiled Waste (Items contaminated with body fluids including
cotton, dressings, soiled plaster casts, lines, bedding and other
materials contaminated with blood.)
Incineration@ / autoclaving /
microwaving
Category No. 7Solid Waste (Waste generated from disposable items other than
the waste sharps such as tubing, catheters, intravenous sets, etc.)
Disinfecting by chemical
treatment@@ / autoclaving /
microwaving and
mutilation / shredding# #
Category No. 8Liquid Waste (Waste generated from the laboratory and
washing, cleaning, house keeping and disinfecting activities)
Disinfecting by chemical
treatment@@ and discharge
into drains
Category No. 9Incineration Ash (Ash from incineration of any biomedical
waste)
Disposal in municipal
landfill
Category No.10Chemical Waste (Chemicals used in production of biologicals,
chemicals used in disinfecting, as insecticides, etc.)
Chemical treatment @@ and
discharge into drains for
liquids and secured landfill
for solids.
@@ Chemical treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It
must be ensured that chemical treatment ensures disinfection.
** Mutilations / Shredding must be such as to prevent unauthorized reuse.
@ There will be no chemical pre-treatment before incineration. Chlorinated plastics shall not be incinerated.
* Deep burial shall be an option available only in towns with population less than five lakh and in rural areas.
COLOUR CODING AND TYPE OF CONTAINER SCHEDULE II
Colour Coding Type of Container Waste Category Treatment options as per Schedule I
Yellow Plastic bagCat.1,Cat.2, Cat.3
and Cat.6Incineration/ deep burial
RedDisinfected container/
plastic bag
Cat.3, Cat.6, and
Cat.7
Autoclaving/Micro waving/ Chemical
Treatment
Blue/ White
Translucent
Plastic Bag/ puncture
proof containerCat.4 and Cat.7
Autoclaving/Micro waving/ Chemical
Treatment and destruction/ shredding
Black Plastic bagCat.5, Cat.9, and
Cat.10 (solid)Disposal in secured landfill
Notes:
Colour coding of waste categories with multiple treatment options as defined in Schedule I, shall be
selected depending on treatment option chosen, which shall be specified in Schedule I.
Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics.
Categories 8 and 10 (liquid) do not require containers/bags.
Category 3 if disinfected locally need not be put in containers/bags.
IMPLEMENTATION OF BIO-MEDICAL WASTE RULES 1998 in Haryana
OBJECTIVE
Stop the indiscriminate disposal of hospital waste/ bio-medical waste
Ensure that such waste is handled without any adverse effect on the human health and
environment.
RULES ARE APPLICABLE TO :
All institutions generating bio-waste such as Hospitals, Nursing Homes/clinics,
Pathological Labs & Blood Banks
RESPONSIBILITY/ DUTY
Every occupier of an institution generating, collecting, receiving, storing, transporting,
treating, disposing and/or handling bio-medical waste in any manner except such
occupiers (dispensaries, blood banks, pathological labs.) providing treatment to less than
1000 patients per month.
NODAL AGENCY FOR AUTHORISATION
Haryana State Pollution Control Board
PENALTY
Defaulters to be penalised as per provisions of Environment (Protection) Act 1986 and other
Pollution Control Acts.
Punishment – imprisonment for a term which may extend for 5 years with fine
which may extend to Rs. one lakh, or with both.
If failure or contravention of the provisions of the Act continues, additional fine
which may extend to Rs.5000/- per day is levied upto the date the contravention is
removed.
If the failure or contravention continues beyond a period of one year after the date
of conviction, the offender shall be punished with imprisonment for a term which
may extend upto 7 years.
IMPLEMENTATION OF BIO-MEDICAL WASTE RULES 1998 in Haryana:-
BMW Rules have been adopted and notified in Haryana State with the objective to Stop
the indiscriminate disposal of hospital waste/ bio-medical waste and ensure that such
waste is handled without any adverse effect on the human health and environment.
