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                                                                        Table of Contents
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       Type chapter title (level 3) .................................................................................................................................................3
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   Type chapter title (level 2) .....................................................................................................................................................5
       Type chapter title (level 3) .................................................................................................................................................6




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                                                       E.E

                                       Hospital Waste Management
                                                                                             By: Shubhankar Sood

Research Question

To compare the bio-medical waste management practices at private hospital to that of government hospital in a
metropolitan city in India.
Aim

To analyze and compare the bio- medical waste management practices at Hinduja hospital (private ownership)
to that of L.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-medicalwaste management
practices followed by both the hospitals.

There may becomparable difference in the bio-medical waste management practices followed by both
hospitals. Were in, private hospitals waste management practices should be closer to the norms and
government hospitals waste management practices lag behind the standard norms.

Variables:

       Independentvariables: 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

What 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
             human beings, e.g. kitchen waste, packaging material, paper, wrappersand plastics.

       (2)     Pathological waste: Consists of tissue, organ, body part, human foetuses, blood and body fluid. It
             is hazardous waste.

       (3)     Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity
             that could cause diseases. It is hazardous e.g. culture and stocks of infectious agents from
             laboratories, waste from surgery, waste originating from infectious patients.

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      (4)    Sharps: Waste materials which could cause the person handling it, a cut or puncture of skin e.g.
            needles, broken glass, saws, nail, bladesand scalpels.

      (5)    Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have
            been returned 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’s generated from in-vitro analysis of body tissues and fluid, in-vivo body organ
            imaging and tumour localization and therapeutic procedures.

Amount and composition of hospital waste generated:

      (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%

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                             Non-combustible:

          Non-combustible products                 20%


[Source: Medical Superintendent at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow]

What is biomedical waste?

        Any solid, fluid and liquid or liquid waste, including its container and any intermediate product, which is
generated during the diagnosis, treatment or immunisation of human being or animals, in research pertaining
thereto, or in the production 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.

Hospital Waste an Environmental Hazard and Its Management:

        Hospital is a place of almighty, a place to serve the patient. Since beginning, the hospitals are known for
the treatment of sick persons but many are unaware about the adverse effects of the garbage and filth
generated by them on human body and environment. Now it is a well-established fact that there are many
adverse and harmful effects to the environment including human beings which are caused by the "Hospital
waste" generated during the patient care. Hospital waste is a potential health hazard to the health care
workers, public and flora and fauna of the area. Hospital acquired infection, transfusion transmitted diseases,
rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of
catching many diseases. Air pollution due to emission of hazardous gases by incinerator such as Furan, Dioxin,
Hydrochloric acid etc. have compelled the authorities to think seriously about hospital waste and the diseases
transmitted through improper disposal of hospital waste. This problem has now become a serious threat for
the public health and, ultimately, the Central Government had to intervene for enforcing proper handling and
disposal of hospital waste.

Rationale of hospital waste management:

Hospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15% of
hospital waste i.e. "Biomedical waste" is hazardous, not the complete. But when hazardous waste is not
segregated at the source of generation and mixed with non-hazardous waste, then 100% waste becomes
hazardous. The question then arises that what is the need or rationale for spending so many resources in terms
of money, man power, material and machine for management of hospital 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.


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    Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and
ash.

Approach for hospital waste management:

1. Segregation of waste

Segregation is the essence of waste management and should be done at the source of generation of Bio-
medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labour rooms,
treatment rooms etc. 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 categories mentioned in the rules.

2. Collection of bio-medical waste

Collection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. At
ordinary 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 Plastic bags                      Black
              Cytotoxic waste
6.            Solid (biomedical waste)             -do-                       Yellow
7.            Solid (plastic)                      Plastic bag puncture proof Blue/White Translucent
                                                   containers
8.            Incineration waste                   Plastic bag                     Black
9.            Chemical waste (solid)               -do-                            -do-

3. Transportation

Within hospital, waste routes must be designated to avoid the passage of waste through patient care areas.
Separate time should be earmarked for transportation of bio-medical waste to reduce chances of it's mixing
with general waste. Desiccated wheeled containers, trolleys or carts should be used to transport the
waste/plastic bags to the site of storage/ treatment.

Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage. The wheeled
containers should be so designed that the waste can be easily loaded, remains secured during transportation,
does not have any sharp edges and is easy to clean and disinfect. Hazardous biomedical waste needing
transport to a long distance should be kept in containers and should have proper labels. The transport is done
through desiccated vehicles specially constructed for the purpose having fully enclosed body, lined internally
with stainless steel or aluminium to provide smooth and impervious surface which can be cleaned. The
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driverscompartment should be separated from the load compartment with a bulkhead. The load compartment
should be provided with roof vents for ventilation.

4. Why treatment of hospital waste?

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.

5.Treatment of general waste:

The 85% of the waste generated in the hospital belongs to this category. The, safe disposal of this waste is the
responsibility of the local authority.

6.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 population.

     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.

     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
BMW rules 1998 and a certificate may be taken from CPCB/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
can be incinerated depending upon the local policies of the hospital and feasibility. The polythene bags made of
chlorinated plastics should not be incinerated.

     It may be noted that there are options available for disposal of certain category of waste. The individual
hospital can choose the best option depending upon the facilities available and its financial resources.
However, it may be noted that depending upon the option chosen, correct colour of the bag needs to be used.

7. Safety measures



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       All the generators of bio--medical waste should adopt universal precautions and appropriate safety
 measures while doing 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.

 8. Measures for waste minimization

 As far as possible, purchase of reusable items made of glass and metal should be encouraged. Select non PVC
 plastic items. Adopt procedures and policies for proper management of waste generated, the mainstay of
 which is segregation to reduce the quantity of waste to be treated. Establish effective and sound recycling
 policy for plastic recycling and get in touch with authorised manufactures.

                                     INDIAN BIO-MEDICAL WASTE RULES1998:

 Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment
 Protection Act by the Ministry of Environment and Forest (Government of India) bio-medical waste has to be
 segregated according to the following 10 categories:




Option                          Waste Category                                        Treatment & Disposal

Category No. 1                  Human Anatomical Waste                                incineration /deep burial
                                (human tissues, organs, body parts)

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)




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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/shredding


Category No. 5                Discarded Medicines and Cytotoxic drugs                 incineration/destruction and
                              (Waste comprising of outdated, contaminated and         drugs disposal in secured
                              discarded medicines)                                    landfills


Category No. 6                 Soiled Waste                                            incineration/autoclaving/m
                               (items contaminated with blood, and body fluids         icrowaving
                               including cotton, dressings, soiled plaster casts,
                               linen, bedding, other material contaminated with
                               blood)
Category No. 7                 Solid Waste                                             disinfection by chemical
                               (Waste generated from disposal items other than         treatment/autoclaving/mic
                               the sharps such a tubing’s, catheters, intravenous      rowaving and
                               sets etc.)                                              mutilation/shredding


Category No. 8                 Liquid Waste                                            disinfection by chemical
                               (Waste generated from laboratory and washing,           treatment and discharge
                               cleaning, housekeeping and disinfecting activities)     into drains



Category No. 9                 Incineration Ash                                        disposal in municipal
                               Ash from incineration of any bio-medical waste)         landfill


Category No. 10                Chemical Waste                                          chemical treatment and
                               (Chemicals used in production of biological,            discharge into drains for
                               chemicals used in disinfection, as insecticides,        liquids and secured landfill
                               etc.)                                                   for solids


                                               W.H.O REGULATIONS

 Definition according to W.H.O:

 Health-care waste includes all the waste generated by health-care establishments, research facilities, and
 laboratories. In addition, it includesthe waste originating from ‘minor’ or ‘scattered’ sourcessuch as
 thatproduced in the course of health care undertaken in the home (dialysis,insulin injections, etc.)

 W.H.O Classification:

 As per W.H.Othe biomedical wastes could be classified into eight categories on the basis of the type of waste
 and the risk of transmission of infectious material in them.
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1. General waste (domestic)
2. Pathological
3.Radioactive
4. Chemical

5. Infectious
6. Pharmaceutical wastes
7. Sharps
8. Pressurised containers

                                          Data Collection and Processing

I had visited two different hospitals, in different localities and with different ownerships for my research work.
Collecting information and data through interviews, cross-sectional study, and observational study; pertaining
to the waste generated by the hospital and its subsequent management and disposal.

The two hospitals visited are:

1] P. D. Hinduja National Hospital and Medical Research Centre: private ownership

2] L.T.M.G. Sion Hospital: governmental ownership

                          P. D. Hinduja National Hospital and Medical Research Centre

Also popularly known as Hinduja Hospital, is a private hospital located at Mahim in Mumbai, India.The hospital
was established in 1951 byParmanandDeepchandHinduja.The hospital is a modern multi-speciality tertiary care
hospital 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 in emerging economies (2006).

