Hospital Waste Management Waste: Everything is made for a defined

purpose. “Any thing which is not intended further use termed as waste”.

Any waste generated by out of hospitals can be said to be “hospital waste”. Any waste generated by consequent to health care activity including those at home is “Health Care Waste”.

According to Biomedical Waste(Management and Handling) Rules 1998, of India, Biomedical Waste(BMW) is defined as a waste generated during diagnosis, treatment, immunization of human being or animal or in the research activities pertaining thereto or in the production or testing of biologicals. It also includes waste from veterinary institutes and slaughter houses. However, radioactive waste is not included under BMW.

INTRODUCTIONHospitals generated large volume wastes as a by-product of a variety health services and procedure

carried out such as surgery, dressing of wounds, dialysis, deliveries, laboratory and dental procedures, PM procedures, etc. Such a waste may be infectious

or non-infectious. If such waste is not properly collected, transported and disposed off, it not only

results in causation of hospital acquired infection(Nosocomial infections) but also poses a

major public health hazard by causing pollution of air, water and soil.

• Persons who are constantly exposed to these wastes especially waste-sharps, are nurses, rag pickers cleaners, laundry staff, etc . who are always risk of getting fatal disease like Hepatitis B, C, and HIV through injuries by contaminated needles and sharps as an occupational hazard. Also indiscriminate dumping of the hospital wastes into backyards or into open municipal pits, become breeding places for diseases (mosquitoes, flies, rodents and microbes).

Epidemics can result from the contamination of drinking water and food sources with these infectious wastes, which are washed by rains. Indiscriminate open burning of infectious wastes, especially plastic will result in emission of noxious gasses, which may produce CA. Further, there is scope of re-use of syringes, needles, polythene bags, catheters, etc.

• It is estimated that only 10-15% Health Care Waste is “Infected Waste”. Non hazards “general waste” comparable to domestic waste. Non-contaminated or non-infectious waste becomes infected when it gets mixed with infected waste. Hence one should not allow mixing of infected waste with household (non-contaminated) waste. This is possible only if the waste is segregated or sorted into “Infected” and “Household” waste at the sources or point of generation.

Quantity of Health Care Waste: This depends upon the type of health care

setting and the services offered. It is estimated that 0.5 to 1 kg wastes/d/bed, in CHC, SDH i.e. 15-50 kg/d, whereas in DH, MCH. It is about 200-1000kg/D.

Classification of hazards waste1. Infectious waste(suspect to contain pathogen)e.g. Lab culture,

waste from I.W, tissue swab, etc.2. Pathological waste: (containing human tissue or fluid)e.g. Body

parts , blood and other fliuds, etc3. Sharps(sharp materials)4. Pharmaceutical waste(containing pharmaceutical 5. Genotoxic waste, e.g. containing cytotoxic dugs, genotoxic

chemicals.6. Chemical waste, e.g. lab. Reagent, film developer7. Waste with heavy metal- broken thermometer8. Pressurized containers-aerosol cans, gas cylinder9.Radioactive material -unused liquid from radiotherapy, excreta

from pt. treated with unsealed radio-nucleotide.

Objectives of the HWM system:• 1. To reduce the infectious/hazards nature of waste.• 2. To reduce Volume of the waste.• 3. To prevent misuse or abuse of waste.• 4. To ensure occupational safety and health.• 5, To consider aesthetically.• 6. To recycle the wastes so that it can be serve as another utility item.

Safe Waste Management Practices Helps:• 1. To maintain order and cleanliness in the hospital.• 2. To maintain a health environment for pts, staff, and public.• 3. To prevent spread of infectious diseases.• 4. To project good impression of the management.• 5. To attract more clientele.• 6. To. Generate revenue for the institution.

Sources of health care wastes:Govt. Hospital and private hospital,Nursing home,Physician’s and Dentist’s clinics,Dispensaries,Medical research and training ins.,MortuariesBlood banksLabSlaughter housesVaccine center, etc

Health care waste generation:Health care waste generation not only differ

from countries to countries but also within the country. It depends on numerous factors such as type of health establishment, proportion of pts. Treated on day care basis.

In middle and low income countries waste generation less than high income group.

Health Hazards of health-care waste:Exposure of health-care waste can result in

disease or injury due to one or more of the following factors:

1. It contain infectious agent,2. It contain toxic or chemical hazards,3. It contain sharps,4. It is radioactive.

All individual who exposed to such hazards material are potentially at risks, including who generate the waste or who handle the waste:

The main groups who exposed:1. Dr. and nurse, hospital maintenance personnel,2. Pts. in health-care establishment,3. Workers who facilities waste disposal4. Visitors.

