COMPLIANCE RATE STUDY OF BIO-MEDICAL WASTE

APEX HOSPITAL , VARANASI

SEGREGATION AT SOURCE IN THE PATIENT CARE
AREAS OF APEX HOSPITAL , VARANASI

APEX HOSPITAL
VARANASI

0
 OVERVIEW OF THE ORGANIZATION

Apex Hospital is a landmark tertiary care health destination promoted by a team of

professionals. The Multi-Specialty Hospital cum Cancer Research Institute with Modern
Diagnostic Centre and a capacity of 180 Beds has the state-of-the-art technology over
virtually all specialties. The technology advantage is complemented by the man power
excellence providing sophisticated and specialized medical care at affordable cost. The expert
team of doctors and support staff ensure the best care is delivered at all time with utmost
dedication. It is their sacrament to enrich and preserve valuable human lives. From the
moment you arrive, you will notice that our hospital is unique. Our team is dedicated to
bringing you a world of care with every visit. World-class medical care, friendly, devoted
service and affordability are the key features in our every touch. We have achieved laurels for
being one of the best-organized multi-specialty hospitals. The highly competent experts in
various disciplines taking charge of patient care give the double advantage of safety and
mental peace for the patients .We emphasize on humane approach in patient care, which is
obvious in every staff’s activities. “Early detection and timely intervention” is our mantra and
no undue delay is observed during administering treatment. Together with the technology to
match world-class standards and support services like pharmacy, laboratory and cafeteria we
pledge to make your stay at the hospital peaceful and comfortable.

VISION

“To be World Class Super Specialty health Provider in North India”

MISSION

 To be the Largest healthcare provider in North India by 2012

 Available, Accessible &Affordable Healthcare

 Care &Cure with Compassion & Commitment

 Ensure Excellence in Healthcare

 Provide Healthcare Service by adhering to ethical code of conduct.

1
VALUES

Integrity

We are committed to the highest ethical standards in our conduct.

Service Excellence

We are committed to our standards of service excellence and dedicated to exceeding the
expectations to those we serve.

Responsibility

We accept personal accountability for the work we do.

Teamwork

We will foster work environment that encourages new ideas and creativity.

Professionalism

We will uphold public trust in the healthcare profession by our conduct, standard of service
and quality of medical care.

Innovation

We are committed to a supportive environment that encourages new ideas and creativity.

Quality

We are consistently striving to provide the highest quality and safe patient care.

Safety

We are dedicated to creating the safest hospital for all.

2
 HOSPITAL PROFILE
Apex Hospital is an ISO 9001:2015 certified, 200-bedded multi-disciplinary & super
speciality Health care & Life Saving Referral & Research hospital, one of the most well-
equipped patient & family friendly hospital in Central India with largest campus in
private sector.

Since inception by the blessing of Prof. S.M. Tuli, a great clinician & human being, after
1988, the Hospital has come a long way with the commitment and passion of over 500
dedicated healthcare professionals, comprising nationally & internationally acclaimed
Medical, Surgical Specialist, Physicist, Technologist & Paramedical Staff, Co-ordinated
with committed administrative team, providing personalized patient-centered
treatment and care, 24 x 365 days support and services, we uphold high ethical
standards while breaking new grounds in the field of healthcare and medicine.

We have to our credit numerous path breaking achievements in the field, which is
indeed the result of our undeterred pursuit of excellence in healthcare. In continuation
to our legacy of care, compassion and commitment, as established by our founder Dr. S.
K. Singh, MBBS, MS, MCh Ortho, Apex Hospital now has a world-class medical complex
integrated with the best of all infrastructure and medical expertise, to cater the needs of
International and local patients with equal passion. All adding up to our steadfast
dedication which ensures that on the road to recovery, there are no unpleasant
surprises.

Apex Hospital also dedicates its advanced facilities and know-how to research and
development making further inroads in the field of health and medicine. The hospital
runs educational institutions to impart knowledge and training in Nursing,
Physiotherapy, Paramedical Sciences and Radiological Techniques, to build an efficient
workforce of healthcare professionals, to adequately handle the global requirements of
medical and surgical emergencies.

Today, with more than over two decades of experience in the field, we remain the
hospital of choice for providing medical care to visiting International delegates, tourists,
eminent personalities, common people of the surroundings, various corporates and
MNCs to handle their emergency rescue and evacuation services.