P. D. Hinduja National Hospital has many departments and wards like:

   1. Trauma centre
   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
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        14. Pharmacy
        15. Etc...

 Note: Due to time constrain and for sake of comparison only some main target departments have been studied
 for data.

 All the waste generated in the hospital is segregated, collected and disposed according to the categories of
 waste defined by ‘INDIAN BIO-MEDICAL WASTE RULES 1998’. Hence the below mentioned data is in terms of
 these categories

 NOTE: the ‘INDIAN BIO-MEDICAL WASTE RULES 1998’ categories have been listed in tabular form earlier in the
 report. Hence it is advisable to keep in mind the ‘waste categories’ while referring to the data given below.

         DATA COLLECTION:Table 1

  Wards or                                      Hospital Waste Collected[kg/Bed/week] (03/09/11-09/09/11)

   Dept.
             Category    Category    Category      Category     Category     Category      Category     Category       Category    Category
               No.1        No.2        No.3          No.4         No.5         No.6          No.7         No.8           No.9       No.10

 OPD area       -           -           -            0.08         0.01         0.08          0.04            0.08         -          0.01


 Causality     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         -          0.05


 Diagnosti      -           -          0.46          0.09         0.03         0.04          0.08            0.20         -          0.42
 c Labs

 Radiology      -           -           -            0.02         0.02         0.02          0.03            0.18         -          0.08
 Dept.

 Pharmacy       -           -           -            0.01         0.18         0.02          0.01            0.07         -          0.01




 Table 2

Wards or                              Hospital Waste Collected[kg/Bed/week] (10/09/11-16/09/11)

  Dept.       Category    Category    Category      Category     Category     Category      Category        Category    Category     Category
                No.1        No.2        No.3          No.4         No.5         No.6          No.7            No.8        No.9        No.10
OPD area            -           -           -         0.09         0.01         0.11          0.03           0.14             -        0.02

Causality       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



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OT area          1.21       -          0.07    0.58          0.02        1.32          0.78     0.73         -         0.09

Diagnostic        -         -          0.96    0.16          0.08        0.09          0.17     0.38         -         0.93
Labs
Radiology         -         -           -      0.08          0.04        0.08          0.05     0.24         -         0.07
Dept.
Pharmacy          -         -           -      0.03          0.09        0.01          0.01     0.08         -         0.02



 Table 3

Wards or                           Hospital Waste Collected[kg/Bed/week] (17/09/11-23/09/11)

  Dept.      Category   Category   Category   Category   Category       Category   Category   Category    Category   Category
               No.1       No.2       No.3       No.4       No.5           No.6       No.7       No.8        No.9      No.10
OPD area     -          -          -          0.08       -          0.14           0.04       0.18       -           0.03

Causality    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

OT area      1.29       -          0.09       0.62       0.03       1.38           1.03       0.93       -           0.12

Diagnostic   -          -          1.03       0.22       0.06       0.08           0.21       0.42       -           0.99
Labs
Radiology    -          -          -          0.09       0.03       0.08           0.08       0.29       -           0.07
Dept.
Pharmacy     -          -          -          0.03       0.09       -              -          0.09       -           0.02



 Table 4

Wards or                           Hospital Waste Collected[kg/Bed/week] (24/09/11-30/09/11)

  Dept.      Category   Category   Category   Category   Category       Category   Category   Category    Category   Category
               No.1       No.2       No.3       No.4       No.5           No.6       No.7       No.8        No.9      No.10
OPD area          -         -           -      0.06           -          0.08          0.02     0.07         -         0.01

Causality        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         -         0.09



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Diagnostic       -            -        0.91       0.26       0.07        0.06       0.17        0.36         -         1.00
Labs
Radiology        -            -          -        0.07       0.01        0.05       0.05        0.27         -         0.05
Dept.
Pharmacy         -            -          -        0.05       0.08          -          -         0.07         -         0.01


          Data Processing:                                                                                           Table
          5

Wards or                          Total Hospital Waste Collected[kg/bed/month](03/09/11-30/09/11)

  Dept.       Category     Category   Category   Category   Category   Category   Category    Category    Category   Category
                No.1         No.2       No.3       No.4       No.5       No.6       No.7        No.8        No.9      No.10
OPD area         -            -          -        0.31       0.02       0.41       0.13         0.47         -         0.07

