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  • 1. ESS Extended Essay Topic: Bio-medical waste management Research question:To compare the bio-medical waste management practices at private hospital to that of government hospital in a metropolitan city in India.
  • 2. Abstract Hospital is a place of almighty, a place to serve the patient. Since beginning, the hospitals areknown for the treatment of sick persons but many are unaware about the adverse effects of the garbageand filth generated by them on human body and environment. Now it is a well-established fact that thereare many adverse and harmful effects to the environment including human beings which are caused bythe "Hospital waste" generated during the patient care. Hospital waste is a potential health hazard to thehealth care workers, public and flora and fauna of the area. Hospital acquired infection, transfusiontransmitted diseases, rising incidence of Hepatitis B, HIV and H1N1 flue, increasing land and waterpollution all these and other factors lead to increasing possibility of catching many diseases. Airpollution due to emission of hazardous gases by incinerator such as Furan, Dioxin and Hydrochloricacid etc. have compelled the authorities to think seriously about hospital waste and the diseasestransmitted through improper disposal of hospital waste. This problem has now become a serious threatfor the public health, ultimately WHO and the Central Government had to intervene for enforcing properhandling and disposal of hospital waste. Hospital waste is a very broad category to be studied and analysed in this short period of timealong with the word restrictions posed by the IBO for the extended essay. Hence I have taken a smallportion of this broad topic i.e. Bio-Medical waste. Bio-Medical waste is basically that component ofhospital waste that is hazards to the environment which also does include humans. In hospital it usuallycomprises of 15% of total hospital waste. There for my research question is ‘to compare the Bio-Medical waste management practices at private hospital to that of government hospital in ametropolitan city in India’. Word Count: 298
  • 3. Table of contents1. Abstract2. Research Question3. Aim4. Hypothesis5. Variables6. Introduction: a. What is Bio-Medical waste? b. Rationale of hospital waste management7. Steps for Bio-Medical waste management a. Segregation of waste b. Collection of Bio-Medical waste c. Transportation d. Treatment of bio-medical waste8. Why is treatment of Bio-Medical waste necessary?9. Safety measures10. Measures for waste minimization11. W.H.O Waste Management Regulations12. Indian Bio-Medical Waste Rules 199813. Data Collection and Processing a. P. D. Hinduja National Hospital and Medical Research Centre
  • 4. b. L.T.M.G. Sion Hospital14. Comparative Study: Hinduja Hospital vs. Sion Hospitals (Dept. Wise)15. General Discussion and Further Analysis16. Limitations and Evaluation17. Conclusion18. Bibliography19. Appendix 1: Hospital waste and Its Classification20. Appendix 2: Questionnaire21. Addendum 1
  • 5. Research QuestionTo compare the Bio-Medical waste management practices at private hospital to that of government hospital in ametropolitan city in India. AimTo compare the bio- medical waste management practices at Hinduja hospital (private ownership) to that ofL.T.M.G. Sion Hospital (governmental ownership). Hypothesis Null Hypothesis: there is no comparable difference in the waste management practices followed by both the hospitals. Alternative Hypothesis: there is distinctive comparable difference in the bio-medical waste management practices followed by both the hospitals. There may be comparable difference in the bio-medical waste management practices followed by both hospitals. Wherein private hospitals waste management practices should be closer to the norms and government hospitals 0waste management practices would probably lag behind the standard norms. Variables Independent Variables: management of hospitals (private or government) Dependent Variables: the method used for segregation and disposing bio-medical waste Controlled Variables: location of the hospitals (including country and city); morbidity pattern of the city 2
