Bio-Medical Waste Management

BIO- MEDICAL WASTE MANAGEMENT

                   

                                            ABSTRACT

Biomedical waste is any kind of waste containing infectious (or potentially

infectious) materials. It may also include waste associated with the generation of biomedical waste that visually appears to be of medical or laboratory origin (e.g., packaging, unused bandages, infusion kits, etc.), as well research laboratory waste containing bio molecules or organisms that are restricted from environmental release. As detailed below , discarded sharps are considered biomedical waste whether they are contaminated or not, due to the possibility of being contaminated with blood and their propensity to cause injury when not properly contained and disposed of. Biomedical waste is a type of bio waste.

                                   

Biomedical waste may be solid or liquid. Examples of infectious waste include discarded blood, sharps, unwanted microbiological cultures and stocks, identifiable body parts (including those as a result of amputation), other human or animal tissue, used bandages and dressings, discarded gloves, other medical supplies that may have been in contact with blood and body fluids, and laboratory waste that exhibits the characteristics described above. Waste sharps include potentially contaminated used (and unused discarded) needles, scalpels, lancets and other devices capable of penetrating skin.

INTRODUCTION

Biomedical waste management has recently emerged as an issue of major concern not only to hospitals, nursing home authorities but also to the environmental and law enforcement agencies, media and the general public. Biomedical waste is forming approximately 1 to 2 percent of the total municipal solid waste stream. Some of these wastes are potential threat to the human health and environment. Composition and quantity of biomedical wastes generated differ not only from country to country but also within the country. Health care facilities viz. laboratories, clinics, nursing homes, medical, dental, and veterinary hospitals, generate a waste stream varied in its composition. Among these facilities the hospitals contribute maximum wastes. The greatest risk of biomedical waste is from the infectious and sharp components of the waste because health care workers (HCW) and people associated with handling waste are often getting needle prick injuries and can contract HIV or  AIDS, Hepatitis B and C. Risks in hospitals or health care settings are very high. Because of these concerns about biomedical waste generated at national and international level, the Union Ministry of Environment and Forest, Government of India has notified ‘Biomedical Waste (Management and Handling) Rules,1998’  under the provision of Environment (Protection)  Act, 1986. However, it has been observed that biomedical waste management is a complex and one has to go further in the intricacy of management and attitude of the health workers.

DEFINITION

According to Biomedical Waste (Management and Handling) Rules, 1998 of India “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 bio logical. The Government of India (notification, 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities. This involves management of range of activities, which are mainly engineering functions, such as collection, transportation, operation or treatment of processing systems, and disposal of wastes. One of India’s major achievements has been to change the attitudes of the operators of health care facilities to incorporate good HCW management practices in their daily operations and to purchase on-site waste management services from the private sector. World Health Organization states that 85% of hospital wastes are actually non-hazardous, whereas 10% are infectious and 5% are non-infectious but they are included in hazardous wastes. About 15% to 35% of Hospital waste is regulated as infectious waste. This range is dependent on the total amount of waste generated

Classification of Bio Medical Waste

The World Health Organization (WHO) has classified medical waste into eight categories: 

·         General Waste 

·          Pathological 

·          Radioactive 

·         Chemical 

·          Infectious to potentially infectious waste 

·          Sharps 

·         Pharmaceuticals

·          Pressurized containers

Effect of Hazardous sites

Bio hazardous waste, also known as infectious or biomedical waste, is any waste that contains infectious materials or potentially infectious substances such as blood. Of particular concern are sharps such as scalpel blades, needles, glass pipettes, or any other waste material that may cause an injury during handling.

Bio hazardous waste must be handled according to strict federal, state and local regulations. Mishandled biohazard waste poses a threat not only to healthcare professionals, patients, and local community members , it also poses a significant threat to the environment.

Wildlife and Pharmaceuticals - Biohazard waste that is not disposed of properly can end up in lakes, parks, and other wildlife refuges where birds and fauna live. Wildlife are very curious about pharmaceuticals. It is thought they are attracted to the scent or color of pills and liquid medicine. This curiosity results in digestion of medication, which can injure or even kill the animal.