 Our goal is continuous improvement everyday at every level of operation

 Medical Tourism

 Distant Consultation (Through telemedicine / phone / e-mail)

 Assistance at the Airport

 Emergency Medical Evaluation

 Co-ordination of doctor's appointments

 Local Travel Arrangements

3
  Accommodation for relatives and attendants

Key features of the hospital are:

 Fully Air conditioned building state of-the-art laminar flow Air conditioning in
Operation Theaters & ICU’s.

 7 Operation Theaters and 180 beds including advanced ICU & CCU.

 Highly qualified and experienced team of doctors, Para medical staff and other
professionals to run various departments of the hospital.

 Departments equipped with advanced and sophisticated equipment to provide world

class healthcare.

 Liver-kidney transplant in the Chandigarh region

4
 Fall
08

CONTENTS

Page no.

ACKNOWLEDGMENT 3

AN OVERVIEW OF THE ORGANIZATION 4

HOSPITAL PROFILE 710

LIST OF TABLES 10

EXECUTIVE SUMMARY 12

Chapter Title Page no.

1 INTRODUCTION 13

2 REVIEW OF LITERATURE 18

3 METHODOLOGY 29

4 RESULTS AND ANALYSIS 32

5 CONCLUSION AND RECOMMENDATIONS 38

6 BIBLIOGRAPHY 41

7 ANNEXURES

a) ANNEXURE I – Survey Questionnaire for Hospital waste segregation

b) ANNEXURE II – Questionnaires filled by hospital staff

5
 LIST OF TABLES

Table no. Title Page No.

I Treatment & disposal of Bio-Medical Waste 21

II Color coding and type of container for disposal 23

of B.M.W according to the BIO-MEDICAL WASTE
(MANAGEMENT & HANDLING RULES 1998)

III Color coding and type of container for disposal of 28

BIO-MEDICAL WASTE at Apex Hospital

IV Compliance rate and subsequent findings regarding 34

the B.M.W segregation practices in the patient care
areas of Apex Hospital

6
 ABSTRACT

Issues of improving the management of bio-medical wastes are receiving attention

throughout the world since healthcare institutions generate tons of biomedical waste each
year. The key to minimization and effective management of biomedical waste is segregation
(separation) and identification of the waste. Improper segregation leads to mixing of
hazardous and non-hazardous waste and dumping of hazardous waste outside the hospital.
This is a hazard to community as it can lead to many infectious diseases such as hepatitis,
tetanus and HIV. The rag pickers who pick up discarded materials from such areas often use
contaminated needles and sharp objects causing infection. So it is necessary to properly
segregate the bio-medical waste at the point of generation only.
In the present study an attempt is made to determine the compliance rate of bio-medical
waste segregation at source in patient care areas of Apex Hospital and reasons for non-
compliance. Recommendations are also provided to improve the compliance rate.
The topic includes the literature regarding the bio-medical waste segregation and also covers
the bio-medical waste act.
The method adopted for the present study was observation method. The data was collected
through direct observations and data was than statistically analyzed.
From the analysis data it was found out that there has been non-compliance in few
departments of the hospital due to some reasons which are given in the report.
Recommendations are also provided.

7
 EXECUTIVE SUMMARY

Background: Segregation is an essential part of the bio-medical waste management process.

Improper segregation at source is a hazard to the community leading to many infectious
diseases such as tetanus, hepatitis, HIV etc. So it is necessary to properly segregate the bio-
medical waste at the point of generation only. The present study was performed to know the
compliance rate of bio-medical waste segregation at source in Apex Hospital .

Method: Direct observations were used in the study.

Results: The results of the study show that there was non-compliance in some departments.
ICU and Cath lab had the worse compliance rate.

Data analysis: Various analytical techniques were used such as Percentage estimation chart,
fish bone analysis. A comparative analysis of different departments was also done.

Reasons and recommendations: The reasons for non-compliance were known. Some of the
reasons were lack of knowledge, careless attitude of staff etc. Recommendations are also
provided for improving the compliance rate.

Conclusions: After analyzing the results it is felt that there is non-compliance in the
segregation of waste at source which can be hazard to the community. Immediate measures
must be taken to improve the compliance rate.

