INTRODUCTION

Hospital Overview

Dr. R.N. Patil's Suraj Neurology & Multi-specialty Hospital is situated at the prime location of Navi
Mumbai, Sector - 15, Sanpada, off Palm Beach Road. It is a full fledged Neurological & Multispecialty
set up comprising of latest technology equipment which are most contemporary in their category to
provide most sophisticated preventive diagnostic & curative health care services under one roof by
affordable, highly reputed & competent doctors of various specialties / super specialties. Qualified &
experienced RMO's, staff nurses & paramedical staff are available for service under supervision of Dr.
R.N. Patil who is a neurosurgeon.

The hospital is on the panel of various schemes of central govt. and State govt. organizations,
corporate companies, State Govt. Health Schemes and other banks for cashless treatment.
The hospital has tie-ups with all the third party administrators and insurance companies for cashless
facilities. The hospital also runs occupational health center in various corporate industries and
conducting occupation health check up in industries.

The hospital is currently in process for accreditation by National Authority Board for Hospitals
(NABH).

Hospital vision

Hospital with Human Touch

Hospital Mission

 To provide patient friendly environment

 To provide quality healthcare to the patients, confirming to scientific and ethical
standards
 To constantly upgrade the quality of medical practice and education in the hospital
 Continuously audit and improve services

Quality Objective

 To provide minimum 20 hours training to every employee.

 To ensure 0% waiting time for emergency patients.
 To deliver prompt and quality treatment to patients of all categories

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Following are the facilities provided by the hospital

1. Super-specialty brain and spine neurological centre

2. Advanced accident trauma care centre.

3. Specialist and super-specialty consultation

4. Well equipped operation theatre

5. Well equipped I.C.U. with modern ventilators.

6. Neuro-Rehabilitation centre

7. Neuro-psychiatric counseling centre

8. CT scan

9. Cathlab

10. Dialysis Centre

11. 24 Hr. pathology laboratory

12. 24 Hr. X-ray facility

13. Physiotherapy centre

14. Specialist diabetes, hypertension care centre

15. Sonography

16. Health check up

17. 24 Hr pharmacy

18. E.E.G/EMG/2D echo/ TMT Test

19. C-Arm facility for Orthopedic cases

20.Audiometry

21. Pulmonary Function Tests

22. Home services for emergency and pathology services

23. Occupational health check up for industries

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R.N. Patil's Suraj Hospital Layout

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 Hospital Departments/ Sections

Outpatient Department

Outpatient department is the part of the hospital designed for the treatment of outpatients, people with
health problems who visit the hospital for diagnosis or treatment, but do not at this time require a bed or
to be admitted for overnight care. It offers a wide range of treatment services, diagnostic tests and
minor surgical procedures.

Inpatient Department

Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in
modern medicine and the advent of comprehensive out-patient clinics ensure[that patients are only
admitted to a hospital when they are extremely ill or have severe physical trauma.

Operation Suite

The operating suite forms a distinct section within the hospital consisting of operating theatres (OT).
Besides the operating rooms, there is a wash room, a room for personnel to change, storage cabinets, a
fridge and an autoclave for sterilization of equipment. It is separated from other departments so that
only authorized personnel have access.

An operating theatre is a facility within a hospital where surgical operations are carried out in
a sterile environment. The hospital has 2 operating theatres - major and minor. The major has an area of
2000 square feet and the minor has an area of 1200 square feet. They are spacious, easy to clean, and
well-lit and have overhead surgical lights, viewing screens and monitors. It is windowless and features
controlled temperature and humidity. Special air handlers filter the air and maintain a slightly elevated
pressure. There is a backup power generator in case of power cuts. Rooms are supplied with wall
suction, oxygen, and possibly other anesthetic gases. There are tables to set up instruments and storage
racks where common surgical supplies are kept in containers. There are also containers for disposables.

4
Operating room equipment

Operating table with lights above it

The operating room consists of the following equipment:

 The operating table in the center of the room can be raised, lowered, and tilted in any direction.
 The operating room lights are over the table to provide bright light, without shadows, during
surgery.
 The anesthesia machine is at the head of the operating table. This machine has tubes that connect to
the patient to assist him or her in breathing during surgery, and built-in monitors that help control
the mixture of gases in the breathing circuit.

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 The anesthesia cart is next to the anesthesia machine. It contains the medications, equipment, and
other supplies that the anesthesiologist may need.
 Sterile instruments to be used during surgery are arranged on a stainless steel table.
 The suction machine is specially designed for those surgeries that require the thick liquids like
phlegm and negative pressure suction. The machine, integrated with an oil free piston pump is
environmentally friendly with no generation of oil and smoke.
 An electronic monitor (which records the heart rate and respiratory rate by adhesive patches that are
placed on the patient's chest).
 The pulse oximeter machine attaches to the patient's finger with an elastic band aid. It measures the
amount of oxygen contained in the blood.

 An electrocautery machine uses high frequency electrical signals to cauterize or seal off blood
vessels and may also be used to cut through tissue with a minimal amount of bleeding.
 If surgery requires, a Heart-lung machine, or other specialized equipment, may be brought into the
room. Heart lung machine takes the temporary control of the heart and lung during the surgery
maintaining the circulation of blood and oxygen content of the body.

Storage racks where operating room supplies are kept

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Autoclave

The autoclave door with temperature controls

The hospital has one autoclave which is used to sterilize surgical equipment, laboratory instruments,
pharmaceutical items, and other materials. It can sterilize solids, liquids, hollows, and instruments of
various shapes and sizes. Autoclaves vary in size, shape and functionality. It uses the power of steam to
kill bacteria, spores and germs resistant to boiling water and powerful detergents. It is located within
the operating suite.

High dependency unit

The high dependency unit is located closely to the intensive care unit, where patients can be cared for
more extensively than on a normal ward, but not to the point of intensive care, it is appropriate for
patients who have had major surgery and for those with single-organ failure. The HDU of the hospital
has 4 beds with ventilators.

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Intensive care unit

An intensive care unit (ICU) is a special department of a hospital or health care facility that
provides intensive treatment medicine.
Intensive care units cater to patients with severe and life-threatening illnesses and injuries, which
require constant, close monitoring and support from specialist equipment and medications in order to
ensure normal bodily functions. They are staffed by highly trained doctors and nurses who specialize in
caring for critically ill patients.
The ICU of the hospital has 8 beds fitted with ventilators and 3 trolleys, 2 of which have provision for
oxygen cylinder to be attached. The equipment in the ICU includes mechanical ventilators, cardiac
monitors including those with telemetry; equipment for the constant monitoring of bodily functions; a
web of intravenous lines, feeding tubes, nasogastric tubes, suction pumps, drains, and catheters; and a
wide array of drugs to treat the primary condition of hospitalization.

Hospital Wards

The hospital wards have beds for inpatients. The wards are focused on a variety of patient types :
1. Male ward : This ward is meant exclusively for male patients.
2. Female ward : This ward is meant exclusively for female patients.
3. General ward : Both male and female patients can be housed here.
4. Day care center : This ward is meant for patients who are admitted for a single day.

Dialysis room

It is a room consisting of dialysis equipment. Patients in need of dialysis treatment are admitted in this
room. It has 2 beds.

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Store room

A shelf containing medical supplies with names of supplies indicated

It is a room where all hospital supplies are stored such as dressings, medicines, sanitary napkins,
cleaning liquids, solutions, etc. They are located at various places in the hospital and the list of
supplies is pasted on the store room door. The store room is managed by the store manager.

A cleaning checklist

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The hospital has many checklists which are used for inspection of hospital supplies. Inspection of
supplies is done daily, 3 times a day. There are checklists for various rooms such as toilets, stores,
wards, deluxe rooms, fridges, etc.

Medical Records Department

This department manages medical records of all patients treated over the past seven years. This
information is stored in the hospital server and can be accessed by all other departments. Hospital
registers are used for manually recording details related to various departments of hospital such as
patient details, stores, hospital supplies, medicines. There are 3 types of registers:
Patient registers contain details of patients such as name, employment details, insurance scheme, etc.
This is done as a back-up although it is also entered in the database.
The stores register contains list of all stores that have been purchased by the hospital such as D-mart
along with receipt are written and which department has it been dispatched to and how much stock is
remaining.
In the maintenance register, list of all hospital equipment that require maintenance is written along
with details of issues.

Casualty room

Casualty room is a room where badly injured patients are first brought. The doctors conduct an initial
diagnosis of the patient after which he is taken to the required department for treatment.