Groundwater Contamination - Much thought and effort has been taken to ensure landfills are built to protect the earth around them. Most are built with a special lining so nearby soil and groundwater cannot

The  historical  Srinagar  city  is  the  summer capital of  Jammu  And  Kashmir  State, surrounded  by  hills  on  east  and  north  eastern side longitude.  Altitude  of  Srinagar  varies  from  1580 m in  the  low  lying  vicinity  of  River  Jhelum  and 1620m  on  the  eastern  hill  slopes  with  an  average elevation  of  about  1586m  above  mean  sea  level (Bates,  2005).  The  city  lies  on  both  side  of  river Jhelum,  which  swirls  through  the  heart  of  the Srinagar  city. For the present  study  two hospitals were selected which  have  different  characteristics  in  terms  of their  size,  treatment  technology  and  the  type  of patients catered.  The  two study  stations  were: Sheri  Kashmir  Institute  of  Medical  Sciences (SKIMS), Soura It  is  a  tertiary  care  hospital,  catering  to  the average  socio-economic  class  of  people  and provides  a total  of  600 beds. Shri  Maharaja  Hari  Singh  Hospital  (SMHS), Karan Nagar It is a teaching  hospital  associated  to Government  Medical  College,  Srinagar  and  is the  biggest  general  hospital  in  terms  of  bed capacity.

become contaminated. Mishandled biohazard waste can compromise even the best landfill design. Syringes and other sharp objects can easily rip the lining. As rain falls, contaminants in the landfill can seep out to the exterior soil, and the groundwater become toxic.

Radioactive Pollution - In order to accurately diagnose patients, doctors must sometimes use radioactive tools. When disposed of improperly, radioactivity can enter landfills and other areas. These substances emit particles that are dangerous to people. Excessive exposure to radioactivity can result in serious diseases.

Airborne Pollutants - Certain medical waste can be destroyed by incineration. But, if not ignited properly, pollutants can move through the air. Airborne pollutants can be worse than land-based types because they can spread far and wide and quickly.

Biohazard waste poses serious risks and must be handled and disposed of properly.

Everyone working in the healthcare industry has a responsibility to handle these materials correctly and speak up if they see others ignoring safety measure and regulations.

 How to manage biomedical waste

Ø  Use only disposable syringes etc 

Ø   Bandages, cotton and other blood stained materials should not be thrown with general garbage.

Ø    Use black plastic bags to dispose biomedical wastes.

Ø   Keep trash out of reach of small children and infants.

Ø   Diapers, Sanitary napkins etc.

                                                                    

STUDY AREA

Biomedical waste management is receiving greater attention due to recent regulations of the Biomedical Wastes (Management & Handling Rules, 1998). Inadequate management of biomedical waste can be associated with risks to healthcare workers, patients, communities and their environment. The present study was conducted to assess the quantities and proportions of different constituents of wastes, their handling, treatment and disposal methods in different health-care settings. Various health care units were surveyed using a modified survey questionnaire for waste management. This questionnaire was obtained from the World Health Organization (WHO), with the aim of assessing he processing systems for biomedical waste disposal. Hazards associated with poor biomedical waste management and shortcomings in the existing system were identified. The development of waste management policies, plans, and protocols are recommended, in addition to establishing training programs on proper waste management for all healthcare workers.

 Surveys carried out by various agencies show that health care establishments in India are not giving due attention to their waste management. The need for treating BMW was not taken up as a serious issue till the late 90’s. However, the initiatives taken up led to the formulation of the ‘Bio-medical Waste – Handling and Management Rules – 1998’ which was amended in 2000 by the MEF and taken forward by the Central Pollution Control Board. After the notification of the Bio-medical Waste (Handling and Management) Rules, 1998, these establishments are gradually streamlining the process of waste segregation, collection, treatment, and disposal. Many of the larger non hospitals have either installed the treatment facilities or in the process of doing so while entrepreneurs have set up centralized waste treatment facilities.

Primary Data Source:

Status of biomedical waste in Uttar Pradesh

Balrampur Hospital:

To address the biomedical waste problem the ‘Biomedical Waste Management Rules, 2000’ have recently been adopted in the State of Uttar Pradesh. Regulators and regulated are both in the process of evolving strategies and action plans to implement this regulation and to address the fact that cur-rently there are no incinerators in Uttar Pradesh for treating biomedical waste. Given the early stage of public attention to this issue, the information base currently available with the Government Department of Health or the Uttar Pradesh Pollution Control Board (UPPCB) do not throw much light on the nature and extent of the problem.