8
 CHAPTER I

INTRODUCTION

9
 1. INTRODUCTION

1.1 INTRODUCTION

Hospital is one of the complex institutions which is frequented by people from every walk of
life in the society without any distinction between age, sex, race and religion. This is over and
above the normal inhabitants of hospital i.e patients and staff. All of them produce waste
which is increasing in its amount and type due to advances in scientific knowledge and is
creating its impact. The hospital waste, in addition to the risk for patients and personnel who
handle these wastes poses a threat to public health and environment. Keeping in view
inappropriate biomedical waste management, the Ministry of Environment and Forests
notified the “Biomedical Waste (management and handling) Rules, 1998” in July 1998. In
accordance with these Rules (Rule 4), it is the duty of every “occupier” i.e a person who has
the control over the institution and or its premises, to take all steps to ensure that waste
generated is handled without any adverse effect to human health and environment. The
hospitals, nursing homes, clinic, dispensary, animal house, pathological lab etc., are therefore
required to set in place the biological waste treatment facilities.

1.2 BIO-MEDICAL WASTE MANAGEMENT PROCESS

Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are
vital steps for safe and scientific management of bio-medical waste in any establishment. The
key to minimization and effective management of biomedical waste is segregation
(separation) and identification of the waste.

1.3 TOPIC OF THE PROJECT

Compliance rate study of bio-medical waste segregation at source in the patient care areas of
“Apex Hospital ”.

10
1.4 GOAL OF THE PROJECT

To know the compliance rate of bio-medical waste segregation at source and to identify the
areas which provide an opportunity to improve the compliance rate and recommend effectual
and practical measures to it.

1.5 NEED AND SIGNIFICANCE –

The key to minimization and effective management of biomedical waste is segregation

(separation) and identification of the waste. Proper segregation reduces the amount of waste
needs special handling and treatment, prevents the mixture of medical waste like sharps with
the general municipal waste, prevents illegal reuse of certain components of medical waste
like used syringes, needles and other plastics, provides an opportunity for recycling certain
components of medical waste like plastics after proper and thorough disinfection, Recycled
plastic material can be used for non-food grade applications, of the general waste, the
biodegradable waste can be composted within the hospital premises and can be used for
gardening purposes, reduces the cost of treatment and disposal (80 per cent of a hospital’s
waste is general waste, which does not require special treatment, provided it is not
contaminated with other infectious waste).So Segregation is the essence of waste
management and should be done at the source of generation of Bio-medical waste e.g. all
patient care activity areas, diagnostic services areas, operation theaters, labor rooms,
treatment rooms etc. The responsibility of segregation should be with the generator of
biomedical waste i.e. doctors, nurses, technicians etc. (medical and paramedical personnel).

1.6 STATEMENT OF THE PROBLEM

Only 10 - 15% of hospital waste i.e. "Biomedical waste" is hazardous. But when hazardous
waste is not segregated at the source of generation and mixed with non-hazardous waste, then
100% waste becomes hazardous. Hence, improper bio-medical waste segregation at source is
risk to healthcare workers, waste handlers and the community. The objective of the project is
to check out the compliance rate of bio-medical segregation at source in the patient care areas
of Apex Hospital and to improve this compliance rate.

11
1.7 DEFINITION OF KEY TERMS

1.7.1 BIO-MEDICAL WASTE - “Bio-medical waste” means 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.

1.7.2 SEGREGATION AT SOURCE - “Segregation at source” means to dispose off non –

hazardous waste and hazardous waste separately in different containers at the point of
generation only . Different types of hazardous waste must also be dispose off separately in
different containers. Proper color coding should be followed.

