Healthcare waste is such waste which is generated from healthcare facilities, natal care, treatment centers of human and animals. It mainly includes different types of wastes such as sharps, infected syringes, animal and human tissues, drugs and medicines. There are different health risks associated with each type of waste so their management is necessary.
Healthcare waste is of several types and its exposure to public, nurses, cleanliness staff, patients and paramedical staff is from several routes like inhalation, ingestion and skin contact. Once it gets entry into environment it causes several health impacts which may lead to death. There are guidelines and treatment systems in Pakistan for the treatment of healthcare waste but since there is no system of check and balance so condition is worse here. Most of the diseases are caused from the exposure to different types of healthcare waste. So there is need to treat this waste according to WHO guidelines before its final disposal into environment.
Government and associated departments should step in to control the situation. There is serious need of handling of waste specially sharps and syringes, pathological waste and infectious waste.
Hospitals, which are major part of healthcare waste, must be charged if they don’t handle waste properly.
Workers should be given trainings for the awareness of health hazardous of healthcare waste.
There should be strict rules and regulations for the use of protective equipment such as gloves and masks and special dress for the collection and disposal of waste.
Above all, there should be proper system for the segregation, collection, storage and transportation of waste.
Storage area must be separate and away from healthcare facility so that it cannot affect health of workers.
The health care waste management plan of Trishuli Hospital was prepared by two program officers from Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ) GmbH
Assessment of hospital waste management constraints and related environmental...faysalgcuf
Hospital waste is one of the biggest problems in developing countries as most of the generated waste is directly dumped along the municipal waste or burnt openly, thus polluting the environment. Unfortunately, scarce data is available on the amounts, characteristics and management of the various types of wastes that are continuously generated by healthcare units in Pakistan. In this study, primary data was collected through comprehensive surveys, including questionnaire form, personal observations, formal and informal meetings while secondary data was collected from hospital's records. Average waste generation rate was 1.12 kg day-1 bed-1 and nearly one sweeper for seven beds. The studied hospitals generate approximately 2.9 tons waste day-1 which contain 12% infectious waste. Heavy metal analysis of incinerator ash reveals that the Zn and Pb were high among other metals. The present study showed that hospitals in district Faisalabad do not have any effective hospital waste management policy.
Healthcare waste is such waste which is generated from healthcare facilities, natal care, treatment centers of human and animals. It mainly includes different types of wastes such as sharps, infected syringes, animal and human tissues, drugs and medicines. There are different health risks associated with each type of waste so their management is necessary.
Healthcare waste is of several types and its exposure to public, nurses, cleanliness staff, patients and paramedical staff is from several routes like inhalation, ingestion and skin contact. Once it gets entry into environment it causes several health impacts which may lead to death. There are guidelines and treatment systems in Pakistan for the treatment of healthcare waste but since there is no system of check and balance so condition is worse here. Most of the diseases are caused from the exposure to different types of healthcare waste. So there is need to treat this waste according to WHO guidelines before its final disposal into environment.
Government and associated departments should step in to control the situation. There is serious need of handling of waste specially sharps and syringes, pathological waste and infectious waste.
Hospitals, which are major part of healthcare waste, must be charged if they don’t handle waste properly.
Workers should be given trainings for the awareness of health hazardous of healthcare waste.
There should be strict rules and regulations for the use of protective equipment such as gloves and masks and special dress for the collection and disposal of waste.
Above all, there should be proper system for the segregation, collection, storage and transportation of waste.
Storage area must be separate and away from healthcare facility so that it cannot affect health of workers.
The health care waste management plan of Trishuli Hospital was prepared by two program officers from Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ) GmbH
Assessment of hospital waste management constraints and related environmental...faysalgcuf
Hospital waste is one of the biggest problems in developing countries as most of the generated waste is directly dumped along the municipal waste or burnt openly, thus polluting the environment. Unfortunately, scarce data is available on the amounts, characteristics and management of the various types of wastes that are continuously generated by healthcare units in Pakistan. In this study, primary data was collected through comprehensive surveys, including questionnaire form, personal observations, formal and informal meetings while secondary data was collected from hospital's records. Average waste generation rate was 1.12 kg day-1 bed-1 and nearly one sweeper for seven beds. The studied hospitals generate approximately 2.9 tons waste day-1 which contain 12% infectious waste. Heavy metal analysis of incinerator ash reveals that the Zn and Pb were high among other metals. The present study showed that hospitals in district Faisalabad do not have any effective hospital waste management policy.