Based on the number of hospital beds, Table 1 gives an estimate of the quantities of waste generated in each district. The total quantity of biomedical waste for Uttar Pradesh is estimated as 20.76 tonnes per day. As UPPCB is in the proc-ess of generating an inventory of all categories of biomedical

	Hospitals	Generation of	Hospitals with	Generation of	Hospitals	Generation of	Hospitals	Generation of
		infectious		infectious	with > 50	infectious		infectious
Area	with > 500		> 200 and				with < 50
		waste per day		waste per day	and < 199	waste per day		waste per day
	beds		< 499 beds				beds
		(kg)		(kg)	beds	(kg)		(kg)
Ghaziabad	1	125	1	87.5	11	344	34	2125
Noida	0	0	1	87.5	14	437.5	5	31
Kanpur	1	125	7	612.5	18	562.5	136	850
Jhansi	1	125	1	87.5	9	281	3	19
Allahabad	1	125	4	350	14	437.5	175	1094
Meerut	2	250	2	175	11	344	193	1206
Agra	2	250	1	87.5	16	500	47	294
Aligarh	2	250	4	350	2	62.5	58	362.5
Mathura	0	0	1	87..5	7	219	37	231
Lucknow	5	625	6	525	13	406	246	1537.5
Bareilly	0	0	4	350	37	1156	174	1087.5
Gorakhpur	1	125	2	175	2	62.5	54	337.5
Faridabad	0	0	1	87.5	6	187.5	32	200
Raibarelly	0	0	2	175	4	125	57	356
Varanasi	1	125	1	87.5	6	187.5	28	175
Muradabad	0	0	2	175	5	156	109	681
Total	17	2125	40	3412.5	175	5468.5	1388	10587
Average per		125		85		31.0		8.0
hospital
Assumptions:

average number of beds for hospitals with < 50 beds is 25.

average number of beds for hospitals with 50 to 199 beds is 125.

average number of beds for hospitals with 200 to 499 is 350.

average number of beds for hospitals with >500 beds is 500.

average waste generation factor is 250/bed per day for infectious biomedical waste (CPCB 2000).

Status of hospital’s compliance to biomedical rules in Uttar Pradesh

Bed capacity	Number of	Hospitals having own or common	Hospital having approval for disposal
	hospitals	incinerating facility	of biomedical wastes
500 or more than 500 bed capacity	17	8	3
More than 200 but less than 500 bed capacity	38	13	3
Less than 50 and less than 200 bed capacity	180	33	2
Less than 50 bed capacity	1389	290	4
Total	1624	344	12

Allergy	Dental and oral health	Homeopathy	Orthopaedics	Radiology
Anti rabies	Emergency	Leprosy	Ophthalmology	Urology
Andrology	Ear, nose & throat	Neurosurgery	Paediatrics	Ultrasonography
Blood bank	General medicine	Nephrology	Pathology-with the computerized	Video endoscope
Burn and plastic surgery	General surgery	Neurology	autoanalyser	Vaccination
Cardiology			Physiotherapy	X-ray
Chest and isolation			Psychiatric

: Characteristics of biomedical waste generated at Balrampur Hospital.

Waste type	Components	Moisture content (%)	Heat value (kcal/kg)
Anatomical	Human tissue	70–90	50–800
Kitchen	Food, peelings	70	1400
Clinical	Bandages, gauze	0–30	3600–4500
Paper	Packings, boxes	0–10	4700
Cotton	Personal effects	0–10	4700
Plastics	PET, LDPE, HDPE items	0–1	9000–11000

MEDICAL WASTE MANAGEMENT IN THE BALRAMPUR HOSPITAL

The present study noted that there is no proper system for the collection and disposal of biomedical waste in the Bal-rampur Hospital. The collection of infectious and non-infec-tious wastes is done by a team of two waste collectors; one pulls the hand-driven trolley and the other collects mixed waste from each ward. The waste is piled in a corner of the hospital and often burned inside the premises or otherwise it ends up in the municipal waste that is collected or dumped in

nearby areas. The hospital administration spends 76 000 rupees (approximately US$ 1700) per year for the waste manage-ment in the hospital.

In general the health conditions of rag pickers are very poor. They also face problems with scavenging animals and dogs in addition to being socially ostracized. The recycling of con-taminated materials further spreads the contamination through several resource chains in various commercial and domestic activities in the city, increasing the risk of disease and con-tamination. The burning of waste releases toxic fumes into the atmosphere and causes smoke nuisance (Figure 3).

ROOM-WISE GENERATION OF HOSPITAL WASTE

Biomedical wastes are generated in various departments, wards and laboratories of the hospital. The surgical ward, emergency facility, out-patient department, out-patient department for women and orthopedic department all generate major quan-tities of solid waste. Hence, the quantities of different catego-ries of waste have to be estimated by discussions, interviews and by physical checks. An estimated quantity of 50–70 kg/day is generated from these places. The details are given in the Table 6.

Table 6 shows that the highest value of 15–20 kg/day of biomedical waste is generated from ward no. 7 (out-patient department for women) followed by surgical ward, plaster room, emergency out-patient department, ward no. 2 (dress-ing room), pathology laboratory, orthopaedic department and ward no. 3 (accidental dressing). The average quantity of waste generation in the hospital is 0.5 kg/bed per day. Thus, the total waste generation for Balrampur Hospital with a capacity of 656 beds is 328 kg/day.

