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Abstract
Hospitals being the centre of cure are also an important centre of infectious waste generation. Present study deals
with the study of the fate of the hospital waste at national and international level. An exhaustive survey and detailed
investigation of the waste generated, recycled and their disposal procedures adopted in the leading hospitals in Terai
belt of Uttar Pradesh in India have been reported through a “Self Assessment Audit Form” which consisted of 122
parameters divided in to 33 broad categories. It has been found that the amount of the infectious components in the
waste is very little and this needs careful handling. Norms prescribed by the government for the disposal of hospital
waste has also been discussed. In most of the cases it was found that regulations were being violated.
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Research Article Biology and Medicine, 1 (3): 25-32, 2009
all the institutions related to the health problem to the nature of wastes. All institutions have a
(Acharya and Singh, 2000). central collection area. Government institutions
The minimization and effective have conducted training program to train their
management of biomedical waste is through staff about safe handling of biomedical waste
identification and segregation of the hazardous but it is not known about the study site-4. Thus
waste. To tackle the problem of identification of three of the selected institutions have trained
biomedical waste different types of colour code staffs who are handling biomedical wastes.
plastic bags or containers are used which is the None of the institutions were found to have a
most appropriate way (Dwivedi et al., 2008). record for the amount of wastes they are
Sharps should be collected in puncture proof generating. Government health institutions of
bags or containers. Highly infectious waste is to Uttar Pradesh have recently made a contract
be sterilized before dumping with general waste. with a private organization for proper transport
Needles and syringes are to be destroyed with and disposal of hospital wastes generated by
the help of needle destroyer and syringe cutters different institutions through out the state.
at the point of generation. All disposable plastics None of the institutions have been found
should be subjected to shredding before in practice to reduce, eliminate and recycle their
disposing off to vendor. The ultimate treatment toxic chemicals, equipments and materials
practices of biomedical waste are incineration, return program. Though all the institutions have
autoclaving, hydroclaving or microwaving. mercury containing equipment and equipments
falling under universal waste (batteries, lamps,
Materials and Methods mercury, and thermostats) but none had the
In the light of hospital waste management four proper facility to prevent release of these to the
hospitals in the Terai belt of Uttar Pradesh were environment. Every institution has claimed that
selected as the study sites. District Hospital they have proper labeling and segregation of
Gorakhpur was selected as the study site-1; their dangerous wastes through labeled
Baba Raghav Das Medical College and containers at central storage systems. None of
Hospital, Gorakhpur was selected as the study the institutions are found to recycle their used
site-2; District Hospital, Basti was noted as the articles like paper, aluminum cans, card board,
study site-3 and site-4 was the Sanjeevani steel cans, sharps, news paper, toner cartridges,
Nursing Home, Gorakhpur. Study sites 1, 2, and solvent, fixers, pallets, inkjet cartridges, wood,
3 were government organizations, while the printer ribbons, lead aprons, motor oils,
study site 4 was a private nursing home. The pharmaceuticals, box board, computer, ice
selected study sites have been surveyed packs, coolers, glass, silver recovery,
regarding facilities; types of waste generated i.e. construction wastes, mercury, X- ray films,
solid, liquid, reuse, their collection areas, way of batteries, plastics, alkaline, nickel, cadmium and
disposal etc. The study was carried out by lead acid (Table: 1). Three out of the four
collecting information through the “Self surveyed institutions claim to have on-site
Assessment Audit Form” (Table: 1). To bring out incineration facility. The disposal of their red bag
the exact figure, this “Self Assessment Audit waste is performed through on-site incineration.
Form” was equipped with 122 parameters Autoclaving or other methods of disposal are not
divided in to 33 broad categories. Further, in practice in any of the selected institutions. A
detailed analysis regarding the total hospital record regarding the production of extremely
activities such as, total outdoors, indoors, hazardous substances, amount and the types of
pathological investigations etc. on monthly basis wastes is not maintained by any institution. Like
was conducted at the study site-1. wise, there is no reporting system of these
records to higher authorities. Certain articles and
Results and Discussion instruments for e.g. patient dishware, employee
Information given by the institutions revealed dishware, glass ware, baking pans, metal trays,
that most of the hospitals generate solid and bath basins, bed pans, urinals, pillows,
liquid wastes of different natures, some of which instruments pans, splash basins, ,medicine
are hazardous as well. All surveyed institutions cups, gowns towels, drapes, ventilator tubing,
have labeled collection container with color pulse oximeters, suture removal kits and vaginal
coding (Red, Black, Yellow, White or Blue) for speculum are reused by health institutions.
collection of different types of wastes, according
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Research Article Biology and Medicine, 1 (3): 25-32, 2009
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Research Article Biology and Medicine, 1 (3): 25-32, 2009
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Research Article Biology and Medicine, 1 (3): 25-32, 2009
NC: No Comment.