Blood sample collection room

In this room, blood samples of the patient are taken and blood tests are carried out for case diagnosis.

Hospital Labs

The hospital is equipped with hi-tech labs which are used for carrying out various types of scans to
help diagnosis of patients. The labs include:

- X-ray lab
- Sonography lab
- EEG/EMG lab
- Audiometry lab
- MRI lab
- Pathology lab

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Marketing and TPA department

It manages insurance schemes and policies of patients. The hospital has tie-ups with two types of
insurers - public and private. When patient first gets admitted, he gives his insurance card and papers
to the reception staff. The reception staff feed the patient details into the system which is now
accessible to all departments. The marketing staff review this information and contact the relevant
insurance company regarding the scheme and coverage. If the details match, the company gives
acceptance or rejection. Until this time, hospitals asks for cash payment from patient. Once the
insurance is approved, treatment is provided on a credit basis. Once the patient is discharged, initial
cash payment is refunded.

If the patient qualifies for insurance, the hospital receives an initial payment from insurance company
followed by installments until the full payment is received. This could take several weeks and can be a
temporary loss to the hospital. In case of government companies, the payment is delayed. However
these companies send a regular stream of patients to the hospital irrespective of treatment charges. So
revenue is fixed and discounts can be given. In case of private companies, although payment is done in
short time, patients are sent to those hospitals where treatment is done at a cheaper rate.

Decontamination room

It is a room where all medical clothing, supplies and equipment are decontaminated and cleaned. This
is done by chemical treatment and there is also two washing machines for this purpose.

Hospital Front Office

The hospital has a reception or front office located in the OPD lobby to cater to visitors and patients as
they enter. It also has a database software which is used by the front office staff for transaction
processing and keeping records of patients. It has 6 different modules for different departments i.e.
OPD, IPD, TPA, Lab, Accounts and Consultants. Staff belonging to each department are given access
to the respective module. This helps to make the billing process localized to each department. Eg: All

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OPD payments are made at the reception. IPD payments at the IPD counter and so on. Bed occupancy
list is also available for all wards.

Transport facilities

There are 3 ambulances on duty at the hospital which provide on-call 24 hour service to any patient and
2 private vehicles.

Procurement

The procurement of hospital supplies and equipment has been outsourced to distributor 'Divine Centre'
which operates within the hospital premises. Whenever the hospital has any requirement, it gives a
request to DC which provides the supplies along with an invoice to the stores department. DC has many
suppliers/manufacturers for its products. It asks suppliers to provide drugs with certain composition and
it gives the name for drug and markets it. All its suppliers are ISO certified. It has many clients one of
which is Suraj hospital.
All records of transactions for past 7 years are in the database system. There are 2 softwares - one for
medical supplies and other for medical equipment. DC has a wholesaler license. It was established so
that the hospital could purchase supplies at a cheaper rate as it is a wholesaler. DC calculates the rate at
which it should sell by deducting the distributor's margin, retailer's margin and taxes from the MRP.
Every purchase and sales order has a registration number. If the number is entered into the database, all
details about the transaction will appear like company name, product date, purchase rate from
manufacturer, selling rate to buyers, credit terms, taxes, etc.

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 RESEARCH OBJECTIVES
1. To study the classification and sources of hospital waste, problems and need for biomedical waste
management in Maharashtra.

2. To study internationally recognized hospital waste management procedures and biomedical waste
treatment in Mumbai region.

3. To study the hospital waste management at R.N. Patil's Suraj Hospital, calculate its bio-medical
waste generation/day/bed and evaluate its biomedical waste management level.

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 LITERATURE REVIEW

Mishra K., Sharma A.,Sarita and Ayub S.(2016) conducted a study on the various techniques used for
biomedical waste management along with the knowledge and attitude of people and healthcare
workers. Along with this, the scenario of biomedical waste management in various hospitals in India
is discussed. The results reveal that 318 out of 388 of primary care, 15 out of 25 of secondary care, 13
out of 24 facilities are in RED category, which needs a lot of efforts to improve the biomedical waste
management across all over country. The state of biomedical waste Management (BMW) at primary
care health facilities indicates requirement of major inputs for improvement. The situation was worst
in rural areas with median score of 1.58 as compared to the urban facilities with median score 2.74.
Public sector providers in rural areas had better BMW Management system than counterparts in
urban areas. In contrast, there was almost complete lack of biomedical waste management system in
private sectors in rural areas. The study concluded that each and every healthcare facilities which
generates biomedical waste, needs to set up requisite treatment facilities to ensure proper treatment
of wastes and its disposal so as to minimize risk of exposure to staff, patients, doctors and the
community from biomedical hazards. Safe and effective management of biomedical waste is not only
a legal necessity but also a social responsibility.

Mohankumar S. and Dr. K. Kottaiveeran (2011) conducted a study on the present scenario and
challenges of hospital wastes in India. Its objective was to analyze the health care waste management
system, including practices and compliances. The cost of hospital waste management was also studied.
Waste segregation, storage, collection, handling and transportation techniques were suggested. The
findings reveal that safe management of hospital waste has received much attention over recent years in
India. Emphasis is placed mainly on the proper handling, segregation and disposal of hospital wastes.
However, waste minimization and recycling are still not well promoted. The main issues considered
were the adverse environmental and health impacts that arise from poor handling and disposal
practices, the responsible institutions and initiatives taken and the policy framework. The study
concluded that proper hospital waste management system can help control spread of diseases and can
reduce community exposure to resistant bacteria. It could also reduce HIV/AIDS and Hepatitis
transmission from dirty needles and other improperly cleaned or disposed medical items. Regarding
environmental issues, a correct and sustainable management system of hospital waste will avoid the
negative long term health effects, from the environmental release of toxic substances such as dioxin,
mercury and others.

Arshad N., Nayyar S., Dr.Amin F. and Dr. Mahmood K. (2011) conducted a research on the extent to
which proper waste management practices are being followed in teaching hospitals in Lahore. The

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findings showed that waste segregation was done in all hospitals. 60% of hospitals had waste
generation plan and existence of hospital waste management team. In 80% of hospitals, different
colour bags were used for waste disposal. For on-site waste collection, different type of transportation
means were present among them carts were commonly used. Transportation of waste to final treatment
was done by employees in 80% hospitals and contractors in 20% hospitals. Incineration was considered
the final treatment method in 80% of hospitals. 40% hospitals had liquid waste management plans and
in 60% hospitals, record of waste generated was kept. The study concluded that proper collection and
segregation of biomedical waste are important. But there is not enough information on medical waste
management technologies and its impact on public health and environment. However, there is need for
raising awareness about medical waste and its related issues. It also advocates that the role of
pharmacists in waste management is significant by establishing a disposal process, possibly in
conjunction with associations, manufacturers and hospital administration.

Ramesh Babu B., Parande A.K., Rajalakshmi R., Suriyakala P. and Volga M.(2009) conducted a study
to summarize the rules for management and handling of biomedical wastes, to give the definition,
categories of biomedical wastes, suggested storage containers including colour-coding and treatment
options. The study also highlighted the effects of biomedical waste in the environment such as air, land,
radioactive pollution and disposal of wastes, regulation and recommendations. It concluded that proper
management of biomedical waste is a concern that has been recognized by both government agencies
and NGOs. Inadequate and inefficient segregation and transportation system may cause severe
problem to the society hence implementing of protective measures, written policies all of these factors
contribute to increased risk of exposure of staff, patients and the community to biomedical hazards. In
order to accelerate the rate at which proper processing and management methods are designed, timely
regulatory and legislative policies and procedures are needed. To properly separate, process and isolate
wastes, they must be well-characterized, which is challenging. Safe and effective management of
biomedical waste is not only a legal necessity but also a social responsibility. Lack of concern in
persons working in that area less motivation, awareness and cost factor are some of the problems faced
in the proper hospital waste management. Proper surveys of waste management procedures in various
practices are needed. Clearly there is a need for education as to the hazards associated with improper
waste disposal. An effective communication strategy is imperative keeping in view the low awareness
level among different category of staff in the health care establishments regarding biomedical waste
management

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 RESEARCH METHODOLOGY

Information for the study was collected through primary and secondary means. The entire waste
disposal process at R.N. Patil's Suraj hospital was studied. The number, location, condition, proper
color coding and content of waste bins and the means of collection were observed. The hospital was
visited daily for a 2 month period and waste bins were inspected twice a day. Based on this, a checklist
was prepared for hospital waste disposal inspection. The items of medical supplies used by the hospital
and the corresponding waste generated were studied. The hospital staff were asked about the problems
they encountered while disposing hospital waste.