Causality       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         -         0.35

Diagnostic       -            -        3.36       0.60       0.59       0.27       0.63         1.15         -         3.34
Labs
Radiology        -            -          -        0.26       0.10       0.23       0.21         0.77         -         0.27
Dept.
Pharmacy         -            -          -        0.12       0.44       0.03       0.02         0.31         -         0.06



          METHOD OF WASTE DISPOSAL ADOPTED BY HINDUJA HOSPITAL:

              Colour Coding                              Waste Category                    Method of Disposal Adopted by
                                                                                                     Hospital
                 Yellow                                Category 1,2,3 &6                   Deep burial /Incineration [has in
                                              [Human & Animal anatomical waste /                 house incinerator]
                                                 Micro-biology waste and soiled
                                              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
                                                               etc.]
                  Black                                 Category 5,8,9 &10              Disposal in secured landfill/
                                              [Discarded medicines/cytotoxic drugs,         Chemical treatment
                                                Incineration ash, Chemical waste.]
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      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 Hospital

LTMGH, (LokmanyaTilak Municipal General Hospital), locally known as "Sion Hospital", is a general municipal
hospital situated in Sion, a suburb of Mumbai, India. It was started in 1947 with 10 beds initially, which has 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 graduate
studies 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
   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 do that so as to make data comparison easier and clearer.

       Data Collection:
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Wards or                           Hospital Waste Collected[kg/Bed/week] (03/10/11-09/10/11)

  Dept.      Category   Category   Category   Category   Category   Category   Category   Category    Category   Category
               No.1       No.2       No.3       No.4       No.5       No.6       No.7       No.8        No.9      No.10
OPD area          -         -         -        0.17       0.03        0.10      0.05        0.14         -          -

Causality        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

OT area          0.68       -       0.08       0.37       0.03        0.41      0.46        0.37         -         0.08

Diagnostic        -         -       0.63       0.17       0.08        0.09      0.11        0.25         -         0.36
Labs
Radiology         -         -         -        0.04       0.04        0.05      0.05        0.19         -         0.03
Dept.
Pharmacy          -         -         -        0.03       0.28        0.03        -         0.04         -          -



Wards or                           Hospital Waste Collected[kg/Bed/week] (10/10/11-16/10/11)

  Dept.      Category   Category   Category   Category   Category   Category   Category   Category    Category   Category
               No.1       No.2       No.3       No.4       No.5       No.6       No.7       No.8        No.9      No.10
OPD area          -         -         -        0.23       0.03        0.20      0.07        0.28         -         0.05

Causality        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         -         0.17

Diagnostic        -         -       1.65       0.46       0.04        0.17      0.19        0.51         -         1.10
Labs
Radiology         -         -         -        0.20       0.03        0.08      0.03        0.29         -         0.09
Dept.
Pharmacy          -         -         -        0.17       0.17        0.04      0.02        0.05         -         0.02



Wards or                           Hospital Waste Collected[kg/Bed/week] (17/10/11-23/10/11)

  Dept.      Category   Category   Category   Category   Category   Category   Category   Category    Category   Category
               No.1       No.2       No.3       No.4       No.5       No.6       No.7       No.8        No.9      No.10
OPD area     -          -          0.06       0.31       0.02       0.28       0.07       0.31       -           0.04


                                                                                                                    14
Candidate Number:
Causality      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       -           0.15

Diagnostic     -          -          1.79       0.55       0.04       0.35       0.24       0.45       -           0.98
Labs
Radiology      -          -          -          0.27       0.02       0.17       0.04       0.31       -           0.09
Dept.
Pharmacy       -          -          -          0.28       0.19       0.05       0.03       0.04       -           0.03



Wards or                             Hospital Waste Collected[kg/Bed/week] (24/10/11-30/10/11)

  Dept.        Category   Category   Category   Category   Category   Category   Category   Category    Category   Category
                 No.1       No.2       No.3       No.4       No.5       No.6       No.7       No.8        No.9      No.10
OPD area            -          -          -      0.06         -         0.11       0.04       0.27         -         0.01

Causality          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         -         0.10

Diagnostic          -          -         0.99    0.38       0.07        0.22       0.18       0.35         -         1.01
Labs
Radiology           -          -          -      0.13       0.01        0.08       0.05       0.23         -         0.06
Dept.
Pharmacy            -          -          -      0.16       0.08          -          -        0.05         -         0.02



