INTRODUCTION:Waste produced in the course of health care activities carries a higher potential for infection and injury than

another type of waste. There for it is essential to have safe and reliable method for its handling. Inadequate inappropriate handling of health care waste may have serious public health consequences and significant impact on the environment. Appropriate management of health care waste in thus a crucial component of environmental health protection and it should become an integral feature of health care protection DEFINITION:According to bio medical waste rules 1998 of India ,bio-medical waste means any waste which is generated during the diagnosis ,treatment or immunization of human being or animals or in research activities pertaining there to or in the production or testing of biological CLASSIFICATION OF HEALTH CARE WASTE [W .H. O] INFECTIOUS WSATE:- waste suspected to contain pathogens E.g. laboratory cultures, waste from isolation wards, tissues, materials or equipment that have been in contact with infected patients PATHOLOGICAL WASTE:- human tissues or fluids e.g. Body parts, blood and other body fluids, feature SHARPS:-Instruments having sharp end or pointed end E.g. needle, infusion sets, scalpels, knives, blades, broken glass PHARMACEUTICAL WASTE:- Waste containing pharmaceuticals E.g. pharmaceutical that are expired or no longer needed items contaminated by or containing pharmaceuticals [, bottle, boxes] GENOTOXIC WASTE:- Waste contain substances with genotoxic properties e.g. waste containing cystostatic drugs[often used in cancer therapy] ,genotoxic chemicals

 CHEMICAL WASTE: - Waste containing chemicals. E.g. laboratory reagents, film developer, disinfectant ant that are expired or no longer needed, solvents WASTE WITH CONTENT OF HEAVY METALS:- batteries ,broken thermometers, blood pressure gauzes PRESURIZED CONTAINERS:- Gas cylinder, gas cartridges ,aerosol cans RADIOACTIVE WASTE:- Waste contain radio active substances unused substance from radio therapy or laboratory research SOURSES OF HEALTH CRAE WASTE: Government hospital Private hospitals Nursing homes Physician clinic or office Dentist office or clinic Dispensaries Primary health care centre Medical research and training establishments Mortuaries Blood bank and collection centers Animal houses Slaughter houses Laboratories[clinic, pathology, hematology, microbiology] Research organizations Vaccinating centers Bio-technology institutions HEALTH CARE WASTE GENERATION:In middle and low income countries health care waste generated is lower than high income countries. Developing countries that have performed their own surveys of health carte waste find the following essentials for an average e.g.

distribution of health care wastes useful for preliminary planning of waste management 80% general health care waste which may be dealt with by normal domestic and urban waste management system 15% pathological and infectious waste 1% sharps waste 3% chemical and pharmaceutical waste Less than 1% special waste such as radioactive or cytotonic waste ,pressurized containers or broken thermometers and used batteries HEALTH HAZARDS OF HEALTH CARE WASTE:Exposure of hazardous health care waste can result in disease or injury due to one or more of following characteristic It contains infectious agents It contains toxic or hazardous chemicals or pharmaceuticals It contains sharps It is genotoxic It is radio active All individuals exposed to such hazardous health care waste are potentially at risk, including those who generate the waste or those either handle such waste or are exposed to it as a consequence of careless management. The main groups at risk are: Medical doctors, nurses, health care auxiliaries and hospitals maintains personal Patients in health care establishments Visitors to health care establishments Workers in support service allied to health care establishments such as laundries ,waste handling and transportation Workers in waste hospital facilities such as land fills or incinerators including scavengers a. Hazardous from infectious waste and sharps:-

Pathogens in infectious waste may enter the human body through a puncture, abrasions, or cut in the skin, through mucus membranes by inhalation or ingestion b. Hazardous from chemical and pharmaceutical waste:Many of the chemicals and pharmaceuticals used in health care managements are toxic, genotoxic, corrosive flammable, reactive, explosive or shocksensitive. Although present in small quantity they may cause in toxification, either by or acute or chronic exposure and injuries including burns c. Hazardous from genotoxic waste:The severity of the hazardous for the health care workers responsible for handling or disposal of genotoxic waste governed by combination of the substance toxicity itself and extent and duration of or treatment with particular drug or chemical. The main pathway of exposure is inhalation of dust or aerosol through the skin, ingestion of food accidentally contaminated with cytotoxic drugs, chemicals or waste etc d. Hazardous from radio active waste:The type disease caused by radioactive waste determined by the type and extent of exposure. It can range headache, dizziness and vomiting to much more serious problem. Because it is genotoxic, it may also affect genetic material e. Public sensitivity :Apart from health hazardous the general public is very sensitivity to visual impact of health care waste particular anatomic waste TERATMENT AND DISPOSAL TECHNIQUES FOR HEALTH CARE WASTE :Incineration used to be the method of choice for most hazardous health care wastes and is still widely used. However recently developed alternative treatment method are becoming increasingly popular. The final choice of treatment should be made on the basis of factors, many of which depend on local conditions I. INCINERATION:-