-Bio-Medical Waste
-Contents:
-Evolution of Bio-Medical Waste in India
-Biomedical Waste
-Need of Rules for Bio-Medical Waste
-Present Scenario in India
-Disease Caused by Improper Disposal of Waste
-BMW(H&M) 1998
-Major Differences between BMW 1998 and BMW 2016
-BMW (H&M) 2016
-Conclusion
Evolution of Bio-Medical Waste Management Rules in India:
-First Bio-Medical Rules were notified by the Govt. of India, erstwhile
MOEF on 20th July 1998.
-Modification in the next following years (2000, 2003 and 2011)
-BMW rules 2011 remained as the draft
-MOEFCC in March 2016 has amended the BMWM rules.
-BMW Management 2016 was released on 27 March 2016
Bio-Medical Waste:
means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals
or research activities pertaining thereto
or in the production or testing of biological or in health camps, including the categories mentioned in Schedule I appended to these rules;
Biomedical waste management and biohazards by Dr. Sonam AggarwalDr. Sonam Aggarwal
According to biomedical waste (management and Handling rules 1998 of India) –
"bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps.
https://www.slideshare.net/SonamAggarwal7/biomedical-waste-management-and-biohazards-by-dr-sonam-aggarwal
Disposal of medical waste the role of citizens - the legal issuesRuby Med Plus
Bio-Medical Wastes are characteristically heterogeneous in nature and include infectious or ‘‘red bag’ wastes (e. g., pathological wastes, human blood and blood products, contaminated sharps and anatomical wastes, isolation wastes), hazardous waste (including radioactive waste, pharmaceuticals waste, cytotoxic waste i.e., agents used in chemotherapy, chemical waste, liquid infectious waste, mercury or other heavy metals, ), and any other general wastes (e. g., office paper, food waste, non-infectious patient waste). The Bio-Medical waste like body parts, organs, tissues, blood and body fluids along with soiled linen, cotton, bandage and plaster casts from infected and contaminated areas are very essential to be properly collected, segregated, stored, transported, treated and disposed of in safe manner to prevent nosocomial or Hospital Acquired Infection (HAI).
India is likely to generate about 775.5 tons of medical wast per day by 2020, from the current level of 550.9 tons per day growing at CAGR about 7%.
Safe and effective management of waste is not only a legal necessity but also a social responsibility.
These kinds of topics give more information and awareness of medical history. Getting acquainted with these kinds of topics and information makes us more responsible.
The greenhouse effect is a process that occurs when gases in Earth's atmosphere trap the Sun's heat to make the earth surface warmer leading to global warming.
Smog is a kind of intense air pollution, originally named for the mixture of smoke and fog in the air. Major cities around the world are experiencing the effects of air pollution.
Acid rain or Acid deposition penetrates deeply into the sensitive fabric of ecosystem, thereby changing the chemistry of air, water, and soil and has huge impact
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
1. Prof. (Dr.) Prashant Mehta
M.Sc, Ph.D. (Chemistry), MBA, Ph.D. (Management)
National Law University, Jodhpur
Healthcare Waste
An Environmental Concern of Escalating Magnitude
5. Regulatory Framework: India
Environmental Protection Rules, 1986 - This regulations were drawn up by the government under the powers
conferred on it in terms of the Environment Protection Act, 1986.
1. The Municipal Solid Wastes (Management and Handling) Rules 1999
2. The Hazardous Waste (Management and Handling) Rules, 1989
3. The Plastics (Manufacture, Usage and Waste Management Rules), 2009
4. The E-Waste (Management and Handling Rules), 2010
5. National Rural Health Mission (NRHM) under Ministry of Health and Family Welfare, in 2007 developed and
adopted an Infection Management Environment Plan (IMEP) which outlines a comprehensive framework for
implementation of infection control measures and effective healthcare waste management generated by
healthcare facilities.
6. The issue of Bio-Medical Waste Management (BMWM) in India has attracted the attention of the highest judicial
body at the level of Supreme Court of India.
7. It has issued instructions regarding management of Bio-Medical Waste and Government of India was one of the
first countries to frame and implement Bio-Medical Waste Management and Handling Rules, 1998 (later
amended in 2000 and 2003) in the exercise of power conferred by Sections 6, 8, and 25 of the Environment
(Protection) Act, 1986.
6. Bio-Medical Waste Management and Handling Rules
• Definition of biomedical waste - Any waste that is generated during the diagnosis, treatment, or immunization of human beings or animals, or in research activities
pertaining to or in the production or testing of biologicals.