            Data Processing:

Wards or                           Total Hospital Waste Collected[kg/bed/month] (03/09/11-30/09/11)

  Dept.        Category   Category   Category   Category   Category   Category   Category   Category    Category   Category
                 No.1       No.2       No.3       No.4       No.5       No.6       No.7       No.8        No.9      No.10
OPD area                       -                                                                           -




                                                                                                                      15
Candidate Number:
Causality                  -                                                                    -

ICU’s                      -                                                                    -

OT area                    -                                                                    -

Diagnostic                 -                                                                    -
Labs
Radiology                  -                                                                    -
Dept.
Pharmacy                   -                                                                    -



          METHOD OF WASTE DISPOSAL ADOPTED BY L.T.M.G. SION HOSPITAL:

             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 /
                                        [Tubing’s, Catheters, IV sets.]       Chemical treatment/Collected by
                                                                                BMC and dumped at Deonar
              Blue/White                          Category 4                    Autoclaving / Microwaving /
                                              [Waste sharps like                   Chemical treatment /
                                       Needles, Syringes, Scalpels, blades    Shredding/Collected by BMC and
                                                     etc.]                          dumped at Deonar
                 Black                        Category 5,8,9 &10              Chemical treatment/Collected by
                                    [Discarded medicines/cytotoxic drugs,       BMC and dumped at Deonar
                                      Incineration ash, Chemical waste.]