  • 6. IntroductionWhat is biomedical waste?Any solid, fluid and liquid or liquid waste, including its container and any intermediate product, which is generatedduring the diagnosis, treatment or immunisation of human being or animals, in research pertaining thereto, or in theproduction or testing of biological and the animal waste from slaughter houses or any other similar establishment.All biomedical waste is hazardous. In hospital it comprises of 15% of total hospital waste. For more information onhospital waste and its classification refer Appendix 1.Rationale of hospital waste management:Hospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15% of hospitalwaste i.e. "Bio-medical waste" is hazardous, not the complete. But when hazardous waste is not segregated at thesource of generation and mixed with non-hazardous waste, then 100% waste becomes hazardous. The question thenarises that what is the need or rationale for spending so many resources in terms of money, man power, material andmachine for management of bio-medical waste? The reasons are: Injuries from sharps leading to infection to all categories of hospital personnel and waste handler. Nosocomial infections in patients from poor infection control practices and poor waste management. Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals. Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels. "Disposable" being repacked and sold by unscrupulous elements without even being washed. Drugs which have been disposed of being repacked and sold off to unsuspecting buyers. Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash. Steps for Bio-Medical waste management 3
  • 7. 1. Segregation of wasteSegregation is the essence of waste management and should be done at the source of generation of Bio-medicalwaste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labour rooms, treatment roomsetc. The responsibility of segregation should be with the generator of biomedical waste i.e. doctors, nurses,technicians etc. (medical and paramedical personnel). The biomedical waste should be segregated as per categoriesmentioned in the rules.2. Collection of bio-medical wasteCollection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. Atordinary room temperature the collected waste should not be stored for more than 24 hours.Type of container and colour code for collection of bio-medical waste Category Waste class Type of container Colour 1. Human anatomical waste Plastic Yellow 2. Animal waste -do- -do- 3. Microbiology and Biotechnology -do- Yellow/Red waste 4. Waste sharp Plastic bag puncture proof Blue/White Translucent containers 5. Discarded medicines and Cytotoxic Plastic bags Black waste 6. Solid (biomedical waste) -do- Yellow 7. Solid (plastic) Plastic bag puncture proof Blue/White Translucent containers 8. Incineration waste Plastic bag Black 4
  • 8. 9. Chemical waste (solid) -do- -do-3. TransportationWithin hospital, waste routes must be designated to avoid the passage of waste through patient care areas. Separatetime should be earmarked for transportation of bio-medical waste to reduce chances of its mixing with generalwaste. Desiccated wheeled containers, trolleys or carts should be used to transport the waste/plastic bags to the siteof storage/ treatment.Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage. The wheeled containersshould be so designed that the waste can be easily loaded, remains secured during transportation, do not have anysharp edges and is easy to clean and disinfect. Hazardous biomedical waste needing transport to a long distanceshould be kept in containers and should have proper labels. The transport is done through desiccated vehiclesspecially constructed for the purpose having fully enclosed body, lined internally with stainless steel or aluminiumto provide smooth and impervious surface which can be cleaned. The driver’s compartment should be separatedfrom the load compartment with a bulkhead. The load compartment should be provided with roof vents forventilation.5. Treatment of bio-medical waste:  Deep burial: The waste under category 1 and 2 only can be accorded deep burial and only in cities having less than 5 lakh populations.  Autoclave and microwave treatment Standards for the autoclaving and microwaving are also mentioned in the Biomedical waste (Management and Handling) Rules 1998. All equipment installed/shared should meet these specifications. The waste under category 3,4,6,7 can be treated by these techniques. Standards for the autoclaving are also laid down. 5
  • 9.  Shredding: The plastic (IV bottles, IV sets, syringes, catheters etc.), sharps (needles, blades, glass etc) should be shredded but only after chemical treatment/microwaving/autoclaving. Needle destroyers can be used for disposal of needles directly without chemical treatment.  Secured landfill: The incinerator ash, discarded medicines, cytotoxic substances and solid chemical waste should be treated by this option.  Incineration: The incinerator should be installed and made operational as per specification under the Indian Bio Medical Waste Rules 1998 (BMW) and a certificate may be taken from State Pollution Control Board and emission levels etc. should be defined. In case of small hospitals, facilities can be shared. The waste under category 1, 2, 3, 5, 6 of Indian Bio Medical Waste Rules 1998 can be incinerated depending upon the local policies of the hospital and feasibility. The polythene bags made of chlorinated plastics should not be incinerated.  