Secondary data was collected mainly through research papers and websites on hospital waste
management and Mumbai Waste Management norms for hospital waste management. The policy and
procedure on the segregation, treatment, handling and disposal of healthcare waste and lists of items
designated as hazardous healthcare or other types of waste was reviewed.

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 RESEARCH ANALYSIS

Hospitals are important sites for the generation of waste. Every department in the hospital generates
waste and the overall product is waste of different kinds; healthcare, household and administrative
waste. The wastes generated from health care units depend upon a number of factors such as waste
management methods, type of health care units, occupancy of healthcare units, specialization of
healthcare units, ratio of reusable items in use, availability of infrastructure and resources etc.

The management of hospital generated waste is not only the responsibility of the hospital
administration but also of every department and every healthcare providing personnel in the hospital.
The Government of India specifies that Hospital waste management is a part of hospital hygiene and
maintenance activities. This involves management of range of activities, which are mainly engineering
functions, such as collection, transportation, operation or treatment of processing systems, and disposal
of wastes.

Hospital waste management has recently emerged as an issue of major concern not only to hospitals
and nursing home authorities but also to the environment. The proper management of hospital waste
has become a worldwide humanitarian topic today. Hazards of poor management of hospital waste have
aroused the concern world over, especially in the light of its far-reaching effects on human, health and
the environment.

Classification of healthcare waste

Healthcare waste can be broadly classified into two categories:
 General waste (85% of hospital waste)
This waste is non-hazardous to human beings, consisting of bio-degradable (cotton, paper,
packaging materials) and bio-degradable (plastic, soil, caps, lids, tops)
 Biomedical waste
This is any waste which is generated during the diagnosis, treatment or immunization of human
beings or animals or in research activities pertaining thereto or in the production or testing of
biologicals. It is hazardous to humans
WHO has classified biomedical waste into eight categories
 Pathological
It includes human tissues or fluids e.g. body parts, blood and other body fluids, fetuses. Also
glass slides containing fixed and embedded tissue, all materials used in embedding fixed tissue
and containers with fixative for fixing tissue.

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  Infectious
Waste suspected to contain pathogens e.g. laboratory cultures, waste from surgery, isolation
wards, tissues(swabs), materials, or equipment that have been in contact with infected patients,
excreta etc. All materials which cannot be re-sterilized or reused within or brought into patient
care.

 Sharps
Any waste materials which could cause the person handling it a cut or puncture and have been
used in animal/human patient care or treatment. Sharp waste include needles, infusion sets,
scalpels, knives, blades, broken glass etc.

 Pharmaceutical
Waste containing pharmaceuticals e.g. pharmaceutical products, drugs and chemicals that have
been returned from wards, are expired/ outdated or no longer needed, items contaminated by or
containing pharmaceuticals. (bottles, boxes)

 Genotoxic
Waste containing substances with genotoxic properties e.g. waste containing cytostatic drugs
(often used in cancer therapy), genotoxic chemicals.

 Chemical
Waste containing solid, liquid and gaseous chemical substances e.g. laboratory reagents,
photographic fixing and developing solutions in X-ray departments, cleaning products,
disinfectants, organic and inorganic chemicals, anesthetic gases and waste containing high
content of heavy metals such as batteries, broken thermometers, blood-pressure gauges, etc.

 Pressurized containers
Gas cylinders, gas cartridges, aerosol cans etc.

 Radioactive
Includes solid, liquid and gaseous waste that is contaminated with radio-nuclides generated
from in vitro analysis. e.g. unused liquids from radiotherapy or laboratory research,
contaminated glassware, packages, or absorbent paper, urine and excreta from patients treated
or tested with unsealed radio-nuclides, sealed sources.

Common sources of Biomedical Waste

Hospitals produce waste, which is increasing over the years in its amount and type. The hospital waste,
in addition to the risk for patients and personnel who handle them also poses a threat to public health
and environment.
Major Sources
 Govt. hospitals/private hospitals/nursing homes/ dispensaries.
 Primary health centers.
 Medical colleges and research centers/ paramedic services.
 Veterinary colleges and animal research centers.
 Blood banks/mortuaries/autopsy centers.

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  Biotechnology institutions.
 Production units.

Minor Sources
 Physicians/ dentists’ clinics
 Animal houses/slaughter houses.
 Blood donation camps.
 Vaccination centers.
 Acupuncturists/psychiatric clinics/cosmetic piercing.
 Funeral services.
 Institutions for disabled persons

Problems relating to biomedical waste

A major issue related to current Bio-Medical waste management in many hospitals is that the
implementation of Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a
haphazard, improper and indiscriminate manner. Lack of segregation practices, results in mixing of
hospital wastes with general waste making the whole waste stream hazardous. Inappropriate
segregation ultimately results in an incorrect method of waste disposal.
Inadequate Bio-Medical waste management thus will cause environmental pollution, unpleasant smell,
growth and multiplication of vectors like insects, rodents and worms and may lead to the transmission
of diseases like typhoid, cholera, hepatitis and AIDS through injuries from syringes and needles
contaminated with human.
Various communicable diseases, which spread through water, sweat, blood, body fluids and
contaminated organs, are important to be prevented. The Bio Medical Waste scattered in and around the
hospitals invites flies, insects, rodents, cats and dogs that are responsible for the spread of
communication disease like plague and rabies. Rag pickers at final disposal sites, 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, HIV, and other viral diseases. It becomes primary responsibility of Health administrators to
manage hospital waste in most safe and eco-friendly manner. Research and radio-immunoassay
activities may generate small quantities of radioactive gas.

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has
become an issue of increasing concern, prompting hospital administration to seek new ways of
scientific, safe and cost effective management of the waste, and keeping their personnel informed about
the advances in this area. The need of proper hospital waste management system is of prime importance
and is an essential component of quality assurance in hospitals.

Need of biomedical waste management in hospitals

The reasons due to which there is great need of management of hospitals waste is explained below:
1. Injuries from sharps leading to infection to all categories of hospital personnel and waste handler.
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 2. Hospital acquired infections in patients from poor infection control practices and poor waste
management.
3. Risk of infection outside hospital for waste handlers and scavengers and at time general public
living in the vicinity of hospitals

4. Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels.
5. Disposable containers being repacked and sold by unscrupulous elements without even being
washed.
6. Drugs which have been disposed of being repacked and sold off to unsuspecting buyers.
7. Risk of air, water and soil pollution directly due to waste, or due to defective incineration
emissions and ash.

Bio-Medical Waste Management in Maharashtra

Biomedical Waste (Management and Handling) Rules (BMW Rules) were promulgated under the
Environment (Protection) Act, 1986. In Maharashtra, Maharashtra Pollution Control Board (MPCB) is
the apex agency to enforce these rules. The role of MPCB includes:

1. Authorization of Healthcare Establishments (HCEs) for generation and handling

2. Authorization of HCEs for generation and handling of BMW (Form I of BMW Rules)

3. Authorization biomedical waste (BMW) treatment facilities for collection, treatment and disposal of BMW
(Form I of BMW Rules) Periodic inspection and review of the "system" for compliance

4. Take action on non-compliance

5. Carry out inventorization of BMW to report the status

6. Undertake awareness programs at HCEs

Health Care Establishments (HCEs) are the major generators of the BMW. HCEs need to take authorization from
MPCB for handling of BMW. The HCEs are classified into two categories:

i. Bedded HCEs- (Hospitals/ Nursing Homes with Bed Facility)

ii. Non-bedded HCEs

a. Treating/ Providing Service to 1000 and above Patients per Month

b. Treating/ Providing Service to less than 1000 Patients per Month c. Education, Research Institute,
Veterinary Hospitals, etc.

c. Others (Education, Research Institute, Veterinary Hospitals, etc.)

