Biomedical waste
Biomedical waste/hospital waste is any kind of waste containing infectious (or potentially
infectious) materials.[1] It may also include waste associated with the generation of biomedical waste
that visually appears to be of medical or laboratory origin (e.g., packaging, unused bandages,
infusion kits, etc.), as well research laboratory waste containing biomolecules or organisms that are
mainly restricted from environmental release. As detailed below, discarded sharps are considered
biomedical waste whether they are contaminated or not, due to the possibility of being contaminated
with blood and their propensity to cause injury when not properly contained and disposed of.
Biomedical waste is a type of biowaste.
Biomedical waste may be solid or liquid. Examples of infectious waste include discarded blood,
sharps, unwanted microbiological cultures and stocks, identifiable body parts (including those as a
result of amputation), other human or animal tissue, used bandages and dressings, discarded
gloves, other medical supplies that may have been in contact with blood and body fluids, and
laboratory waste that exhibits the characteristics described above. Waste sharps include potentially
contaminated used (and unused discarded) needles, scalpels, lancets and other devices capable of
penetrating skin.
Biomedical waste is generated from biological and medical sources and activities, such as the
diagnosis, prevention, or treatment of diseases. Common generators (or producers) of biomedical
waste include hospitals, health clinics, nursing homes, emergency medical services, medical
research laboratories, offices of physicians, dentists, and veterinarians, home health care,
and morgues or funeral homes. In healthcare facilities (i.e., hospitals, clinics, doctor's offices,
veterinary hospitals and clinical laboratories), waste with these characteristics may alternatively be
called medical or clinical waste.
Biomedical waste is distinct from normal trash or general waste, and differs from other types
of hazardous waste, such as chemical, radioactive, universal or industrial waste. Medical facilities
generate waste hazardous chemicals and radioactive materials. While such wastes are normally not
infectious, they require proper disposal. Some wastes are considered multihazardous, such as
tissue samples preserved in formalin.
Risk to human health[edit]
Sharpsmart Reusable Sharps Container
Disposal of this waste is an environmental concern, as many medical wastes are classified
as infectious or biohazardous and could potentially lead to the spread of infectious disease. The
most common danger for humans is the infection which also affects other living organisms in the
region. Daily exposure to the waste (landfill) leads to accumulation of harmful substances or
microbes in the person's body.
A 1990 report by the United State CountryAgency for Toxic Substances and Disease
Registry concluded that the general public is not likely to be adversely affected by biomedical waste
generated in the traditional healthcare setting. They found, however, that biomedical waste from
those settings may pose an injury and exposure risks via occupational contact with medical waste
for doctors, nurses, and janitorial, laundry and refuse workers. Further, there are opportunities for
the general public to come into contact medical waste, such as needles used illicitly outside
healthcare settings, or biomedical waste generated via home health care.[2]
Management[edit]
Biomedical waste must be properly managed and disposed of to protect the environment, general
public and workers, especially healthcare and sanitation workers who are at risk of exposure to
biomedical waste as an occupational hazard. Steps in the management of biomedical waste include
generation, accumulation, handling, storage, treatment, transport and disposal.[3]
The development and implementation of a national waste management policy can improve
biomedical waste management in health facilities in a country[4]
On-site versus off-site
Disposal occurs off-site, at a location that is different from the site of generation. Treatment may
occur on-site or off-site. On-site treatment of large quantities of biomedical waste usually requires
the use of relatively expensive equipment, and is generally only cost effective for very large hospitals
and major universities who have the space, labour and budget to operate such equipment. Off-site
treatment and disposal involves hiring of a biomedical waste disposal service (also called a truck
service) whose employees are trained to collect and haul away biomedical waste in special
containers (usually cardboard boxes, or reusable plastic bins) for treatment at a facility designed to
handle biomedical waste.
SELECTION OF TOPIC
A biomedical waste can be define as a waste that consists of infectious agents. It includes the
material that can be of medical pr laboratory origin. For, example packaging, infusion kits, unused
bandage, syringe, tubes and others. These materials are restricted to environmental release as
these are contaminated with harmful disease causing pathogen such as bacteria, virus, protozoa,
fungi and others.
The goals of biomedical waste treatment are to reduce or eliminate the waste's hazards, and usually
to make the waste unrecognizable. Treatment should render the waste safe for subsequent handling
and disposal. There are several treatment methods that can accomplish these goals.
Biomedical waste is often incinerated. An efficient incinerator will destroy pathogens and sharps.
Source materials are not recognizable in the resulting ash. Alternative thermal treatment can also
include technologies such as gasification[8] and pyrolysis including energy recovery with similar waste
volume reductions and pathogen destruction.