                                                                                                          16

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  • 1. Candidate Number: Table of Contents Type chapter title (level 1) ........................................................................................................................................................1 Type chapter title (level 2) .....................................................................................................................................................2 Type chapter title (level 3) .................................................................................................................................................3 Type chapter title (level 1) ........................................................................................................................................................4 Type chapter title (level 2) .....................................................................................................................................................5 Type chapter title (level 3) .................................................................................................................................................6 1
  • 2. Candidate Number: E.E Hospital Waste Management By: Shubhankar Sood Research Question To compare the bio-medical waste management practices at private hospital to that of government hospital in a metropolitan city in India. Aim To analyze and compare the bio- medical waste management practices at Hinduja hospital (private ownership) to that of L.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-medicalwaste management practices followed by both the hospitals. There may becomparable difference in the bio-medical waste management practices followed by both hospitals. Were in, private hospitals waste management practices should be closer to the norms and government hospitals waste management practices lag behind the standard norms. Variables: Independentvariables: 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 What 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 human beings, e.g. kitchen waste, packaging material, paper, wrappersand plastics. (2) Pathological waste: Consists of tissue, organ, body part, human foetuses, blood and body fluid. It is hazardous waste. (3) Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that could cause diseases. It is hazardous e.g. culture and stocks of infectious agents from laboratories, waste from surgery, waste originating from infectious patients. 2
  • 3. Candidate Number: (4) Sharps: Waste materials which could cause the person handling it, a cut or puncture of skin e.g. needles, broken glass, saws, nail, bladesand scalpels. (5) Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have been returned 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’s generated from in-vitro analysis of body tissues and fluid, in-vivo body organ imaging and tumour localization and therapeutic procedures. Amount and composition of hospital waste generated: (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% 3
  • 4. Candidate Number: Non-combustible: Non-combustible products 20% [Source: Medical Superintendent at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow] What is biomedical waste? Any solid, fluid and liquid or liquid waste, including its container and any intermediate product, which is generated during the diagnosis, treatment or immunisation of human being or animals, in research pertaining thereto, or in the production 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. Hospital Waste an Environmental Hazard and Its Management: Hospital is a place of almighty, a place to serve the patient. Since beginning, the hospitals are known for the treatment of sick persons but many are unaware about the adverse effects of the garbage and filth generated by them on human body and environment. Now it is a well-established fact that there are many adverse and harmful effects to the environment including human beings which are caused by the "Hospital waste" generated during the patient care. Hospital waste is a potential health hazard to the health care workers, public and flora and fauna of the area. Hospital acquired infection, transfusion transmitted diseases, rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of catching many diseases. Air pollution due to emission of hazardous gases by incinerator such as Furan, Dioxin, Hydrochloric acid etc. have compelled the authorities to think seriously about hospital waste and the diseases transmitted through improper disposal of hospital waste. This problem has now become a serious threat for the public health and, ultimately, the Central Government had to intervene for enforcing proper handling and disposal of hospital waste. Rationale of hospital waste management: Hospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15% of hospital waste i.e. "Biomedical waste" is hazardous, not the complete. But when hazardous waste is not segregated at the source of generation and mixed with non-hazardous waste, then 100% waste becomes hazardous. The question then arises that what is the need or rationale for spending so many resources in terms of money, man power, material and machine for management of hospital 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. 4