Other Options: It may be noted that there are options available for disposal of certain category of waste under the Indian Bio Medical Waste Rules 1998. The individual hospital can choose the best option depending upon the facilities available and its financial resources. However, depending upon the option chosen correct colour of the bag needs to be used. Why is treatment of Bio-Medical waste necessary?Treatment of waste is required:  To disinfect the waste so that it is no longer the source of infection.  To reduce the volume of the waste.  Make waste unrecognizable for aesthetic reasons.  Make recycled items unusable. 6
  • 10. Safety measuresAll the generators of bio--medical waste should adopt universal precautions and appropriate safety measures whiledoing therapeutic and diagnostic activities and also while handling the bio-medical waste.It should be ensured by the hospital and the government that:  Drivers, collectors and other handlers are aware of the nature and risk of the waste.  Written instructions, provided regarding the procedures to be adopted in the event of spillage/ accidents.  Protective gears provided and instructions regarding their use are given.  Workers are protected by vaccination against tetanus and hepatitis B. Measures for waste minimizationAs far as possible, purchase of reusable items made of glass and metal should be encouraged. Select non PVCplastic items. Adopt procedures and policies for proper management of waste generated, the mainstay of which issegregation to reduce the quantity of waste to be treated. Establish effective and sound recycling policy for plasticrecycling and get in touch with authorised manufactures. W.H.O WASTE MANAGEMENT REGULATIONSBio-Medical waste definition according to W.H.O:Bio-medical waste includes all the waste generated by health-care establishments, research facilities, andlaboratories. In addition, it includes the waste originating from ‘minor’ or ‘scattered’ sources such as that producedin the course of health care undertaken in the home (dialysis, insulin injections, etc.)W.H.O Classification: 7
  • 11. As per W.H.O the biomedical wastes could be classified into eight categories on the basis of the type of waste andthe risk of transmission of infectious material in them. The classifications are as follows:1. General waste (domestic)2. Pathological3. Radioactive4. Chemical5.Infectious6. Pharmaceutical wastes7. Sharps8. Pressurised containers INDIAN BIO-MEDICAL WASTE RULES 1998Based on Indian Bio-medical Waste (Management and Handling) Rules 1998, notified under the EnvironmentProtection Act by the Ministry of Environment and Forest (Government of India) bio-medical waste has to besegregated according to the following 10 categories:Option Waste Category Treatment & DisposalCategory No. 1 Human Anatomical Waste incineration /deep burial (human tissues, organs, body parts) 8
  • 12. Category No. 2 Animal Waste incineration/deep burial (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)Category No. 3 Microbiology & Biotechnology Waste local autoclaving/micro- (Wastes from laboratory cultures, stocks or micro- waving/incineration organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biological, toxins, dishes and devices used for transfer of cultures)Category No. 4 Waste Sharps disinfection (chemical (needles, syringes, scalpels, blade, glass, etc. that treatment) /auto may cause puncture and cuts. This includes both claving/microwaving and used and unused sharps) mutilation/shreddingCategory No. 5 Discarded Medicines and Cytotoxic drugs incineration/destruction and (Waste comprising of outdated, contaminated and drugs disposal in secured discarded medicines) landfillsCategory No. 6 Soiled Waste incineration/autoclaving/mic (items contaminated with blood, and body fluids rowaving including cotton, dressings, soiled plaster casts, linen, bedding, other material contaminated with 9
  • 13. blood)Category No. 7 Solid Waste disinfection by chemical (Waste generated from disposal items other than treatment/autoclaving/micro the sharps such a tubing’s, catheters, intravenous waving and sets etc.) mutilation/shreddingCategory No. 8 Liquid Waste disinfection by chemical (Waste generated from laboratory and washing, treatment and discharge into cleaning, housekeeping and disinfecting activities) drainsCategory No. 9 Incineration Ash disposal in municipal landfill Ash from incineration of any bio-medical waste)Category No. 10 Chemical Waste chemical treatment and (Chemicals used in production of biological, discharge into drains for chemicals used in disinfection, as insecticides, etc.) liquids and secured landfill for solids Data Collection and ProcessingI had visited two different hospitals, in different localities and with different ownerships for my research work.Collecting information and data through cross-sectional study, observational study and interviews (Refer Appendix2 for a copy of the Questionnaire); pertaining to the waste generated by the hospital and its subsequent managementand disposal.The two hospitals visited were:1] P. D. Hinduja National Hospital and Medical Research Centre: private ownership 10