An autoclave may also be used to treat biomedical waste. An autoclave uses steam and pressure
to sterilize the waste or reduce its microbiological load to a level at which it may be safely disposed
of. Many healthcare facilities routinely use an autoclave to sterilize medical supplies. If the same
autoclave is used to sterilize supplies and treat biomedical waste, administrative controls must be
used to prevent the waste operations from contaminating the supplies. Effective administrative
controls include operator training, strict procedures, and separate times and space for processing
biomedical waste.
Microwave disinfection can also be employed for treatment of Biomedical wastes. Microwave
irradiation is a type of non-contact heating technologies for disinfection. Microwave chemistry is
based on efficient heating of materials by microwave dielectric heating effects. When exposed to
microwave frequencies, the dipoles of the water molecules present in cells re-align with the applied
electric field. As the field oscillates, the dipoles attempts to realign itself with the alternating electric
field and in this process, energy is lost in the form of heat through molecular friction and dielectric
loss. Microwave disinfection is a recently developed technology which provides advantage over old
existing technologies of autoclaves as microwave based disinfection has less cycle time, power
consumption and it requires minimal usage of water and consumables as compared to autoclaves.
For liquids and small quantities, a 1–10% solution of bleach can be used to disinfect biomedical
waste. Solutions of sodium hydroxide and other chemical disinfectants may also be used, depending
on the waste's characteristics. Other treatment methods include heat, alkaline digesters and the use
of microwaves.
For autoclaves and microwave systems, a shredder may be used as a final treatment step to render
the waste unrecognizable. Some autoclaves have built in shredders.
Methodology
This chapter relates to methodology and procedures followed in research study. The
present study has been done in Nasik City. Next chapter deals with Overview of Nasik
City. It means field work done in Nasik on various parameters of research.
Descriptive Analysis of Survey Data has been planned as separate chapter, Chapter 5.
Survey method is used to find out methods and procedures adopted to dispose off hospital
waste in general hospitals of Nasik. The limited Cost Effective Analysis (CEA) and
issues of impact of bio medical waste on workers/community health have been combined
together as discussion points, results, observations in Chapter 6. The details of
methodology have been discussed under following headings;
@ Statement of problem.
@ Need, and significance of study.
@ Definition of terms used in research project.
@ Objectives of study.
@ Limitations of Study.
@ Selection and preparation of an appropriate research design.
@ Sampling.
@ Tools for data collection.
@ Data collection.
@ Special Observations by the Researcher
@ Data Analysis
Statement of Problem;
Any research process begins with problem discovery and identifying the problem. The
word PROBLEM in general usage or narrow sense suggests that something has gone
wrong. It does not connote a business opportunity, the need for evaluation of an existing
program. It should be noted that initial stage of any research process is problem discovery
in broader sense and not narrow. The researcher may not have a clear cut statement of the
problem at outset of research. Only symptoms may be apparent at the beginning. The
researcher may not know exact magnitude of the problem; therefore problem statement is
made in general only. What is to be investigated? is not yet specially identified. So, we
begin with statement of problem for current study.
STATUS OF HOSPITAL WASTE MANAGEMENT IN NASHIK
Need and Significance of Study;
The hazards of poor management of bio-medical waste have aroused concern all over the
world in light of its impact on human health and environment. The foregoing review of
present scenario of hospital waste management in our country clearly reflects serious
weaknesses in management of bio medical waste.
In spite of introduction of Government of India Legislation as bio medical (management
and handling rules) July 1998, reviewed many times up to September 2011 hospitals
continue to dump their medical waste into municipal bins and do not follow rules and
regulations . Thus there is need to set up guidelines for implementation of efficient bio
medical waste procedures. But for efficient implementation of these procedures
information related to queries given below are required.
What facilities are available to the hospitals for implementing latest rules?
What facilities are required by these hospitals, and how to make these available to
them?
What different kinds of difficulties do healthcare workers face while implementing these
procedures, and how to rectify them?
Are hospital personnel besides doctors; like nurses, workers, technicians etc aware about
public health hazards created by negligence in medical waste disposal?
If not, what steps are required to make healthcare personnel aware of public health
hazard?
Present study aims to get answers to these queries; and about procedures of segregation,
storage, transportation, treatment and disposal of infectious waste in general hospitals of
Nashik.
The findings can be used for drafting hospital waste management plan by hospital
administrators and solving problems of health care personnel. Information secured from
this study can also be used by apex authorities like Maharashtra Pollution Control Board,
Nasik Municipal Corporation to frame rules for effective implementation of bio medical
waste rules for safe environment.
The present study has made an attempt to study different alternative waste treating
technologies with respect to their capital costs with installation type of waste treated,
reduction in weight and volume their technical capacity, operational and maintenance
expenditure etc so as to arrive at cost effectiveness of these biomedical disposal systems.
