Hospital waste management By Dr Nikhil Bansal

1. Hospital Waste Management
Team & Operation

2. The Team
• The medical officer in-charge will be the overall
supervisor of the waste management
programme,& composes his team as follows-
⁻ Team Leader
-Waste Management coordinator ( Medical
officer I/c of the hospital)
⁻ Members
o The second M.O.
o Senior Staff Nurse
o FDA
o SDA
o Senior Group ‘D’ Worker
o Low level Group ‘D’ Worker

3. Hospital Waste Management Structure
Head of
Hospital
Head Of
Depts. , Advisers on
House infection
Keeping, control
Admi
Waste
management
officer
Matron &
Support Staff Senior Staff
Hospital
Attendents &
ancillary
workers

4. Workers Health Safety
• The production, segregation, transportation,
treatment and disposal of health care waste
involve the handling of potentially hazardous
material.
• Protection against personal injury is therefore
essential for all workers who are at risk.

5. Protective clothing
• Helmets
• Face masks
• Eye protectors
• Industrial aprons
• Leg protectors
• Disposable gloves
• Coveralls

6. Personal hygiene
• For reducing the risks from handling health care
waste.
• Convenient washing facilities should be available.
IMMUNIZATION
• Viral hepatitis B & tetanus immunization is
commonly recommended.

8. Cytotoxic safety
• Written procedures that specify safe working
methods for each process.
• Data sheets based on suppliers specifications, to
provide information on potential hazards.
• Established procedures for emergency response
in case of spillage or other occupational accident.
• Appropriate education and training for all
personnel involved in the handling of cytotoxic
drugs.

9. Training & Supervision
• All health care establishments should have written
policies on waste handling procedures
• The people responsible for implementing these policies
should be clearly identified.
• The waste handling procedure should be made known
& readily available to all personnel concerned, not only
those at the senior level.
• Basic training in waste handling procedure should be
given to all new personnel in service. Training for all
personnel should form part of a training programme.

10. The Basic content of training programmes should
include information on
• The hazards of health care waste.
• The methids of preventing the transmission of
nosocomial infections related to waste handling.
• The safety procedures for dealing with chemical,
pharmaceutiocal & radioactive waste & sharps
• Proper waste segregation, handling packaging,
transport & disposal.

11. In case of emergency
• Action & notification to supervisiors in case of accident.
• These programmes should be periodically reviewed &
updated as necessary
• Good supervision is essential for the maintenance of
efficient & safe waste handling operations.
• The selection and training of supervisory personnel plays a
fundamental role in IN-House Waste Management
• Information on health care waste management policy &
methods should also given to support staff, maintenance
personnel from external organization, such as transport
firms, who may be involved in handling the waste

12. Effects of 'improper hospital waste
management
• Collection, reuse or resale of the single-use
products without adequate treatment results
in spread of infection
• Infections to waste handlers, especially the rag
pickers & pourakarmikaas
• Improper burning or sub standard incineration
of these plastics release dioxins and furans
which are carcinogenic in nature
• Improper landfilling or dumping them results
in leaching & contamination of soil &
surronding water bodies.

13. IMPROPER HOSPITAL WASTE MANAGEMENT ARE DUE TO :
• Improper handling; Unsafe actions: handling
without personal protective equipment (PPE),
• Poor storage (e.g. high temperature conditions
combined with prolonged storage time before
treatment),
• Manual Transportation for longer distances.
• Use of uncovered containers instead of closed
plastic bags
• Exposure times beyond acceptable limits and
• Lack of adequate worker and equipment
decontamination process/procedures

14. Legislative Framework
• The Gov of India put forward a legislation on
20th July 1998 under section 6 ,8 ,25 of the
Environment protection Act, 1986.
• The rule defines Adminstrative Medical Officer
of Health Care facilities as Biomedical Waste
generators & fix responsibilities on them for
developing an effective waste disposal
mechanism for the waste they generate

15. • The rule spells out Treatment & disposal options
for various categories of Bio- medical waste
• The standards for various treatment and disposal
technologies have been stipulated
• The rules have also fixed time scale for
implementation & disposal technology
• At State level the State Pollution Control Board is
the regulatory body, which monitors the proper
implementation of the rules.

16. Summary of Bio-Medical rules
• The rules apply to all persons who generate, collect,
receive, store, transport, treat, dispose & handle bio –
medical waste in any form
• The defination of Biomedical waste
• Facilty for treatment is one which is authorized by
prescribed authority to deal with all aspects of bio-
medical wastes
• Every ‘Generator/Occupier’ has a responsibility to take
steps to ensure proper waste disposal without any
adverse effect on human health & enviorment
• Bio medical waste shall be segregated, at source,
collected in color coded containers & transported for
treatment & disposal within 48 hrs of its generation

17. Type of Waste Color of the box Categories involved Type of Container
Human anatomical Cat 1, Cat 2, Plastic bag
waste, animal waste,
microbiology and Cat 3 & Cat 6
biotech. waste & soiled Yellow
waste
Microbial and biotech Cat 3, Cat 6 & Disinfected
waste & solid waste Red Cat 7 container/plastic
bag
Waste Sharps Cat 4, Cat 7 Plastic bag
White /Puncture proof
container
Discarded medicines Cat 5, Cat 9 & Plastic bag
and cytotoxic drugs, Black
incinerator ash & Cat 10 (solid)
chemical waste

18. • Cytotoxic waste should be collected
in strong leak proof containers clearly
marked “CYTOTOXIC WASTES ”
• Heavy metal waste collected
separately
• Staff instructions Should be adequate
& followable

19. Collapsible
Cardboard
Sharps
Container

20. The Persisting Problem
• Lack of segregation practices, mixing of hospital wastes
with general waste makes whole waste stream hazardous;
• Mushrooming of clinics often unregistered aggravating the
problem; (typical Indian problem). How to cover them in
the existing legislation.
• Open burning by clinics, dispensaries & some hospitals;
• Incinerators are old and poorly maintained;
• Poor legislative measures/standards, poor implementation;
• Public ignorance of the law
• Informal sectors largely involved in recycling and reusing
medical waste items.

21. The Ray Of Hope
The Scope of improvement
• source reduction has higher potential to be implemented in health care
waste management.
• Benefits of source reduction:
Resources conservation;
Reduction of collection, transportation, and disposal costs;
Decreased pollution control liability, Reduce Regulatory & compliance costs
• Segregation and handling of generated waste
Segregation reduces the volume & toxicity of waste stream;
Proper procurement practices such changing the products & materials can
help to reduce the harm (Hg based thermometer can be substituted by
electronic sensing devices)
Increasing awareness of hospital staffs, employee training in hazardous
materials management and waste minimization