1. ESS Extended Essay
Topic: Bio-medical waste management
Research question:
To compare the bio-medical waste management practices at private hospital to that of
government hospital in a metropolitan city in India.
2. Abstract
Hospital is a place of almighty, a place to serve the patient. Since beginning, the hospitals 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, HIV and H1N1 flue, increasing land and water
pollution all these and other factors lead to increasing possibility of catching many diseases. Air
pollution due to emission of hazardous gases by incinerator such as Furan, Dioxin and 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, ultimately WHO and the Central Government had to intervene for enforcing proper
handling and disposal of hospital waste.
Hospital waste is a very broad category to be studied and analysed in this short period of time
along with the word restrictions posed by the IBO for the extended essay. Hence I have taken a small
portion of this broad topic i.e. Bio-Medical waste. Bio-Medical waste is basically that component of
hospital waste that is hazards to the environment which also does include humans. In hospital it usually
comprises of 15% of total hospital waste. There for my research question is ‘to compare the Bio-
Medical waste management practices at private hospital to that of government hospital in a
metropolitan city in India’.
Word Count: 298
3. Table of contents
1. Abstract
2. Research Question
3. Aim
4. Hypothesis
5. Variables
6. Introduction:
a. What is Bio-Medical waste?
b. Rationale of hospital waste management
7. Steps for Bio-Medical waste management
a. Segregation of waste
b. Collection of Bio-Medical waste
c. Transportation
d. Treatment of bio-medical waste
8. Why is treatment of Bio-Medical waste necessary?
9. Safety measures
10. Measures for waste minimization
11. W.H.O Waste Management Regulations
12. Indian Bio-Medical Waste Rules 1998
13. Data Collection and Processing
a. P. D. Hinduja National Hospital and Medical Research Centre
4. b. L.T.M.G. Sion Hospital
14. Comparative Study: Hinduja Hospital vs. Sion Hospitals (Dept. Wise)
15. General Discussion and Further Analysis
16. Limitations and Evaluation
17. Conclusion
18. Bibliography
19. Appendix 1: Hospital waste and Its Classification
20. Appendix 2: Questionnaire
21. Addendum
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5. 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 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-medical waste management
practices followed by both the hospitals.
There may be comparable difference in the bio-medical waste management practices followed by both
hospitals. Wherein private hospitals waste management practices should be closer to the norms and government
hospitals 0waste management practices would probably lag behind the standard norms.
Variables
Independent Variables: management of hospitals (private or government)
Dependent Variables: the method used for segregation and disposing bio-medical waste
Controlled Variables: location of the hospitals (including country and city); morbidity pattern of the city
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6. Introduction
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. For more information on
hospital waste and its classification refer Appendix 1.
Rationale of hospital waste management:
Hospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15% of hospital
waste i.e. "Bio-medical 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 bio-medical waste? The reasons are:
Injuries from sharps leading to infection to all categories of hospital personnel and waste handler.
Nosocomial infections in patients from poor infection control practices and poor waste management.
Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the
vicinity of hospitals.
Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels.
"Disposable" being repacked and sold by unscrupulous elements without even being washed.
Drugs which have been disposed of being repacked and sold off to unsuspecting buyers.
Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash.
Steps for Bio-Medical waste management
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7. 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 Cytotoxic Plastic bags Black
waste
6. Solid (biomedical waste) -do- Yellow
7. Solid (plastic) Plastic bag puncture proof Blue/White Translucent
containers
8. Incineration waste Plastic bag Black
4
8. 9. Chemical waste (solid) -do- -do-
3. 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, do 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 driver’s compartment should be separated
from the load compartment with a bulkhead. The load compartment should be provided with roof vents for
ventilation.
5. Treatment of bio-medical waste:
Deep burial: The waste under category 1 and 2 only can be accorded deep burial and only in cities
having less than 5 lakh populations.