• Application of the Biomedical Waste Rules - The rules apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle BMW’s in any form.
• Duty of occupier (operator) - of a healthcare facility (hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank
etc) to ensure that BMWs are handled without any adverse effect to human health and the environment, and according to the prescribed treatment and disposal
requirements as per the Biomedical Waste Rules.
• Prescribed authority - State Pollution Control Boards (SPCBs) in States and Pollution Control Committees in territories are responsible for permitting and enforcing the
requirements of the Biomedical Waste Rules.
• Permit - Each occupier (operator) handling BMW’s and providing services to 1,000 or more patients per month is required to obtain a permit from the prescribed
authority.
• Recordkeeping - Each occupier (operator) is required to maintain records on the generation, collection, reception, storage, transportation, treatment, and disposal of
BMWs. All records are subject to inspection and verification by the prescribed authority at any time.
• Accident reporting - Each occupier (operator) is required to report any accident related to the management of BMW’s.
• Annual reporting - Each occupier is required to submit an annual report to the prescribed authority to provide information about categories and amounts of wastes
generated and treated, and modes of treatment used.
• Common disposal/ Incineration sites - Local public entities are required to provide common disposal / incineration sites, and the occupiers (operators) of such sites are
required to comply with the Biomedical Waste Rules.
• Segregation, Packaging, Transportation, and Storage - BMWs are not to be mixed with other waste. According to the Rules, BMWs are to be segregated into labelled
bags/containers. Transportation of BMWs is to be conducted in authorized vehicles. No untreated waste is to be stored more than 48 hours, unless special permission is
obtained from the regulatory authorities.
• Standards - Technology and discharge standards for incineration, autoclaving, microwaving, liquid waste discharges, and deep burial are prescribed in the Biomedical
Waste Rules.
7. Categories and Segregation of Bio-Medical Waste
S. No. Bio-Medical Waste Categories Container Colour Treatment and Disposal
1. Human anatomical waste Yellow Incineration / Deep Burial
2. Animal Waste Yellow Incineration / Deep Burial
3. Microbiology and biotechnology waste (infectious
wastes from laboratory)
Yellow / Red Incineration / Autoclaving / Microwaving
4. Waste sharps (for example, needles, syringe,
scalpels)
Blue / White /
Translucent
Disinfection / Mutilation / Autoclaving / Microwaving
5. Discarded medicines and cytotoxic drugs Black Incineration/Destruction and Secure Landfilling
6. Soiled waste (items contaminated with blood or
body fluids such as cotton dressings, beddings)
Yellow / Red Incineration / Autoclaving / Microwaving
7. Solid waste (for example, tubing, catheters,
intravenous sets)
Blue / White /
Translucent / Red
Disinfection by chemical treatment / Autoclaving / Microwaving
8. Liquid waste (from laboratory, washing, cleaning,
housekeeping, disinfecting)
- Disinfection by chemical treatment and discharge into drains
9. Incineration ash Black Municipal Landfilling
10. Chemical wastes Black Chemical treatment and discharge into drains for liquids, and
secured landfills for solids.
8. BMW Categories Draft - 2011 Amendments
BMWM RULES - 2011 BMWM RULES - 1998
Every occupier generating BMW, irrespective of the quantum of wastes
comes under the BMW Rules and requires to obtain authorization.
Occupiers with more than 1000 beds required to obtain authorization.
Duties of the Operator are clearly listed Duties of Operator were absent
Categories of Biomedical Waste reduced to Eight. Category No. 8
(containing liquid waste generated from laboratory, cleaning, washing,
and disinfection activities) and Category No. 9 (containing incineration
ash) have been discarded.
Biomedical waste was divided in ten categories
Treatment and disposal of BMW made mandatory for all the Healthcare
Establishments.
Treatment and disposal of BMW made mandatory for all the Healthcare
Establishments with more than 1000 beds.
A format for annual report is appended with the Rules. Accident reporting
has been made mandatory.
There was no format for Annual Report
Form VI i.e. the report of the operator on HCEs not handing over the BMW
added to the Rules. It empowers the operator of CBMWTF to report
against the HCEs who are not carrying out proper segregation of their
wastes.