  • 5. Candidate Number:  Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash. Approach for hospital waste management: 1. Segregation of waste Segregation is the essence of waste management and should be done at the source of generation of Bio- medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labour rooms, treatment rooms etc. 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 categories mentioned in the rules. 2. Collection of bio-medical waste Collection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. At ordinary 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 Plastic bags Black Cytotoxic waste 6. Solid (biomedical waste) -do- Yellow 7. Solid (plastic) Plastic bag puncture proof Blue/White Translucent containers 8. Incineration waste Plastic bag Black 9. Chemical waste (solid) -do- -do- 3. Transportation Within hospital, waste routes must be designated to avoid the passage of waste through patient care areas. Separate time should be earmarked for transportation of bio-medical waste to reduce chances of it's mixing with general waste. Desiccated wheeled containers, trolleys or carts should be used to transport the waste/plastic bags to the site of storage/ treatment. Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage. The wheeled containers should be so designed that the waste can be easily loaded, remains secured during transportation, does not have any sharp edges and is easy to clean and disinfect. Hazardous biomedical waste needing transport to a long distance should be kept in containers and should have proper labels. The transport is done through desiccated vehicles specially constructed for the purpose having fully enclosed body, lined internally with stainless steel or aluminium to provide smooth and impervious surface which can be cleaned. The 5
  • 6. Candidate Number: driverscompartment should be separated from the load compartment with a bulkhead. The load compartment should be provided with roof vents for ventilation. 4. Why treatment of hospital waste? 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. 5.Treatment of general waste: The 85% of the waste generated in the hospital belongs to this category. The, safe disposal of this waste is the responsibility of the local authority. 6.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 population.  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.  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 BMW rules 1998 and a certificate may be taken from CPCB/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 can be incinerated depending upon the local policies of the hospital and feasibility. The polythene bags made of chlorinated plastics should not be incinerated.  It may be noted that there are options available for disposal of certain category of waste. The individual hospital can choose the best option depending upon the facilities available and its financial resources. However, it may be noted that depending upon the option chosen, correct colour of the bag needs to be used. 7. Safety measures 6
  • 7. Candidate Number: All the generators of bio--medical waste should adopt universal precautions and appropriate safety measures while doing 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. 8. Measures for waste minimization As far as possible, purchase of reusable items made of glass and metal should be encouraged. Select non PVC plastic items. Adopt procedures and policies for proper management of waste generated, the mainstay of which is segregation to reduce the quantity of waste to be treated. Establish effective and sound recycling policy for plastic recycling and get in touch with authorised manufactures. INDIAN BIO-MEDICAL WASTE RULES1998: Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India) bio-medical waste has to be segregated according to the following 10 categories: Option Waste Category Treatment & Disposal Category No. 1 Human Anatomical Waste incineration /deep burial (human tissues, organs, body parts) 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) 7
  • 8. Candidate Number: 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/shredding Category No. 5 Discarded Medicines and Cytotoxic drugs incineration/destruction and (Waste comprising of outdated, contaminated and drugs disposal in secured discarded medicines) landfills Category No. 6 Soiled Waste incineration/autoclaving/m (items contaminated with blood, and body fluids icrowaving including cotton, dressings, soiled plaster casts, linen, bedding, other material contaminated with blood) Category No. 7 Solid Waste disinfection by chemical (Waste generated from disposal items other than treatment/autoclaving/mic the sharps such a tubing’s, catheters, intravenous rowaving and sets etc.) mutilation/shredding Category No. 8 Liquid Waste disinfection by chemical (Waste generated from laboratory and washing, treatment and discharge cleaning, housekeeping and disinfecting activities) into drains Category No. 9 Incineration Ash disposal in municipal Ash from incineration of any bio-medical waste) landfill Category No. 10 Chemical Waste chemical treatment and (Chemicals used in production of biological, discharge into drains for chemicals used in disinfection, as insecticides, liquids and secured landfill etc.) for solids W.H.O REGULATIONS Definition according to W.H.O: Health-care waste includes all the waste generated by health-care establishments, research facilities, and laboratories. In addition, it includesthe waste originating from ‘minor’ or ‘scattered’ sourcessuch as thatproduced in the course of health care undertaken in the home (dialysis,insulin injections, etc.) W.H.O Classification: As per W.H.Othe biomedical wastes could be classified into eight categories on the basis of the type of waste and the risk of transmission of infectious material in them. 8
  • 9. Candidate Number: 1. General waste (domestic) 2. Pathological 3.Radioactive 4. Chemical 5. Infectious 6. Pharmaceutical wastes 7. Sharps 8. Pressurised containers Data Collection and Processing I had visited two different hospitals, in different localities and with different ownerships for my research work. Collecting information and data through interviews, cross-sectional study, and observational study; pertaining to the waste generated by the hospital and its subsequent management and disposal. The two hospitals visited are: 1] P. D. Hinduja National Hospital and Medical Research Centre: private ownership 2] L.T.M.G. Sion Hospital: governmental ownership P. D. Hinduja National Hospital and Medical Research Centre Also popularly known as Hinduja Hospital, is a private hospital located at Mahim in Mumbai, India.The hospital was established in 1951 byParmanandDeepchandHinduja.The hospital is a modern multi-speciality tertiary care hospital 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 in emerging economies (2006). P. D. Hinduja National Hospital has many departments and wards like: 1. Trauma centre 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 9