  • 14. 2] L.T.M.G. Sion Hospital: governmental ownership P. D. Hinduja National Hospital and Medical Research CentreAlso popularly known as Hinduja Hospital, is a private hospital located at Mahim in Mumbai, India. The hospitalwas established in 1951 by Parmanand Deepchand Hinduja. The hospital is a modern multi-speciality tertiary carehospital with a medical research centre set up in collaboration with Massachusetts General Hospital (MGH),Boston. The hospital has an inpatient capacity of 381 beds including of 53 critical care beds in different specialities.As a tertiary care hospital, it offers services covering investigations & diagnosis to therapy, surgery, and post-operative care. It is the first tertiary care hospital to have received ISO 9002 certification from KEMA, Netherlands,for Quality management systems, and was awarded the "Golden Peacock Global Award" for philanthropy inemerging economies (2006).P. D. Hinduja National Hospital has many departments and wards like: 1. Trauma center 2. Burn unit 3. Main OT 4. Urology dept. 5. Neurology dept. 6. ENT dept. 7. Minor OT 8. Emergency Dept. 9. Eye Dept. 10. Pediatric Dept. 11. Dermatology Dept. 12. Gynecology Dept. 13. Diagnostic Labs 11
  • 15. 14. Pharmacy 15. Etc...Note: Due to time constrain and for sake of comparison only some main target departments have been studied fordata.All the waste generated in the hospital is segregated, collected and disposed according to the categories of wastedefined by ‘INDIAN BIO-MEDICAL WASTE RULES 1998’. Hence the below mentioned data is in terms of thesecategoriesNOTE: the ‘INDIAN BIO-MEDICAL WASTE RULES 1998’ categories have been listed in tabular form earlier inthe report. Hence it is advisable to keep in mind the ‘waste categories’ while referring to the data given below. Hinduja Hospital: Data Collection Table 1Wards or Bio-Medical Waste Collected[kg/Bed/week] (03/09/11-09/09/11) Categor Categor Categor Categor Categor Categor Categor Category Categor Category Dept. y No.1 y No.2 y No.3 y No.4 y No.5 y No.6 y No.7 No.8 y No.9 No.10OPD area 0 - 0 0.08 0.01 0.08 0.04 0.08 - 0.01Causality 0.12 - 0.02 0.15 0.02 0.22 0.24 0.15 - 0.02 ICU’s 0.04 - 0.01 0.19 0.03 0.27 0.29 0.21 - 0.03 OT area 0.59 - 0.03 0.21 - 0.32 0.37 0.32 - 0.05Diagnosti 0 - 0.46 0.09 0.03 0.04 0.08 0.20 - 0.42 c LabsRadiology 0 - 0 0.02 0.02 0.02 0.03 0.18 - 0.08 Dept.Pharmacy 0 - 0 0.01 0.18 0.02 0.01 0.07 - 0.01 12
  • 16. Table 2Wards or Bio-Medical Waste Collected[kg/Bed/week] (10/09/11-16/09/11) Categor Categor Categor Categor Categor Category Categor Categor Categor Category Dept. y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 No.10OPD area 0 - 0 0.09 0.01 0.11 0.03 0.14 - 0.02Causality 0.14 - 0.03 0.23 0.03 0.28 0.42 0.23 - 0.03 ICU’s 0.08 - 0.02 0.31 0.03 0.35 0.51 0.36 - 0.05 OT area 1.21 - 0.07 0.58 0.02 1.32 0.78 0.73 - 0.09Diagnostic 0 - 0.96 0.16 0.08 0.09 0.17 0.38 - 0.93 LabsRadiology 0 - 0 0.08 0.04 0.08 0.05 0.24 - 0.07 Dept.Pharmacy 0 - 0 0.03 0.09 0.01 0.01 0.08 - 0.02 Table 3Wards or Bio-Medical Waste Collected[kg/Bed/week] (17/09/11-23/09/11) Categor Categor Categor Categor Categor Category Categor Categor Categor Categor Dept. y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10OPD area 0 - 0 0.08 0 0.14 0.04 0.18 - 0.03Causality 0.12 - 0.04 0.30 0.02 0.36 0.59 0.32 - 0.05 ICU’s 0.09 - 0.02 0.38 0.02 0.61 0.84 0.38 - 0.06 13
  • 17. OT area 1.29 - 0.09 0.62 0.03 1.38 1.03 0.93 - 0.12Diagnostic 0 - 1.03 0.22 0.06 0.08 0.21 0.42 - 0.99 LabsRadiology 0 - 0 0.09 0.03 0.08 0.08 0.29 - 0.07 Dept.Pharmacy 0 - 0 0.03 0.09 0 0 0.09 - 0.02 Table 4Wards or Bio-Medical Waste Collected[kg/Bed/week] (24/09/11-30/09/11) Categor Categor Categor Categor Categor Category Categor Categor Categor Categor Dept. y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10OPD area 0 - 0 0.06 0 0.08 0.02 0.07 - 0.01Causality 0.08 - 0.03 0.32 0.01 0.39 0.61 0.30 - 0.04 ICU’s 0.05 - 0.02 0.40 0.03 0.70 0.80 0.41 - 0.05 OT area 0.89 - 0.06 0.60 0.02 0.44 0.32 0.90 - 0.09Diagnostic 0 - 0.91 0.26 0.07 0.06 0.17 0.36 - 1.00 LabsRadiology 0 - 0 0.07 0.01 0.05 0.05 0.27 - 0.05 Dept.Pharmacy 0 - 0 0.05 0.08 0 0 0.07 - 0.01 Hinduja Hospital: Data Processing Table 5Wards or Total Bio-Medical Waste Collected[kg/bed/month] (03/09/11-30/09/11) 14
