A STUDY OF HOSPITAL WASTE MANAGEMENT IN HEALTH FACILITIES OF THE DISTRICT PAURI GARHWAL (UTTARAKHAND)

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1 International Journal of Management Research and Technology Volume 5 Number 1 January-June 2011: I J M R T Serials Publications A STUDY OF HOSPITAL WASTE MANAGEMENT IN HEALTH FACILITIES OF THE DISTRICT PAURI GARHWAL (UTTARAKHAND) Amit K. Singh *, Ruchita R. Dixit * & Navin Bhatt * Abstract: Objective: To study the status of Hospital Waste Management in different Health facilities of the district. Materials & Methods: The study was conducted as a cross-sectional study among different hospitals of the district after selection of the hospitals by simple random sampling technique. The facilities of hospital waste collection, segregation, transport and disposal were observed directly and by interviewing the selected staff members by using a modified survey questionnaire for waste management. This questionnaire was obtained from the World Health Organization (WHO), with the aim of assessing the processing systems for biomedical waste disposal. Results & Discussion: Among all the health facilities: Govt. Medical College and one of the Combined hospital were having the facility of Color-coding system for hospital wastes collection & Segregation. Govt. medical college was generating about 69% Non infectious waste and 31% infectious waste of the total waste. The Rag pickers were playing a major role in off- site segregation of the wastes and were exposing themselves to hospital waste handling hazards. None of the health facility was observed to have a storage facility of biomedical wastes before disposal. PHCs were transporting their wastes mainly by manual method to the disposal sites without any protection to the waste handlers and none of the health facility was having staffs specially trained for the purpose. Among all the health facilities only Govt. Medical College & hospital was having the facility of Centralized Incinerator system for biomedical waste disposal other hospitals were observed disposing their wastes by open dumping without any pretreatment. Conclusion: The issue of Hospital Waste Management is still in its nascent stage in the district as well as the state and there is an urgent need of intersectoral collaboration to create awareness among all the levels of health facility and the Government, to prevent an epidemic to take place which is waiting for. Keywords: Hospital wastes; Color-coding; Segregation; Incineration INTRODUCTION Hospital Waste has recently emerged as a public health threat in not only our country but also for the whole world. Hospital waste includes garbage, refuse, rubbish and Bio Medical Waste. 1 Hospitals committed to patient care and community health care has 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 health facilities, organizations, laboratories etc. have been also been an important source of environmental and public health problem. 2 * Assistant Professor, Department of Community Medicine VCSGGMSRI, Srinagar, (Garhwal) Uttarakhand, India, (E- mail: singh120377@yahoo.co.in)

2 24 International Journal of Management Research and Technology Average waste generated in the hospitals of United States is 7-10 kg/bed/day, of which only % is infectious. In Europe the average waste generated in the hospitals is 3-6 kg/bed/day, of which only % is infectious. 3 India generates around three million tones of medical wastes every year and the amount is expected to grow at eight per cent annually. The average quantity of hospital solid waste produced in India ranges from 1.5 to 2.2 kg/day/bed, as quoted by Pruthvish S, 4 Bangalore generates 1,32,500 kg of health care waste per day. 5 The greatest risk of Biomedical waste is from infectious and sharp components of the waste, because health care workers, and people associated with handling waste are often getting needle prick injuries and can contract HIV/AIDS, hepatitis B and C. 6 Rag pickers in the hospital, sorting out the garbage are at a risk of getting tetanus and HIV infections. The recycling of disposable syringes, needles, IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis B, HIV and other viral diseases. 7 The hospital waste like, organs, tissues, blood and body fluids along with soiled linen, cotton, bandage and plaster casts from infected and tainted areas along with used needles, syringes and other sharps are very essential to be properly collected, segregated, stored, transported, treated and disposed of in a safe manner to prevent nosocomial infections. Various communicable diseases, which spread through water, sweat, blood, body fluids and contaminated organs, are important to be prevented. 8 to avoid all these hazards a proper waste management system should be installed in all health care system. AIMS AND OBJECTIVE 1. To assess hospital waste Management system in the district. 2. To estimate the quantity of waste generated in different departments of Govt. Medical College hospital. 3. To estimate the percentage of Infectious and non infectious waste generated in the Govt. medical college. MATERIALS & METHODS The present study was conducted in different Health facilities of the district. The research was executed as cross-sectional study from Jan 2010 to June The health facility (Government sector) of the district is formed by: Health Facilities Government Medical College. Community Health Centers. Primary Health Centers. Add P.H.C District hospital Combined hospital Sub Additional Dispensary No. of Hospitals (As per current census) 1 (one) 5 (five) 10 (six) 20 (twenty) 2 (two) 2 (two) 67 (Sixty seven)