  • 10. Candidate Number: 14. Pharmacy 15. Etc... Note: Due to time constrain and for sake of comparison only some main target departments have been studied for data. All the waste generated in the hospital is segregated, collected and disposed according to the categories of waste defined by ‘INDIAN BIO-MEDICAL WASTE RULES 1998’. Hence the below mentioned data is in terms of these categories NOTE: the ‘INDIAN BIO-MEDICAL WASTE RULES 1998’ categories have been listed in tabular form earlier in the report. Hence it is advisable to keep in mind the ‘waste categories’ while referring to the data given below.  DATA COLLECTION:Table 1 Wards or Hospital Waste Collected[kg/Bed/week] (03/09/11-09/09/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - - 0.08 0.01 0.08 0.04 0.08 - 0.01 Causality 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 - 0.05 Diagnosti - - 0.46 0.09 0.03 0.04 0.08 0.20 - 0.42 c Labs Radiology - - - 0.02 0.02 0.02 0.03 0.18 - 0.08 Dept. Pharmacy - - - 0.01 0.18 0.02 0.01 0.07 - 0.01 Table 2 Wards or Hospital Waste Collected[kg/Bed/week] (10/09/11-16/09/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - - 0.09 0.01 0.11 0.03 0.14 - 0.02 Causality 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 10
  • 11. Candidate Number: OT area 1.21 - 0.07 0.58 0.02 1.32 0.78 0.73 - 0.09 Diagnostic - - 0.96 0.16 0.08 0.09 0.17 0.38 - 0.93 Labs Radiology - - - 0.08 0.04 0.08 0.05 0.24 - 0.07 Dept. Pharmacy - - - 0.03 0.09 0.01 0.01 0.08 - 0.02 Table 3 Wards or Hospital Waste Collected[kg/Bed/week] (17/09/11-23/09/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - - 0.08 - 0.14 0.04 0.18 - 0.03 Causality 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 OT area 1.29 - 0.09 0.62 0.03 1.38 1.03 0.93 - 0.12 Diagnostic - - 1.03 0.22 0.06 0.08 0.21 0.42 - 0.99 Labs Radiology - - - 0.09 0.03 0.08 0.08 0.29 - 0.07 Dept. Pharmacy - - - 0.03 0.09 - - 0.09 - 0.02 Table 4 Wards or Hospital Waste Collected[kg/Bed/week] (24/09/11-30/09/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - - 0.06 - 0.08 0.02 0.07 - 0.01 Causality 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 - 0.09 11
  • 12. Candidate Number: Diagnostic - - 0.91 0.26 0.07 0.06 0.17 0.36 - 1.00 Labs Radiology - - - 0.07 0.01 0.05 0.05 0.27 - 0.05 Dept. Pharmacy - - - 0.05 0.08 - - 0.07 - 0.01 Data Processing: Table 5 Wards or Total Hospital Waste Collected[kg/bed/month](03/09/11-30/09/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - - 0.31 0.02 0.41 0.13 0.47 - 0.07 Causality 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 - 0.35 Diagnostic - - 3.36 0.60 0.59 0.27 0.63 1.15 - 3.34 Labs Radiology - - - 0.26 0.10 0.23 0.21 0.77 - 0.27 Dept. Pharmacy - - - 0.12 0.44 0.03 0.02 0.31 - 0.06 METHOD OF WASTE DISPOSAL ADOPTED BY HINDUJA HOSPITAL: Colour Coding Waste Category Method of Disposal Adopted by Hospital Yellow Category 1,2,3 &6 Deep burial /Incineration [has in [Human & Animal anatomical waste / house incinerator] Micro-biology waste and soiled 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 etc.] Black Category 5,8,9 &10 Disposal in secured landfill/ [Discarded medicines/cytotoxic drugs, Chemical treatment Incineration ash, Chemical waste.] 12
  • 13. Candidate Number: 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 Hospital LTMGH, (LokmanyaTilak Municipal General Hospital), locally known as "Sion Hospital", is a general municipal hospital situated in Sion, a suburb of Mumbai, India. It was started in 1947 with 10 beds initially, which has 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 graduate studies 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 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 do that so as to make data comparison easier and clearer. Data Collection: 13
  • 14. Candidate Number: Wards or Hospital Waste Collected[kg/Bed/week] (03/10/11-09/10/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - - 0.17 0.03 0.10 0.05 0.14 - - Causality 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 OT area 0.68 - 0.08 0.37 0.03 0.41 0.46 0.37 - 0.08 Diagnostic - - 0.63 0.17 0.08 0.09 0.11 0.25 - 0.36 Labs Radiology - - - 0.04 0.04 0.05 0.05 0.19 - 0.03 Dept. Pharmacy - - - 0.03 0.28 0.03 - 0.04 - - Wards or Hospital Waste Collected[kg/Bed/week] (10/10/11-16/10/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - - 0.23 0.03 0.20 0.07 0.28 - 0.05 Causality 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 - 0.17 Diagnostic - - 1.65 0.46 0.04 0.17 0.19 0.51 - 1.10 Labs Radiology - - - 0.20 0.03 0.08 0.03 0.29 - 0.09 Dept. Pharmacy - - - 0.17 0.17 0.04 0.02 0.05 - 0.02 Wards or Hospital Waste Collected[kg/Bed/week] (17/10/11-23/10/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - 0.06 0.31 0.02 0.28 0.07 0.31 - 0.04 14
  • 15. Candidate Number: Causality 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 - 0.15 Diagnostic - - 1.79 0.55 0.04 0.35 0.24 0.45 - 0.98 Labs Radiology - - - 0.27 0.02 0.17 0.04 0.31 - 0.09 Dept. Pharmacy - - - 0.28 0.19 0.05 0.03 0.04 - 0.03 Wards or Hospital Waste Collected[kg/Bed/week] (24/10/11-30/10/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - - 0.06 - 0.11 0.04 0.27 - 0.01 Causality 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 - 0.10 Diagnostic - - 0.99 0.38 0.07 0.22 0.18 0.35 - 1.01 Labs Radiology - - - 0.13 0.01 0.08 0.05 0.23 - 0.06 Dept. Pharmacy - - - 0.16 0.08 - - 0.05 - 0.02 Data Processing: Wards or Total Hospital Waste Collected[kg/bed/month] (03/09/11-30/09/11) Dept. Category Category Category Category Category Category Category Category Category Category No.1 No.2 No.3 No.4 No.5 No.6 No.7 No.8 No.9 No.10 OPD area - - 15
  • 16. Candidate Number: Causality - - ICU’s - - OT area - - Diagnostic - - Labs Radiology - - Dept. Pharmacy - - METHOD OF WASTE DISPOSAL ADOPTED BY L.T.M.G. SION HOSPITAL: 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 / [Tubing’s, Catheters, IV sets.] Chemical treatment/Collected by BMC and dumped at Deonar Blue/White Category 4 Autoclaving / Microwaving / [Waste sharps like Chemical treatment / Needles, Syringes, Scalpels, blades Shredding/Collected by BMC and etc.] dumped at Deonar Black Category 5,8,9 &10 Chemical treatment/Collected by [Discarded medicines/cytotoxic drugs, BMC and dumped at Deonar Incineration ash, Chemical waste.] 16