  • 18. Dept. Categor Categor Categor Categor Categor Categor Category Categor Categor Categor y No.1 y No.2 y No.3 y No.4 y No.5 y No.6 No.7 y No.8 y No.9 y No.10OPD area 0 - - 0.31 0.02 0.41 0.13 0.47 - 0.07Causality 0.46 - 0.12 1.00 0.08 1.25 1.86 1.00 - 0.14 ICU’s 0.26 - 0.07 1.28 0.11 1.93 1.96 1.36 - 0.19 OT area 3.98 - 0.25 2.01 0.07 1.69 2.52 2.88 - 0.35Diagnostic 0 - 3.36 0.60 0.59 0.27 0.63 1.15 - 3.34 LabsRadiology 0 - 0 0.26 0.10 0.23 0.21 0.77 - 0.27 Dept.Pharmacy 0 - 0 0.12 0.44 0.03 0.02 0.31 - 0.06 METHOD OF WASTE DISPOSAL ADOPTED BY HINDUJA HOSPITAL: Table 6 Colour Coding Waste Category Method of Disposal Adopted by Hospital Yellow Category 1,2,3 &6 Deep burial(through private [Human & Animal anatomical waste / agency)/Incineration [has in- house Micro-biology waste and soiled incinerator] cotton/dressings/linen/beddings etc.] Red Category 7 Autoclaving / Microwaving / [Tubing’s, Catheters, IV sets.] Chemical treatment Blue/White Category 4 Autoclaving / Microwaving / [Waste sharps like Chemical treatment & Destruction / Needles, Syringes, Scalpels, blades Shredding 15
  • 19. etc.]Black Category 5,8,9 &10 Disposal in secured landfill/ [Discarded medicines/cytotoxic drugs, Chemical treatment Incineration ash, Chemical waste.] Hinduja Hospital has its own Hospital Infection Control Team (HICT), which carries out surveillance/inspection of different areas of hospital.HICT comprises of: - 1. Medical Superintendent 2. Nursing Superintendent 3. H.O.D. Microbiology 4. Casualty Medical Officer (CMO) 5. Ward Medical Officers L.T.M.G. Sion HospitalL.T.M.G.H, (Lokmanya Tilak Municipal General Hospital), locally known as "Sion Hospital", is a generalmunicipal hospital situated in Sion, a suburb of Mumbai, India. It was started in 1947 with 10 beds initially, whichhas now grown into multi-specialty hospital with 1,416 beds. In the same campus, it is attached to LTMMC(LokmanyaTilak Municipal Medical College) which is a teaching institute for undergraduate and post graduatestudies in medical sciences. It is named after LokmanyaTilak, an eminent Maharashtra freedom fighter in pre-independence India.L.T.M.G. Sion Hospital has many departments and wards like: 1. Trauma centre 16
  • 20. 2. Burn unit 3. Main OT 4. Urology dept. 5. Neurology dept. 6. ENT dept. 7. Minor OT (Ward 4) 8. Emergency Dept. 9. Eye Dept. 10. Pediatric Dept. 11. Dermatology Dept. 12. Gynecology Dept. 13. Diagnostic Labs 14. Pharmacy 15. Etc... Note: Due to time constrain and for sake of comparison only some main target departments have been studied for data. The hospital did not maintain perfect data according to the categories provided by ‘INDIAN BIO-MEDICAL WASTE RULES 1998’; hence I had done that so as to make data comparison easier and clearer. L.T.M.G. Sion Hospital: Data Collection Table 7Wards or Bio-Medical Waste Collected[kg/Bed/week] (03/10/11-09/10/11) Categor Categor Categor Categor Categor Category Categor Categor Categor Categor Dept. y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10OPD area 0 - 0 0.17 0.03 0.10 0.05 0.14 - 0Causality 0.19 - 0.07 0.22 0.06 0.29 0.29 0.18 - 0.02 ICU’s 0.08 - 0.04 0.25 0.08 0.38 0.37 0.29 - 0.04 17
  • 21. OT area 0.68 - 0.08 0.37 0.03 0.41 0.46 0.37 - 0.08Diagnostic 0 - 0.63 0.17 0.08 0.09 0.11 0.25 - 0.36 LabsRadiology 0 - 0 0.04 0.04 0.05 0.05 0.19 - 0.03 Dept.Pharmacy 0 - 0 0.03 0.28 0.03 0 0.04 - 0 Table 8Wards or Bio-Medical Waste Collected[kg/Bed/week] (10/10/11-16/10/11) Categor Categor Categor Categor Categor Category Categor Categor Categor Categor Dept. y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10OPD area 0 - 0 0.23 0.03 0.20 0.07 0.28 - 0.05Causality 0.29 - 0.10 0.56 0.06 0.36 0.49 0.35 - 0.09 ICU’s 0.15 - 0.16 0.74 0.09 0.41 0.56 0.48 - 0.13 OT area 2.71 - 0.23 1.28 0.03 2.72 1.09 0.99 - 0.17Diagnostic 0 - 1.65 0.46 0.04 0.17 0.19 0.51 - 1.10 LabsRadiology 0 - 0 0.20 0.03 0.08 0.03 0.29 - 0.09 Dept.Pharmacy 0 - 0 0.17 0.17 0.04 0.02 0.05 - 0.02 Table 9Wards or Bio-Medical Waste Collected[kg/Bed/week] (17/10/11-23/10/11) Categor Categor Categor Categor Categor Category Categor Categor Categor Categor Dept. y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10 18
  • 22. OPD area 0 - 0.06 0.31 0.02 0.28 0.07 0.31 - 0.04Causality 0.27 - 0.08 0.75 0.04 0.47 0.63 0.42 - 0.06 ICU’s 0.18 - 0.13 0.98 0.07 0.65 0.89 0.57 - 0.18 OT area 3.04 - 0.28 1.63 0.06 2.93 1.17 1.04 - 0.15Diagnostic 0 - 1.79 0.55 0.04 0.35 0.24 0.45 - 0.98 LabsRadiology 0 - 0 0.27 0.02 0.17 0.04 0.31 - 0.09 Dept.Pharmacy 0 - 0 0.28 0.19 0.05 0.03 0.04 - 0.03 Table 10Wards or Bio-Medical Waste Collected[kg/Bed/week] (24/10/11-30/10/11) Categor Categor Categor Categor Categor Category Categor Categor Categor Categor Dept. y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10OPD area 0 - 0 0.06 0 0.11 0.04 0.27 - 0.01Causality 0.11 - 0.03 0.34 0.01 0.28 0.58 0.33 - 0.03 ICU’s 0.09 - 0.07 0.62 0.03 0.53 0.74 0.41 - 0.09 OT area 1.04 - 0.12 1.00 0.04 1.08 1.09 0.91 - 0.10Diagnostic 0 - 0.99 0.38 0.07 0.22 0.18 0.35 - 1.01 LabsRadiology 0 - 0 0.13 0.01 0.08 0.05 0.23 - 0.06 Dept.Pharmacy 0 - 0 0.16 0.08 0 0 0.05 - 0.02 L.T.M.G. Sion Hospital: Data Processing Table 11 19
