Introduction

 Hospitals stand as symbols of health care and hygiene.

 But, public health and environmental problems arising

from hospital wastes are very high.

 The disposal of solid waste and treatment of wastewater

has become an issue of growing concern
Types of Waste
Generated
 Food Wastes - These include wastes from canteens and
wards comprising essentially of organic matter that are
biodegradable

 Wastes from Administrative Activities – Paper and

cardboard, plastics, glass containers, plastic containers,
packing cartons and other packaging materials belong to
this type.

 Pathological Wastes – Tissues, body parts, human

fetus, animal carcasses, organs and tissues infected with
human pathogens and other similar wastes from
surgeries and biopsies.
 Infectious Wastes – which cause diseases on exposure,
coming from isolation wards, autopsies etc. They also include
blood and blood products, items like surgical gloves, linen and
bandages contaminated with agents like blood, serum and
plasma, culture and stocks of infectious agents from laboratories,
discarded live and attenuated vaccines etc.

 Sharp Wastes – Needles, syringes, scalpels, blades, razors,

catheters, intravenous sets, contaminated broken glass, blood
tubes and other similar materials.

 Pharmaceutical Wastes – Outdated medications of all kinds as

well as residuals of drugs that may be cytotoxic, genotoxic,
mutagenic, teratogenic or carcinogenic.
 Radioactive Wastes – Solid, liquid, or pathological wastes
contaminated with radioactive isotopes.
 Incineration Ash – Ash from incineration of any bio-
medical waste
 Chemical Wastes – Solid, liquid or gaseous chemicals
such as solvents, reagents, film developer, ethylene oxide
and other chemicals that may be toxic, corrosive,
flammable, explosive or carcinogenic
 The liquid wastes generated from this hospital are from the
following sources:
Washings from Theatre, X-ray unit, Laboratory,
Floor etc.
Discharge from Canteen
Discharge from Laundry etc.
Rate of waste generation from Amala Cancer Hospital

550
Number of Beds

Number of Wards 23
Avg. Inpatient 45 per day

Avg. Outpatient 520 per day

Avg. Solid Waste Generated 1.80 kg/bed/day
Avg. Flow Rate of Liquid Waste600 litres/bed/day
Generated
Quantitative estimation of solid waste from Amala Cancer Hospital

Avg. Weight (kg/day) Percentage (%)

Type Of Waste
General Wastes 575 58.08
a. From Rooms and Wards
b. From Canteen 100 10.10
c. From Office, Pharmacy, Others 10 1.01
Bio-medical Wastes 40 4.05
a. Pathological Wastes
b. Infectious Wastes 150 15.15
c. Sharp Wastes 92 9.30
d. Pharmaceutical Wastes 5 0.50
e. Radioactive Wastes 3 0.30
f. Chemical Wastes 15 1.51
Total Waste Generated 990 100.00
 Relative Composition of Solid Waste Generated In
Amala Cancer Hospital, Thrissur

Food Wastes Administrative Wastes

Pathological Wastes Infectious Wastes
Sharp Wastes Pharmaceutical Wastes
Radioactive Wastes Chemical Wastes
 The Bio-Medical Rules have recommended different colour
codes for waste containers in which different types of
wastes needs to be stored. Clinical and general wastes
should be segregated at source and placed in colour coded
plastic bags and containers of definite specifications prior
to collection and disposal.
 Categories and colour coding recommended for
segregation in health-care establishment, including the
categories mentioned in the Bio-Medical Waste
Regulations of the Ministry of Environment and Forests,
Government of India.
Standard reference table for the disposal of wastes in to different buckets

WASTE CODE
CATEGORY
Cat 1& 2 Human tissue,organs,bodyparts,fluids and blood etc Yellow

Cat 3 Microbiology and biotechnology waste Red

Cat 6 Solid waste
Cat 4 Needles,scalpels,bladges,glass etc may causeBlue
puncture and cuts
Cat 5 Discarded medicines and cytotoxic drugs(wasteBlack
Cat 10 comprising of outside, contaminated and discarded
medicines)
Chemical waste (chemicals used in production of
biological, chemical used in disinfection etc).

Cat 6 General waste (food waste, paper packages etc). Green

Cat 7 Solid waste (waste generated disposal of item otherTranslucent
than the waste sharps such as tubing, catheters,
I.V.sets, syringes, plastic containers etc).