Survey of Health institutions in the private sector has been completed.
All government institutions including hospitals/ CHCs/ PHCs /Laboratories/Blood Banks
have applied for authorisation under the Act.
Incineration facilities installed at 11 District hospitals Ambala, Panchkula, Kurukshetra,
Bhiwani, Faridabad, Hisar, Sirsa, Jind, Sonipat, Karnal & Panipat have been offered to
the health institutions working in private sector on the payment of nominal charges.
Notification regarding the use of incineration facilities of Govt. by private doctors on the
payment of prescribed amount and creation of district Bio-Medical waste Management
Societies has been issued.
Segregation and disposal of Bio-medical waste has been started in hospitals.
Sensitization of all Civil Surgeons about BMW Rules have been done at State
Headquarter.
24 Senior Officers from various districts have been got trained in Bio-Medical Waste
(Management & Handling) Rules at National Institute of Management at Jaipur from
26.12.2000 to 4.1.2001.
Civil Surgeons have completed the training for medical and paramedical personals in
these respective Districts.
Tenders for proper Bio-Medical Waste Disposal according to guidelines have been
floated by the Department. Private Firms have submitted the tenders and they are under
active consideration of the Govt.
ADVISORY COMMITTEE:- (ENVIRONMENT DEPARTMENT) The 23rd July, 1999
In exercise of the powers conferred by rule 9 of the Bio-Medical Waste (Management and
Handling) Rules, 1998, the Governor of Haryana hereby constitutes an Advisory Committee for
the purpose of the said rule 9 consisting of the following members, namely :-
1. Commissioner and Secretary to Government, Haryana
Environment Department,Chairman
2. Chairman, Haryana State Pollution Control Board,,Chandigarh, Member
3. Engineer-in-Chief, PW (Public Health) Department.
Haryana, Chandigarh, Member
4. Director General, Health Services, Haryana Chandigarh ,Member
5. Director, Animal Husbandry Haryana, Chandigarh, Member
6. Dean, College of Veterinary Sciences, Chaudhry Charan Singh,
Haryana Agriculture University, Hisar, Member
7. Dean, Medical College, Rohtak, Member
8. President, Indian, Medical Association Haryana Branch, Member
9. Director Environment, Haryana , Member-Secretary
Introduction To Hospital
General Hospital Sirsa strives for the best spirit of Health Care and Welfare. This hospital is
100 bedded multi specialty hospital located in urban area of Sirsa city catering to population of
more than 3 lacs. This is main Dist. Hospital in Sirsa in Govt. sector. It has specialist wards for
the patients requiring care by specialists like Physician, General Surgeon, Orthopaedic Surgeon,
Eye Surgeon, Gynaecologist & Obstetrician, Pediatrician, ENT Surgeon, Dental Unit and
Physiotherapy Centre. All the specialists also give their services in the OPD. Hospital is having a
separate casualty and ICU facility having 8 beds catering to patients of different kinds needing
intensive care. ICU, OPD’s, Gynae Unit, and Operation Theatres are fully air conditioned and
equipped with all modern and latest facilities. Almost 5-7 major General /Orthopaedic/ Gynae/
Eye Surgeries are being performed including Emergency Care. Family planning operations are
done every day. Lower strata of society are taking the full advantage of this Govt. hospital as
most of the services are provided without any cost or on a nominal fee.
The Radiology Dept. has State of Art facilities like Spiral CT, Color Doppler, 500 MA X-Ray
fixed and portable.
Beside all this a fully equipped Trauma Centre is attached to this hospital having 11 ambulances
scattered all over District, two of them fitted with respirators, monitors, defibrillators, infusion
pumps. All the ambulances are centralized with Emergency Medical Response Call Centre which
is housed in Trauma Centre.
Hospital has its own three mobile units,- Delivery Van, Dental, and Eye hospital on wheels with
Operation theatres in all the units. These units are meant for the services to far reaching rural
area of Sirsa and its adjoining Fatehabad Dist.