Autoclave and microwave treatment Standards for the autoclaving and microwaving are also
mentioned in the Biomedical waste (Management and Handling) Rules 1998. All equipment installed/shared
should meet these specifications. The waste under category 3,4,6,7 can be treated by these techniques.
Standards for the autoclaving are also laid down.
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9. Shredding: The plastic (IV bottles, IV sets, syringes, catheters etc.), sharps (needles, blades, glass
etc) should be shredded but only after chemical treatment/microwaving/autoclaving. Needle destroyers can
be used for disposal of needles directly without chemical treatment.
Secured landfill: The incinerator ash, discarded medicines, cytotoxic substances and solid chemical
waste should be treated by this option.
Incineration: The incinerator should be installed and made operational as per specification under the
Indian Bio Medical Waste Rules 1998 (BMW) and a certificate may be taken from State Pollution Control
Board and emission levels etc. should be defined. In case of small hospitals, facilities can be shared. The
waste under category 1, 2, 3, 5, 6 of Indian Bio Medical Waste Rules 1998 can be incinerated depending
upon the local policies of the hospital and feasibility. The polythene bags made of chlorinated plastics
should not be incinerated.
Other Options: It may be noted that there are options available for disposal of certain category of
waste under the Indian Bio Medical Waste Rules 1998. The individual hospital can choose the best option
depending upon the facilities available and its financial resources. However, depending upon the option
chosen correct colour of the bag needs to be used.
Why is treatment of Bio-Medical waste necessary?
Treatment of waste is required:
To disinfect the waste so that it is no longer the source of infection.
To reduce the volume of the waste.
Make waste unrecognizable for aesthetic reasons.
Make recycled items unusable.
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10. Safety measures
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.
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.
W.H.O WASTE MANAGEMENT REGULATIONS
Bio-Medical waste definition according to W.H.O:
Bio-medical waste includes all the waste generated by health-care establishments, research facilities, and
laboratories. In addition, it includes the waste originating from ‘minor’ or ‘scattered’ sources such as that produced
in the course of health care undertaken in the home (dialysis, insulin injections, etc.)
W.H.O Classification:
7
11. As per W.H.O the biomedical wastes could be classified into eight categories on the basis of the type of waste and
the risk of transmission of infectious material in them. The classifications are as follows:
1. General waste (domestic)
2. Pathological
3. Radioactive
4. Chemical
5.Infectious
6. Pharmaceutical wastes
7. Sharps
8. Pressurised containers
INDIAN BIO-MEDICAL WASTE RULES 1998
Based on Indian 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)
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12. Category No. 2 Animal Waste incineration/deep burial
(animal tissues, organs, body parts carcasses,
bleeding parts, fluid, blood and experimental
animals used in research, waste generated by
veterinary hospitals, colleges, discharge from
hospitals, animal houses)
Category No. 3 Microbiology & Biotechnology Waste local autoclaving/micro-
(Wastes from laboratory cultures, stocks or micro- waving/incineration
organisms live or vaccines, human and animal cell
culture used in research and infectious agents from
research and industrial laboratories, wastes from
production of biological, toxins, dishes and devices
used for transfer of cultures)
Category No. 4 Waste Sharps disinfection (chemical
(needles, syringes, scalpels, blade, glass, etc. that treatment) /auto
may cause puncture and cuts. This includes both claving/microwaving and
used and unused sharps) mutilation/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/mic
(items contaminated with blood, and body fluids rowaving
including cotton, dressings, soiled plaster casts,
linen, bedding, other material contaminated with
9
13. blood)
Category No. 7 Solid Waste disinfection by chemical
(Waste generated from disposal items other than treatment/autoclaving/micro
the sharps such a tubing’s, catheters, intravenous waving and
sets etc.) mutilation/shredding
Category No. 8 Liquid Waste disinfection by chemical
(Waste generated from laboratory and washing, treatment and discharge into
cleaning, housekeeping and disinfecting activities) drains
Category No. 9 Incineration Ash disposal in municipal landfill
Ash from incineration of any bio-medical waste)
Category No. 10 Chemical Waste chemical treatment and
(Chemicals used in production of biological, discharge into drains for
chemicals used in disinfection, as insecticides, etc.) liquids and secured landfill
for solids
Data Collection and Processing
I had visited two different hospitals, in different localities and with different ownerships for my research work.