On the basis of these findings, this study in Nashik will help hospital administrators to
know alternate technologies presently used for treatment and disposal of medical waste in
general hospitals in Nashik and will help them in selecting cost effective bio medical
waste treating technologies for treatment and
Observation
The study was conducted in 25 districts spread over 20 States of India
including urban and rural areas. Primary (n=388), secondary (n=25) and
tertiary care (n=24) health facilities from public (n=238) and private (n=199)
sector were assessed and scored for the state of BMWM through 9 items
representing system capacity, availability of resources and processes in place.
Health facilities were assigned into one of the three categories (Red, Yellow
and Green) based on the cumulative median scores.
Results:
Around 82 per cent of primary, 60 per cent of secondary and 54 per cent of
tertiary care health facilities were in the ‘RED’ category. Multivariate analysis
indicated that charts at the point of waste generation, availability of
designated person, appropriate containers and bags, availability of functional
needle destroyers, availability of personal protective gears, segregation of
waste at point of generation and log book maintenance were independently
(OR-between 1.2-1.55; P <0.03 or less) associated with better BMWM system
in the health facilities. This was true for both rural-urban and public or private
health facilities.
Interpretation & conclusions:
The study highlighted the urgent need for greater commitments at policy and
programme levels for capacity building, and resource investments in BMWM.
disposal of their biomedical waste. All these steps will lead to
secure a safer environment for society at large.
Importance
A lot has been said over the years regarding the health and hygiene in hospitals, but one
thing that is over looked time and again is hospital-acquired infections. As such, one of the
most important tools in hospital hygiene is hospital bins.
Medical waste is unwanted biological products that are highly infectious in nature. It has to
be disposed properly otherwise it poses a health and environmental danger. Medical waste
is found in hospitals, laboratories, research centres, tattoo parlours, etc. Medical waste is
broadly classified as infectious waste and biohazardous waste, and can easily spread any
disease virally and can even pose a danger to life.
Hospital bins are a great source of dirt that gets accumulated over a period of time if not
emptied timeously. They house a great deal of waste that can contain bacteria, which may
further reduce the levels of hygiene in patients. They also contain bodily fluids and other
waste products that, if stringent measures are not followed, will cause numerous problems
for staff and patients.
The management of medical waste in developing countries poses a major health problem,
inviting serious health implications. When visiting health care facilities, patients should not
become more ill then they already are, hence it is vitally important to ensure patient safety
by keeping the health centre clean and environmentally sound. Waste collection service
providers also have to be looked at meticulously.
Illegal disposal
In many instances of illegal disposal, medical waste is mixed with the municipal waste and a
percentage is buried without any measure or burned with no proper regulation. Public
awareness of health care waste has grown in recent years, especially with the emergence
of Aids. In addition, the possibility that health care wastes could transmit HIV, hepatitis B
virus (HBV) and other agents associated with blood-borne diseases is also a major concern.
Therefore, the disposal of health care waste and its potential health impact are an important
public health issue.
Waste threats and disposal
Effective medical waste disposal is the first and foremost way to prevent unwanted disease
and prevent untoward infection from medical wastes. All staff in any hospital or laboratory
are equally responsible in housekeeping. Good housekeeping can reduce the infection to a
great extent. It also cuts down on the spreading of microorganisms and bacteria. The
advantages of proper medical waste disposal include the creation of a healthy atmosphere
that is free from microbes, thus minimising the risk of infection to staff, visitors and other
people, cutting off unpleasant sights and bad odours, and the reduction of fleas and insects.
Most staff are not aware of the risks involved when handling medical waste and the related
infections. Sharp objects, such as used needles, pose serious risk of infections like HIV,
HBV, etc. If medical waste is not properly disposed by staff, then infection may easily
spread to patients and other clients who visit hospital and laboratories. Moreover, while
disposing of medical waste, it must be done cautiously without polluting the environment. In
an ideal world, staff disposing of medical waste must be well-trained and must be observed
by a supervisor. In addition, every hospital must follow the segregation guidelines.
Bin varieties
Some hospitals have installed fire retardant bins in many places that are required by the
rules of safety and hygiene. The safety of the patients is crucial to hospitals, making these
bins very important in areas where patients’ health and safety is at risk. Hygiene should be
a top focus in places where health care is of primary importance. These bins are not only
retard the fire, but also have antibacterial and microbial properties, which help ensure that
the bin is not responsible for spreading any kind of disease or infection.
There are many medical waste bins, community waste bins and waste collection bins in
hospitals that are colour-coded and are available in different areas throughout the health
care facility. This helps prevent any kind of contaminated diseases making its way to a
conventional landfilling during the collection process. There are also simple sack holder bins
that have pedals or even sensors to prevent mishandling of the bin. Mishandling of bins is a
serious issue as this is where most transfer of infections occurs.
