INTRODUCTION

Hospital waste refers to all waste, biologic or non biologic that is discarded and not intended for further use. Medical waste is a subset of hospital waste; it refers to the material generated as a result of diagnosis, treatment or immunization of patients and associated biomedical research. Biomedical waste (BMW) is generated in hospitals, research institutions, health care teaching institutes, clinics, laboratories, blood banks, animal houses and veterinary institutes. Although very little disease transmission from medical waste has been documented, both the American Dental Association (ADA) and Center for Disease Control recommend that medical waste disposal must be carried out in accordance with regulation. Hospital waste management has been brought into focus in India recently, particularly with the notification of the BMW (Management and Handling) Rules, 1998. The rule makes it mandatory for the health care establishments to segregate, disinfect and dispose their waste in an eco-friendly manner. Biomedical waste means any waste which is generated during the diagnosis, treatment or immunization of human beings, animals or in research activities pertaining thereto or in the production or testing of biological including categories mentioned in the Schedule 1 of the biomedical waste rules (Management and Handling), 1998. Waste: Any items or things for which the immediate owner can find no use.

Medical waste: Any waste which is generated during the diagnosis, treatment or immunization of human beings or animals in research activities is called biomedical waste.

Potential Implications of Biomedical Waste:A. Risk to healthcare workers and waste handlers Improperly contained contaminated sharps pose greatest infectious risk associated with hospital waste. There is also theoretical health risk to medical waste handlers from pathogens that may be aerosolized during the compacting, grinding or shredding process that is associated with certain medical waste management or treatment practices. Physical (injury) and health hazards are also associated with the high operating temperatures of incinerators and steam sterilizers and with toxic gases vented into the atmosphere after waste treatment.

B. Risk to the public Public impacts are confined to esthetic degradation of the environment from careless disposal and the environmental impact of improperly operated incinerators or other medical waste treatment equipment. There may be inBcreased risk of nosocomial infections in patients due to poor waste management. Improper waste management can lead to change in microbial ecology and spread of antibiotic resistance.

Classification

Non-hazardous waste:This constitutes about 85% of the waste generated in most healthcare set-ups. This includes waste comprising of food remnants, fruit peels, wash water, paper cartons, packaging material etc. [8] Hazardous waste:A) Potentially infectious wasteOver the years different terms for infectious waste have been used in the scientific literature, in regulation and in the guidance manuals and standards. These include infectious, infective, medical, biomedical, hazardous, red bag, contaminated, medical infectious, regulated and regulated medical waste. All these terms indicate basically the same type of waste, although the terms used in regulations are usually defined more specifically. [9] It constitutes 10% of the total waste which includes: 1. Dressings and swabs contaminated with blood, pus and body fluids. 2. Laboratory waste including laboratory culture stocks of infectious agents 3. Potentially infected material: Excised tumours and organs, placenta removed during surgery, extracted teeth etc. 4. Potentially infected animals used in diagnostic and research studies. 5. Sharps, which include needle, syringes, blades etc. 6. Blood and blood products. [8]

B) Potentially toxic waste1. Radioactive waste: It includes waste contaminated with radionuclide; it may be solid, liquid or gaseous waste. These are generated from in vitro analysis of body fluids and tissue, in vitro imaging and therapeutic procedures. [6]

2. Chemical waste: It includes disinfectants (hypochlorite, gluteraldehyde, iodophors, phenolic derivatives and alcohol based preparations), X-ray processing solutions, monomers and associated reagents, base metal debris (dental amalgam in extracted teeth). 3. Pharmaceutical waste: It includes anesthetics, sedatives, antibiotics, analgesics etc. [10]

Other types of Hospital Waste:1. 2. 3. 4. 5. 6. 7. 8. General waste Pathological waste Radioactive waste Chemical waste Infectious waste Sharps Pharmaceutical waste Pressurized waste

Need for Hospital Waste Management:1. 2. 3. 4. 5. 6. Control nosocomial disease Reduce community exposure Reduce HIV/AIDS and Hepatitis transmission Control zoonoses (infections from animals) Prevent illegal repacking and resale Avoid negative long term health effects e.g. cancer from the environmental release of toxic substances e.g. mercury 7. Waste in mans environment constitute a positive health hazard particularly the hospital refuge. 8. Organic portion of solid waste ferments and favors fly breeding. 9. Garbage attracts rats. 10. Flies and dust can convey pathogens to men. 11. Air pollution 12. Water pollution. 13. Street urchins handling the refuge spread diseases 14. Increasing need of using disposable materials in health care sector 15. Increasing awareness of & concern for environment protection 16. Ambience of the hospital gets disturbed. Hazardous nature of hospital waste: Contains infectious agents. Contains toxic chemicals or pharmaceuticals.