Waste generated per day.

Name of ward	Quantity of waste (kg/day)
Ward no. 7 (out-patient department for women)	15–20
Surgical ward	10–15
Plaster room	8–10
Emergency out-patient department	5–10
Ward no. 2 (dressing room)	5
Pathology laboratory	3–5
Orthopaedic department	2–3
Ward no. 3 (accident dressing)	2
Total	50–70

EXISTING WASTE DISPOSAL PRACTICES IN BALRAMPUR HOSPITAL

The Balrampur Hospital does not practice segregation of infectious and non-infectious waste. There is no mechanism for waste segregation. The waste from wards, which include used cotton, dressing materials, blood, bottles, PVC drip sets, needles, syringes and their covers, are thrown on the floor by the doctors, nurses and attendants alike. These wastes are

spread all around, swept to a remote corner or under the stairs. There are huge waste piles in Balrampur Hospital, usually located on the roadside. These waste piles are frequented by rag packers, who collect the recyclable items such as plastics and polythene. The waste piles are constantly visited by nat-ural scavengers (e.g. cows, dogs, pigs, micro-organisms, mice, rats). The garbage is usually thrown in the open and loaded on to the trucks of the municipal corporation.

DISPOSAL OF HUMAN PARTS AND ORGANS FROM THE HOSPITAL

Amputated human parts such as limbs, organs surgically removed or residual pieces of intestines and bowel are either packed in bags or PVC jars, preserved in formaldehyde and transported to pathology labs for further studies. When these organs are not useful and are not considered for pathological studies, they are thrown in the waste pile or disposed of in the municipal garbage.

DISPOSALS FROM PATHOLOGY, MICROBIOLOGY, ANATOMY, BIOCHEMISTRY AND PHARMACOLOGY DEPARTMENTS

Office wastes and other general garbage are mostly collected in bins and disposed of in garbage pits or burned in the open. The remnants of human organs preserved in formaldehyde for pathological examination are subsequently buried in the backyard of the department at least 3 feet under the ground. Unused blood specimens, sera, full bottles of expired blood after intermittently practiced chemical disinfection are washed down the drains and are mixed with the sewage. Glass culture plates, pipettes, enzyme-linked immunosorbent assay plates and other contaminated bacteriological and virological material are either chemically disinfected or auto-claved. The glass items are washed and reused.

METHODOLOGY

This study investigated medical waste practices used by hospitals in Oregon, Washington, and Idaho, which includes the majority of hospitals in the U.S. Environmental Protection Agency's (EPA) Region 10. During the fall of 1993, 225 hospitals were surveyed with a response rate of 72.5%. The results reported here focus on infectious waste segregation practices, medical waste treatment and disposal practices, and the operating status of hospital incinerators in these three states. Hospitals were provided a definition of medical waste in the survey, but were queried about how they define infectious waste. The results implied that there was no consensus about which agency or organization's definition of infectious waste should be used in their waste management programs. Confusion around the definition of infectious waste may also have contributed to the finding that almost half of the hospitals are not segregating infectious waste from other medical waste. The most frequently used practice of treating and disposing of medical waste was the use of private haulers that transport medical waste to treatment facilities (61.5%). The next most frequently reported techniques were pouring into municipal sewage (46.6%), depositing in landfills (41.6%), and autoclaving (32.3%). Other methods adopted by hospitals included Electro-Thermal-Deactivation (ETD), hydropulping, microwaving, and grinding before pouring into the municipal sewer. Hospitals were asked to identify all methods they used in the treatment and disposal of medical waste. Percentages, therefore, add up to greater than 100% because the majority chose more than one method. Hospitals in Oregon and Washington used microwaving and ETD methods to treat medical waste, while those in Idaho did not. No hospitals in any of the states reported using irradiation as a treatment technique. Most hospitals in Oregon and Washington no longer operate their incinerators due to more stringent regulations regarding air pollution emissions. Hospitals in Idaho, however, were still operating incinerators in the absence of state regulations specific to these types of facilities.

                                            

Medical wastes are highly hazardous and put people under risk of fatal diseases. The understanding of medical waste management and control techniques is important. In this paper, introductory materials on the definition of medical waste, medical waste management regulatory acts, the risks of exposure, medical waste management procedures and control techniques are presented.