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Biomedical Waste management scenario in Maharashtra
S.
No. Category of Total Total No. of No. of Total Total No of HCEs No. of
HCE Nos. of Nos. of HCEs HCEs quantity Quantity violated actions taken
HCE Beds obtained having own of BMW of BMW BMW Rules by MPCB by
authorizatio facility for generated treated violations
n from treatment (Kg/day) (Kg/day)
MPCB and
disposal

Bedded HCEs

1 >500 beds 49 34420 1081 309 7052 5154 0 0

2 200 - 499 beds 87 24362 67 2 4633 3652 0 0

3 50 - 199 beds 349 28638 241 28 4615 3824 2 17

4 <50 beds 13953 107203 10586 1242 14584 13971 1908 1624

Total (A) 14438 194623 11975 1581 30884 30256 1910 1641

Non-bedded HCEs

5 >1000 7179 N/A 439 - 532 478 31 26

patients/month

6 <1000 23727 N/A 19020 - 6952 6512 5115 3417

patients/month

7 Others 440 N/A 81 - 5013 956 345 30

Total (B) 31346 - 19540 - 12496 7946 5491 3473

Grand Total (A+B) 45784 194623 31515 1581 43380 38202 7401 5114

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BMW generated in different regions of Maharashtra (kg/day)

Source Amravati Aurangabad Kalyan Kolhapur Mumbai Nagpur Nashik Navi Pune Raigad Thane Maharashtra
Mumbai

Bedded 1427 3107 836 3240 5929 6131 3189 229 4158 1297 702 300884

Non- 157 373 74 950 4160 1386 410 312 4337 189 148 12496
bedded

Total 1584 3480 910 4190 10089 7517 3608 541 8495 2116 850 43380

Total BMW treated (kg/day) in Maharashtra as reported by BMW treatment facilities

Amravati Aurangabad Kalyan Kolhapur Mumbai Nagpur Nashik Navi Pune Raigad Thane Maharashtra
Mumbai

BMW 422 977 15 3240 0 1892 488 0 473 226 0 7734

treated
by own
facilities

BMW 1037 2445 885 2590 10401 1877 3198 1531 4817 3933 707 33420
treated
by BMW
treatment
facilities

Total 1459 3423 900 5830 10401 3769 3686 1531 5290 4159 707 41154

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Total BMW treated (kg/day) in Maharashtra as reported by Healthcare Establishments
S. Category Amravati Aurang- Kalyan Kolhapur Mumbai Nagpur Nashik Navi Pune Raigad Thane Maharashtra
No. of HCE abad Mumbai

Bedded HCEs

1 >500 beds 21 637 0 1650 1539 - 237 9 1056 0 5 5154

2 200 - 499 493 217 50 620 1182 - 400 24 502 15 149 3652
beds

3 50 - 199 256 379 262 540 763 - 686 50 765 16 107 3824
beds

4 <50 beds 656 1984 524 3670 2445 - 1759 147 1835 627 324 13971

Total (A) 1427 3217 836 6480 5929 3654 3082 230 4158 658 585 30256

Non-bedded HCEs

5 >1000 0 61 4 13 - 160 48 105 86 0 0 478

patients/m
onth

6 <1000 31 302 60 224 4085 904 278 122 329 171 5 6512
patients/m
onth

7 Others 0 2 0 5 75 41 32 85 717 0 0 956

Total (B) 31 365 64 242 4160 1104 358 312 1132 171 5 7946

Grand Total 1459 3582 900 6722 10089 4758 3440 542 5290 829 590 38202
(A+B)
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Interpretation

1. From the above tables, it can be seen that the total BMW treated in Maharashtra is close to 38,202 kg/day out of a total of generated
BMW of 43,380 kg/day. This estimate includes BMW treated from both bedded and non bedded facilities. Source of this data is
from HCEs.

2. As reported by the BMW treatment facilities however the total BMW treated in Maharashtra is close to 41,154 kg/day. There is a
need therefore to develop a harmonized schema of data coordination on BMW - between MPCB, HCEs and BMW treatment
facilities.

3. Mumbai has 32.4% share of HCEs and 23.26% share in BMW generated, Pune has 15.69% share of HCEs and has 19.58% share in
BMW generated and Nagpur has only 7.85% HCEs but contributes 17.33% of total BMW generated. On the other hand Amravati
has 8.82% HCEs and 3.65% BMW generated.

4. It can be seen that among bedded HCEs, those with less than 50 beds have the highest contribution to BMW generated and also
highest number of violations. Among non-bedded HCEs, those with less than 1000 patients per month, have a higher contribution of
BMW generated and also highest number of violations. So the focus of BMW management would have to be shifted to these HCE
categories.

24
Number of Violations of BMW rules and Action taken against Healthcare Establishments by BMW treatment
facilities
Bedded Non-bedded serving >1000 Non-bedded serving <1000
patients per month patients per month
S. Region Total No. Total Nos. Total Total Total Total Total Total Total
No. of HCEs of Nos. of No. of Nos. of Nos. of No. of Nos. of Nos. of
Violations Actions HCEs Violations Actions HCEs Violations Actions
1 Amravati 913 17 12 1 0 0 3126 0 0
2 Aurangabad 2678 705 0 37 0 0 1450 353 630
3 Kalyan 556 0 15 17 0 0 426 81 81
4 Kolhapur 1543 612 618 5 10 5 1975 3950 1975
5 Mumbai 1417 - - 6704 - - 6702 78 78
6 Nagpur 1166 22 22 160 0 0 2231 0 0
7 Nasik 2569 554 559 28 21 21 1634 653 653
8 Navi 191 0 0 35 0 0 514 0 0
Mumbai
9 Pune 2764 0 415 172 0 0 4232 0 0
10 Raigad 404 0 0 20 0 0 642 - -
11 Thane 235 - - 0 0 0 795 0 0
Total 14438 1910 1641 7179 31 26 23727 5115 3417

Interpretation

In case of bedded healthcare establishments (HCEs), it could be noted that maximum numbers of violation are recorded in Aurangabad
region, against which no actions have been initiated. Kolhapur region follows Aurangabad in terms of violation, however number of actions
taken is higher than the violations. In Pune and Kalyan there are no violations but actions have been initiated in 415 cases in Pune and 15 cases in
Kalyan.

In case of non-bedded HCEs serving greater than 1000 patients/month, maximum numbers of violations are recorded in Nasik region.
However, actions have been taken against all of the violations.

In case of non-bedded HCEs serving less than 1000 patients/month, maximum numbers of violations are recorded in Kolhapur Region.
Action has been taken against 67% of the violations. In Aurangabad, the number of actions taken is higher than the number of violations.
25
A comparison of biomedical waste management in some of the major Healthcare Establishment in Maharashtra
Sr. HCE Location No. of beds BMW BMW Awareness BMW Remarks
No. generated generation/ manage
(approx) bed/day ment
(kg/month) level
1 Parmanand Mumbai 350 3236.5 0.31 High Good Training is provided.
Deepchand Awareness is high.
Hinduja National Management is adequate.
Hospital and
Medical Centre

2 Bombay Hospital Mumbai 721 2000 0.09 Low Bad No wt. wise or category
and Medical wise measurements done
Research Centre at hospital. Only nos. of
bags is counted.
Training and awareness
level among staff is poor.

3 St. Georges Mumbai 467 2700 0.19 Average Good The BMW storage area is
Hospital (and not enclosed. Details of
Grant Medical awareness sessions not
College) known. Otherwise BMW
management adequate.
4 Hiranandani Thane 15 240 0.53 Average Good Awareness level high.
Hospital, Thane BMW treatment facility
conducts training. BMW
management adequate
5 Jupiter Lifeline Thane 200 3300 0.55 Low Very Awareness level is low.
Hospital Poor BMW generation is very
high. Management
intervention req. BMW
management not
26
 adequate.

Sr. HCE Location No. of beds BMW BMW Awareness BMW Remarks
No. generated generation/ manage
(approx) bed/day ment
(kg/month) level

6 Chhrapati Shivaji Thane 500 156 0.01 High Good Awareness level high.
Maharaj Hospital Management is very
and Rajiv Gandhi willing. BMW
Medical College management adequate

7 Icon Hospital Pvt. Dombivali 60 550 0.31 Average Average Awareness level is
Ltd. , Kalyan average to low. BMW
storage is poor. BMW
management is less than
adequate.
8 Asian Institute of Dombivali 100 120 0.04 Low Bad Awareness level is low.
Medical Science , Kalyan BMW management is
(AIMS) less than adequate.

9 Fortis Hospital Pune 63 581.5 0.31 High Good Awareness level is very
Ltd. high. BMW management
adequate.
10 Sancheti Institute Pune 100 1575 0.53 Average Average Awareness level is very
of Orthopedics and high. BMW management
Rehabilitation adequate.

