Bio Medical Waste Management

PART 2 : SUMMARY OF THE PROJECT

Introduction :

Dr. Sushila Tiwari Memorial Government Hospital, Haldwani is a 640 bedded tertiary care associated teaching hospital of Government Medical College, Haldwani. The Hospital has OPD block, Operation Theatres (OT) Block, Ward Areas, ICCU, NICU, ICU, Blood Bank, Emergency, Teaching Areas in Ward and OPDs, Radiology, Canteen, Laundry, Mess area. The average daily attendance in OPD is approx 1000, Emergency/Casualty is approx 100, and IPD is approx 72 admissions per day with bed occupancy of 86%. On an daily average, approx 70 operative procedures, 250 Radiological investigations and procedures and approx 1800 Laboratory Investigations and procedures are performed. The hospital is supported by the Central Bio-Medical Waste treatment facility at its super Speciality Campus for the disposal of the Bio-Medical waste generated by the hospital. The facility is equipped with Incinerator with 100Kg/hour capacity with proper air pollution control devices and effluent treatment plant, a microwave and a shredder. The hospital is well authorized under stipulated rules by the Uttarakhand Environment Protection and Pollution Control Board, Haldwani.
According to Bio Medical Waste (Management and Handling )Rules 1998 of India "Bio-medical waste" means any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biological, and including categories mentioned in Schedule I". About 75-90% waste generated by the health care facilities (HCF) is Non-Hazardous or Non-Risk and the remaining 10-25% are "Hazardous" or "Risk" waste and may create various healths hazardous. The Hazardous waste generated in the HCF can be categorized as presented in Table.1
Table 1: Healthcare waste categories and description
Waste category Description and examples
Infectious waste Waste suspected of containing pathogens e.g. laboratory cultures, waste from isolation wards, tissues, materials or equipment having been in contact with infected patients, excreta
Pathological waste Human tissue or fluids e.g. body parts, blood and other body fluids, human foetuses
Sharps Sharp waste e.g. needles, infusion sets, scalpels, knives, blades, broken glass, etc.
Pharmaceutical waste Waste containing pharmaceuticals e.g. pharmaceuticals which are expired or no longer needed, items contaminated or containing pharmaceuticals (bottles, boxes)
Genotoxic waste Waste containing substances with genotoxic properties e.g. waste containing cytotoxic drugs (often used in cancer therapy),genotoxic chemicals
Chemical waste

Waste containing discarded chemical substances e.g. laboratory reagents, film developer, disinfectants which are expired or no longer needed, solvents
Wastes with high content of heavy metals e.g batteries, broken thermometers, blood pressure gauges
Pressurized containers e.g. gas cylinders, cartridges and aerosol cans
Radioactive waste Waste containing radioactive substances e.g. unused liquids from radiotherapy or laboratory research, contaminated glassware, packages or absorbent paper, urine and excreta from patients treated or tested with unsealed radio-nuclides

The Bio-Medical Waste (Management & Handling) Rules 1998 of India has categorized the waste into 11 Categories as per the schedule-I of the rules. The categorization is presented in the Table-2.
Table-2 : Categorization as per bio-medical waste regulation
Category Type of waste
1. Human anatomical waste Human tissues, organs, body parts
2. Animal wastes Animal tissues, organs, body parts, carcasses, fluid, blood; experimental animals used in research, waste generated by veterinary hospitals
3. Microbiology and biotechnology wastes Waste from laboratory cultures, stocks or specimens of micro-organisms, live or attenuated vaccines, human and animal cell cultures used in research, infectious agents from research and industrial laboratories, from production of biological wastes, toxins, dishes and devices used to transfer of cultures
4. Waste sharps Needles, syringes, scalpels, blades, glass, etc., capable of causing punctures and cuts. This includes both used and unused sharps
5. Discarded medicines and
6. cytotoxic drugs Waste comprising outdated, contaminated and discarded drugs and medicines
7. Soiled wastes Items contaminated with blood fluids including cotton, dressings, soiled plaster casts, linens, bedding
8. Solid wastes Disposable items other than the waste sharps, such as tubing, catheters, IV sets etc.
9. Liquid wastes Waste generated from laboratories, washing, cleaning, house-keeping and disinfection activities
10. Incineration ash Ash from incineration of any medical wastes
11. Chemical wastes Chemicals used in production of biological, disinfection, insecticides The distribution of the Health Care Waste (HCW) in India comprises 80% of the general waste includes (food waste, sweeping from hospital premises, paper, wrappers etc.) 15% of pathological & Infectious waste, 1% Sharps waste, 3% Chemical & pharmacological waste and 1% special waste viz. waste from oncology centre, mercury spillage etc.
The objectives of the study:
1. To study the present status of the Bio-Medical Waste Management in Dr.Sushila Tiwari Memorial Government hospital, Haldwani.
2. Impact of Mismanaged Bio-medical Waste to the Hospital personnel's and general public.
3. Interventions and suggestive measures.
Study design:
A case study research based study shall be conducted at Bio-Medical waste generation sites of Dr.Sushila Tiwari Memorial Government Hospital Haldwani. The thrust area for the study is focused on the present status of the Bio-medical Waste Management in the Hospital. Literature review shall be conducted to assist in targeting and formulating the questions and Knowledge enhancement. The information shall be collected from all the points of generation of Bio-Medical Waste on the following characteristics: - Availability and number of Bins for the collection of the generated waste, availability of Needle and Syringe destroyers, availability of the local disinfectants, no. of beds, quantity of the waste generated, awareness regarding the rules among the staff, implementation of the guidelines under Bio-Medical Waste (Management and Handling) Rules 1998 of India, Transportation of the waste from generation site to the disposal site, Equipments available for the final disposal of the waste, conformity to the rules at the central bio-Medical waste treatment Facility (CBWTF).

PROJECT SYNOPSIS
PART 3: TECHNICAL DETAILS

1. Introduction

Origin of the proposal:

Bio-Medical waste management in the health care facilities (HCF) is a very important aspect with respect to the quality of services and environmental concern. As by the Bio-Medical Waste (Management & Handling) rules 1998 of India it is the responsibility of all the HCFs to implement the scientific disposal of the waste as per the guidelines issued under the rules. So far, no concrete study reports are available regarding the status of the Bio-Medical waste management in this hospital. If the status of the bio-Medical Waste is known, attempts to enhance the existing system and to prevent the further replication of the non-preferred practises

Science and Technology components of the project:

If the present status of the Bio-medical Waste is known from our case study – impact assessment, training requirements, compliance assessment, and model study can be conducted in next studies. Therefore, it is proposed to study the Bio-Medical Waste management process in Dr.Sushila Tiwari Memorial Government Hospital, Haldwani.

Importance of the proposal with reference to Bio-Medical Waste management process in Dr.Sushila Tiwari Memorial Government Hospital, Haldwani

a. Inventorization of the waste generation and facilities available for the proper disposal of the Bio-Medical Waste.
b. Identification of the gaps in the proper Bio-Medical Waste Management from generation to the final disposal of the waste.
c. Suggestive measures to overcome the gaps.

2. Work Plan:

Study Set up
The study shall be conducted in the Dr. Sushila Tiwari Memorial Govt. Hospital, Haldwani.

Methods of analysis and conclusion
Data shall be entered in a database program. Appropriate descriptive and analytical statistics shall be used for analysis.