Regarding liquid wastes, all the selected is in two out of the four selected study sites. All
institutions are found discharging their waste the selected hospitals are using computer,
water directly into the sewer system. copier and printers but scanners are being used
Quantitative amount of waste water discharge at only of the selected study site. At the same,
per day is not in their record. No comments time fax machine is being used only at the two
regarding the magnitude of waste water being sites. Also, all the selected hospitals are using
discharged per day, number of discharge points water cooler, refrigerator and freezers.
in their institutions was provided and neither any Though, it was an exhaustive survey but
diagram of their sewer system was available. authors feel that the hospital authorities found
Physico-chemical property of the waste water them-selves uncomfortable to disclose their
being discharged has never been analyzed. facts. It was not an easy task to drag the
None of the surveyed institution was authorized information. The self audit form has also its
to discharge polluted water, but all the limitations. Information regarding the assistance
institutions were found directly discharging their from Government, financial flow and the annual
dangerous waste down to the drain. Water budget could not be incorporated in the self
conservation is being practiced only at Baba audit form because of certain limitations. These
Raghav Das Medical College in Gorakhpur. studies may be done as another part of the
Instrument for monitoring total water used is not study.
installed in any institutions. They have no
comment about low flow toilets. Recycling of
water is not being done in any institution but A case study of District Hospital Gorakhpur
regular inspections and repair of leaks are in To conduct the detailed investigation, district
practice. hospital Gorakhpur was selected for evaluation
Regarding facilities available at the of the magnitude of the hospital waste
institutions dental facility is at every institution. generated. The record of one year (2006) for
None of the institutions have Amalgam total indoor, total outdoor patients and related
separators, Filters, Silver recovery, Recycle film, investigations such as pathology x-rays and ultra
Pharmacy, Boilers, Grinder, Solvents, Waste oil sonogram have been summarized in table 2. On
water separator, Grounds keeping, Irrigation the ground of the table it was found that the
system, Audit water of irrigation system and hazardous waste is generated from orthopedic,
Grease trap. Equipment Maintenance Schedule indoor surgery and pathology. X-ray and ultra
(EMS), X- ray Photography Laboratory, sonogram were the process through which
Pathology, Laundry, Vehicle or equipment excess of heavy metals like silver (Ag) is
maintenance, Washing, Sterilization; all these released. Since, 600 gram hospital waste is
facilities are available at all the institutions. generated by single patient on an average,
Facilities like Histology and Digital photography therefore 9259 patients (table 2) would produce
are in practice only at Baba Raghav Das 5555.4 kg of hospital waste in a year and this is
Medical College, Gorakhpur. Facility like Kitchen a projected estimation.
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Cause of the Problem are four states which play a key role in the
In India, excepting a few large hospitals, most of generation of voluminous amount of hazardous
the smaller hospitals and nursing homes lack solid waste. In India, adequate and requisite
any effective system to safely dispose off their number of sanitary landfills is lacking. Therefore,
waste. Even the Government and municipal the biomedical waste are openly dumped into
hospitals are no better than the private nursing the open bins on the road sides, low lying area
homes, regarding disposal of their waste. Thus, or they are directed into the water bodies;
an unauthorized reuse of medical wastes by rag through which severe disease causing agents
pickers is being promoted through irresponsible are spread into the air, soil and water. This
dumping of these dangerous wastes into open would result into the incurable diseases like
bins. Biomedical waste, because of its infectious AIDS and Hepatitis B. Rule 1998 and seventh
nature and serious health hazards need care for schedule of Indian constitution are related to the
its proper collection, segregation and disposal to hazardous waste management program. These
minimize the pollution of air, water and soil rules are to be strictly enforced by the Central
(Singh and Sharma, 1996). For this, government Pollution Control Board (CPCB). Waste means
of India has laid down certain rules which should anything which is not intended for further use or
be enforced by authorities and should be strictly reuse. But here in the case of solid waste
followed by institutions and clinics in the welfare materials, released by the health care
of mankind and the safety of animals. institutions or nursing homes may further be
Central Pollution Control Board and the used after minimizing or reducing its infectivity.
State Pollution Control Boards, the In developed countries, these waste
agencies responsible to enforce these rules materials are treated with the different kinds and
in hospitals are on one hand lacking adequate strength of chemicals to minimize its
power and on the other hand there is no pathogenicity and then used in the power
commitment. As a result, most of the large production. Medical waste has a broad stream; it
hospitals have not complied with these rules includes all types of waste materials like waste
even after expiry of new deadlines. In such from offices, kitchen, canteen, cafeteria,
situation NGO’s and voluntary bodies have to pathology and also from different wards. All
come forward and compel the hospitals and these are not infectious in nature only some of
nursing homes to fall in the line with the rules. these are perilous in nature. The waste
materials are also divided into two categories on
Remedial Measures the basis of their degradability.
Biomedical waste management is of paramount Hospital wastes carry to a greater extent
importance at each level. In India Andhra of harmful disease causing microscopic
Pradesh, Bihar, Uttar Pradesh and Tamil Nadu organisms. Proper management and disposal of
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