Treatment and disposal technology for wastes. A. Incineration, method of choice for most hazardous waste.But, recently alternative method becoming popular.Incineration: is a high temp.(1000oC)dry oxidation process,

that reduces organic and combustible waste to inorganic incombustible matter results in significant reduction of waste vol. and wt(85-95). This process of burning is usually select to treat waste that can not be recycled, reused.

Incineration require no pre-treatment.

Waste types not to be Incinerated:1. Pressurized gas containers,2. Large amount of reactive chemical wastes,3. Photographic and radioactive wastes,4. Halogenated plastic such as PVC,5. Waste with high Hg or cadmium content such

as broken thermometer, used batteries, etc,6. Sealed ampules or ampules with heavy metals.

B. Chemical Disinfection(CD)Chemical are added to waste to kill or inactivate pathogens, its contains, disinfection rather than sterilization. CD suitable liquid for wastes, e.g. Blood , urine, stool, etc.

C. Microwave irradiation: Water contained within waste is rapidly heated by microwaves and infectious components are destroyed by heat conduction.

D. Land Disposal Municipal disposal sites: Two type –open and

sanitary land fills. Health care waste should not be deposited on and around open dumps. Sanitary land fill is the choice because 1. geographic isolation of waste, 2. Appropriate engineering preparation, 3. Staff present on the site to control operation and 4. organized deposit and daily coverage.

E. Wet and dry thermal treatment: Wet technology: Infectious to high temp. and high pressure

stream. Screw feed technology: Non-burn, dry thermal disinfection process

in which waste is reduced by 80% in vol. and by 20-25% in wt. F. Inertization: Mixing waste with cement and other substance before disposal in

order to minimize risk of toxic substances in waste to migrate in surface or ground water.. Proportion of mixing: 65% cement, 15% lime and 5% water.

Categories waste: as per these rule, there are 10 categories of biomedical waste:

Option Waste categoryCat.-1 Human anatomical waste.Cat.-2 Animal waste-animal tissues, etc. including waste generated in vet. Hosp. college, discharge from animal house.Cat.-3 Microbiology and biotechnology waste.Cat-4 Waste sharps(used and unused-needle,

Cat.-5 Discarded medicine and cytotoxic drugsCat.-6 Soiled waste-contaminated with blood and body fluid-swab, dressing, plasters, etc.Cat-7 Solid waste-catheters, IV set, bl.bag etc.Cat-8 Liquid waste-waste generated from lab.Cat-9 Incineration ash.Cat-10 Chemicals Waste wastes of disinfectants insecticides, etc.

Biomedical waste management in India: The bio-medical waste should be segregated in

to bags/container at the point of generation of waste. The colour coding and type of containers use for disposal waste is fixed.

Colour coding Type of container Treatment

Yellow Plastic bag Incineration /deep burialRed Disinfected container Autoclaving/Micro /Plastic bag /chemical

Blue/White Plastic bag/ As above/destruction

Puncture proof container

Black Plastic bag Disposal in secured land fill

Strategy Adopted For Hospital waste Management1. Waste reduction strategy.2. Waste assessment strategy.3. Waste recycling strategy.4. Hospital waste disposal.

Waste reduction strategy:Objectives Reducing Waste quantity by a significant %.Decreasing waste disposal efforts and expence.Recycling all paper and cardboard wasteEnhance hospital’s reputation in community

Waste assessment strategy:Waste assessment indicates type and amount of

waste generated in the hospital.

Hospital Waste Disposal This is the critical part total hospital waste

management, because any failure in this aspect hazards consequence GOI has prescribed certain procedure and guidelines as follow:

1. Collection of wastes 2. Source segregation 3. Transportation 4. Storage 5. Treatment

Thus waste ,management is a comprehensive term, comprising collection, segregation, transportation, storage, treatment and ultimate safe disposal of waste.

Dos and DONTs of Health Care Waste.DOsi. Segregate all waste at the point where they

generateii. Have at least 4 types of container in each area of

genOne to collect kitchen garbageSecond to collect infected wasteThird to collect all type of waste sharpForth waste paper, wrapper, etc. iii. Do designate a separate place to keep mop, etc.

iv. Ensure 5-6 lat./50-60pts. indoor, 1lat. at OPD.v. Do ensure adequate availability of H2O for lat.

DON’TsDo not consider any type of health waste in a causal mannerDo not through any type of health care waste into street binsDo not encourage reuse of the disposablesDo not attempt to recycle and/or dispose without ensuring

adequate decontaminationDo not be ignorant of the legislative provisions regarding

waste management especially health care waste. Do not incinerate all kinds of waste.