  • 23. Wards or Total Bio-Medical Waste Collected[kg/bed/month] (03/09/11-30/09/11) Categor Categor Categor Categor Categor Categor Category Categor Categor Categor Dept. y No.1 y No.2 y No.3 y No.4 y No.5 y No.6 No.7 y No.8 y No.9 y No.10OPD area 0 - 0.06 0.77 0.08 0.69 0.23 1.00 - 0.1Causality 0.86 - 0.28 1.87 0.20 1.40 1.99 1.28 - 0.2 ICU’s 0.5 - 0.4 2.59 0.27 1.97 2.56 1.75 - 0.44 OT area 7.47 - 0.71 4.28 0.16 7.14 3.81 3.31 - 0.5Diagnostic 0 - 5.06 1.56 0.23 0.83 0.72 1.56 - 3.45 LabsRadiology 0 - 0 0.64 0.10 0.38 0.17 1.02 - 0.27 Dept.Pharmacy 0 - 0 0.64 0.72 0.12 0.05 0.18 - 0.07 METHOD OF WASTE DISPOSAL ADOPTED BY L.T.M.G. SION HOSPITAL: Table 12 Colour Coding Waste Category Method of Disposal Adopted by Hospital Yellow Category 1,2,3 &6 Deep burial / Collected by BMC and [Human & Animal anatomical waste dumped at Deonar(near Chembur) / Micro-biology waste and soiled cotton/dressings/linen/beddings etc.] Red Category 7 Autoclaving / Microwaving / Chemical [Tubing’s, Catheters, IV sets.] treatment 20
  • 24. Blue/White Category 4 Autoclaving / Microwaving / Chemical [Waste sharps like treatment / Shredding Needles, Syringes, Scalpels, blades etc.] Black Category 5,8,9 &10 Chemical treatment/Collected by BMC [Discarded medicines/cytotoxic and dumped at Deonar drugs, Incineration ash, Chemical waste.] Comparative Study: Hinduja Hospital vs. Sion Hospitals (Dept. Wise)OPD Area: Graph 1 1.2 Hinduja Hospital L.T.M.G. Sion Hospital Waste Collected [kg/bed/month] 1 0.8 0.6 0.4 0.2 0 No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 Bio-Medical Watse CategoriesCausality Ward: Graph 2 21
  • 25. 2.5 Hinduja Hospital L.T.M.G. Sion Hospital Waste Collected [kg/bed/month] 2 1.5 1 0.5 0 No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 Bio-Medical Watse CategoriesICU’S Department: Graph 3 3 Hinduja Hospital L.T.M.G. Sion Hospital Waste Collected [kg/bed/month] 2.5 2 1.5 1 0.5 0 No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 Bio-Medical Watse CategoriesOT Area: Graph 4 22
  • 26. 8 Hinduja Hospital 7 L.T.M.G. Sion Hospital Waste Collected [kg/bed/month] 6 5 4 3 2 1 0 No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 Bio-Medical Watse CategoriesDiagnostic Labs: Graph 5 6 Hinduja Hospital L.T.M.G. Sion Hospital Waste Collected [kg/bed/month] 5 4 3 2 1 0 No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 Bio-Medical Watse CategoriesRadiology Department: Graph 6 23
  • 27. 1.2 Hinduja Hospital L.T.M.G. Sion Hospital 1 Waste Collected [kg/bed/month] 0.8 0.6 0.4 0.2 0 No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 Bio-Medical Watse CategoriesPharmacy Department: Graph 7 0.8 Hinduja Hospital L.T.M.G. Sion Hospital 0.7 Waste Collected [kg/bed/month] 0.6 0.5 0.4 0.3 0.2 0.1 0 No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 Bio-Medical Watse Categories 24
  • 28. General Discussion and Further Analysis Bio-medical Waste generation: It was noticed that quantity of Bio-medical waste generated (especiallycotton, dressings and sharps) was more in government run Sion hospital than private Hinduja hospital. On theother hand waste like Catheters, Tubings, Radiological and chemical wastes were more from diagnostic labs ofHinduja hospitals. Bio-medical waste segregation methods: Segregation methods were followed and closely monitored inHinduja hospital. All colour coded containers were in place in each department and clearly labeled. In Sionhospitals all colour coded containers were present but segregation of waste was not being carried out efficientlyby the nursing and housekeeping staff. Bio-medical waste collection method: In Sion hospital the waste from each department is collected by thehousekeeping staff in government approved colour coded bags but on one or two occasions shortage of colorcoded bags led to deliberate mixing of different category of waste which the staff said was not in their hands.Were as in Hinduja hospital the housekeeping staff was more sensitive towards collecting the wastes indifferent government approved colour coded bags and storing it in the waste collection room; from where thesegregated waste was collected by the Bio-medical waste collection vehicle at 12 noon. Bio-medical waste disposal techniques: Though both the hospitals claim that they follow Indian PollutionControl board approved waste disposal methods, but on ground in Sion hospital not much effort was taken toproperly disinfect and dispose highly infectious waste from OTs, HIV positive patients and radiologydepartment; Eg: biological tissues from the OT department was not autoclaved before final disposal and soiledlinen from the HIV positive patients were not disinfected and properly segregated. Though the autoclavingmachines were present with the hospital but were out of order due to lack of proper maintenance (only 1 of theautoclaving machines was active). In Hinduja hospital waste like biological waste from OTs, soiled linen,cotton, swabs, etc. were properly segregated, collected and autoclaved before disposal. In the radiologicaldepartment radioactive waste was collected in proper closed containers and then sent for further disposal. But itwas noticed that some samples of blood used for testing in the lab was directly discarded into the municipaldrains without any chemical treatment. 