Collecting information and data through cross-sectional study, observational study and interviews (Refer Appendix
2 for a copy of the Questionnaire); pertaining to the waste generated by the hospital and its subsequent management
and disposal.
The two hospitals visited were:
1] P. D. Hinduja National Hospital and Medical Research Centre: private ownership
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14. 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 by Parmanand Deepchand Hinduja. 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 center
2. Burn unit
3. Main OT
4. Urology dept.
5. Neurology dept.
6. ENT dept.
7. Minor OT
8. Emergency Dept.
9. Eye Dept.
10. Pediatric Dept.
11. Dermatology Dept.
12. Gynecology Dept.
13. Diagnostic Labs
11
15. 14. Pharmacy
15. Etc...
Note: Due to time constrain and for sake of comparison only some main target departments have been studied 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.
Hinduja Hospital: Data Collection Table 1
Wards or Bio-Medical Waste Collected[kg/Bed/week] (03/09/11-09/09/11)
Categor Categor Categor Categor Categor Categor Categor Category Categor Category
Dept.
y No.1 y No.2 y No.3 y No.4 y No.5 y No.6 y No.7 No.8 y No.9 No.10
OPD area 0 - 0 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 - 0.46 0.09 0.03 0.04 0.08 0.20 - 0.42
c Labs
Radiology 0 - 0 0.02 0.02 0.02 0.03 0.18 - 0.08
Dept.
Pharmacy 0 - 0 0.01 0.18 0.02 0.01 0.07 - 0.01
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16. Table 2
Wards or Bio-Medical Waste Collected[kg/Bed/week] (10/09/11-16/09/11)
Categor Categor Categor Categor Categor Category Categor Categor Categor Category
Dept.
y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 No.10
OPD area 0 - 0 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
OT area 1.21 - 0.07 0.58 0.02 1.32 0.78 0.73 - 0.09
Diagnostic 0 - 0.96 0.16 0.08 0.09 0.17 0.38 - 0.93
Labs
Radiology 0 - 0 0.08 0.04 0.08 0.05 0.24 - 0.07
Dept.
Pharmacy 0 - 0 0.03 0.09 0.01 0.01 0.08 - 0.02
Table 3
Wards or Bio-Medical Waste Collected[kg/Bed/week] (17/09/11-23/09/11)
Categor Categor Categor Categor Categor Category Categor Categor Categor Categor
Dept.
y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10
OPD area 0 - 0 0.08 0 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
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18. Dept. Categor Categor Categor Categor Categor Categor Category Categor Categor Categor
y No.1 y No.2 y No.3 y No.4 y No.5 y No.6 No.7 y No.8 y No.9 y No.10
OPD area 0 - - 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 0 - 3.36 0.60 0.59 0.27 0.63 1.15 - 3.34
Labs
Radiology 0 - 0 0.26 0.10 0.23 0.21 0.77 - 0.27
Dept.
Pharmacy 0 - 0 0.12 0.44 0.03 0.02 0.31 - 0.06
METHOD OF WASTE DISPOSAL ADOPTED BY HINDUJA HOSPITAL: Table 6
Colour Coding Waste Category Method of Disposal Adopted by
Hospital
Yellow Category 1,2,3 &6 Deep burial(through private
[Human & Animal anatomical waste / agency)/Incineration [has in- house
Micro-biology waste and soiled incinerator]
cotton/dressings/linen/beddings etc.]
Red Category 7 Autoclaving / Microwaving /
[Tubing’s, Catheters, IV sets.] Chemical treatment
Blue/White Category 4 Autoclaving / Microwaving /
[Waste sharps like Chemical treatment & Destruction /
Needles, Syringes, Scalpels, blades Shredding
15
19. etc.]