11 Hardikar Hospital Pune 60 500 0.28 Low Very Extremely poor

Poor awareness. Segregation
was very poor. BMW
management absolutely
not adequate.

27
Sr. HCE Location No. of beds BMW BMW Awareness BMW Remarks
No. generated generation/ manage
(approx) bed/day ment
(kg/month) level

12 Noble Hospital Pune 250 1238 0.17 Average Average Increased beds to 250
without approval.
Generating BMW
(1000-1500 kg/month)
way higher than
proposed (430 - 450
kg/d). Average
awareness.

13 Bharati Hospital Sangli, 500 347.52 0.02 High Good Awareness high in
and Medical Kolhapur hospital. BMW
College management adequate.

14 Pasmabhushan Sangli, 388 2800 0.24 Average Average Average awareness.

Vasantdada Patil Kolhapur BMW management
Govt. Hospital adequate.

15 Dr. G.S. Kulkarni Miraj, 100 375 0.13 Average Average Average awareness.
Orthopedic Kolhapur BMW management
Hospital adequate.

28
Hospital waste management process as per World Health Organization

1. Waste minimization

This first step comes prior to the production of waste and aims at reducing as much as possible the
amount of hospital waste that will be produced by setting up an efficient purchasing policy and having
a good stock management.

2. Hospital Waste generation

The point at which waste is produced.

3. Segregation and containerization

The correct segregation of waste at the point of generation relies on a clear identification of the
different categories of waste and the separate disposal of the waste in accordance with the
categorization chosen.

Segregation must be done at the point of generation of the waste. To encourage segregation at source,
(reusable) containers or baskets lined with plastic bags, which are chlorine free and of the correct size
and thickness are placed as close to the point of generation as possible. They should be properly colour-
coded (yellow or red for infectious waste) and have the international infectious waste symbol clearly
marked. Dustbins should be of such capacity that they do not overflow between each cycle of waste
collection. They should be cleaned after every cycle of clearance of waste with disinfectants.

When they are 3/4 full, the liners are closed with plastic cable ties or string and placed into larger
containers or liners at the intermediate storage areas. Suitable latex gloves must always be used when
handling infectious waste.

4. Intermediate storage in the hospital

In order to avoid both the accumulation and decomposition of the waste, it must be collected on a daily
basis. This area, where the larger containers are kept before removal to the central storage area, should
both be close to the wards and not accessible to unauthorized people such as patients and visitors.

5. Internal transport in the hospital

Transport to the central storage area is usually performed using a wheelie bin or trolley. Wheelie bins
or trolley should be easy to load and unload, have no sharp edges that could damage waste bags or
containers and be easy to clean. Ideally, they should be marked with the corresponding coding color.

Chutes can also be used which are vertical conduits provided for easy transportation of refuse
vertically in case of institutions with more than two floors. They are necessary to avoid horizontal
transport of waste thereby minimizing the routing of the waste within the premises and hence reducing
the risk of secondary contamination. Alternatively, elevators with mechanical winches or electrical
winches can be provided down waste containers from each floor.

29
. The transport of general waste must be carried out separately from the collection of biomedical waste
to avoid potential cross contamination or mixing of these two main categories of waste. The collection
should follow specific routes through the HCF to reduce the passage of loaded carts through wards and
other clean areas.

6. Centralized storage in the hospital

The central storage area should be sized according to the volume of waste generated as well as the
frequency of collection. The facility should not be situated near to food stores or food preparation areas
and its access should always be limited to authorized personnel. It should also be easy to clean, have
good lighting and ventilation, and be designed to prevent rodents, insects or birds from entering. It
should also be clearly separated from the central storage area used for HCGW in order to avoid cross-
contamination. Storage time should not exceed 24-48 hours especially in countries that have a warm
and humid climate.

7. External transport

External transport should be done using dedicated vehicles. They shall be free of sharp edges, easy to
load and unload by hand, easy to clean / disinfect, and fully enclosed to prevent any spillage in the
hospital premises or on the road during transportation. The transportation should always be properly
documented and all vehicles should carry a consignment note from the point of collection to the
treatment facility.

8. Treatment and final disposal

There are a number of different treatment options to deal with infectious waste. These are detailed in
the resources section under the treatment options chapter.

Personnel safety devices

The use of protective gears is mandatory for all the personnel handling waste.

Gloves: Heavy-duty rubber gloves should be used for waste handling by the waste retrievers. This
should be used for waste handling by the waste retrievers. This should be bright yellow in colour. After
handling the waste, the gloves should be washed twice. The gloves should be washed after every use
with carbolic soap and a disinfectant. The size should fit the operator.

Aprons, gowns, suits or other apparels: Apparels worn to prevent contamination of clothing and
protect skin. It could be made of cloth or impermeable material such as plastic. People working in
incinerator chamber should have gowns or suits made of non-inflammable material.

Masks: Various types of masks, goggles, and face shields are worn alone or in combination, to
provide a protective barrier. It is mandatory for personnel working in the incinerator chamber to wear a
mask covering both nose and mouth, preferably a gas mask with filters.

Boots: Leg coverings, boots or shoe-covers provide greater protection to the skin when splashes or
large quantities of infected waste have to be handled. The boots should be rubber-soled and anti-skid
type. They should cover the leg up to the ankle

30
Cleaning devices
Brooms: The broom shall be a minimum of 1.2 m long, such that the worker need not stoop to sweep.
The diameter of the broom should be convenient to handle. The brush of the broom shall be soft or hard
depending on the type of flooring.

Dustpans: The dustpans should be used to used to collect the dust from the sweeping operations. They
may be either of plastic or enamelled metal. They should be free of ribs and should have smooth
contours, to prevent dust from sticking to the surface. They should be washed with disinfectants and
dried before every use.

Mops: Mops with long handles must be used for swabbing the floor. They shall be of either the cloth
or the rubber variety. The mop has to be replaced depending on the wear and tear. Teh mechanical
screw type of mop is convenient for squeezing out the water.

Vacuum cleaners: Domestic vacuum cleaners or industrial vacuum cleaners can be used depending on
the size of the rooms.

Biomedical wastes categories and their segregation, collection, treatment,

processing and disposal options (Bio-Medical Waste Management and Handling
Rules,1998)

Category Type of waste Type of bag or Treatment or disposal

container options
Yellow (a) Human Yellow coloured non- Incineration or Plasma
Anatomical Waste: chlorinated plastic Pyrolysis or deep burial
Human tissues, bags
organs, body parts
and fetus below the
viability period

(b) Animal
Anatomical Waste:
Experimental animal
carcasses, body parts,
organs, tissues,
including the waste
generated from
animals used in
experiments or testing
in veterinary
hospitals or colleges
or animal houses.
(c) Soiled waste: Incineration or Plasma
Items contaminated Pyrolysis or deep burial
with blood, body
31
 fluids like dressings, In absence of above
plaster casts cotton facilities, autoclaving or
swabs and bags micro-
containing residual or waving/hydroclaving
discarded blood and followed by shredding
blood components. or mutilation or
combination of
sterilization and
shredding treated waste
to be sent for energy
recovery.
(d) Expired or Yellow coloured non- Expired cytotoxic drugs
discarded medicines: chlorinated plastic and contaminated with
Pharmaceutical waste bags or containers cytotoxic drugs returned
like antibiotics, back to the
cytotoxic drugs manufactured supplier
including all items for incineration at
contaminated with temperature >1200C or
cytotoxic drugs along to common bio-medical
with glass or plastic waste treatment facility
ampoules, vials etc. or hazardous waste
treatment, storage and
disposal facilit for
incineration at >1200C
or encapsulation or
Plasma Pyrolysis at
>1200C

All other discarded

medicines shall be either
sent back to
manufacturer or
disposed by
incineration.
(e) Chemical waste: Yellow coloured Disposed of by
Chemicals used in containers or non- incineration or Plasma
production of chorinated plastic Pyrolysis or
biological and used bags Encapsulation in
or discarded hazardous waste
disinfectants. treatment, storage and
disposal facility.
. (f) Chemical Liquid Separate collection After resource
Waste: system leading to recovery, the chemical
Liquid waste effluent treatment liquid waste shall be
generated due to use system pre-treated before
of chemicals in mixing with other
production of wastewater.
biological and used or
discarded
32
 disinfectants, Silver
X-ray film developing
liquid, discarded
Formalin, infected
secretions, aspirated
body fluids, liquid
from laboratories and
floor washings
cleaning, house-
keeping and
disinfecting activities
(g) Discarded linen, Non-chlorinated Non-chlorinated
mattresses, beddings yellow plastic bags or chemical disinfection
contaminated with suitable packing followed by incineration
blood or body fluid. material or Plasma Pyrolysis or
for energy recovery.