Incineration is a high temperature dry oxidation process that reduces organic and combustible waste to incombustible matter and result in a very significant reduction waste volume and weight .the process is usually selected to treat waste that cannot be recycled ,reused or disposed off in a land fill site Incineration requires no pretreatment, provided that certain waste types are not included in the matter to be incinerated. Characteristics of the waste suitable for incineration are: Low healing volume above 2000k cal/kg for single chamber incinerators and above 3500kcal/kg for pryolytic double chamber incinerators Content of combustible matter above 60 % Content of non-combustible solid below 5% Content of non-combustible fines below 20% Moisture content below 30%

Waste products not to be incinerated are:Pressurized gas containers Large amount of reactive chemical waste Silver salts and photographic or radiographic waste Waste with high mercury or cadmium content such as broken thermometers, used batteries, and lead-lined wooden panels Sealed ampoules or ampoules containing heavy metals

Type of incinerators:Three basic kinds of incinerators technology are of interest for treating health care waste Double chamber pyrolytic incinerators which may be especially designed to burn infectious health care waste Single- chamber furnace with static great, which should be used only if pyrolytic incinerators are not affordable.

 Rotary kilns operating at high temperature, capable of causing decompositions of genotoxic substances and heat-resistant chemicals ii.CHEMICAL DISINFECTION:Chemicals are added to waste to kill or incinerate the pathogens it contains, this treatment usually result in disinfection rather than sterilization. Chemical disinfection is most suitable for treating liquid waste such as blood, urine, and stool or hospitals sewage. However solid waste including microbiological cultures, sharps etc may be also be disinfected chemically with certain limitation. iii. WET AND DRY THERMAL HEAT:Wet thermal heat: - wet thermal treatment or steam disinfection is based on exposure of shredded infectious waste to high temperature, high pressure steam and is similar to autoclave sterilization process. The process is inappropriate for the treatment of anatomical waste and animal carcasses and will not efficiently treat chemical and pharmaceutical waste Screw feed technology:- screw feed technology is the basis of non burn, dry treatment disinfection process in which waste is shredded and heated in a rotary auger. The waste is reduced by 80% in volume and by 20-3% in weight. This process is suitable for treating infectious waste and sharps. But it should not be used to process pathological cytotoxic or radioactive waste iv. MICROWAVE IRRADIATION Most microorganisms are destroyed by the action of micro wave of a frequency of about 2450 MHz and wave length of 12-24cm. the water contained within the waste is rapidly heated by the microwaves and the infectious components are destroyed by heat conduction. The efficiency of the microwave wave disinfection should be checked routinely through bacteriological and virological test v. LAND DISPOSAL Municipal disposal site: - if a municipality or medical authority genuinely lacks the means to treat waste before disposal, the use of a land fills has to regard as

an acceptable disposable route. There are two type of disposal they are open dumps and sanitary landfills. Health care should not be deposited on or around open dumps. The risk of either people or animals coming to contact with infectious pathogens is obvious Sanitary landfills are designed to have at least four advantages over open dumps:-geological isolation of waste from the environment ,appropriate engineering preparation before the site is ready to accept waste , staff personal on site to control operations and organized deposit and daily coverage of waste VI. INERTIZATION:The process of inertization involves mixing waste with cement and other substance before disposal in order to minimize the risk of toxic substance contained in the waste migrating in to the surface water or ground water. A typical proportion of mixture is 65% pharmaceutical waste, 15%cent line, 15%cement and 5% water. A homogenous mass is formed and cubes or pellets are produced on site and then transported to suitable site The United Nations conference on the environment and development [UNCED] in 1992 recommended the following measures: Prevent and minimize the waste production Reuse and recycle the waste to the extent possible Treat waste by safe and environmentally sound method Dispose off the final residue by landfill in contained and carefully designated site