25
  • 29. Awareness levels of the hospital staff: In Sion hospital the administrative, medical and nursing staffs werewell aware of the principles of bio-medical waste management like waste segregation, collection and disposal atleast in theory as they were reluctant to put in extra effort to practice the principles on ground. Were as thehousekeeping and class IV employees were all not very well informed and trained about Bio-medical wastemanagement practices, they just followed the protocol given to them by the hospital administration withoutmuch background knowledge. The hospital did have an infection control committee which gave time to timetraining to the housekeeping, nursing and class IV staff but there level of awareness still seemed low. InHinduja hospital the infection control committee was much more effective in training and creating awarenessamong their staff. Hospitals administration ensured proper waste management practices through closemonitoring of each department. CCTV cameras were also installed in curtails departments like OTs, ICUs, labs,etc. which helped in monitoring and ensuring proper working of the hospital staff. Money spent on Bio-medical waste management: Sion hospital being a government owned hospital, lotsof money was spent on buying expensive autoclaving, microwaving and ultra-sonic sterilizers. Colour codedcontainers and waste disposal bags were also bought in bulk by the hospital. But due to lack of maintenance lotof equipment is out of order and many waste collecting and disposing containers and bags have also beenmisplaced. Hinduja hospital being a private owned hospital, had allotted adequate amount of funds for wastemanagement equipment’s like autoclaves, ultra-sonic sterilizers, needle burners, etc. Because of propermaintenance all equipment’s are at max efficiency hence giving full value for money. Limitations and Evaluation  Data for Bio-Medical waste collection of both the hospitals Hinduja and L.T.M.G. Sion was taken for a short period of time (1 month). If the hospitals would have been studied over greater period of time with more available data then the report produced may have been more comprehensive and effective.  Collecting sufficient data from both the hospitals was a challenge in itself as Hinduja hospital did manage bio-medical waste according to the categories described by the Indian Bio-Medical Rules (1998) 26
  • 30. but with some modifications of the standard rules to suit their hospitals waste management model and on the other side L.T.M.G. Sion hospital did not maintain perfect bio-medical waste management data according to the categories provided by Indian Bio-Medical Waste Rules (1998); hence had to personally sit, observe and collect data according to the categories so as to make data from both hospitals comparable and fit for further analysis.  Due to time constrain and word limit range set by the IBO for the extended essay, I had to constrict myself to compare both hospitals according to the Indian Bio-Medical Waste Rules (1998) waste categories and not fully analyze other waste segregation and management policies like that proposed by the WHO and some other national and state level waste management rules.  Language used for communication by the cleaning and housekeeping staff at L.T.M.G. Sion hospital was Marathi (regional language); not being very familiar with the language I had difficulty understanding what they were trying to communicate (did call for an interpreter later). This was not the case at Hinduja hospital there the housekeeping and cleaning staff communicated in English or in Hindi (national languages). Conclusion In the existent health care scenario management of bio-medical waste is considered to be a critical area ofoperation for the hospital. WHO and the Indian government has laid down very stringent policies, procedure andprotocols for Bio-medical waste management to which the hospitals are required to comply. Of the two hospitalswhich were compared it stand very clear the here Hinduja hospital (private hospital) was found to be more awareof waste management principles, policies and procedures. The staff, doctors and management were betterequipped to handle this area with good discipline. Were as the Sion hospital (government hospital) though largerin area, no. of beds and being a teaching hospital was found lacking in understanding and implementation of thebasic policies, procedures and principle of the Bio-medical waste management. 27