Form VI absent
9. Healthcare Waste and Examples
Types of Healthcare Wastes Examples
Communal or General healthcare waste (solid
wastes that are not infectious, chemical, or
radioactive)
Infectious waste (wastes suspected of
containing pathogens)
Anatomical waste
Sharps
Pharmaceutical waste
Genotoxic waste
Chemical waste
Heavy metal waste
Pressurized containers
Radioactive waste
Cardboard boxes, paper, food waste, plastic and glass bottles
Cultures, tissues, dressings, swabs, and other blood-soaked items; waste from isolation wards
Recognizable body parts, amputated organs, placenta, aborted foetuses
Needles, scalpels, knives, blades, broken glass
Expired or no longer needed medicines or pharmaceuticals
Wastes containing genotoxic drugs and chemicals (used in cancer therapy)
Laboratory reagents, film developer, solvents, expired or no longer needed disinfectants, and
organic chemical wastes (for example, formaldehyde, phenol-based cleaning solutions)
Batteries, broken thermometers, blood pressure gauges
Aerosol cans, gas cylinders (that is, anaesthetic gases such as nitrous oxide, halothane, enflurane,
and ethylene oxide; oxygen, compressed air)
Unused liquids from radiotherapy; waste materials from patients treated or tested with unsealed
radionuclides
10. Problems With Healthcare Wastes
• According to the Ministry of Environment and Forests (MoEF) gross generation of bio-medical wastes in India is
4,05,702 kg/day of which only 2,91983 kg/day is disposed, which means that almost 28 percent of the bio-
medical and hospital waste is left untreated and not disposed off.
• Extrapolating from past figures of number of beds and average quantity of waste generation at the rate of 1 to
1.5 kg per bed per day, it is estimated that about 0.33 million tonnes of hospital waste is being generated per
year which is far less than waste generated by other developed countries.
• Almost 53.25 percent of healthcare establishments are in operations without the adequate authorization from
State Pollution Control Board (SPCB), and the waste generated from such facilities goes unaccounted / untreated
and is dumped without any treatment illegally.
• The waste generated by healthcare establishments by the process of rendering healthcare services, can be
hazardous, toxic, and even lethal due to the presence of pathogens in sufficient concentration or quantity that
could result in rapid proliferation, transmission, and spreading of infectious, dangerous and fatal communicable
diseases such as Hepatitis, HIV/AIDS, Cancer, and other blood borne diseases.
• During incineration, in most cases there is no proper filtering of emitted flue gases which pollutes the air causing
illnesses to the nearby populations. Therefore institutionalizing effective healthcare waste management systems
in all healthcare facilities is a key prerequisite to improving efficiency and effectiveness of healthcare of people.
11. Genotoxic Wastes
Genotoxic waste is highly hazardous and may have mutagenic, teratogenic, or carcinogenic properties.
It raises serious safety problems, both inside hospitals and after disposal, and should be given special attention.
Genotoxic waste may include certain cytostatic drugs (see below), vomit, urine, or faeces from patients treated
with cytostatic drugs, chemicals, and radioactive material.
Cytotoxic (or antineoplastic) drugs, the principal substances in this category, have the ability to kill or stop the
growth of certain living cells and are used in chemotherapy of cancer. They play an important role in the therapy
of various neo-plastic conditions but are also finding wider application as immunosuppressive agents in organ
transplantation and in treating various diseases with an immunological basis.
Cytotoxic drugs are most often used in specialized departments such as oncology and radiotherapy units, whose
main role is cancer treatment; however, their use in other hospital departments is increasing and they may also
be used outside the hospital setting.
12. Most Common Genotoxic Wastes
Classified as carcinogenic
Chemicals: benzene
Cytotoxic and other drugs: azathioprine, chlorambucil, chlornaphazine, ciclosporin, cyclophosphamide, melphalan,
semustine, tamoxifen, thiotepa, treosulfan
Radioactive substances: (radioactive substances are treated as a separate category in this handbook)
Classified as possibly or probably carcinogenic
Cytotoxic and other drugs: azacitidine, bleomycin, carmustine, chloramphenicol, chlorozotocin, cisplatin, dacarbazine,
daunorubicin, dihydroxymethylfuratrizine (e.g. Panfuran S—no longer in use), doxorubicin, lomustine, methylthiouracil,
metronidazole, mitomycin, nafenopin, niridazole, oxazepam, phenacetin, phenobarbital, phenytoin, procarbazine
hydrochloride, progesterone, sarcolysin, streptozocin, trichlormethine a
Classified by working groups of the International Agency for Research on Cancer (IARC).