1.8 WHY “SEGREGATION AT SOURCE” IS NECESSARY ?

In fact only 10 - 15% of hospital waste i.e. "Biomedical waste" is hazardous, not the
complete. But when hazardous waste is not segregated at the source of generation and mixed
with non-hazardous waste, then 100% waste becomes hazardous. The non – hazardous waste
is dumped outside the hospitals at waste dump sites. This leads to Dumping of heaps of
hazardous medical wastes consisting of bandages, syringes, plastic and aluminum equipment
etc. along with non-hazardous waste outside the hospitals, creating a lot of health problems.
At the waste dump sites there are several rag pickers trying to salvage any discarded material
to sell them and make a living. These rag pickers are exposed to the risk of injuries from
contaminated needles and other sharp objects and to various infectious diseases . The
biomedical waste (BMW) also emits a foul smell during the rainy season. The stagnant waste
and unsanitary conditions are potential breeding ground for flies, Mosquitoes, rodents and
insects, which maintain the already existing disease cycle. Due to these acts, diseases like
hepatitis, tetanus and dengue fever, HIV infection, etc. generally spread. So Segregation is
the essence of waste management and should be done at the source of generation of Bio-
medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters,
labour rooms, treatment rooms etc. The responsibility of segregation should be with the
generator of biomedical waste i.e. doctors, nurses, technicians etc. (medical and paramedical
personnel).

12
1.9 OBJECTIVE OF PROJECT

 To find out the compliance rate of bio-medical waste segregation at source in all
patient care areas of the “Apex Hospital ”.

 To know the factors responsible for non- compliance and to improve them.

 To compare the compliance rate of various departments.

 To know the knowledge of the staff.

13
 CHAPTER II

REVIEW OF LITERATURE

14
 2. REVIEW OF LITERATURE

2.1 BIO-MEDICAL WASTE”:-

“Bio Medical Waste” means 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 biological including containers.

Bio-medical waste means “any solid and/or liquid waste including its container and any
intermediate product, which is generated during the diagnosis, treatment or immunization of

human beings or animals.

2.2 COMPONENTS OF BIO-MEDICAL WASTE

 Human anatomical waste (tissues, organs, body parts etc.).

 Animal waste (as above, generated during research/experimentation, from veterinary
hospitals etc.).
 Microbiology and biotechnology waste, such as, laboratory cultures, micro-
organisms, human and animal cell cultures, toxins etc.
 Waste sharps, such as, hypodermic needles, syringes, scalpels, broken glass etc.
 Discarded medicines and cyto-toxic drugs.
 Soiled waste, such as dressing, bandages, plaster casts, material contaminated with
blood etc.
 Solid waste (disposable items like tubes, catheters etc. excluding sharps).
 Liquid waste generated from any of the infected areas.
 Incineration ash
 Chemical waste

15
2.3 SOURCES OF BMW

The major sources of health-care waste are hospitals and other health-care establishments,
laboratories and research centers, mortuary and autopsy centers, animal research and
testing laboratories, blood banks and collection services, and nursing homes for the
elderly.

2.4 QUANTITY OF BMW

Hospitals and other health care facilities generate lots of waste which can transmit
infections, particularly HIV, Hepatitis B & C and Tetanus, to the people who handle it or
come in contact with it. High-income countries can generate up to 6 kg of hazardous
waste per person per year. In the majority of low-income countries, health-care waste is
usually not separated into hazardous or non-hazardous waste. In these countries, the total
health-care waste per person per year is anywhere from 0.5 to 3 kg.

2.5 BIO- MEDICAL WASTE MANAGEMENT ACT

BIOMEDICAL WASTE
(MANAGEMENT & HANDLING) RULES 1998
Amended on 2000

 The Bio medical waste (Management and handling) Rules 1998 were notified under
the Environment Protection Act, 1986 (29 of 1986) by the Ministry of Environment
and Forest, Govt of India on 20th July, 1986. The guidelines have been prepared to
enable each hospital to implement the said rules, by developing comprehensive plan
for hospital waste management, in terms of segregation, collection, treatment,
transportation and disposal of hospital waste.

 The BMW Rules are applicable to every occupier of an institution generating

biomedical waste which includes a hospital, nursing homes, clinic, dispensary,
veterinary institutions, animal houses, pathological lab, blood bank by whatever name
called, the rules are applicable to even.

16
  Under the BMWR, segregation of bio-medical waste is mandated as the key basic
step to proper waste management.
(1) Bio-medical waste shall not be mixed with other wastes.

(2) Bio-medical waste shall be segregated into containers/bags at the point of

generation in accordance with Schedule II prior to its transportation, treatment and
disposal. The containers shall be labeled according to Schedule III.