Black Category 5,8,9 &10 Disposal in secured landfill/
[Discarded medicines/cytotoxic drugs, Chemical treatment
Incineration ash, Chemical waste.]
Hinduja Hospital has its own Hospital Infection Control Team (HICT), which carries out surveillance/inspection
of different areas of hospital.
HICT comprises of: -
1. Medical Superintendent
2. Nursing Superintendent
3. H.O.D. Microbiology
4. Casualty Medical Officer (CMO)
5. Ward Medical Officers
L.T.M.G. Sion Hospital
L.T.M.G.H, (Lokmanya Tilak 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
16
20. 2. Burn unit
3. Main OT
4. Urology dept.
5. Neurology dept.
6. ENT dept.
7. Minor OT (Ward 4)
8. Emergency Dept.
9. Eye Dept.
10. Pediatric Dept.
11. Dermatology Dept.
12. Gynecology Dept.
13. Diagnostic Labs
14. Pharmacy
15. Etc...
Note: Due to time constrain and for sake of comparison only some main target departments have been studied for
data. The hospital did not maintain perfect data according to the categories provided by ‘INDIAN BIO-MEDICAL
WASTE RULES 1998’; hence I had done that so as to make data comparison easier and clearer.
L.T.M.G. Sion Hospital: Data Collection Table 7
Wards or Bio-Medical Waste Collected[kg/Bed/week] (03/10/11-09/10/11)
Categor Categor Categor Categor Categor Category Categor Categor Categor Categor
Dept.
y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10
OPD area 0 - 0 0.17 0.03 0.10 0.05 0.14 - 0
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
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21. OT area 0.68 - 0.08 0.37 0.03 0.41 0.46 0.37 - 0.08
Diagnostic 0 - 0.63 0.17 0.08 0.09 0.11 0.25 - 0.36
Labs
Radiology 0 - 0 0.04 0.04 0.05 0.05 0.19 - 0.03
Dept.
Pharmacy 0 - 0 0.03 0.28 0.03 0 0.04 - 0
Table 8
Wards or Bio-Medical Waste Collected[kg/Bed/week] (10/10/11-16/10/11)
Categor Categor Categor Categor Categor Category Categor Categor Categor Categor
Dept.
y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10
OPD area 0 - 0 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 0 - 1.65 0.46 0.04 0.17 0.19 0.51 - 1.10
Labs
Radiology 0 - 0 0.20 0.03 0.08 0.03 0.29 - 0.09
Dept.
Pharmacy 0 - 0 0.17 0.17 0.04 0.02 0.05 - 0.02
Table 9
Wards or Bio-Medical Waste Collected[kg/Bed/week] (17/10/11-23/10/11)
Categor Categor Categor Categor Categor Category Categor Categor Categor Categor
Dept.
y No.1 y No.2 y No.3 y No.4 y No.5 No.6 y No.7 y No.8 y No.9 y No.10
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28. General Discussion and Further Analysis
Bio-medical Waste generation: It was noticed that quantity of Bio-medical waste generated (especially
cotton, dressings and sharps) was more in government run Sion hospital than private Hinduja hospital. On the
other hand waste like Catheters, Tubings, Radiological and chemical wastes were more from diagnostic labs of
Hinduja hospitals.
Bio-medical waste segregation methods: Segregation methods were followed and closely monitored in
Hinduja hospital. All colour coded containers were in place in each department and clearly labeled. In Sion
hospitals all colour coded containers were present but segregation of waste was not being carried out efficiently
by the nursing and housekeeping staff.
Bio-medical waste collection method: In Sion hospital the waste from each department is collected by the
housekeeping staff in government approved colour coded bags but on one or two occasions shortage of color
coded bags led to deliberate mixing of different category of waste which the staff said was not in their hands.
