Since beginning, the hospitals are known for the treatment of sick persons but we are unaware about the adverse effects of the wastes (solid wastes as well as liquid wastes) produced by hospitals, nursing homes, clinics, research laboratories , diagnostic centres, veterinary hospitals, etc., these are potential sources of health hazards, and need to be specially treated and disposed of.
Approximately 1.45 kg of waste is generated per patient per day in Indian hospitals ; whereas it is much higher in developed countries. In Western-countries, approximately 15-20% of this total waste is found to be hazardous and infected, whereas the percentage of hazardous and infected waste in India is usually much higher, since we do not have proper waste segregation practices in all the hospitals except in some big hospitals.
The greatest risk of clinical waste is from the infection and sharp components like needles, syringes etc. Healthcare workers and people associated with the hospital waste disposal, often get needle prick injuries and can even get AIDS/HIV or other type of infection like Hepatities B & C , through skin route.
Legal Laws on Management
Keeping its potential hazardous effects on humans, living in the surrounding of medical wastes, the Indian Union Ministry of Environment and Forests has recently notified “Biomedical Waste (Management and Handling) Rules 1998”. These rules have been notified under the Environment (protection) Act 1986. Under these rules, every health care institute, big or small, will have to make arrangements to ensure that their produced waste is handled and managed without causing any adverse health effect on human beings and the environment. In case of non -compliance with these rules, the occupier, i.e. the head of such institution, shall be liable to be punished under the Environment (Protection) Act, 1986.
Collection and treatment The various types of medical wastes are divided into different categories , and collected in different coloured bins or containers , as to help in segregation of hazardous and non-hazardous wastes , needing different types of treatments. The process is known as waste segregation. The correct classification of collection of different waste items in different coloured dust bins, is to be done by the various hospitals, and it is the duty of the hospital doctors and nurses to ensure correct disposal of different waste items in their respective dust bins or containers, The system of using different coloured bins and bags to collect different types of medical wastes , is known as colour coding.
According to the 1998 Indian Rules notified for the disposal of biomedical wastes, such wastes are to be segregated in the bins or containers of the following colours:
* Blue/white; and
The most important aspect of management of biomedical waste is that the hazardous biomedical waste should not be mixed with the non-hazardous general waste. In order to achieve this, different types of wastes in hospital should be collected in different coloured bins and containers, and disposed of suitably. If a large number of color coding is going to create confusion, then one may decide to divide the wastes into the following three categories only:
(A) Yellow bins waste: These wastes need to be incinerated or buried deep, and may include: human anatomical wastes, animal wastes, pathological wastes. Micro-biological wastes, sharp wastes, discarded medicines, cytotoxic drugs, and solid wastes.
(B) Red bin wastes: These wastes will have to be autoclaved, disinfected with chemicals, or microwaved. They may include: plastic wastes, and disposable items like tubes , catheters, blood or urine bags, gloves, etc.
(C)Black bin wastes: These wastes can be sent for disposal to secure landfills/burials, and may include, chemical solid wastes and incinerated ash, etc.
Collection of Sharp Wastes:
In collection of various types of biomedical wastes , special attention is required to be given to sharp wastes, as they constitute a unique category of medical waste, and always pose a risk factor of many infectious pathogens. Sharp may be defined as objects that are capable of puncturing or cutting due to any points or proturbences, and may include: syringes, needles, scalpels, blades, Pasteur pipettes, and broken glasses or plastics. As a matter of fact, 98% of all health facilities generate sharp wastes.
To ensure their safe handling, manufacturers must develop mechanisms to render the syringes ‘non-sharp’ , immediately after use. This will reduce the needle stick injury, by preventing the puncture. Self-sheathing syringes, self-blunting blood collection needles, and even needleless syringes are hence gaining popularity.
Labeling for Identification
All labeling and sign posting should follow the international symbols and colour coding. All the infected, soiled, pathological, human and sharp wastes, should be marked with biohazard symbol in black colour cytotaxic wastes, a symbol of cytotoxic hazards, i.e. C in a triangle.
Storage of Bio-medical Waste:
According to the rules, the infectious waste cannot be stored for more than 48 hours. However, hospital waste may need to be stored, if immediate treatment and disposal cannot be done. These wastes should be refrigerated on site to prevent rotting and offensive smells. These wastes may then the carted and stored in off-site storage facilities, built in R.C.C, in notified areas , away from the general public. These storage housed must be properly designed to allow wash down water and rain water.
Wastes in hospital should be frequently lifted from well marked designated collection points in hospital wards or rooms. Open trolleys are often used to collect wastes from individual bins. In all such cases, each bin and each trolley must be thoroughly cleaned and disinfected with 1% solution of bleaching powder(hypochlorite) at least once a weak. The movement of the sanitation staff should be prevented or minimized through the designated clean areas of the hospital. Automated waste handling and transport system is much better than the manual ones.
Treatment and Disposal
All the plastic disposable items contained in medical waste are vulnerable for reuse without proper sterilization, unless destroyed completely. Several cases of repacking, supply and sale of syringes catheters, etc. just after washing, or after low temperature autoclaving in unauthorized factories , have been reported in the recent past in the country and even in the capital city of Delhi. This practice is highly risky for the health of patients, for whom these used and repacked items are used . It has therefore, been made mandatory to mutilate and shred such items at the generation points itself. The wastes should also be disposed of in a manner which does not cause any harm to the people or their environment.
The management of a hospital or a nursing home must develop a commitment for safe dispose of its waste . At the same time, devoted and trained personnel become more important than the technology. Almost any treatment and disposal which is operated by well trained and devoted staff can eventually provide more protection for the staff, patients, and the community in general.
Community Awareness: Implementation of the environmental laws and safe practices in not only the responsibility of the government alone, but active participation of the people is essential . National level educational programme for the masses about proper waste management is hence called for, in any good waste management system. The public awareness programme should be continuous and consistent, and should not last for a limited time. It should also be wide spread over the state and the country, as a whole.
(The author is Assistant Engineer (Civil), PHE Division Udhampur)