Cat 8 Bottles (small &big) Aluminium bucket

Cat 9 Aluminium items Wastebasket –Mesh
type
WASTE MANAGEMENT
 There are Guidelines for Hospital Waste
Management In India prepared by the
Environmental Health Unit, of the Ministry of Health,
Government of India.
 It gives detailed information and covering all aspects
of safe hospital waste management in the country,
including the risk associated with the waste,
formation of a waste management team in hospitals,
their responsibilities, plan, collection, segregation,
transportation, storage, disposal methods,
containers, and their colour coding, waste
minimization techniques, protective clothing, etc.
Mainly two types of wastes are produced in any
hospital

 Solid wastes

 Waste water
SOLID WASTES:
 BURNING AT HIGH TEMPERAURE IN
INCINERATORS
 The incinerator (costs about 6 lakhs) of Amala hospital is
manufactured at HAAT industries, UK. At present a two
chambered incinerator of chimney/stack height 20m is
functioning inside the hospital compound.
 All the combustible carcinogens, pathologically
contaminated materials, toxic organic compounds and
biologically active waste materials produced in the
hospital are being incinerated using this device after
separating chlorinated plastics from them.
 The solid waste fed into the primary combustion chamber is
combusted using automatic pressure jet burners at a
temperature of about 800°C and the gases and partially burnt
vapours entering the secondary chamber are additionally
heated to a temperature of about 1200°C, after which the flue
gas produced is cooled.

 The ash (highly poisonous) thus produced from incinerator is

properly collected and dumped in highly covered concrete
wells to avoid the contact with the nature, mainly the water
resources.

 Sharp wastes and chemical wastes generated in the hospital

are being treated in 1% hypochlorite solution before disposal
Waste water
treatment:
treatment

 Hospitals generate on average 600 L of wastewater by bed and

a day. These effluents are loaded with pathogenic micro
organisms, pharmaceutical partially metabolized, radioactive
elements and other toxic chemical substances.

 The basic principle underlying effective wastewater

management is a strict limit on the discharge of hazardous
liquids to sewers.
Efficient on-site treatment of hospital sewage should
include the following Operations:

 Primary treatment

 Secondary biological purification

 Tertiary treatment
Primary treatment

 Primary treatment removes the materials that can be

easily collected from the raw wastewater and
disposed of. The typical materials that are removed
during primary treatment include to fats, oils, and
greases (also referred to as FOG), sand gravels and
rocks (also referred to as grit), larger settleable solids
including human waste, and floatable materials. This
step is done entirely with machinery, hence the name
mechanical treatment.
Secondary treatment

 Most helminthes will settle in the sludge resulting from

secondary purification, together with 90-95% of
bacteria and a significant percentage of viruses; the
secondary effluent will thus be almost free of
helminthes, but will still include infective
Concentrations of bacteria and viruses.
Tertiary treatment

 The secondary effluent will probably contain at least

20 mg/litre suspended organic matter, which is too
high for efficient chlorine disinfection. It should
therefore be subjected to a tertiary treatment, such as
lagooning; if no space is available for creating a
lagoon, rapid sand filtration may be substituted to
produce a tertiary effluent with a much reduced
content of suspended organic matter (<10mg/litre).
 In this hospital they first preferred methods
like aerobic (honey comb) method. Because of its
inefficiency, they changed this method and introduced
anaerobic plant.
Main source of wastewater is from the
large number of bathrooms, which are used by both
patients and staffs of the hospital. They are collecting
the waste water to a big tank near the anaerobic plant
by means of underground pipes.

The treated water coming out of the plant

is used only for the irrigation purpose. Due to this
abundant availability of wastewater, they have set up
massive gardens all around the hospital.
Effect of the Pollutants on the Environment:
Environment

Some of the wastes produced in the

hospital are being dumped into landfills. But, landfills can
pollute the underground water by leaching toxic substances
from the garbage into the ground. The situation is worsened
when rain falls on the landfill and quickens the flow. Landfills
are also a threat to air quality as they release gases like
methane, carbon dioxide, carbon monoxide, nitrogen,
hydrocarbons and other volatile organic compounds.
Methane build-up can even be explosive when mixed with
air. Other viable methods could be used for disposing these
wastes.
 SUGGESTIONS:
The different buckets, which are being
used to divide various wastes, are not sufficient. They are
keeping most of the wastes in open buckets, and that to
without categorizing them. The staffs that are exposed to this
careless storage of waste are at a high risk of suffering from
serious infections. The staffs should be made aware about
the dangerous that may cause due to this careless.
They are not a part of waste
management programme of IMA. We are suggesting to join
in that programme, so that the waste can be transported to
proper treatment.
Here the syringes and needles are
scattered in open air, it’s not a good practice. It should be
properly incinerated.
CONCLUSIO
N
BIBILOGRFY