Genotoxic Radioactive Contains sharps Hazards of infectious wastes & sharps Hazards from chemical & pharmaceutical wastes Hazards from radioactive wastes Public sensitivity Distribution of Hospital Waste:80% - general, non hazardous waste. 15% - pathological and infectious waste. 1% - sharps waste. 3% - chemical or pharmaceutical waste. 1% - others.

o In India 1.8 2.2 kg/bed/day hospital waste is generated.

Distribution of Hospital Waste Generated o By Weight Plastic 14% 45% 18% _ 20%

Combustible Dry solid Wet solid Non-combustible _

Volume of Wastes: In general hospital- 1-3 kg/bed/day In teaching hospital- 1.5- 3.5kg/bed/day Persons at risk: Doctors, nurses, hosp auxiliary staff. Patients in hosp or home care. Visitors to hosp. Staff in support services. Workers in waste disposal facilities.
WARDS OPD SERVICE AREA 67.5% 13.4% 19.1%

MATERIALS AND METHODS

 Materials:Colour code Container type Waste type

Yellow

Plastic bag

Human anatomical waste placenta, biopsy tissue, amputated parts, etc Soiled infectious -cotton, gauze, bandages, blood pus or urine soaked materials. Plastic and rubber disposable, glass vials Sharps-needle, blades, cut ampoules, General- polythene bag, cups, papers, flowers Food, cafeteria , kitchen waste

Red

Plastic bag/container

Blue

Plastic bag

White/ blue

Transparent puncture proof plastic container Plastic bag

Black

Green

Plastic bag

Pre Disposal Disinfection agents for Waste Materials:-

Wastes / Articles

Disinfectants

Human tissues, pathological waste, animal waste, blood and body fluids Foul infected linen

Formalin 10%

Liquid bleach Boiling

Laboratory discarding jars

Sodium hypochlorite( 5% Cl ) Carbolic acid(phenol)

Sharp objects

Gluteraldehyde 2%

Steps in Waste Management:-

Medical waste should be managed according to its type and characteristics. For waste management to be effective, the waste should be managed at every step, from acquisition to disposal. The following are the elements of a comprehensive waste management system: waste survey, segregation, accumulation and storage, transportation, treatment, disposal and also waste minimization. 1. Waste survey: The survey should differentiate and quantify the waste generated. It should determine the points of generation, the type of waste at each point and the level of generation and disinfection within the hospital. This helps to determine the method of disposal. 2. Waste segregation: This consists of placing different kinds of wastes in different containers or coded bags at the point of generation. It helps to reduce the bulk of infectious waste as well as treatment costs. Segregation also helps to contain the spread of infection and reduces the chances of infecting other health care workers. In segregation Wastes to be incinerated should not be collected in chlorinated plastic bags. Category 3 if locally disinfected should not be put in bag/ container. Segregation of infectious waste from non- infectious done only of 30 % of hospital. Advantages of Segregation
3.

General waste does not become infectious. Segregation reduces chances of infection to staff. Treatment cost comes down. Non- infected waste can be recycled. Waste accumulation and storage: Waste accumulation and storage occurs between the point of waste generation and site of waste treatment and disposal. While accumulation refers to the temporary holding of small quantities of waste near the point of generation, storage of waste is characterized by longer holding periods and large waste quantity. Storage areas are usually located near where the waste is treated. Any offsite holding of waste is also considered storage.

To contain spills, storage areas should not have floor drains and should be recessed to hold liquids. Floor and walls should be impervious to liquid and easy to clean. They should be disinfected regularly. Refrigeration may be required for prolonged storage of putrifiable and other wastes. Proper storage facilities should be at the site of generation of wastes.Local storage areas should be available for accumulated wastes under adequate security.
4.