Were as in Hinduja hospital the housekeeping staff was more sensitive towards collecting the wastes in
different government approved colour coded bags and storing it in the waste collection room; from where the
segregated waste was collected by the Bio-medical waste collection vehicle at 12 noon.
Bio-medical waste disposal techniques: Though both the hospitals claim that they follow Indian Pollution
Control board approved waste disposal methods, but on ground in Sion hospital not much effort was taken to
properly disinfect and dispose highly infectious waste from OTs, HIV positive patients and radiology
department; Eg: biological tissues from the OT department was not autoclaved before final disposal and soiled
linen from the HIV positive patients were not disinfected and properly segregated. Though the autoclaving
machines were present with the hospital but were out of order due to lack of proper maintenance (only 1 of the
autoclaving machines was active). In Hinduja hospital waste like biological waste from OTs, soiled linen,
cotton, swabs, etc. were properly segregated, collected and autoclaved before disposal. In the radiological
department radioactive waste was collected in proper closed containers and then sent for further disposal. But it
was noticed that some samples of blood used for testing in the lab was directly discarded into the municipal
drains without any chemical treatment.
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29. Awareness levels of the hospital staff: In Sion hospital the administrative, medical and nursing staffs were
well aware of the principles of bio-medical waste management like waste segregation, collection and disposal at
least in theory as they were reluctant to put in extra effort to practice the principles on ground. Were as the
housekeeping and class IV employees were all not very well informed and trained about Bio-medical waste
management practices, they just followed the protocol given to them by the hospital administration without
much background knowledge. The hospital did have an infection control committee which gave time to time
training to the housekeeping, nursing and class IV staff but there level of awareness still seemed low. In
Hinduja hospital the infection control committee was much more effective in training and creating awareness
among their staff. Hospitals administration ensured proper waste management practices through close
monitoring of each department. CCTV cameras were also installed in curtails departments like OTs, ICUs, labs,
etc. which helped in monitoring and ensuring proper working of the hospital staff.
Money spent on Bio-medical waste management: Sion hospital being a government owned hospital, lots
of money was spent on buying expensive autoclaving, microwaving and ultra-sonic sterilizers. Colour coded
containers and waste disposal bags were also bought in bulk by the hospital. But due to lack of maintenance lot
of equipment is out of order and many waste collecting and disposing containers and bags have also been
misplaced. Hinduja hospital being a private owned hospital, had allotted adequate amount of funds for waste
management equipment’s like autoclaves, ultra-sonic sterilizers, needle burners, etc. Because of proper
maintenance all equipment’s are at max efficiency hence giving full value for money.
Limitations and Evaluation
Data for Bio-Medical waste collection of both the hospitals Hinduja and L.T.M.G. Sion was taken
for a short period of time (1 month). If the hospitals would have been studied over greater period of time
with more available data then the report produced may have been more comprehensive and effective.
Collecting sufficient data from both the hospitals was a challenge in itself as Hinduja hospital did
manage bio-medical waste according to the categories described by the Indian Bio-Medical Rules (1998)
26
30. but with some modifications of the standard rules to suit their hospitals waste management model and on
the other side L.T.M.G. Sion hospital did not maintain perfect bio-medical waste management data
according to the categories provided by Indian Bio-Medical Waste Rules (1998); hence had to personally
sit, observe and collect data according to the categories so as to make data from both hospitals comparable
and fit for further analysis.
Due to time constrain and word limit range set by the IBO for the extended essay, I had to constrict
myself to compare both hospitals according to the Indian Bio-Medical Waste Rules (1998) waste categories
and not fully analyze other waste segregation and management policies like that proposed by the WHO and
some other national and state level waste management rules.
Language used for communication by the cleaning and housekeeping staff at L.T.M.G. Sion hospital
was Marathi (regional language); not being very familiar with the language I had difficulty understanding
what they were trying to communicate (did call for an interpreter later). This was not the case at Hinduja
hospital there the housekeeping and cleaning staff communicated in English or in Hindi (national
languages).