CATEGORIES OF BIO-MEDICAL WASTE

Schedule – I (Rule 5)

TREATMENT AND DISPOSAL

WASTE CATEGORY TYPE OF WASTE
OPTION

Category No. 1 Human Anatomical Waste (Human tissues, organs, body parts) Incineration@ / deep burial*
Animal Waste (Animal tissues, organs, body parts, carcasses, bleeding parts,
fluid, blood and experimental animals used in research, waste generated by
Category No. 2 veterinary hospitals and colleges, discharge from hospitals, animal houses) Incineration@ / deep burial*

Microbiology & Biotechnology Waste (Wastes from laboratory cultures,

stocks or specimen of live micro organisms or attenuated vaccines, human
Local autoclaving/ microwaving /
and animal cell cultures used in research and infectious agents from research
incineration@
Category No. 3 and industrial laboratories, wastes from production of biologicals, toxins and
devices used for transfer of cultures)

Disinfecting (chemical
Waste Sharps (Needles, syringes, scalpels, blades, glass, etc. that may cause treatment@@ / autoclaving /
puncture and cuts. This includes both used and unused sharps) microwaving and mutilation /
Category No. 4 shredding##

Discarded Medicine and Cytotoxic drugs (Wastes comprising of outdated,

contaminated and discarded medicines) Incineration@ / destruction and
Category No. 5
drugs disposal in secured landfills
Soiled Waste (Items contaminated with body fluids including cotton,
dressings, soiled plaster casts, lines, bedding and other materials Incineration@ / autoclaving /
Category No. 6 contaminated with blood.)
microwaving
Disinfecting by chemical
Solid Waste (Waste generated from disposable items other than the waste treatment@@ / autoclaving /
sharps such as tubing, catheters, intravenous sets, etc.) microwaving and mutilation /
Category No. 7 shredding# #

17
 Liquid Waste (Waste generated from the laboratory and washing, cleaning, Disinfecting by chemical
housekeeping and disinfecting activities)
Category No. 8 treatment@@ and discharge into
drains

Category No. 9 Incineration Ash (Ash from incineration of any biomedical waste) Disposal in municipal landfill

Chemical Waste (Chemicals used in production of biologicals, chemicals used Chemical treatment @@ and
in disinfecting, as insecticides, etc.)
Category No.10 discharge into drains for liquids
and secured landfill for solids.

@@ Chemical treatment using at least 1% Sodium hypochlorite solution or any other

equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection.

** Mutilations / Shredding must be such as to prevent unauthorized reuse. @ There will be

no chemical pre-treatment before incineration. Chlorinated plastics shall not be incinerated.

* Deep burial shall be an option available only in towns with population less than five
lakh and in rural areas

SCHEDULE II

(Rule 6)

COLOUR CODING AND TYPE OF CONTAINER FOR DISPOSAL OF

BIO-MEDICAL WASTE

TABLE II

Type of container
Color coding Waste category Treatment options as per schedule I

Yellow Plastic bag Cat 1,2,3,6 Incineration/deep burial

Blue Plastic Cat 7 Autoclaving/microwaving/chemical

Bag/Disinfected treatment
container

18
White Puncture proof Cat 4 Autoclaving/microwaving/chemical
container/Plastic treatment & mutilation
bag

Green Plastic bag Cat 5,10 ( Solid) Disposal in secured Landfill

Green Plastic bag General paper recyclable

waste

Notes:

 Color coding of waste categories with multiple treatment options as defined in

Schedule I, shall be selected depending on treatment option chosen, which shall be
specified in Schedule I.

 Waste collection bags for waste types needing incineration shall not be made of
chlorinated plastics.

 Category 3 if disinfected locally need not be put in containers/bags.

SCHEDULE III

(See Rule 6)

LABEL FOR BIO-MEDICAL WASTE CONTAINERS/BAGS

19
2.6 BIO- MEDICAL WASTE SEGREGATION

 Segregation means the separation of the entire waste generated in a hospital in

defined, different waste groups according to the specific treatment and disposal
requirements. Only a segregation system can ensure that the waste will be treated
according to the hazards of the waste and that the correct disposal routes are taken and
that the correct transportation equipment will be used.

 Segregation is the key to any effective waste management. Without effective

segregation system, the complete waste stream must be considered as hazardous.

 Occupational safety can only be maintained if the risks from the materials are defined,
identifiable and the resulting counter measures are taken. By this, the risk of injury
and incidents can be minimized in a cost effective waste.