MAIN ADVANTAGES AND DISADVANTAGES OF TREATMENT AND DISPOSAL OPTIONS:Disposal method Advantages Disadvantages

Rotary kilns

- Adequate for all infectious waste, - high investment and more . chemical waste and operating costs pharmaceutical waste

Pyrolytic incineration

- very high disinfection efficiency and most pharmaceuticals and chemical waste

- incomplete destruction -relativelyhigh investment and operating costs - significant emission of need for periodic

- adequate for all infectious waste of cytotoxins

Single incineration

chamber - good disinfecting efficiency volume land fills

-drastic reduction of weight and atmosphere pollutions -the residue may be disposed of in removal of slag and soot

Wet treatment

thermal -environmentally sound -relatively low investment operating costs

- shredders are subject to and frequent breakdowns and poor functioning operation requires qualified technicians -inadequate anatomical ,pharmaceutical chemical and waste is not

Micro irradiation

wave - good disinfection efficiency under readily steam-permeable operating condition -drastic reduction in waste volume -potential operation and maintenance problems -high investment

Encapsulation

-simple, low cost and safe may also be applied to pharmaceuticals - not recommended for non-sharp infectious

Safe burying

- low cost and safe restricted and where

waste natural site is limited and certain precaution are taken

-relatively safe if access to site is - safe only if access to infiltration is limited Inertization -relatively inexpensive - no need of highly trained operators Drum and insufficiency in destroying brick -drastic reduction of weight and resistant volume of waste -very low investment - destroys only 99% of microorganism -massive gas Chemical disinfection -highly efficient disinfection under good operating conditions -uses comprehensive measure hazardous safely substances that require emission of black smoke ,fly ash toxic incinerator thermally

COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF BIOMEDICAL WASTE:Color coding 1)Yellow 2)Red Type of container Plastic bag Disinfected container/plastic bag 3)Blue/White Plastic Translucent 4)Black puncture container Plastic bag bag/ proof Cat.4,7 Autoclaving/microwaving/chemical treatment& destruction shredding Cat.5,9,10 disposal in secured land fill Cat.3,6,7 Waste category Cat 1,2,3,6 Autoclaving/microwaving Treatment schedule Incineration/ deep burial opinion as per

CATEGORIES

OF

BIO-MEDICAL

WASTE

IN

INDIA

(AS

PER

THE

ENVIRONMENTAL&FOREST GUIDELINES)

Category no Category 1 Category2

Waste category Human anatomical waste [human tissues, organs, body parts] Animal waste[animal tissues, organs ,body parts, carcasses, bleeding ,fluids, experimental animals used in research, waste generated by veteneriary hospitals colleges, discharges from the hospital]

Category3

Microbiology

&biotechnology

waste

[waste

from

laboratory

cultures, stocks or specimens of micro-organism, liver or attenuated vaccines ,human and animal cell culture used in research and infectious agents from research &industrial laboratories] Waste sharps [needles, syringes scalpels, blades, glass etc, that Category4 Category5 Category 6 may cause puncture and cuts .this includes both used and unused sharps] Discarded medicines and cytotoxic drugs [waste comprising of outdated, contaminated and discarded medicines ] Solid waste [ item contaminated with blood &fluids including cotton dressing Category7 Category 8 Category 9 Category 10 solid plaster casts, linen, beddings, other material contaminated with blood] Solid waste [waste generated form disposable items other than the waste sharps such as tubing, catheters, intravenous sets etc.] Liquid waste[ waste generated from laboratorary and disinfecting activities Incineration ash [ash from incineration of bio-medical waste] Chemical used in production of biological, chemicals used in disinfection as insecticides etc

SUMMARY:-

So far we went through the introduction, definition, classification, sources, health care waste generation, health hazards, treatment and disposal techniques, main advantages and disadvantages. Bibliography:k.park, Text book of preventive and social medicines ,published by banaras das, pp no567-574 Bruner &sidhartha, Text book of medical surgical nursing,7 th Published by Lippincott, Pp no 1200-1212 R C Anand ,sidhartha sathapathy,Hospital waste management,2 nd edition Published by jaypee,Pp no 2-98 Potter &perry,Basic nursing,6th edition,published by mosby,Pp no 220-226 edition