(h) Microbiology, Autoclave safe plastic Pre-treat to sterilize with

biotechnology and bags or containers non-chlorinated
other clinical chemicals on-site as per
laboratory waste: National AIDS Control
Blood bags, Organization or World
Laboratory cultures, Health Organization
stocks or specimens guidelines thereafter for
of micro-organisms, incineration.
live or attenuated
vaccines, human and
animal cell cultures
used in research,
industrial
laboratories,
production of
biological, residual
toxins, dishes and
devices used for
cultures.
Red Contaminated Red-coloured non- Autoclaving or micro-
Waste (Recyclable) chlorinated plastic waving/ hydroclaving
Wastes generated bags or containers followed by shredding
from disposable items or mutilation or
such as tubing, combination of
bottles, intravenous sterilization and
tubes and sets, shredding. Treated
catheters, urine bags, waste to be sent to
syringes (without registered or authorized

33
 needles and fixed recyclers or for energy
needle syringes) and recovery or plastics to
vaccutainers with diesel or fuel oil or for
their needles cut) and road making, whichever
gloves is possible.
Plastic waste should not
be sent to landfill sites.
White Waste sharps Puncture proof, Leak Autoclaving or dry heat
(Translucent) including Metals: proof, tamper proof sterilization followed by
Needles, syringes containers shredding or mutilation
with fixed needles, or encapsulation in
needles form needle metal container or
tip cutter or burner, cement concrete;
scalpels, blades or combination of
any other shredding cum
contaminated sharp autoclaving; and sent for
object that may cause final disposal to iron
puncture and cuts. foundries (having
This include both consent to operate from
used, discarded and the State Pollution
contaminated metal Control Boards or
sharps Pollution Control
Committees) or sanitary
landfill or designated
concrete waste sharp
pit.
Blue (a) Glassware: Cardboard boxes with Disinfection (by soaking
Broken or discarded blue coloured the washed glass waste
and contaminated marking after cleaning with
glass including detergent and Sodium
medicine vials and Hypochlorite treatment)
ampoules except or through autoclaving
those contaminated or microwaving or
with cytotoxic wastes hydroclaving and then
sent for recycling
(b)Metallic Body
Implants

34
Biomedical Waste Treatment technologies
There are mainly six technology options available for the treatment of biomedical waste can be
grouped as:
1. Chemical processes
These processes use chemicals that act as disinfectants. Sodium hypochlorite, dissolved chlorine
dioxide, peracetic acid, hydrogen peroxide, dry inorganic chemical and ozone are examples of such
chemical. Most chemical processes are water intensive and require neutralizing agents.
2. Thermal processes
These processes utilize heat to disinfect. Depending on the temperature they operate it is been grouped
into two categories, which are low-heat systems and high heat systems.
Low heat systems (operates between 93-177 C) use steam, hot water, or electromagnetic radiation to
heat and decontaminate the waste. Autoclave and microwave are low heat systems.
 Autoclaving
An autoclave is a cylindrical vessel used to sterilize equipment, supplies and wastes. It operates on the
principle of the standard pressure cooker. The process involves using high pressure saturated steam at
high temperatures. The steam generated at high temperature penetrates waste material and kills all the
micro organisms. These are of three types: Gravity type, Pre-vacuum type and Retort type.
In the first type (Gravity type), air is evacuated with the help of gravity alone. The system operates with
temperature of 121 deg. C. and steam pressure of15 psi. for 60-90 minutes.
Vacuum pumps are used to evacuate air from the Pre vacuum autoclave system so that the time cycle is
reduced to 30-60 minutes. It operates at about 132 deg. C.
Retort type autoclaves are designed much higher steam temperature and pressure. Autoclave treatment
has been recommended for microbiology and biotechnology waste, waste sharps, soiled and solid
wastes. This technology renders certain categories (mentioned in the rules) of bio-medical waste
innocuous and unrecognizable so that the treated residue can be land filled.
 Microwaving
Microwaving is a process which disinfect wastes by moist heat and steam generated by microwave
energy. It is based on the principle of generation of high frequency waves. These waves cause the
particles within the waste material to vibrate, generating heat. This heat generated from within kills all
pathogens
High heat systems (operates between 540 - 8300 C) employ combustion and high temperature plasma
to decontaminate the waste. Incineration and hydroclaving are high heat systems.
 Incineration Technology
This is a high temperature thermal process employing combustion of the waste under controlled
condition for converting them into inert material and gases. Incinerators can be oil fired or electrically
powered or a combination thereof. Broadly, three types of incinerators are used for hospital waste:
multiple hearth type, rotary kiln and controlled air types. All the types can have primary and secondary
combustion chambers to ensure optimal combustion. These are refractory lined.
35
  Hydroclaving
The hydroclave is essentially a double-walled (jacketed) cylindrical, pressurized vessel, horizontally
mounted, with one or more side or top loading doors, and a smaller unloading door at the bottom.
It sterilizes the waste utilizing steam, similar to an autoclave, but with much faster and much more even
heat penetration. It hydrolyzes the organic components of the waste such as pathological material. Then
it removes the water content (dehydrates) the waste. Breaks up the waste into small pieces of
fragmented material. It reduces the waste substantially in weight and volume. It accomplishes the
above within the totally sealed vessel, which is not opened until all waste it totally sterile.
The vessel is fitted with a motor driven shaft, to which are attached powerful fragmenting/mixing arms
that slowly rotate inside the vessel. When steam is introduced in the vessel jacket, it transmits heat
rapidly to the fragmented waste, which, in turn, produces steam of its own. A temperature sensor is
located in the bottom inside part of the vessel, which measures the temperature of the waste as it is
agitated and mixed, and this sensor reports back to the main computerized controller, which
automatically sets treatment parameters ensuring complete waste sterility – even liquid infectious
waste. After sterilization, the liquid but sterile components of the waste, are steamed out of the vessel,
re-condensed and drained to sewer. The remaining waste is dehydrated, fragmented, and self-unloaded
via a reverse rotation of the mixer/agitator.

3. Mechanical processes

These processes are used to change the physical form or characteristics of the waste either to facilitate
handling or to process the waste in conjunction with other treatment steps. The two primary mechanical
processes are:

 Compaction
It is used to reduce the volume of the waste

 Shredding
It is used to destroy plastic and paper waste to prevent their reuse. Only the disinfected waste
can be used in a shredder.

4. Irradiation processes

This process exposes waste to ultraviolet or ionizing in an enclosed chamber. These systems require
post shredding to render the waste unrecognizable.

5. Biological processes

It makes use of biological enzymes for treating medical waste. It is claimed that biological reactions
will not only decontaminate the waste but also cause the destruction of all the organic constituents so
that only plastics, glass and other inert substances will remain in residues.
36
6. Plasma Pyrolysis
Plasma pyrolysis is a state-of-the-art technology for safe disposal of medical waste. It is an
environment-friendly technology, which converts organic waste into commercially useful byproducts.
The intense heat generated by the plasma enables it to dispose all types of waste including municipal
solid waste, biomedical waste and hazardous waste in a safe and reliable manner. Medical waste is
pyrolysed into CO, H2, and hydrocarbons when it comes in contact with the plasma-arc. These gases
are burned and produce a high temperature (around 1200oC).

Comparison of treatment technologies for biomedical waste disposal

Treatment Autoclave Hydroclave Microwave Incinerator Chemical

systems
Description Steam Steam Microwave High Mixing pre-
sterilization sterilization heating of temperature ground waste
(Direct (indirect pre-shredded waste with
heating) heating) waste incineration chemicals such
Simultaneous as chlorine.
shredding and
dehydration
Sterilization Medium Medium Medium High (total
Dependent on
efficacy destruction of
chlorine
micro- strength and
organisms) dispersment
through the
waste
Capital cost Low Low High High Moderate
Operating cost Low Low High High Low
Operator Low skill level Low skill level Automated, High level, High level
maintenance required required but high level operator and required for
skills maintenance maintenance chemical
skill required skills required control and
grinder
Air emissions Odorous but Somewhat Somewhat Can be highly Some chlorine
non-toxic odorous but odorous but toxic emissions
non-toxic non-toxic
Water emissions Odorous may Odorous but Negligible None None
contain live sterile
micro-
organisms
Treated waste Wet waste, all Dehydrated, Shredded but Mostly ash, Shredded wet
characteristics material shredded wet waste may contain waste,
recognizable waste, un- toxic containing
recognizable substances chemicals used
material as disinfectants

(Benchmark for costs is Rs 1,00,000)

37
Bio-medical waste treatment in Mumbai
Mumbai has two waste treatment facilities for processing biomedical waste:

1. Mumbai Waste Management Ltd., (MWML) located at Taloja, Raigad

2. SMS Envoclean Ltd. located at Deonar, Mumbai (SEL)

MWML has been chosen for the study as it has a tie-up with R.N. Patil's Suraj hospital for waste
treatment.

