A study on status of biomedical waste management in two … · 2015-12-16 · Available online at WSN 32 (2016) 106-122 EISSN 2392-2192 A study on status of biomedical waste management

Available online at www.worldscientificnews.com

WSN 32 (2016) 106-122 EISSN 2392-2192

A study on status of biomedical waste management in two hospitals of Gulbarga city, Karnataka, India

Jadesh V. Murli1,a, K. S. Kavya2,b, D. S. Shivkumar2,c

1Assistant Professor, Department of P.G. Studies and Research in Zoology, Gulbarga University,

Kalburgi, 585106, Karnataka, India

2Department of P.G. Studies and Research in Zoology, Gulbarga University,

Kalburgi, 585106, Karnataka, India

a-cE-mail address: [email protected] , [email protected] , [email protected]

ABSTRACT

Biomedical waste management was become an important issue as it poses potential health risks

and damage to the environment. Biomedical waste if not handled in a proper way, is a potent source of

diseases like HIV, Hepatitis B and C and other bacterial diseases causing serious threat to human

health so prime attention needed for its safe and proper disposal. Purpose of study was to highlight

certain aspects of hospital waste management status in health facilities providing health care in two

hospitals namely, Dhanvantri Hospital and Vaatsalya Hospital.

Keywords: Biomedical waste; segregation; management

ABBREVIATIONS: KAP- Knowledge, Awareness, Practice, HICPAC- Healthcare Infection Control

Practices Advisory Committee. BMW-Biomedical Waste, ICCU - Intensive Coronary Care Unit, ICU

-Intensive Care Unit, MICU -Medical Intensive Care Unit, NICU -Neonatal intensive Care unit, OPD

–Outpatient department, OT -Operation Theater, SICU -Surgical Intensive care unit

World Scientific News 32 (2016) 106-122

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1. INTRODUCTION

“Bio- medical waste” means any waste, which is generated during the diagnosis,

treatment or immunization 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, according to Bio-medical waste (management and Handling Rules, 1998). The

government of India (Notification, 1998) specifies that Hospital waste Management activities,

which are mainly engineering functions, such as collection, transportation, operation or

treatment of processing systems and disposal of wastes. A major issue related to current

biomedical waste management of Bio- waste regulation is unsatisfactory as some hospitals are

disposing of waste in haphazard, improper and indiscriminate manner. Lake of segregation

practices, results in mixing of hospital wastes with general waste making the whole waste

stream hazardous. Inadequate Bio-medical waste management thus will cause environmental

pollution, unpleasant smell, growth, and multiplication of vectors like insects, rodents and

worms and may lead to the transmission of diseases like typhoid, cholera, hepatitis and AIDS

through injuries from syringes and needled contaminated with human, Praveen., (et al.).

Therefore, segregation, collection, treatment and disposal of BMW in an appropriate

manner is of great importance as it can decrease health risks people, and damage of flora,

fauna and the environment. (HICPAC and Askarian et al.). In present study attempt has been

made to assess generation and management of biomedical waste in Dhanvantri and Vaatsalya

Hospital Gulbarga, Karnataka, India.

2. MATERIAL AND METHODS

A] The study area

Gulbarga city is situated on Bombay Chennai section of the central Railway and is at a

distance from 646 km, from Bangalore, the capital city of Karnataka. The city is situated at a

latitude of 17º 19’N and longitude of 76º54’E. It has a general slope of North - west to South-

East.

B] Ethical clearance

Ethical clearance from institutes ethics committee and permission from Medical

Superintendent to collect data from various patient care areas was taken before the study; the

study was approved by Department of P.G. Studies and Research in Zoology, Gulbarga

University, Gulbarga, and Karnataka, India in 2013.

C] Assessment of operating procedures

Common regional facility for final disposal of infectious waste was also informal

discussion with various hospital functionaries were carried out. Studied wastes generated in

two hospitals were weighed during a week for each hospital.

Quantitative determination of waste

The following steps were involved in the determination of the biomedical waste

generated from different places in the study centre-


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A. solid waste of both types, infectious and non- infectious was weighed individually on

suspension spring scale (±10g) with the assistance of the staff and the weight was recorded

B. each color coded bin or liner meant for collection of particular waste in each block was

weighed and recorded.

C. the quantities of infectious and non-infectious west were recorded in each block of each

liner for 7 days and all the data was compiled to represent the average values.