When installing the medical waste bins, litterbins and waste collection bins, another
important factor to consider is size. All bins should ideally be roughly the same size. If one
type of bin is filled before another, then there is an increased chance that people will fill the
wrong bins with the wrong products – and may lead to improper disposal methods thereof.
The hospital bin is a very important tool that helps ensure that health care facilities remain
hygienic for a long period, and it is ultimately the responsibility of the authorities in question
to take care of this fact.
Conclusion
Our country has a huge medical infrastructure. With increasing number of hospitals
and medical and dental colleges opening, improper disposal of biomedical can lead to
significant environment and health related hazards. Thus, adequate knowledge about this is
essential.
Waste generation should be minimized for the protection of environment and
general public health.People must be sensitized to the issues related to
biomedical waste and should participate in the programs organized for waste
minimization. The medical employees must be trained to create awareness and
foster responsibilities for prevention of exposure and unsafe disposal to the
waste. Medical personnel should strictly follow all the rules and regulations
implemented by concerned governing bodies.
Result
Hospital waste is considered dangerous because it may possess pathogenic agents
and can cause undesirable effects on human health and the environment. In Iran,
neither rules have been compiled nor does exact information exist regarding hospital
waste management. The survey presented in this article was carried out in all 15 private
hospitals of Fars province (Iran) from the total numbers of 50 governmental and private
hospitals located in this province, in order to determine the amount of different kinds of
waste produced and the present situation of waste management. The results indicated
that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of
domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps.
Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of
the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of
the hospitals are equipped with an incinerator and six of them (40%) have operational
problems with the incinerators. In all hospitals municipal workers transport waste
outside the hospital premises daily or at the most on alternative days. In the hospitals
under study, there aren't any training courses about hospital waste management and
the hazards associated with them. The training courses that are provided are either
ineffective or unsuitable. Performing extensive studies all over the country, compiling
and enacting rules, establishing standards and providing effective personnel training are
the main challenges for the concerned authorities and specialists in this field.
Objectives
Know Your Role
As a business owner or decision maker, you must know your role in
waste management. You and the other decision makers in your
health care organization are responsible for keeping everyone from
nurses to waste handlers to the people in your town safe from
hazardous waste. Knowing that the other people in your company will
follow your lead, make it a goal to design thorough policies and
procedures. This way, if something goes wrong, the solution will be
clear and your employees can make the right decisions.
Follow Legal Standards
While laws can be slow to catch up to best practices, your bare
minimum standard for waste management should be to follow all
federal, state and local regulations. Because these laws can be
complex and can vary between jurisdictions, you may want to hire a
lawyer to look over your plans and ensure compliance.
On the state level, you should look for regulations from the agencies
that oversee health and the environment. While some states focus
heavily on one side or the other, some jurisdictions split the duties
evenly. Whatever rules these agencies put forth, you should ensure
your plan abides by them.
Your waste management strategy must also follow regulations from
the federal government. For example, the Occupational Safety and
Health Administration sets rules about how employers should keep
employees safe from harm, including when they are handling waste.
These rules keep workers safe when they are on the job. The U.S.
Food and Drug Administration and the Centers for Disease Control
and Prevention also oversee medical waste.
Protect Human Health
The laws that regulate toxic waste disposal are not without good
reason. If a person gets exposed to medical waste before it goes
through decontamination, the person can become ill. In some cases,
the waste was used as part of a radiation treatment and is still
radioactive.
Other times, the waste may be bodily fluids from a person with a
contagious disease. These illnesses can be as common as the flu or
as deadly as Ebola. Sharp medical waste, such as needles and
scalpels, can injure a person. Furthermore, if these were used on a
person with an infectious disease like HIV, the disease could
transfer.
Because this waste can be so harmful to human health, it's vital that
one of the main goals of waste management is minimizing these
risks. This starts with disposing of waste in separate and safe
receptacles. The entire process from that point should keep human
health in mind until the waste is deemed safe and put in with the
general trash.
Since improperly handled medical waste can spread disease and
cause outbreaks, the CDC has guidelines for proper disposal. You
should take care to follow the CDC's guidelines and regulations
whether you legally have to or not.
Keep the Earth Safe
In much the same way that toxic waste can hurt people, it can cause
serious damage to the environment. For example, if some radioactive
medical waste makes its way to a water source, it can ruin the
ecosystem of the lake. If anyone drinks water from it, he could also
get sick.
To keep such a tragedy from occurring, you should always maintain
environmental safety as one of your goals in medical waste
management. Being environmentally responsible also helps you
meet the other two major goals. The safety of the environment
around people directly affects their health. Furthermore, your state's
environmental agency may have regulations on the subject.