3 A Study of Hospital Waste Management in Health Facilities of the District 25 From the study universe mentioned above Government Medical College and Hospital was included as a whole as there is no other counterpart of it. Then from the other categories of health facilities, 40% hospitals from each category were selected by simple random sampling technique. The hospitals were studied by multistage stratified random sampling technique. In Government Medical College - Hospital all the departments i.e., Medicine, Surgery, Gynecology, Ophthalmology, Otorhinolaryngology, Orthopedics, Pediatrics, were included for the study purpose. Hospital Waste collection and segregation procedures were ascertained in each hospital/ ward, direct observations were made to ascertain the method that was followed for collection and segregation (facility of color-coding) of different type of wastes. 24 hrs collection and segregation of hospital waste was done in different wards and the waste generated was weighted by using weighing machine to calculate the amount of waste generated in the different departments of the medical college. Methods adopted for the storage of hospital waste were ascertained in each hospital/ward by direct observations and interview of health staffs. Hospital waste transport and disposal was further ascertained by direct observation and structured interview schedule of selected staff members of all the hospitals/wards. The mode of transport, the type of vehicle used and other details about the transportation system as well as for the disposal system was observed directly. RESULTS AND DISCUSSION Collection & Segregation of Hospital Wastes Table 1 showed that amongst the Government hospitals, Government Medical College and Hospital was following Color-coding system in 82% of the departments and the combined hospital was also following the color-coding system. Table 1 Hospitals Having Facility of Color-Coding System Health facility Total number Having Percentage of Hospitals the Facility (%) GOVT. MEDICAL COLLEGE 14 (Departments) 11 (Departments) 82 % C.H.C 2 NONE 0% P.H.C 4 NONE 0% Additional P.H.C 8 NONE 0% District hospital 1 NONE 0% Combined hospital % Sub additional Dispensary 27 NONE 0% Hospital waste generated = Approx. waste generated in the ward in 24 hrs kg/bed/day No. of beds in a the ward (occupied)

4 26 International Journal of Management Research and Technology Table 2 Quantity of Solid Waste from Different Departments of Govt. Medical College Departments Non Infectious Infectious Quantity (Kg /Bed /Day) (Kg /Bed /Day) (Kg /Bed /Day) Paediatrics Ophthalmology Medicine Surgery Orthopaedics Obst. & Gynaecology Burn Ward Emergency ENT Mean (Kg /Bed /Day) (69%) (31%) Figure 1 Department wise Solid Waste Generation None of the health facility was observed segregating the wastes as per the standards lay down by the Govt.of India. The hospitals, which were even having the Color-coding system, were not segregating the wastes properly and a lot of mixing was observed during segregation. None of the health facility was having staffs specially trained for hospital waste management even among the doctors only 12% of them were aware of different categories of biomedical wastes. In the present study it was observed that the Govt. Medical College was generating a mean hospital waste of 2.19kg/bed/day.

5 A Study of Hospital Waste Management in Health Facilities of the District 27 A study was conducted by Govt. of Tamilnadu in collaboration with W.H.O in 2003 quotes that the average hospital waste generation in Medical colleges of Tamilnadu was Kg/bed/day. 9 Government Medical College was following Disinfections/Pretreatment methods before final disposal of biomedical wastes in 65% of the departments. Other health facilities were not observed following any pretreatment of biomedical waste. None of the health facility was observed to have a storage facility for biomedical wastes before disposal, General Wastes were seen scattered around the hospital premises and was a dwelling and breeding site for scavengers. MODE OF TRANSPORT TO THE DISPOSAL SITES Government Medical College was transporting their wastes by using Handcarts and Manual methods; other health facilities were manually transporting the hospital wastes to the disposal sites, the health staffs were not observed taking any precaution or protective measures during transportation of the hospital wastes in any of the health facility. In the present study, it was observed that the Government Medical College was having the facility of Centralized Incineration system, for incineration of biomedical wastes collected from different Departments. The incineration of the wastes from the different Departments was done daily. However, other health facilities were not having the facility of incineration. HOSPITAL WASTE DISPOSAL In the present study, it was observed that Government Medical College was disposing their biomedical wastes by Incineration. The general wastes were disposed by open dumping in the hospital premises. There was practically no special method for disposal of hospital wastes except open dumping in other health facilities. CONCLUSION In the present study, it was observed that among all the health facilities Government Medical College was having the facility for Hospital waste Management but not as per the guidelines of BWM and Handling Rules 1998/2000. However at the C.H.C and P.H.C. level there was nonexistence of such facilities. The health staffs including Doctors were not aware of the proper management of Hospital wastes and the health hazards at the Primary and the secondary level of health infrastructure. Health care Waste is an emerging public health threat, Proper handling, management & disposal of Hospital Wastes at all the levels of the health care facilities is the need of the hour, which cannot be successfully implemented without the willingness, devotion, self-motivation, cooperation and participation of all sections of employees of any Health care establishment. RECOMMENDATIONS 1. Health Education to the Community and Health personals to create awareness is required. 2. Proper implementation of the Biomedical waste Management and Handling Rules 1998/ 2000 is required.

6 28 International Journal of Management Research and Technology 3. Time to time training programmes and proper supervision of health facilities is essential to implement the Biomedical Waste Management and Handling Rules 1998/2000. Notes & References 1. Baghotia K. S. (2006), Biomedical Waste Management Scenario in Delhi, Directorate of Health Services, GNCT of Delhi. 2. Kela M, Nazareth S., Agarawal R. (1997), Implementing Hospital Waste Management; a Guide for Health Care Facilities in Shrishti, International Healthcare Waste Network, Patil & Shekdar Pruthvish S, Gopinath D, Jayachandra Rao M, Girish N, Bineesha P, Shivaram C (1997), Health care Waste Disposal - An Exploration, Department of Community Medicine, M S Ramaiah Medical College, Kumar M. (1995), Hospital Waste Disposal, a Planning Consideration, National Seminar on Hospital Architecture, Planning and Engineering, IV, Chamberland ME, Conley LJ, Bush TJ et al. (1991), Healthcare Workers with AIDS: National Surveillance Update. JAMA, 266, Kishore J, Ingle GK (2004), Biomedical Waste Management in India. 8. Website: 9. Tamilnadu Healthcare Management System, A Study, Govt. of Tamilnadu & W.H.O