 Recycling can be only carried out if recyclable materials are separated from the
hazardous waste (contaminated materials are excluded from any recycling activity and
must be treated as mixed hazardous waste). To guarantee a high quality of the
recycling materials it must be collected in a sort pure way. Mixed waste will decrease
the possible income.

 The separate handling, treatment, and disposal of different kind of hazardous and non-
hazardous waste in different ways will reduce dramatically costs. Only the different

20
 kind of hazardous waste will be treated and disposed in a costly way instead of the
entire waste stream in a hospital.

 Conversely small errors at this stage can create lot of subsequent problems.

 It is now universally accepted that segregation is the responsibility of the generator of

wastes i.e. the doctor, nurse or Para-medical personnel. However, in reality, this job is
always relegated to the sanitation staff; and it becomes a truly Herculean task to
segregate or sort out various categories, once they have been mixed up.

 The hospital waste needs to be segregated collected and disinfected at source itself
final disposal, so that the unscrupulous traders do not get any scope to reuse this
material, which might cause highly infectious diseases.

Several things affect the degree of segregation:

1) All bins should be preferably easy to use, in terms of their use and design and
placement. There are instances when mixing of waste was directly linked to the poor
access of particular bin .All decisions regarding bins should be taken in consultation
with the personnel.

2) The bins should be kept clean and should be covered and foot-pressed. This will
eliminate the hesitation to approach a bin due to its appearance.

3) The number of each bin type should be optimized. As each bin directly translates into
a liner (bag), economically it makes sense to use bins intelligently. The bins and bags
should be of the same size to minimize wastage.

2.7 THE PRINCIPLES OF SEGREGATION

 The correct segregation is the clear responsibility of every waste generator,

independent of the organizational position of the generator (Duty of care principle).

21
  In case of doubts regarding the waste group, the precautionary principle must be
followed, that means if a classification of the waste unclear or not recognizable, the
waste must be classified in the highest to be expected risk gro
 The segregation should be carried out by the producer and close as possible to the
place of generation, that means segregation must take place at source, e.g. on the
ward, at the bedside, operation theatre, laboratory, etc. and must be carried out by the
person generating the waste e.g. nurse, physician (proximity principle).

 The segregation must be applied from the point of generation, during collection,
transport, storage and final disposal. Every place of generation should have the
necessary equipment for the types of wastes that are generated at that place like bags,
bag holder, container, etc.

 Segregation and identification instructions should be placed at each waste collection

point.

 Segregated waste should not be mixed during transport and storage. If hazardous and
non hazardous wastes are mixed, the entire mixture must be considered and treated as
hazardous waste.

 Correct segregation will only be achieved through a rigorous training of all hospital
staff and waste generators inside the hospital (this includes patients and visitors).

 The segregation should be carried out first under the “polluter pay” principle and

second under the “precautionary” principle. This means the generator must

segregate as good as possible and shall only in unclear situ.

2.8 COLOR CODING OF THE SEGREGATED WASTE

22
Color coding means to combine different waste groups with “similar” hazards in one
main group and to identify this main group in a fast and easy way by a fixed color . The
different waste groups have different colors for the containers and bags for the
identification according to the hazards and applied throughout the complete disposal
chain (segregation, collection, storage, transport, disposal):

 Warning colors for hazardous waste (Red, yellow, orange)

 Positive colors for recycling (Blue, green, etc.)

 Neutral colors for normal waste (Black, etc.)

APEX HOSPITAL – BIOMEDICAL WASTE

23
 CHAPTER III

RESEARCH METHODOLOGY

24
3.1 STUDY AREA

Apex Hospital , Varanasi, Punjab

3.2 STUDY PERIOD

May-June 2010

3.3 STUDY DESIGN

Observational study

3.4 STUDY TOOLS

1. Observation of Bio-medical waste segregation & handling in the Hospital.

2. Self assessment on Bio-medical waste (management &handling) Rules 1998.

3.5 STUDY TECHNIQUE

The first step was the primary data collection which was done on the following departments –
H.D.U, Triage, I.C.U-1, General ward-1, 2, 3, &4, Dialysis, Cath Lab. The segregation
practices being followed in these departments were closely observed from 9.30 to 6.00pm
daily. Data regarding the no of errors made in the segregation practices and type of bins were
noted/ recorded. According to the Bio- Medical Waste Management and Handling Rules 1998
Bio-Medical Waste shall not be mixed with other wastes and shall be segregated into
containers/bags at the point of generation in accordance with Schedule II prior to its storage,
transportation, treatment and disposal. Any deviation has been considered as an error. The
various reasons for the error were found. The various statistical tools were used with
graphical representation to analyze them and needful recommendations have been given for
the respective reasons.