Conclusion
In the existent health care scenario management of bio-medical waste is considered to be a critical area of
operation for the hospital. WHO and the Indian government has laid down very stringent policies, procedure and
protocols for Bio-medical waste management to which the hospitals are required to comply. Of the two hospitals
which were compared it stand very clear the here Hinduja hospital (private hospital) was found to be more aware
of waste management principles, policies and procedures. The staff, doctors and management were better
equipped to handle this area with good discipline. Were as the Sion hospital (government hospital) though larger
in area, no. of beds and being a teaching hospital was found lacking in understanding and implementation of the
basic policies, procedures and principle of the Bio-medical waste management.
27
31. Bibliography
Books referred:
Tsokos, K. A. Physics for the IB Diploma: [standard and Higher Level]. 5th ed. Cambridge: Cambridge
UP, 2009. Print.
Buckle, Nigel, and Iain Dunbar. Mathematics Higher Level (core): International Baccalaureate. Ed.
Fabio Cirrito. [Victoria]: IBID, 2007. Print.
S.L. Arora. New Simplified Physics A Reference Book for Class XI. 2nd ed. Delhi: Gagan Kapur, 2008.
Print
Web sources:
"The Physics of Cricket." School of Physics - The University of Sydney. 2005. Web. 04 Dec. 2011.
<http://www.physics.usyd.edu.au/~cross/cricket.html>.
"Law 5 (The Ball) - Laws - Laws of Cricket - Laws & Spirit - Lord's." Top Stories - News - Lord's.
2010. Web. 08 Jan. 2012. <http://www.lords.org/laws-and-spirit/laws-of-cricket/laws/law-5-the- ball,31,ar.html>.
Programs used:
Microsoft paint.
Logger pro 3.0
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32. Appendix 1: Hospital waste and Its Classification
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 and wrapper sand 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.
(4) Sharps: Waste materials which could cause the person handling it, a cut or puncture of skin e.g. needles,
broken glass, saws, nail and blade sand scalpels.
(5) Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have 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:
29
33. (a) Amount
Country Quantity (kg/bed/day)
U. K. 2.5
U.S.A. 4.5
France 2.5
Spain 3.0
India 1.5
(b) Hazardous/non-hazardous
Hazardous(total) : 15%
a) Hazardous but non- 5%
infective
b)Hazardous and infective 10%
Non-hazardous 85%
(c) Composition
By Weight:
Plastic 14%
Combustible:
Dry cellulosic solid 45%
Wet cellulosic solid 18%
Non-combustible:
Non-combustible products 20%
[Source: Medical Superintendent at the Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow]
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35. General Questions:
1] What is your name and your post in the hospital?
2] Your educational qualifications?
3] Any previous work experience and since how long are you working with this hospital?
4] Your take on Bio-Medical waste and how your hospital manages waste?
For the nurses, housekeeping and security staff:
1] What according to you is Bio-Medical waste?
2] Are you aware about the different systems/ policies for waste management?
3] What are the categories of waste segregation and collection?
4] Which colour coded plastic bags and containers should be used for different waste categories? Which ones are
actually being used by the hospital?
5] What is the significance of hospital cleanliness and waste management?
6] Are you aware of the dangers and health hazards posed by Bio-medical waste on human health?
7] Are you aware of the safety measures and precautions that one needs to take wile handling hospital waste?
(Especially Biomedical waste)
For the hospital heads and other doctors:
1] What is the importance of Bio-medical waste management in present day scenario and how is your hospital
contributing towards it?
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36. 2] Are you aware about WHO’s hospital waste management policy?
3] What is your take on the Indian Bio-Medical Waste Rules (1998) and do you ensure that your hospital follows
this rules lay down by the government?
4] Does your hospital have an active Infection Control Committee?
5] Do you attend the hospital waste management conference organized by the government?
6] Does your hospital organize workshops to train and spread awareness about biomedical waste among the hospital
staff?
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