The supporting staff of each block was briefed over denature of assistance and support that

was needed in determining the quantity of wastes during the study period.

D. The available medical facilities in the hospital are given blow in the Table 1 (Dhanvantri

Hospital) and Table 4 (Vaataslaya hospital) and Figure 1 shows the study area.

Table 1. Facility available in the Dhanvantri Hospital.

Sl. No. NAME OF WARDS

1 General ward

2 Special room 1

3 Special room 2

4 Special room 3

5 Special room 4

6 Special room 5

7 Special room 6

8 Special room 7

9 Special room 8

10 Mother ward

11 NICU

12 PICU

13 Gynaec OPD

14 Causality

15 A.C. Trauma care

16 x-ray

17 Eye OPD

18 Laboratory

19 General OPD I

20 General OPD II Medicine


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21 General ward III

22 General Ward II

23 ICCU and ICU

Figure 1. Study Area.

Dhanvantri Hospital

Vatsalya Hospital


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Improper dumping of wastes in the ward- Dhanvantri Hospital


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Improper Dumping of Biowaste in the buckets- -

Dhanvantri Hospital


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Collection of waste from the

ward-Vaatsalya Hospital

Liners in the ward – Vaatsalya

Hospital


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3. OBSERVATION AND DICUSSION

A. Qualitative analysis of biomedical waste: The bio-medical waste generated in the

hospital was observed to be infectious and non-infectious waste.

Infectious waste includes-

i. Infected plastics – catheters, caules, syringes, gloves, blood bags, tubes, bottles,

and other infected plastics, microbiological waste from pathological laboratory and

waste generated from disposable items other than sharps, etc. These wastes should

be collected in red color plastic liner or bin.

ii. Infectious waste – human anatomical waste, microbiological waste from

pathological laboratory, items contaminated with blood and body fluids. These

wastes should be collected in yellow color plastic liner.

iii. Infected glass whole and broken glass, test tubes, ampoules, vials and sample

bottles, should be collected in blue liner.

Non- infectious waste includes

iv. Chemical waste- insecticides, disinfectants fumigants, chemical containers,

cytotoxic waste, incinerator ash, expired medicines and other chemicals. This

waste should be collected in black liner.

v. Non- infected recyclable waste- Disposable cups, plastic, card board, metal

containers, paper, non- infectious plastics and other recyclables. Non-infected

recyclable waste should be collected in white.

vi. Non-infected Biodegradable waste includes- left –over food items, vegetables and

fruit peels, egg shells, meat, fish and other biodegradables. These should be

collected in Green containers.

[According to Bio-medical Waste (Management and handling) Rules, 1998]

Improper dumping of food in the corner of ward

-Vaatsalya Hospital


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Our main object of qualitative analysis of biomedical waste in both the hospital was

whether they are following these segregation rules at the source of waste generation or not.

And the Table number 8 shows the KAP (Knowledge-Awareness-Practice) of

Dhanvantri Hospital and Vaatsalya Hospital staff. This shows that in Dhanvantri hospital only

Doctors and GDMO are aware about Handling Rules remaining staff members are not aware.

In Vaatsalya hospital all staff members are aware about the Handling Rules. Table number 8

shows that KAP of both the Hospitals.

KAP of Dhanvantri Hospital was very poor and it was about only 27.28%. KAP of

Vaatsalya hospital is good, Peon and Ayahs don’t have the knowledge about the segregation

rules but all the staff members have positive attitude towards proper segregation of waste and

practicing it properly.

B. Quantitative analysis of biomedical waste

Each color coded bin or liner meant for collection of particular waste in each block was

weighed and recorded for 7 days to get average value. Table number 6 and 7 shows the

average quantity of waste in Kg/day of each liner in each block of Dhanvantri Hospital and

Vaatsalya Hospital respectively.

There is a prescribed color coded liner is meant for the collection of particular waste.

Below table shows the segregation of Bio medical waste as per Bio-medical waste

(Management and Handling) Rules, 1998.

We observed that, in Dhanvantri Hospital blocks/ward don’t have the color coded liner and

the waste generated is collected in one common bin in the wards. In Vaataslaya Hospital only

4 wards have the color coded liner. The average waste present in yellow liner was 0.65 kg;

blue was 16 kg, red was 2.27 kg and green was 8 kg per day.

4. RESULT OF DHANVANTRI HOSPITAL

• When we visited the hospital the number of patients in the hospital was very less.