3.6 TYPES OF ANALYSIS

Quantitative analysis

3.7 ANALYTICAL TOOLS

25
The following analytical tools were used:

I. Percentage estimation chart

II. Fish bone analysis

3.8 SCOPE OF THE STUDY

The present study attempts to determine awareness of health care personnel in Apex Hospital
and to assess their attitude towards it. The study tries to know and improve bio-medical waste
segregation at source in Apex Hospital . The scope of this study is limited to Apex Hospital
only.

3.9 LIMITATION OF THE STUDY

 Doctors not willing to attend the awareness classes conducted by Quality cell.

 Some critical areas such as ICU-2 could not be included in the study due to less no of
patients.

 Low attendance of the nursing staff during the awareness classes conducted by quality
cell.

26
 CHAPTER IV
RESULTS AND ANALYSIS

27
 4.1 COMPLIANCE RATE CHART

After taking observations at the various departments under study the following results
were obtained.

COMPLIANCE RATE (Before the implementation of corrective measures)

May-2010
Data analysis –
 I.C.U-1 has the lowest compliance rate (16%) followed by Cath Lab (20%)
 G.W-2 has the highest compliance rate of 57% followed by G.W-1 (53%)
 Compliance rate of G.W-3 is 45%
 Compliance rate of Dialysis unit is 27%
 Compliance rate of H.D.U is 48%
 Compliance rate of Triage is 37%
 Compliance rate of Cath lab is 20%

Table depicting the compliance rate and subsequent findings regarding the
B.M.W segregation practices in the patient care areas of Apex Hospital

28
 TABLE IV

Criteria for rating:

0-25% - Poor segregation
25-50%-Average segregation
50-75%-Good segregation
75-100%- Excellent segregation

29
 MEASURES TAKEN -
 Awareness classes were conducted by the Quality cell to educate nurses and G.D.A’s
regarding the importance of B.M.W Segregation at source .
 Extra bins were provided in the departments ( wherever required)
 Checking/ Observation / Monitoring of the various departments

COMPLIANCE RATE (After the implementation of the corrective measures)

JUNE -2010
Data Analysis –

 Lot of improvement has occurred and waste mixing has reduced to a great extent.

 I.C.U-1 and Dialysis Unit has shown maximum improvement.

30
4.4 FISH BONE ANALYSIS

31
Effects of Improper Bio-medical Waste Segregation
 Infections waste mixed with non-infectious waste will increase the treatment and
disposal cost.

 Recycling can be only carried out if recyclable materials are separated from the
hazardous waste (contaminated materials are excluded from any recycling activity and
must be treated as mixed hazardous waste). Mixed waste will decrease the possible
income.

 Risk of air, water and soil pollution directly due to waste, or due to defective
incineration emissions and ash.

 Injuries from sharps leading to infection to all categories of hospital personnel and
waste handler.

 Nosocomial infections in patients from poor infection control practices and poor
waste management.

 Risk of infection outside hospital for waste handlers and scavengers and at time
general public living in the vicinity of hospitals.

 Risk associated with hazardous chemicals, drugs to persons handling wastes at all
levels.

 Disposable being repacked and sold by unscrupulous elements without even being
washed.

 Drugs which have been disposed off, being repacked and sold off to unsuspecting
buyers.

32
 CHAPTER V

CONCLUSIONS AND

RECOMMENDATIONS

33
 5. CONCLUSIONS & RECOMMENDATIONS

5.1 SUMMARY

Bio-medical waste segregation at source is an essential part of bio-medical waste

management process. Segregation means mixing of non-hazardous and hazardous waste
which leads to dumping of hazardous waste outside the hospital, which is a hazard to the
community. So it is necessary to properly segregate the bio-medical waste. A study was
performed regarding the bio-medical waste segregation at source in the Apex Hospital to
know the compliance rate of the segregation at source. Observations were taken in different
departments that were under study. The compliance rates of various departments were known
and comparative analysis was done of different departments. Non-compliance was found out
in all the departments. Different types of analytical tools were used to give a better picture.
Analytical tools such as Percentage estimation chart, fish bone analysis were used. There
were many reasons that were responsible for showing non-compliance that have been
discussed in results.