Basic Information

S.No Equipment Existing status

1 Incinerator
2 Autoclave
3 Shredder
4 Sharp pit/ Encapsulation facility Not available
5 Effluent treatment plant
6 Vehicle container
facility
1 no. , capacity= 250 kg/hr
1 no., capacity = 120 lit. top
feeding type
1 no. capacity = 600 lit.
horizontal feed type.
1 no. capacity = 200 kg/hr
Treated effluent is used for
quenching purpose in the
common hazardous waste
incinerator in the same premise.
washing Available

MWML Infrastructure

S.No. Infrastructure Existing status

1 Treatment Equipment Room - All equipments are provided in
a single house.
- Same room is used for storage
of untreated waste.
- Separate room is provided for
storage of treated wastes.
- Rooms are provided with well
designed roof and wall.
- Floor and side walls (height of
2 meter from floor) are
provided with tiles.
- No separate cabin is provided
to supervise the operation of
38
 equipments.
2. Main waste storage room - One portion (at entry side) of
the equipment is used for
unloading and storage of
biomedical waste which are
transported to the facility by
vehicle.
- There is slope and drainage
provision for diverting the liquid
generated handling of waste and
washing into effluent treatment
plant.

3 Treated waste storage room - One room is provided for stage

4 Administrative room
of treated waste.
- Treated wastes are not stored
in separate group as per the
disposal requirements
Provided

5 Generator set Standby generator set is

provided
6 Site security Available

7 Parking Available

8 Sign board Available

9 Green belt Green belt is developed in the

open area.
10 Washing room Facility is provided hand/eye
washing
11 Other important provisions

11.1 Telephone Provided and maintained

11.2 First Aid box Provided and maintained

11.3 Adequate lighting Provided

11.4 Odour prevention No provision is there to keep the

facility and surrounding odour
free.
11.5 Fire fighting Fire extinguishers are provided
and maintained

39
11.6 Pest and insect control measures No measures are evidenced for
control of pest and insect.
11.7 Measures to control the escape of litter The area surrounding the
facility is litter free.
11.8 Control of noise Noise level seemed within the
acceptable level.
11.9 Protective equipment for waste handler Necessary protective equipment
are provided to the waste
handlers and are used by them.
11.10 Vehicle washing facility Indadequate collection and
treatment of wash water, which
is disposed on land.

Key Performance Indicators for BMW Facility Transporters in Mumbai and Navi
Mumbai region

S.No Name of Total Nos. of BMW handled BMW transported

transporter HCEs (kg/day) (kg/day)/(km/day)
1 M/s SMS 8121 10401 3.47
Envoclean
Pvt. Ltd
2 M/s Evergreen 68 45 2.25
Env
3 M/s Mumbai 1387 1486 24.77
Waste
Management
Ltd.

40
Hospital waste management process at R.N. Patil's Suraj Hospital

The hospital has colour coded waste bins for disposal of hazardous and non-hazardous wastes as per
the Mumbai Waste Management norms. A set of 5 waste bins - red, yellow, blue white (hazardous) and
black (non-hazardous) - are kept at various rooms and locations in the hospital. The red, yellow and
black bins are of plastic. They are covered and have a foot lever for opening. They are fitted with
plastic bags into which wastes are disposed. The blue bin is a cardboard box which is open at the top.
Wastes are directly disposed into this box. The white bin is a plastic container with a plastic lid. It
contains a 1% hypo solution mixed with water which is changed every week. A poster showing the
waste disposal rules is displayed on the wall above each bin. The waste disposal process is managed by
the junior HR manager. Hospital waste is sent to Mumbai Waste Management Ltd. for treatment.

The daily routine consists of the following steps:

1. At 9:00 a.m. the junior manager inspects all the waste bins of the hospital to check if waste is
disposed properly and if the level of waste in the bins has reached 75%. This is as per MWM
norms. In case of any error, all nurses and cleaners in the surrounding area are warned that it
should not be repeated.

2. At 6:00 p.m. cleaners collect waste from each set of bins using a trolley and transfer it into large
garbage bags. These bags are colour coded and wastes are disposed accordingly. The bins are
emptied only if they are 75% full and are then fitted with new garbage bags. However the bags

41
 are changed every week irrespective of how full they are. In case of the blue bin, the entire box
is disposed.

3. These bags are tied and kept in colour coded hazardous cabinets on the ground floor.

4. At 8:00 a.m. garbage trucks arrive from Navi Mumbai Municipal Corporation and Mumbai
Waste Management Ltd.

5. The total waste from each hazardous and non hazardous category is weighed and the weight is
noted down on the waste management register.

6. Hazardous wastes are transferred to the MWM truck and non hazardous wastes are transferred
to the NMMC truck.

7. Every month, the hospital receives a report from MWMC and NMMC regarding the quality of
the wastes and the disposal charges. If wastes are wrongly disposed, fines are imposed.

Posters indicating disposal procedures for biomedical waste

42
Checklist for Waste disposal inspection

In order to measure the accuracy of hospital staff in disposing wastes, a waste disposal inspection was
carried out based on which a checklist was prepared. The 10 sets of waste bins in the premises were
checked for any errors and the bins which had reached their capacity were noted. The inspection was
carried out from 8 May to 23 June 2017 for a period of 45 days with the assistance of the junior HR
manager. Following symbols were used in the checklist.

 - correct disposal
 - incorrect disposal
R- Red, B-Blue, Y-Yellow, W- White, N - Non-hazardous container
Level of waste in bin has reached 60-75% and needs to be collected

Patho
1st IPD
OPD lobby logy HDU ICU OT
floor lobby
lab
Waste- Total
bin errors
set 1 2 3 4 5 6 7 8 9 10
Day

         
1 2
Y full R full R full
         
2 1
R full Y full

        
3 R,Y,B 4
full

        
4 B,N, 2
N full
R full

        
5 R,N -
N full
full
 
       
6 N,B, 1
Y full
  
      
7 B,Y B,R 2
full full
 
       
8 R,Y, R,B,N 2
R full N full
B full full
         
9 -

43
 Patho
1st IPD
OPD lobby logy HDU ICU OT
floor lobby
lab
Waste Total
bin errors
Set 1 2 3 4 5 6 7 8 9 10

Day

         
10 2

 
       
11 R,Y R,Y,B 2
B full
full full

        
12 N,B -
full
         
13 1


        
14 B,N 2
full

        
15 R,Y -
full
         
16 1
N full
         
17 -


   R,Y,      
18 2
B,N N full N full
full
         
19 -


R,Y,         
20 1
B,N B full
full
         
21 2
 
       
22 Y,B 1
Y full
full
         
23 -
44
 Patho
1st IPD
OPD lobby logy HDU ICU OT
floor lobby
lab
Waste Total
bin errors
Set 1 2 3 4 5 6 7 8 9 10

Day

        
24 R,Y 1
full
         
25 -
R full
         
26 -
         
27 -
R full
         
28 1
R full

        
29 N full 2
R full
         
30 -
         
31 -
R full

        
32 -

         
33 -
 
       
34 Y,B -
full
         
35 -
         
36 1

        
37 R,N -
B full
full
         
38 1

        
39 2

         
40 -

45
 Patho
1st IPD
OPD lobby logy HDU ICU OT
floor lobby
lab
Waste- Total
bin set errors
1 2 3 4 5 6 7 8 9 10
Days


        
41 B,Y 1
full
         
42 -
B full
         
43 1
N full N full N full
         
44 -
         
45 -
Y full
Total
6 2 4 4 2 6 6 2 5 1 38
errors

Interpretation of the checklist

1) The checklist gives an idea about the efficiency of hospital staff in disposing wastes. It can be seen
that over the 45 day period during which the inspection was carried out, waste was disposed incorrectly
on 26 days.