13. Categories of Harmful Cytotoxic Drugs
• Alkylating agents: cause alkylation of DNA nucleotides, which leads to cross-linking and miscoding of the genetic stock;
• Antimetabolites: inhibit the biosynthesis of nucleic acids in the cell;
• Mitotic inhibitors: prevent cell replication. Cytotoxic wastes are generated from several sources and can include the
following:
• Contaminated materials from drug preparation and administration, such as syringes, needles, gauges, vials, packaging;
• Outdated drugs, excess (leftover) solutions, drugs returned from the wards;
• Urine, faeces, and vomit from patients, which may contain potentially hazardous amounts of the administered
cytostatic drugs or of their metabolites and which should be considered genotoxic for at least 48 hours and sometimes
up to 1 week after drug administration. In specialized oncological hospitals, genotoxic waste (containing cytostatic or
radioactive substances) may constitute as much as 1% of the total healthcare wastes.
14. Chemical Wastes
• Formaldehyde is a significant source of chemical waste in hospitals. It is used to clean and disinfect equipment (e.g.
haemodialysis or surgical equipment), to preserve specimens, to disinfect liquid infectious waste, and in pathology,
autopsy, dialysis, embalming, and nursing units.
• Photographic chemicals Photographic fixing and developing solutions are used in X-ray departments. The fixer usually
contains 5–10% hydroquinone, 1–5% potassium hydroxide, and less than 1% silver. The developer contains
approximately 45% glutaraldehyde. Acetic acid is used in both stop baths and fixer solutions.
• Solvents Wastes containing solvents are generated in various departments of a hospital, including pathology and
histology laboratories, and engineering departments. Solvents used in hospitals include halogenated compounds, such
as methylene chloride, chloroform, trichloroethylene, and refrigerants, and non-halogenated compounds such as
xylene, methanol, acetone, isopropanol, toluene, ethyl acetate, and acetonitrile.
• Organic chemicals Waste generated in health-care facilities include: • disinfecting and cleaning solutions such as
phenol-based chemicals used for scrubbing floors, perchlorethylene used in workshops and laundries; • oils such as
vacuum-pump oils, used engine oil from vehicles (particularly if there is a vehicle service station on the hospital
premises); • insecticides, rodenticides.
• Inorganic chemicals Waste inorganic chemicals consist mainly of acids and alkalis (e.g. sulfuric, hydrochloric, nitric, and
chromic acids, sodium hydroxide and ammonia solutions). They also include oxidants, such as potassium permanganate
(KMnO4) and potassium dichromate (K2Cr2O7), and reducing agents, such as sodium bisulfite (NaHSO3) and sodium
sulfite (Na2SO3).
15. Wastes with High Content of Heavy Metals
• Wastes with a high heavy-metal content represent a subcategory of hazardous chemical waste, and are usually
highly toxic.
• Mercury wastes are typically generated by spillage from broken clinical equipment but their volume is
decreasing with the substitution of solid-state electronic sensing instruments (thermometers, blood-pressure
gauges, etc.).
• Whenever possible, spilled drops of mercury should be recovered. Residues from dentistry have a high mercury
content.
• Cadmium waste comes mainly from discarded batteries. Certain “reinforced wood panels” containing lead are
still used in radiation proofing of X-ray and diagnostic departments.
• A number of drugs contain arsenic, but these are treated here as pharmaceutical waste.
16. Pressurized Containers
• Anaesthetic Gases: nitrous oxide, volatile halogenated hydrocarbons (such as halothane, isoflurane, and
enflurane), which have largely replaced ether and chloroform. Applications in hospital operating theatres, during
childbirth in maternity hospitals, in ambulances, in general hospital wards during painful procedures, in
dentistry, for sedation, etc.
• Ethylene oxide: Applications for sterilization of surgical equipment and medical devices, in central supply areas,
and, at times, in operating rooms.
• Oxygen stored in bulk tank or cylinders, in gaseous or liquid form, or supplied by central piping. Application
inhalation supply for patients.
• Compressed Air: Applications in laboratory work, inhalation therapy equipment, maintenance equipment, and
environmental control systems.
17. Radioactive Wastes
• Radioactive waste includes solid, liquid, and gaseous materials contaminated with radionuclides. It is produced
as a result of procedures such as in-vitro analysis of body tissue and fluid, in-vivo organ imaging and tumour
localization, and various investigative and therapeutic practices.
• Radionuclides used in healthcare have unsealed sources that are usually liquids that are applied directly and not
encapsulated during use; sealed sources are radioactive substances contained in parts of equipment or
apparatus or encapsulated in unbreakable or impervious objects such as “seeds” or needles.