5.2 CONCLUSION

From the following, it was analyzed that there is non-compliance regarding bio-medical
waste segregation at source in the Apex Hospital . All the departments under study show non-
compliance of bio-medical waste. The reasons for non-compliance have been discussed
earlier in the report.

The following are the recommendations to improve the segregation at source:

1. Every week, a nurse should be given additional responsibility to see that the
segregation is proper in their departments and to give the weekly report regarding
the segregation to the nursing head. Different nurses should be appointed for different
shifts.

2. A strict action must be taken against the staff who is not following the instructions.
Punishments such as Censure or for habitual offender’s deduction of the salary for the

34
 day, on which that person was found not segregating properly, will help in improving
the compliance rate.

3. After every month, a 15 minute written test must be conducted for medical staff in
which there are questions regarding the bio-medical waste and its segregation. The
results should be displayed on the notice board containing the scores of each
individual. This will help in increasing the knowledge of the staff and would help the
management to know about the individual performance.

4. Covered bins should be provided in the patient care areas. They offer an aesthetic
advantage, are much safer in cases of accidents (to minimize spillage) and also
prevent the spread of infection.

5. Bio-hazard symbol should be there on the containers containing hazardous waste

along with instruction “Do not throw general waste”. This will help in reducing errors
made by relatives of the patients in areas such as general ward.

6. Proper instructions chart having information regarding the color coding and different
containers used for disposal of bio-medical waste must be provided to each nurse,
technician and helpers individually so that they can go through the charts regularly
even if they are not in the hospital. This will help them in remembering the
instructions.

35
 BIBLIOGRAPHY

REFERENCES

 Gordon JG, Rein Hardt PA, Denys GA (2004): Medical waste management. In:
rd
Mayhall CG (ed). Hospital epidemiology and infection control, (3 ). Lippincott
Williams and Wilkins publication. Pages: 1773-85.

 Rutala WA, Weber DJ (2005). Disinfection, sterilization and control of hospital waste.
In: Mandell, Douglas and Bennett's Principles and practice of infectious diseases (6 th
ed.). Elsevier Churchill Livingstone Publication. Pages: 3331-47

 Rao SK, Ranyal RK, Bhatia SS, Sharma VR (2004): Biomedical waste management:
An infrastructural survey of hospitals, MJAFI, Vol. 60

 Sharma M (2002): Hospital waste management and its monitoring, (1 st ed.), Jaypee
Brothers Medical Publication.

 Cocchiarella L, Scott Deitchman D, Young D (2000): Biohazardous waste

management: What the physicians need to know, Arch Fam Med, 9: 26-9

 The Gazette of India. Biomedical Waste (Management & Handling) Rule 1998. No
460 July 27th 1998 and Amended No. 375, June 2nd 2000

 Jugal Kishore. Joshi TK. Biomedical Waste Management. Employment News 2000.
Govt of India. Feb 19-25.

 Rao SKM, Garg RK. A study of Hospital Waste Disposal System in Service Hospital.
Journal of Academy of Hospital Administration July 1994; 6(2):27-31.

 Singh IB, Sarma RK. Hospital Waste Disposal System and Technology. Journal of
Academy of Hospital Administration, July 1996; 8(2):44-8.

 Acharya DB, Singh Meeta. The book of Hospital Waste Management. Minerva Press,
New Delhi 2000; 15, 47.

 Srivastava JN. Hospital Waste Management project at Command Hospital, Air Force,

36
 Bangalore. National Seminar on Hospital waste Management: a report 27 May 2000.

 A study of Hospital Waste Management System in Command Hospital (Southern

Command), Pune; a dissertation submitted to University of Pune. Wg Cdr RK Ranyal
Dec 2001;page 37.

WEBSITES
www.google.com

37
ANNEXURE - I

38
ANNEXURE I

39
SURVEY QUESTIONNAIRE FOR HOSPITAL WASTE SEGREGATION

40
41
ANNEXURE-II

42
 ANNEXURE - II
QUESTIONNAIRES FILLED BY HOSPITAL STAFF

43