2) Highest number of errors occurred in bins located at HDU (12) and OPD lobby (8). So these areas
would need to be highly scrutinized as compared to other areas.

3) There is a declining trend in the errors during inspection period which means the hospital would
have to pay less fines. This is mainly because the errors were brought to notice of hospital staff and
they were warned not to repeat the errors.

Day No. of days errors

were reported
1-10 8
10-20 7
20-30 5
30-40 3

46
4) The checklist specifies the bins which have reached their capacity and need to be emptied. Using
this information, the HR manager can send the cleaner to only those bins where the level of waste has
reached 70% thus reducing the time taken for collection of waste.

Bio-medical waste management level at R.N. Patil's Suraj hospital

1) Awareness level : Moderate

Remarks:
There were many occasions where the nurses asked the junior HR manager about disposing wastes.
This shows that hospital staff lacked awareness about disposal procedures. They were also careless and
lazy to follow appropriate procedures while disposing wastes into bins. This resulted in errors in
disposing waste due to which the hospital incurred fines. The errors were not corrected in time by the
housekeeping staff, this led to a chance of the same error being reported multiple times.

2) Waste disposal equipment : Moderate

Remarks:
Adequate equipment (colour coded bins) is provided to enable segregation of different categories of
biomedical waste and general waste.
The foot levers of some of the bins did not work which made disposal and inspection difficult as the
lids had to be manually lifted. So the time taken for disposing was more and there was also a risk of
contamination.
The blue cardboard box for sharps is open at the top due to which there can be a risk of harmful vapors
escaping into the air and getting circulated through the ducted split air-conditioning of the hospital.

3) Adherence to disposal procedures : Poor

Remarks:
There were many instances when errors were made by hospital staff in disposing wastes and where
patients disposed waste products into hazardous bins. There is no means of tracking the accuracy of
hospital staff in disposing wastes could not be measured to know if there was any improvement.

4) Adherence to standards of waste disposal process : Good

Remarks:
The existing hospital disposal process was studied and it was compared with the standard hospital
waste disposal procedure prescribed by WHO. The existing process matched completely with the
standards.

47
5) Adherence to safety standards : Good
Remarks:
The cleaners take all necessary safety precautions by wearing safety devices such as gloves and masks
for collecting waste from bins and also while loading into garbage trucks.

6) Hospital cleanliness : Good

Remarks:
The premises of the hospital were cleaned twice a day. In case of spillages of hazardous supplies or
wastes, the area was cleaned, disinfected and dried immediately.

7) Intermediate storage facility : Good

Remarks:
Adequate storage facility exists (cabinets on ground floor) for waste storage. The cabinets are spacious
and have compartments for different categories of waste. Hazardous signs belonging to different waste
categories are indicated on the cabinet door.

8) Internal transport equipment : Good

Remarks:
Trolleys are used for transporting collected waste from waste bins to the ground floor cabinets.
9) Waste minimization : Poor

Remarks:
A large proportion of the plastic wastes are reusable plastic containers. There is no recycling process in
place for them.

10) Existence of waste treatment facility : No

Remarks:
Except for sharps which are chemically treated with hypo solution, all wastes are transferred to
garbage trucks without any treatment.

48
Recommendations to existing waste management process

1) A special meeting could be held every month for all staff to boost awareness about proper disposal
procedures.

2) There could be an arrangement for covering the blue cardboard box so that harmful vapors will be
contained and won't escape into the surrounding air.

3) In addition to the existing posters indication disposal rules, a special poster for patients and visitors
could be displayed to inform then not to dispose trash into hazardous bins.

4) If any mistake is observed during inspection of the bins, the housekeepers need to be immediately
informed to correct it and it should be ensured that the error is corrected on the same day. This would
prevent the same mistake from being reported multiple times.

5) During inspection, the condition of the bins should also be checked and any problems should be
reported.

6) The plastic fluid containers can recycled two or three times before being disposed. This could
reduce healthcare waste, protect the environment and save money.

7) The type and weight of healthcare waste can be determined and planned for in advance by reviewing
the inventory of the medical supplies purchased . It is wise to bear in mind the waste potential of these
supplies when making an order.

8) Orientation on the way the hospital handles healthcare waste should be made part of all in-service
training and education programs. All hospital staff regardless of status, medical students and cleaners
not excepted, should be responsible for the proper handling of healthcare waste.

9) If new housekeepers are appointed, they should be well-acquainted with the layout of the hospital
and comprehend thoroughly the policy and procedure of that hospital on the management of waste in
order to use the proper methods of disposal.

10) A checklist for waste disposal could be made as shown in this study to keep a track of efficiency of
staff in disposing waste. It could also help in waste collection by saving the cleaner's time and effort.

11) Waste bins could be numbered as shown in the checklist so that they can be easily identified by all
staff.

12) Feedback from the staff on all aspects of waste management should be encouraged.

49
13)The concept of Internet Of Things (IOT) can be applied to waste disposal by introducing smart
bins. These bins are fitted with level sensors which track the level of waste in it. When it reaches 75%
level, the sensor would send a message to the administrator's computer via IOT technology. This
information will be provided to cleaners who would collect waste only from those bins thus saving
their time.

50
 RESEARCH FINDINGS
It is seen that huge amount of biomedical waste goes untreated every day in Maharashtra which poses
an immense risk for human health and ecological environment of Maharashtra. Since Mumbai has the
highest contribution of BMW in Maharashtra, BMW management in HCEs and treatment facilities in
Mumbai have to be very high.

The figures reported for treated biomedical waste by the healthcare facilities and treatment facilities do
not match. This means that some of the treated waste is not being reported or some of the waste which
is not being treated is reported as treated. This has resulted in a wrong assessment of the biomedical
waste treatment potential of the state and there is a possibility that the amount of untreated waste may
be much more than what is reported. This error is caused due to lack of coordination by Maharashtra
Pollution Control Board, various Healthcare facilities and waste treatment facilities.

There were a few cases where HCEs violated BMW norms but appropriate action wasn't taken against
them by waste treatment facilities. Due to this, the errors committed by them could be repeated. This
has happened due to lack of stringent inspection of wastes by treatment facilities.

In some cases, action was taken against some HCEs which hadn't violated the norms. This results
unnecessary penalties on HCEs and happens due to improper inspection.

BMW management would need to be focused on bedded HCEs with less than 50 beds and non-bedded
HCEs serving less than1000 patients as they are major contributors to generation of bio-medical waste.

Based on the study on various parameters of bio-medical waste management, the BMW management
level of the hospital is found to be 'moderate'. There is a lot of scope for improvement.

51
 CONCLUSION

1. The classification and sources of hospital waste has been studied

2. The problems and need for biomedical waste management in Maharashtra has been justified.

3. Hospital waste management procedures prescribed by World Health Organization have been studied

4. Mumbai Waste Management Ltd. which is a bio-medical waste treatment facility in Mumbai region
has been studied.

5. To study the hospital waste management process at R.N. Patil's Suraj Hospital and its biomedical
waste management level has been evaluated.

52
 LIMITATIONS OF THE STUDY

The bio-medical waste generation/day/bed of the hospital could not be calculated due to lack of access
to waste management registers and time constraints.

53
 BIBLIOGRAPHY

1. Status of bio-medical waste management in the state of Maharashtra, 2010, MPCB

2. Mishra K., Sharma A., Sarita and Ayub S. (2016), A Study: Biomedical Waste Management in India,
IOSR Journal of Environmental Science, Toxicology and Food Technology; Vol. 10 (5): 64 - 67

3. Mohankumar S. and Dr. Kottaiveeran K. (2011), Hospital Management and Environmental

Problems in India, International Journal of Pharmaceutical & Biological Archives 2011; Vol.
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4. Arshad N., Nayyar S., Amin F., and Dr. Mahmood K. (2011), Hospital Waste Disposal: A Review
Article, Journal of Pharmaeutical Sciences and Research; Vol. 3(8): 1412-1419

5. Bio-medical Waste Management Rules (2016), Gazette of India, Extraordinary, Part II, Section 3,
Sub-section (i)

6. Babu R., Parande A.K., Rajalakshmi R., Suriyakala P. and Volga M. (2009), Management of
Biomedical Waste in India and Other Countries: A Review, Journal of International Environmental
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7. Das K., Prasad S. and Jayaram K., A TQM Approach to Implementation of Handling and
Management of Hospital Waste in Tata Main Hospital

54