• The waste produced by health-care and research activities involving radionuclides, and related activities such as
equipment maintenance, storage, etc., can be classified as follows: • sealed sources; • spent radionuclide
generators; • low-level solid waste, e.g. absorbent paper, swabs, glassware, syringes, vials; • residues from
shipments of radioactive material and unwanted solutions of radionuclides intended for diagnostic or
therapeutic use; • liquid immiscible with water, such as liquid scintillation-counting residues used in
radioimmunoassay, and contaminated pump oil; • waste from spills and from decontamination of radioactive
spills; • excreta from patients treated or tested with unsealed radionuclides; • low-level liquid waste, e.g. from
washing apparatus; • gases and exhausts from stores and fume cupboards.
18. Major Challenges
• Indian healthcare establishments have pitiable operational strategies, absence of documented
waste management and disposal policy, very poor budgetary support in the government run
hospitals, private hospitals ignore the rules for monetary consideration, untrained ward attendants,
and other supporting staff.
• There are no waste management committees at present in Indian hospitals which should essentially
be consist of the head of the establishment, all the departmental heads, hospital superintendents,
nursing superintendents, hospital engineers with a waste management officer along with an
environmental control advisor and an infection control advisor.
• Insufficient support and guidance from regulatory agencies further complicates the problem of
waste management. Regulations in the form of waste reduction and recycling targets, carbon credit
earnings, development of minimum energy efficiency standards for equipments are necessary for
prevention of pollution and reduction of environmental load on sustained basis.
• Adequate and requisite number of sanitary landfills is lacking in India.
• Resistance to change is often a barrier to implementation of new waste management programmes.
19. Waste Exposure Risk
• Until recent times, healthcare waste in India was not segregated before disposal to the dump site or incinerator.
• Infectious wastes containing potentially harmful micro-organisms can also infect hospital patients, healthcare
employees, and visitors to patients and rag pickers mostly women and children from the lowest socio-economic
strata, awareness of health risks in general is poor. .
• As a result many of them contract diseases from used needles, syringes, and other sharps present risks of injury
and infection (for example, hepatitis B and C, and HIV), other infected bio-medical waste.
• WHO predicts that India is on the verge of having an HIV epidemic. Tuberculosis (TB) and HIV combined together
is taking great toll on the human health and life. Hepatitis B and C infections are on the rise. Mortality due to
Hepatitis C has gone up significantly.
• Management of healthcare waste is very important for controlling diseases.
20. Conclusions: Waste Related
• Waste hierarchy as well as rules are not framed for all kinds categories of waste and Waste management efforts
in India are not directed by a clear-cut policy.
• Medical wastes should be classified according to their source, typology, and risk factors associated with its
handling, storage, and ultimate disposal.
• The segregation of waste at source is the key step. Reduction, reuse, and recycling should be considered in
proper perspectives.
• MoEF / Pollution Control Boards / States do not have a complete data about all the various kinds of waste being
generated in India, risks associated to health /environment, and instances of the polluter being held responsible
for unsafe disposal were very few.
• Absence of adequate funds and trained manpower for waste management and handling activities, weak
compliance to laws, ineffective monitoring, and absence of a single body taking ownership of waste issues in
India is burgeoning challenge.
• The challenge before us is to scientifically manage growing quantities of bio-medical waste that is untreated, if
we really want to protect our environment and provide better health for community.
21. Summary
The toxicity of anticancer chemotherapy has been well known since its initial clinical use. Indeed, it has often
been these drugs' toxic side effects that have limited their therapeutic value. The risk-benefit equation for a
cancer patient often determines these drugs' appropriate use despite acknowledged side effects. Although
these drugs present the same potential toxicities to exposed healthcare workers, that risk-benefit ratio is
altered.
A balance must be achieved to continue the use of these beneficial drugs in patients, while assuring the health
of personnel administering them.
A body of guidance now exists on how to achieve this goal. Much of the new guidance revisits the long standing
elements of a comprehensive safe handling program and reminds us that the risk remains and our vigilance is
required, but that a harmonized safe handling approach has been adopted that assures minimal risk to workers
who provide lifesaving therapies to their patients.
Editor's Notes
My presentation is structured on three themes namely - Emerging Prospects – Challenging Problems - Waste Trail in Indian Healthcare
Now I come to third section of my presentation: Bio-Medical / Hospital Waste
Healthcare Waste is Classified as follows
There is direct co-relation between population density and bio-waste generation reflected in this slide