  • 31. BibliographyBooks referred: Tsokos, K. A. Physics for the IB Diploma: [standard and Higher Level]. 5th ed. Cambridge: CambridgeUP, 2009. Print. Buckle, Nigel, and Iain Dunbar. Mathematics Higher Level (core): International Baccalaureate. Ed.Fabio Cirrito. [Victoria]: IBID, 2007. Print. S.L. Arora. New Simplified Physics A Reference Book for Class XI. 2nd ed. Delhi: Gagan Kapur, 2008.PrintWeb sources: "The Physics of Cricket." School of Physics - The University of Sydney. 2005. Web. 04 Dec. 2011.<http://www.physics.usyd.edu.au/~cross/cricket.html>. "Law 5 (The Ball) - Laws - Laws of Cricket - Laws & Spirit - Lords." Top Stories - News - Lords.2010. Web. 08 Jan. 2012. <http://www.lords.org/laws-and-spirit/laws-of-cricket/laws/law-5-the- ball,31,ar.html>.Programs used: Microsoft paint. Logger pro 3.0 28
  • 32. Appendix 1: Hospital waste and Its ClassificationWhat is hospital waste?Hospital waste refers to all waste generated, discarded and not intended for further use in the hospital.General Classification of hospital waste:(1) General waste: Largely composed of domestic or house hold type waste. It is non-hazardous to humanbeings, e.g. kitchen waste, packaging material, paper and wrapper sand plastics.(2) Pathological waste: Consists of tissue, organ, body part, human foetuses, blood and body fluid. It ishazardous waste.(3) Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that couldcause diseases. It is hazardous e.g. culture and stocks of infectious agents from laboratories, waste from surgery,waste originating from infectious patients.(4) Sharps: Waste materials which could cause the person handling it, a cut or puncture of skin e.g. needles,broken glass, saws, nail and blade sand scalpels.(5) Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have beenreturned from wards, have been spilled, are out-dated, or contaminated.(6) Chemical waste: This comprises discarded solid, liquid and gaseous chemicals e.g. cleaning, housekeeping,and disinfecting product.(7) Radioactive waste: It includes solid, liquid, and gaseous waste that is contaminated with radionuclide’sgenerated from in-vitro analysis of body tissues and fluid, in-vivo body organ imaging and tumour localization andtherapeutic procedures.Amount and composition of hospital waste generated: 29
  • 33. (a) Amount Country Quantity (kg/bed/day) U. K. 2.5 U.S.A. 4.5 France 2.5 Spain 3.0 India 1.5 (b) Hazardous/non-hazardous Hazardous(total) : 15% a) Hazardous but non- 5% infective b)Hazardous and infective 10% Non-hazardous 85%(c) Composition By Weight: Plastic 14% Combustible: Dry cellulosic solid 45% Wet cellulosic solid 18% Non-combustible: Non-combustible products 20% [Source: Medical Superintendent at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow] 30
  • 34. Appendix 2: Questionnaire 31
  • 35. General Questions:1] What is your name and your post in the hospital?2] Your educational qualifications?3] Any previous work experience and since how long are you working with this hospital?4] Your take on Bio-Medical waste and how your hospital manages waste?For the nurses, housekeeping and security staff:1] What according to you is Bio-Medical waste?2] Are you aware about the different systems/ policies for waste management?3] What are the categories of waste segregation and collection?4] Which colour coded plastic bags and containers should be used for different waste categories? Which ones areactually being used by the hospital?5] What is the significance of hospital cleanliness and waste management?6] Are you aware of the dangers and health hazards posed by Bio-medical waste on human health?7] Are you aware of the safety measures and precautions that one needs to take wile handling hospital waste?(Especially Biomedical waste)For the hospital heads and other doctors:1] What is the importance of Bio-medical waste management in present day scenario and how is your hospitalcontributing towards it? 32
  • 36. 2] Are you aware about WHO’s hospital waste management policy?3] What is your take on the Indian Bio-Medical Waste Rules (1998) and do you ensure that your hospital followsthis rules lay down by the government?4] Does your hospital have an active Infection Control Committee?5] Do you attend the hospital waste management conference organized by the government?6] Does your hospital organize workshops to train and spread awareness about biomedical waste among the hospitalstaff? 33