At present the hospital has work force of 15 doctors, 30 nurses,15 swepers ,24 ward servents and
other support staff.
A separate administrative staff is provided for official work, medical stores, Xrays, lab.
Admissions, and OPDs are computerized for hospital purposes with a central computer server.
The Hospital has also a Training Centre for Medical Officers, and is a base for clinical training to
various Nursing, Pharmacy, Dental, BAMS students from the institutions located in the vicinity
of Sirsa. Hospital is recognized by Medical Council of India for internship to medical graduates.
The hospital has Bed occupancy rate- 85(average),daily OPD-600(average).This hospital
generate 20 Kg(average) of BMW per day.
2. Objective :-
To evaluate Bio-medical waste management in General Hospital Sirsa
3. Methodology :-
Study Area - General Hospital, Sirsa, Haryana.
Study Period— January 2009
Study design:-Crossectional & observational study
Study Tools:-
1.Self assessment on Bio-medical waste(management &handling)Rules 1998
2.Interview of Health workers & Synergy waste management(P) ltd. Workers 3.Observation of
Bio-medical waste segregation &handling in the Hospital.
4.Information of agreement and other bio-medical waste management measures of General
hospital Sirsa were collected through R.T.I. Act 2005.
Study technique : After getting consent of health care provider , a study based on bio medical
waste(management & handling rules 1998 ,amended on 2000) was done in general hospital
sirsa.The study was done for segregation and packing of biomedical waste in G.H.Sirsa.
Interviews of the staff involved in the Biomedical waste management practices was
conducted.An observation was done in G.H.Sirsa for segregation and packing of biomedical
waste, Information of agreement and other bio-medical waste management measures of General
hospital Sirsa were collected through R.T.I. Act 2005.
Data collection:-Secondary Data was collected from the authority of General Hospital through
RTI Act.2005.
4. Key findings :-
RESULT: some of major strength & weeknesses in g.h. sirsa regarding biomedical waste
management were:-
Strengths:-
Medical waste segregation awareness boards presents in different wards of hospital.
Contract is given to private agency for collection of BMW.
Weaknesses:-
BMW was not segregated, collected according to BMWM rules.
No Quality assessment of bio-medical waste management is done from time to time.
Unavailability of all types of dustbins(i.e Red,Blue, Yellow and Black) in all wards.
Unavailability of plastic bags for medical waste segregation
5. Discussion :-
Medical care is vital for our life, health and well being. But the waste generated from medical
activities can be hazardous, toxic and even lethal because of their high potential for diseases
transmission. The hazardous and toxic parts of waste from health care establishments comprising
infectious, bio-medical and radio-active material as well as sharps (hypodermic needles, knives,
scalpels etc.) constitute a grave risk, if these are not properly treated/disposed or are allowed to
get mixed with other municipal waste. Its propensity to encourage growth of various pathogen
and vectors and its ability to contaminate other nonhazardous/ non-toxic municipal waste
jeopardizes the efforts undertaken for overall municipal waste management. The rag pickers and
waste workers are often worst affected, because unknowingly or unwittingly, they rummage
through all kinds of poisonous material while trying to salvage items which they can sell for
reuse. At the same time, this kind of illegal and unethical reuse can be extremely dangerous and
even fatal. Diseases like cholera, plague, tuberculosis, hepatitis (especially HBV), AIDS (HIV),
diphtheria etc. in either epidemic or even endemic form, pose grave public health risks. So there
was a need of stringent law to be in place. With a judicious planning and management, however,
the risk can be considerably reduced. Studies have shown that about three fourth of the total
waste generated in health care establishments is non-hazardous and non-toxic.Some
estimates put the infectious waste at 15% and other hazardous waste at 5%.Therefore with
a rigorous regime of segregation at source, the problem can be reduced proportionately.
