Continuing Medical Education Indian Journal of Community Medicine Vol. XXV, No.3, Jul-Sopt, 2000 HOSPITAL WASTE MANAGEMENT - A REVIEW Hemangini K. Shab, S.K. Ganguli Depit. of Preventive and Soci Introduction: HOSPITALS" committed to patient care and community health have been cited to paradoxically defy their own objectives. On one hand they cure patients and on the other, have emerged as a source of several diseases because surprisingly, until recent times, not enough attention has been paid to the disposal of hospital waste! ‘The waste generated from R and D organisations, laboratories and slaughter houses ete, have also been an important source of environmental and public health problem and the present indiscriminate disposal of these ‘wastes in the municipal dumps is a potential health hazard”, A focus on installing complex and expensive disposal technologies like Incinerators rather than implementing a practice of waste management within the hospital has been the indulgence of most medical administrators, towards resolving the problem, creating a chain of secondary problems of environmental pollution due to production of toxins like Dioxins and Furans', In addition to the community and environmental hazards health care personnel remain under a constant risk e.g the annual injury rates in health care personnel in developed countries vary from 10 10 20 per 1000 workers*. All the above highlight the ‘multifaceted problems of hospital waste, Formed mind-sets, lack of awareness and sensitivity to the subject on the part of the health care staff especially administrators have ‘emerged as vital causative factors’. Quantum of hospital waste: Global figures based on statistical data of Environmental Protection Agency of America and Japan, Ministry of Health suggested a volume of 1 to LS Ka/dayfbed for hospitals. However, waste produced has been quoted upto 5.24kg in developed countries’. Indian scenario: The average quantity of hospital solid waste produced in India ranges from 1.5 to 2.2kg/day/bed". As quoted by Pruthvish $°, Bangalore generates 1,32,500 kg of health ‘are waste per day while the health care facilities generate 5,100 kg of refuse dily* 196 Medicine, MIMER Medical College, Talegaon, Dabhade Quantity Vs. Quality: “The problem of hospital waste is more of quality as compared to quantity e.g. it is estimated that the total amount of hospital waste in Dethi is only 1.5% ofthe total ‘municipal waste stream’, Yet, a special obligation to deal ‘with this waste in an effective and safe manner is mandatory due to its composition’. In this context, however, what is not commonly known that only a small percentage i.e. 10 t0 20% ofthe hospital waste stream is infectious and requires special disposal techniques’. Hospital waste has been categorised as follows*: General waste: Domestic type of waste, packing ‘material, waste water from laundries etc Pathological waste: consists of tissues, organs, body parts, human foetuses and animal carcasses, blood and body fluids. Radioactive waste: includes solid, liquid and gaseous ‘wastes contaminated with radionuceides generated in vitro or in vivo testing. Chemical waste: Comprises of discarded sold, liquid ‘and gaseous chemicals eg. from diagnosis, ‘experimental work, cleaning, house keeping and disinfecting procedures. Infectious waste: includes cultures and stocks of infectious agents from laboratories, waste from survey and autopsy on patients in isolation wards and dialysis from infected patients. Sharps: includes items like needles, blades, broken Blass ete i.e any item that can cause a cut or puncture. Pharmaceutical wastes: consists of pharmaceutical products, drug and chemicals that have been returned from the wards. Pressurised containers: include those used for demonstration and instructional purpose. Disposal of waste: ‘The step-wise integrated waste management plan has bbeen devised by the Centre for Environmental Education for infectious and non-infectious wastes’. While cytotoxic wastes remain a pending issue, BARC has Inid-down » 2 3) 4) 3’ 6) D 8)regulations for radioactive wastes which must be stored until the hal life period of the wastes expire before disposal. General wastes can be dealt with by composting and recycling Resource material produced by Shrishti, guides authorities towards implementation of a safe waste ‘management system and culture in @ health care establishment through a stage-wise scheme, making it a feasible tsk’ ‘A nodal person identified would serve as a key 10 implement the overall plan and also act asa central point for dissemination of information. Evaluation of the existing system would aid in location to determine suitable positions for the placement of waste disinfection and disposal equipment ‘A waste survey should be conducted in all the wards, operation theatre, out patient departments, emergency, intensive care units, laboratories, administrative sections, kitchen and the main bin of the hospital for two weeks. The waste should be weighed atthe end of each shift brat the time of disposal. The information obtained would aid selecting specific receptacles for different wastes and different levels of output and determine the type of disinfection needed and the point at which it should be earried out in the waste stream ‘A pharmacy inventory is necessary to determine the {ype of products being used and the number of disposables. Also, each hospital must ensure that there exists a list of items and material that will always be considered infectious. Shrishti emphasises that a time specific programme which is more focussed and need based as familiarity increases, is essential to sensitise the staff’. Also finally a sound follow-up and accounting method enables regular appraisal ofthe plan, Conclusion: ‘The most vital component of the waste management plans that have been formulated is to bring about a Indian Joumal of Community Medicine Vol, XXV, No.3, Ju-Sopt, 2000 transformation in the mind sets and develop a system and culture through education, taining and persistent motivation of the health care staff. It should involve the co-ordinated working of several departments in a health care establishment. ie. not just the conventional hospital infection committee but myriad others such as house keeping, engineering, laundry, kitchen and security besides nursing, medical, surgical, laboratory and administrative departments", The cliche lies in segregation of the waste ‘especially infectious waste from the non-infectious waste resulting in defining and limiting expenditures. Reference Kela M, Nazareth S, Agarwal R: Implementing hhospital waste management; a guide for health care facilities in Shrishti 1997:1 Raghupathy L, Kathpalia I: Rules on biomedical waste, Indian Journal of clinical Practice. 1995; 6(4);, 84.99. Pruthvish S, Gopinath D, Jayachandra Rao M, Girish N, Bineesha P, Shivaram C: Health care waste disposal - an exploration, Department of Community Medicine, MS Ramaiah Medical College 1997; 1-11 Kumar M: Hospital Waste Disposal, planning consideration, National seminar on hospital architecture, planning and engineering, 1995; IV: 40-450. Gaur A: Disposal and Recycling of Waste, National seminar on hospital architecture, Planning and Engineering, 1995 IV: 46-50. Editorial, Havoc Medical Waste Wreaks, Health ‘Action (Environment) 1996; 24 Kerac M: The forgotten patient - discharged and dangerous? a case-study report of seven hospitals. Hospital Waste In India, 1997: 2 Krishnan S: Integrated Waste Management Plan, Hospital waste management plan, strategies for implementation, CEE South, 1997, 1