RESUILT AND DISCUSSION

The  important  inferences  regarding  the  various components  of  the  waste  management  hierarchy like  segregation,  packaging,  storage,  collection, transportation  and  disposal  were  drawn  and  then the  framework  of  compliance  was  assessed. Barring  SKIMS,  the  waste  was  not  segregated  at source  as  prescribed  in  the  Biomedical  Waste Management  Rules,  1998  Due  to  poor segregation  practices,  the  general  waste  gets mixed  up  with  the  infectious  waste.  Hospitals were  using  uncovered  plastic  bins  for  waste collection  provided  with  same  kind  of  color coded  labelled  polybags.  Polybags  were  not sealed properly  and its integrity  was  found not  to be  preserved.  In  SMHS  hospital,  waste  sharps were  contained  without  being  subjected  to disinfection  in  open  trays  or  in  any  of  the  bins. While  in  SKIMS,  sharps  were  disinfected properly  and  finally  incinerated. Waste  storage  area  at  SKIMS  was  of  a  size appropriate  to  the  quantities  of  waste  produced but  did  not  have  secured  bins  to  eliminate  the possibility  of  access  to  the  waste  by  rodents, flies,  or  other  natural  scavengers.  The  waste  was placed  in  an  open  area  before  disposal  at  SMHS hospital,  so  it  was  easily  accessible  to unauthorized  personnel  and  animals.  The transportation  of  waste  to  the  storage  site  was done  manually  in  SMHS  hospital,  while  in SKIMS trolleys and pipeline system  (Chute)  was employed. Biomedical  waste  was  autoclaved  and incinerated  (Type  Brick  Kiln;  capacity  125 kg/hr)  onsite,  at  SKIMS.  Ash  so  obtained  was buried  in  onsite  ash  pits,  neither  lined  from below  nor  sealed  above.  Liquid  waste  was treated  in  the  treatment  plant  and  flushed  into the  sewers  .  SMHS  hospital  treats  its biomedical  waste  at  Common  Biomedical  Waste Treatment Facility (CBWTF),  Lassipora Pulwama,  Kashmir,  while  the  liquid  waste  was flushed directly  into the River  Jhelum.

 CONCLUSION

Health-care services in rural or urban settings inevitably generate wastes that may be hazardous to health or have harmful environmental effects. Some of them, such as sharps, cultures from medical laboratories or infected blood, carry a higher potential for infection and injury than any other type of wastes. The absence of or improper management measures to prevent exposure to hazardous health-care waste (HCW) results in important health risks to the general public, in- and outpatients as well as the medical and ancillary staff. Furthermore, improper treatment or disposal of HCW, such as open-air burning, can constitute a significant source of pollution to the environment through the release of substances such as dioxins, furans or mercury. (153) Safe management of HCW is a key issue to control and reduce nosocomial infections inside a hospital and to ensure that the environment outside is well protected. The current practices encountered in most of the Sub-Saharan countries of Africa do not comply with the international requirements to guaranty a safe and environmentally sound management of HCW: the full spectrum of health-care waste management (HCWM) practices are found in the health-care facilities (HCFs), from the most hazardous ones where no segregation system is applied and the waste is simply dumped in the backyard to safer procedures where the waste is segregated and the part considered as hazardous is incinerated separately. To significantly improve the current situation, the Governments of most of the Sub-Saharan countries of Africa must develop a medium and long-term national strategy that should become an integral feature of the HCFs. This strategy should reflect the integrated effort that is necessary to set-up safe and environmentally sound HCWM practices. In particular, a special attention should be paid to the following points: ƒ At each administrative level, clear institutional and individual responsibilities should be established. Moreover, specific monitoringand administrative procedures should be set-up and adequate resources allocated to ensure a proper management of the HCW; Adequate awareness and training program for health officers and planners, hospital administrators, medical staff and environmental health officers should be developed; Appropriate, environmental-friendly and affordable technologies should be selected for the treatment and the disposal of HCW, taking into consideration both technical and financial resources available in the country. (154) In many Sub-Saharan countries, the lack of resources in the health sector tends to affect negatively the way HCW is managed. Furthermore, for a given country, the situation can differ significantly from one region to the other depending on the resources (financial, human and material) locally available. Under these adverse circumstances, planning remains a key issue. It requires the definition of a strategy that takes into account the given constraints and opportunities, appropriate allocation of resources, clear formulation of objectives, practical indicators of achievement and a well structured timeframe.

Medical wastes should be classified according to their source, typology and risk factors associated with their handling, storage and ultimate disposal. The segregation of waste at source is the key step and reduction, reuse and recycling should be considered in proper perspectives. We need to consider 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.

 Hope you find this article helpful. Do share your views and comments.

Thanks a ton!!