• In the hospital no ward contain the liners for segregation at the point of generation all

wastes are dumped in the common dust bins present in the each ward.

• The transportation of waste is regular by CHAMP.

• In the hospital the wastes such as food, empty bottles, injections and other wastes

(some times anatomical waste too)are dumped in the open area in front of the

hospital

• Each ward and OPDs are clean but there is no proper segregation of wastes.

The wastes in front of the hospital affect the health of flora, fauna and that whole

environment

5. RESULT OF VAATASLAYA HOSPITAL

• In the hospital four wards don’t contain liners; those wards have only one common

dust bins. And remaining all wards and OPD has liners and there is proper segregation


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of wastes, collection and transportation of the generated wastes in the hospital

regularly.

• And all nurses, ayahs, workers doing it properly and regularly.

• In the hospital the response was good.

• 85% of the waste is segregated and transported regularly.

• All workers in the hospital have the knowledge of segregation in the particular liners

• Only four wards have no liners and all the wastes are dumping in the one common bin.

• There is one common plastic box to collect the used needles and syringes.

Table 2. Quantification of Biowaste in Dhanavantri Hospital.

Sl.

No. Name of Wards

Average weight of bio-

waste in kgs/day

Total Number

of Beds

Average Number of

patients per day

1 General ward 3 10 5

2 Special room 1 4 5 2








10 Mother ward 2 5 5

11 NICU 0.5 5 No patient

12 PICU 0.5 2 No patient

13 Gynaec OPD 1 1

14 Causality 2 2 1

15 A.C. Trauma care 1 1 -

16 x-ray 0.5 1 -


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Sl.

No. Name of Wards

Average weight of bio-

waste in kgs/day

Total Number

of Beds

Average Number of

patients per day

17 Eye OPD 0.75

-

18 Laboratory 0.5

-

19 General OPD I 0.5 1 -

20 General OPD II

Medicine 1 1 -

21 General ward III 1 7 5

22 General Ward II 2 7 6

23 ICCU and ICU

9 2

Total 33.25 25 42

[Date of Quantification from 01/04/2013 to 06/04/2013]

Table 3. Segregation of wastes in DHANVANTRI Hospital.

Sl. No. NAME OF WARDS PROPER SEGREGATION (YES/NO)

1 General ward No liners

2 Special room 1 No

3 Special room 2 No

4 Special room 3 No

5 Special room 4 No

6 Special room 5 No

7 Special room 6 No

8 Special room 7 No

9 Special room 8 No

10 Mother ward Yes

11 NICU No

12 PICU No


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13 Gynaec OPD Yes

14 Causality Yes

15 A.C. Trauma care No

16 x-ray No

17 Eye OPD Yes

18 Laboratory No

19 General OPD I No

20 General OPD II Medicine No

21 General ward III No

22 General Ward II No

23 ICCU and ICU Yes

Table 4. Facility available in Vaataslaya Hospital.

Sl. No NAME OF WARD

1 Department of nephrology and critical care

2 Special room 1

3 Special room 2

4 Department of oncology and pediatrics

5 Semi special room 1

6 Semi special room 2

7 Male general ward

8 Pediatric general ward

9 PICU

10 Female general ward

11 NICU

12 Surgical OPD


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13 Pediatric OPD

14 Gyanic OPD

15 MICU

Table 5. Quantification of BIo waste in Vaataslaya Hospital.

Sl.

No

Name of

Wards

Date of

Quantification

From 01-04-

2013

to

06-04-213

Average Quantity of Waste in Kgs/day Total

Number

of Beds

Average

number

of

patients

per day Black Yellow White Blue Red Green

1

Department

of

nephrology

and critical

care

No

Bin 0.1

No

Bin 8 0.250 2 4 2

2 Special

room 1

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin 2 2

3 Special

room 2

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin 2 2

4

Department

of

oncology

and

pediatrics

No

Bin 0.250

No

Bin 4 0.02 2 4 3

5

Semi

special

room 1

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin 2 --

6

Semi

special

room 2

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin - -

7

Male

general

ward

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin - -

8

Pediatric

general

ward

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin 9 3

9 PICU

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin - -

10

Female

general

ward

No

Bin No bin

No

Bin

No

Bin

No

Bin

No

Bin 7 2

11 NICU

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin 2 -

12 Surgical

OPD

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin - -


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Sl.