Similarly, with better planning and management, not only the waste generation is reduced, but
overall expenditure on waste management can be controlled. Institutional/Organizational set up,
training and motivation are given great importance these days. Proper training of health care
establishment personnel at all levels coupled with sustained motivation can improve the situation
considerably.
6. Recommendations :- Some suggestions which would act as remedial measures for the
Improvements in health-care waste management are given below :-
1. Specific personnel need to be deputed to monitor the bio-medical waste management.
2. By assessing the need of man power and other things for the BMWM of hospital and
by fulfilling of all the requirements.
3. Quality assessment of bio-medical waste management be done from time to time.
Regular quality analysis by independent authorities.
4. The build-up of a comprehensive system, addressing responsibilities, resource
allocation, handling and disposal. This is a long-term process, sustained by gradual
improvements;
5. Awareness raising and training about risks related to health-care waste, and safe and
sound practices.
6. Clear directives in the form of a notice to be displayed in all concerned areas in local
languages.
7. Issuance of all protective clothes such as, gloves, aprons, masks etc. without fail.
8. Maintenance of Record registers for this purpose.
9. Regular medical check-up (half-early) of staff associated with BMWM.
10. Tracking of Bio Medical Waste upto point of Disposal.
11. Segregated collection and transportation - The use of colour coding and labelling of
hazardous waste including local language.
12. Safety of handling.
13. Selection of safe and environmentally-friendly management options, to protect people
from hazards when collecting, handling, storing, transporting, treating or disposing of
waste.
14. Proper treatment and final disposal.
Government commitment and support is needed to reach an overall and long-term
improvement of the situation, although immediate action can be taken locally.
7. Conclusion :-
WASTE MANAGEMENT -- REASONS FOR FAILURE:-
The absence of waste management, lack of awareness about the health hazards, insufficient
financial and human resources and poor control of waste disposal are the most common
problems connected with health-care wastes. An essential issue is the clear attribution of
responsibility of appropriate handling and disposal of waste. According to the 'polluter pays'
principle, this responsibility lies with the waste producer, usually being the health-care provider,
or the establishment involved in related activities.
We need innovative and radical measures to clean up the distressing picture of lack of civic
concern on the part of hospitals and slackness in government implementation of bare minimum
of rules, as waste generation particularly biomedical waste imposes increasing direct and indirect
costs on society. The challenge before us, therefore, is to scientifically manage growing
quantities of biomedical waste that go beyond past practices. If we want to protect our
environment and health of community we must sensitize our selves to this important issue not
only in the interest of health managers but also in the interest of community.
8.Acknowledgements:-
I acknowledge the hospital staff for their cooperative coordination and support during the study.
9.References:-
1. Wastes from health-care activities(WHO Media centre) .
2. “Bio-medical waste management”, Environmental Management and Policy Research
Institute, Bangalore, 2004. .
3. “Southern regional conference on bio-medical waste management” Tamilnadu Pollution
Control Board, Chennai, 1999. .
4. “Manual on hospital waste management”, Central Pollution Control Board, Delhi,
2000.
5. Report: Biomedical waste management practices at Balrampur Hospital, Lucknow, India
(Saurabh Gupta , Ram Boojh)
6. Biomedical waste management in nursing homes and smaller hospitals in Delhi( Lalji K.
Verma, Shyamala Mania, Nitu Sinha and Sunita Rana)
7. Biomedical solid waste management in an Indian hospital: a case study(Gayathri V.
Patil and Kamala Pokhrel)
8. Knowledge, Attitude and Practices of Bio-Medical Waste Management Amongst Staff of
a Tertiary Level Hospital in India (S. Saini, S.S. Nagarajan, R.K. Sarma)
9. Park’s Text Book,.gov,who.org
10. Profile of Health Department Haryana
11. The Gazette of India. Biomedical Waste (Management & Handling) Rule 1998. No 460
July 27th 1998 and Amended No. 375, June 2nd 2000
Web sites:
http://www.expresshealthcaremgmt.com
http;//www.who.int