Collection and Removal: Method of collection depends upon method of disposal Timing of collection & removal should be convenient to the patient. Route by which waste material to be removed from the hospital. Separate service lifts to be used if available

5. Waste treatment: The term 'treatment' refers to the process that modifies the waste in some way before it is taken to its final resting place. Treatment is mainly required to disinfect or decontaminate the waste, right at source so that it is no longer the source of pathogenic organisms. After such treatment, the residue can be handled safely, transported and stored. Treatment process is following as

Needles and syringe nozzle - shredded in needle destroyer and syringe cutters Scalpel blades/ Lancet/ Broken glass should be put in separate containers with bleach, transferred to plastic/ cardboard boxes; sealed to prevent spillage and transported to incubators Glassware should be disinfected, cleaned and sterilized Culture plates with viable culture should be autoclaved; media are placed in appropriate bags and disposed off. The plates can be reused after sterilization Gloves should be shredded / cut / mutilated before disposal. Swabs should be chemically disinfected followed by incineration. If they contain only a small amount of blood that does not drip, they can be placed in the garbage. Disposable items are often recycled and have the risk of being used illegally. Dipping in freshly prepared 1% sodium hypochlorite for 30 min. - one hour, followed by mutilation before disposal should be the policy adopted for such items. Under no circumstances, should heat be used for disposal of amalgam. The heat will cause mercury to volatize and be released to the environment. So teeth with amalgam restoration should be treated by immersion in high-level disinfectant (e.g. Gluteraldehyde) for 30 min. Treated teeth can then be rinsed. Liquid waste generated by the laboratory is either pathological or chemical in nature. Non-infectious waste should be neutralized with reagents. Liquid infectious waste should be treated with a chemical disinfectant for contamination and then neutralized.

6. Waste transportation: When medical waste is not treated on site, untreated waste must be transported from the generation facility to another site for treatment and disposal. Internal and external transfer of hospital wastes- done in tightly tied polythene bags or in covered containers. For Internal transport trolley/ cart can be used Use disposable plastic gloves Spillage must be avoided. From hospital dumping place waste can be taken to appropriate place for treatment & disposal. Transport of waste from areas of generation must be done only by designated staff. Regular medical checkup for the staff is mandatory . By means of wheeled trolleys, containers or carts not used for any other purpose. Easy to load, secure and unload. Free from sharp edges. Easy to clean, disinfect & drain. Labeled with bio-hazard symbol. Separate vehicle for clinical & general waste. Details of type of waste & disposal, date, time & person responsible be recorded. Transportation instructions to the generator Segregated biomedical waste collected by authorized transporter of MCGM at predetermined route & time Waste carrying lorries should be covered Transported by a special vehicle which has a separate collection &driver cabin The vehicle is equipped with a electronic weigh scale, barcode scanner & computer. Off site Transportation Waste transportation from central storage area to site of final disposal Separate vehicle for clinical and general waste. A consignment note to accompany vehicle. Sealed bags or containers should have label with particulars : Date of waste category, : Date of generation, collection : Place in hospital (ward)
:

Waste description

: Waste destination, senders name with contact no.

7. Waste disposal The waste disposal methods vary in their capabilities, cost, availability to generation and impacts on the environment. So the various disposal methods include incineration, autoclaving, chemical methods, thermal methods (low and high), deep burial and microwaving were used for proper management of biomedical waste. Untreated medical waste can also be disposed off in sanitary landfills. Disposal without treatment is not recommended for human tissues, sharps and culture from clinical laboratories. -Disinfection and Disposal Prevent & minimize waste production Reuse & recycle the waste to the extent possible Treat the waste by safe & environment friendly methods Dispose off the final residue by landfill in confined & carefully designed sites. -Modes of Disposal Recycling Disposal under regulated conditions Disposal in the form of garbage Disposal by sale

X-ray waste treatment:-

1. X-ray fixer solution: It is considered a hazardous waste because of its high silver content. In the environment, free ionic silver acts as an enzyme inhibitor by interfering with the metabolic processes of organisms. These have to be disposed off as a hazardous waste or sent to a silver recovery system. 2. X-ray developer solution: Developer solution can typically go into the wastewater drain. Developer and fixer solutions should not be mixed with fixer solutions. If mixed, they should be separated and treated independently as required. 3. X-ray cleaner solution: Many cleaners for X-ray developer system contain chromium. If the cleaner solution used contains chromium, it should be disposed as a hazardous waste or switch to a non-chrome cleaner. 4. X-ray lead foil / lead shields: The lead foils and lead shields contain pure lead. Lead is a heavy metal that affects neurological development and functions and can potentially leach from landfills into the environment. These are hazardous waste unless they are recycled for their scrap metal content or disposed off as hazardous waste.