No

Name of

Wards

Date of

Quantification

From 01-04-

2013

to

06-04-213

Average Quantity of Waste in Kgs/day Total

Number

of Beds

Average

number

of

patients

per day Black Yellow White Blue Red Green

13 Pediatric

OPD

No

Bin

Common

Dust bin

No

Bin

No

Bin

No

Bin

No

Bin - -

14 Gyanaeco

OPD

No

Bin

Common

Dust bin

No

Bin 1 1

No

Bin - -

15 MICU

No

Bin 0.3

No

Bin 3 1 4 6 5

Total

0.65

16 2.27 8 38 19

Table 6. Segregation of waste in the wards of Vaatsalya Hospital.

Sl.

No NAME OF WARD

PROPER SEGREGATION

(YES/NO)

1 Department of nephrology and critical care Yes

2 Special room 1 No

3 Special room 2 No

4 Department of oncology and pediatrics Yes

5 Semi special room 1 No

6 Semi special room 2 No

7 Male general ward Yes

8 Pediatric general ward Yes

9 PICU Yes

10 Female general ward Yes

11 NICU No patients


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12 Surgical OPD Yes

13 Pediatric OPD No

14 Gyanaeco OPD No

15 MICU Yes

Table 7. Awareness regarding Bio medical waste (Management and Handling) Rules,

1998 in the Hospitals.

Sl.

No. Designation

Name of the Hospitals

Dhanvantri Hospital Vaataslaya Hospital

1 Doctor (specialist) A A

2 Doctor (Resident) A A

3 GDMO A A

4 Nurse NA A

5 Technician NA A

6 Pharmacist NA A

7 Ward boy NA A

8 Peon NA A

9 Ayahs NA A

10 Sweeper NA A

11 Clerk and other Staff NA A


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Table 8. KAP in the Hospitals.

Sl. No. Designation

Knowledge

(Yes/No)

Attitude

(Positive /

Negative)

Practice

(Yes / No )

Dhan

van

tri

Hosp

ital

Vaa

tasl

aya

Hosp

ital

Dhan

van

tri

Hosp

ital

Vaa

tasl

aya

Hosp

ital

Dhan

van

tri

Hosp

ital

Vaa

tasl

aya

Hosp

ital

1 Doctor

(specialist) Y Y + + Y Y

2 Doctor

(Resident) Y Y + + Y Y

3 GDMO Y Y + + Y Y

4 Nurse N Y - + N Y

5 Technician N Y - + N Y

6 Pharmacist N Y - + N Y

7 Ward boy N Y - + N Y

8 Peon N N - + N Y

9 Ayahs N N - + N Y

10 Sweeper N Y - + N Y

11 Clerk and other

Staff N Y - + N Y

6. CONCLUSION

Medical wastes should be classified according to their source, typology and risk factors

associated with their handling, storage and ultimate disposal. The segregation of waste at

source is the key step and reduction, reuse and recycling should be considered in proper

perspective. We need to consider innovative and radical measures to clean up the distressing

picture of lack of civic concern on the part of hospitals and slackness in government

implementation of bare minimum of rules, as waste generation particularly biomedical waste

imposes increasing direct and indirect costs on society. The challenge before us, therefore, is

to scientifically manage growing quantities of biomedical waste that go beyond past practices.

If we want to protect our environment and health of community we must sensitize ourselves

to this important issue not only in the interest of health managers but also in the interest of

community


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Acknowledgement

Author is acknowledging to all staff members for their co-operation during the course of study.

References

[1] Centers for Disease Control and Prevention, Healthcare Infection Control Practices

Advisory Committee (HICPAC), Draft Guideline for Environmental Infection Control

in Healthcare Facilities, (2000) 96-101.

[2] Askarian, Mehrdad, vakili, Mahmood, Kabir, Gholamhosein, Waste Management, 24,

(2004) 347-352.

[3] Bio-medical waste (Management and Handling) Rules, 1998.

[4] Need of Biomedical Waste Management System in Hospitals- an Emerging issue- A

Review, Praveen Matur, Sangeeta Patan and Anand S. Shobhawat, Current World

Environment. An International Research Journal of Environmental Science.

( Received 02 December 2015; accepted 16 December 2015 )

Documents

A study on status of biomedical waste management in two … · 2015-12-16 · Available online at WSN 32 (2016) 106-122 EISSN 2392-2192 A study on status of biomedical waste management