Biomedical
Waste Management Study
Kollam
District
A
Study to assess the total Biomedical Wastes produced in the Kollam District
A Project funded by European Commission Sector Investment Programme
INDIAN MEDICAL ASSOCIATION
Infectious waste should be disposed of with care so that it no longer represents a hazard for the environment. To design suitable treatment and disposal methods calls for a detailed study of the quantum of waste generated in each health care facility. Quantum of waste generated in each facility depends on the number of patients utilizing it too.
Waste Treatment and disposal methods are costly. Segregation at source helps in reducing the quantity of wastes to be treated. This study had envisaged the need for proper segregation of Medical wastes. The hospitals selected for this study were chosen to represent various types of health care facilities-government, private, rural, urban etc.
The decision to under take such a study by the European Commission Sector Investment Programme and the District Health and Family welfare Agency, Kollam is praise worthy. There had never been such a detailed study proposed or completed anywhere else.
Each township in the vast district was painstakingly combed sometimes by foot-to locate the clinics. We had tried to collect as true a picture of the health facilities with regard to biomedical waste generation.
This report contains 7 major chapters.
Chapter 1 - A brief introduction on the need of the study.
Chapter 2 - The method of the study
Chapter 3 - Result of the survey regarding hospitals and beds
Chapter 4 - Wastes generated in hospitals
Chapter 5 - Some observations
Chapter 6 - Recommendations
Chapter 7 - Details on Common Bio Medical Wastes Facility
The Annexures contain almost the complete list of hospitals, clinics, dental clinics, laboratories and the number of beds available in most of the hospitals.
Moreover the previous data on the Kollam District, Maps and on the data on the previous survey are included. The phonographs shown were taken while the studies were done in hospitals and dental clinics.
I thank the leaders of Indian Medical Association especially Dr. P.T.Cheriyan, Dr.R.V.Asokan & Dr. T. Suresh Kumar for all their encouragements and above all the complete freedom given to me to carry out this study. Dr. Narayanan Nair of the Core group needs special thanks for his patience.
Mr.V.S.S.NAIRTECHNICAL CONSULTANT
INDIAN MWDICAL ASSOCIATION
CHAPTER 1A STUDY OF THE HOSPITAL WASTE MANAGEMENT PROGRAMME FOR KOLLAM DISTRICT
INTRODUCTION
The year 1999 saw the Indian Government taking major indications to control and reduce various type of environmental pollution. The Biomedical Waste Management and Handling rules have been notified in 1998. It regulated the disposal of biomedical wastes and lays down the procedures for collection treatment and disposal and standards to be complied with. These rules apply to all persons who generate, collect, receive store, transport, and treat or handle biomedical wastes in any form. Biomedical al wastes mean any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities etc.
The mode of disposal specified is dependant on the type of wastes, and various methods of disposal are used such as Incineration, microwaving, autoclaving, disinfecting and deep burial. This, therefore, makes biomedical waste treatment different form other type of pollutions, as each establishment requires different expertise and resources to handle the waste generated.
NEED FOR THE STUDY
Current Waste Management practices are characterized by poor quality collection service and improper disposal at open dumpsites. Hospital, hazardous and household wastes are mixed together at site. Recoverable wastes, paper and glass are destroyed than separated and recycled for economic use.
For selecting the most efficient treatment method of hospital wastes, the composition analysis is considered to be the fundamental information. Currently there is almost no study done regarding the characteristics of hospital waste.
The study to be done in the hospital in Kollam district should
1. Identify all the hospital and clinics in the District including labs, dental clinics etc.
2. To determine the daily waste generation rate in each facility.
3. Study and evaluate the physical and elemental composition of the wastes.
This study must help design a treatment method for infectious wastes disposable syringes and needs pathologic wastes and kitchen wastes. The quantum of combustible waste also is to be determined.
|
Number of hospital and beds in Kollam district |
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|
1 |
Govt. Hospitals (as per 1995 census) |
|||
|
A |
Hospitals including District Hospital, THQ hospitals |
11 Nos |
1,624 beds |
|
|
B |
Community Health Centre |
4 Nos |
470 beds |
|
|
C |
Community Health Centre |
61 Nos |
285 beds |
|
|
TOTAL 1979 beds |
||||
|
2 |
Private Hospital (1995) |
|||
|
(With beds) 250 Nos |
5,000 beds |
|||
|
TOTAL 7,000 beds |
||||
There had been tremendous increase in the number of hospitals in the private sector during the latter part of ’90.)
METHOD
The present census of the hospital and clinics will be made. The number of beds in each hospital will be ascertained. The quantum of wastes produced in each hospital will be found with its characteristics.
Separate containers and bags will be provided for this purpose. All the hospitals in the entire Kollam District will be covered.
Method of StudyThe first requirement was to do a survey of the Kollam district and find out all the health care facilities. We had started with collecting in formations from various associations such as Medical and Dental Associations. Data from whatever sources possible were collected including Medical Representatives and suppliers of drugs.
We recruited three persons, who completed Hospital Management Courses, and who had done studies in waste management in hospitals during their studies. They traveled to each Taluk in Kollam District and identified the clinics, hospitals, dental clinics and laboratories – where infectious waste is generated. Health care facilities with inpatient facilities and with beds were separately noted.
5 Health care facilities were selected- two in urban area, one rural area, one government hospital and one dental clinic. The waste generations in each of these health care facilities were studies and data collected. This was done concurrently in separate days in a month. Separate colored containers and bags required as per the biomedical waste management Rules were provided to each hospital.
|
Red Bags |
For plastic Tubes, IV Bags, Syringes, Blood and Urine Bags, Catheters and gloves. |
|
Yellow Bags |
Cotton Swabs, Pathological Tissues & Body Parts, Microbiology Waste, Surgical masks |
|
Puncture Proof wires |
Sharps, Needles, Sculpts, Blade, IV Catheters, Ampoules, Containers Vials, Guide |
|
Black Bags |
Papers, Plastic Packing, Food Waste, Disposable Cups & Plates. |
The healthcare workers, including Doctors, Nurses, and Cleaners etc were trained how to segregated the wastes.
Physical verification was made in each hospital.
CHAPTER
3
Number of hospitals and beds in Kollam district
|
1 |
Govt. Hospitals |
|
|
A |
Hospitals including District Hospital, THQ hospitals E S I Hospitals |
1,700 beds |
|
B |
Community Health Centre |
550 beds |
|
C |
Primary Health Centre |
300 beds |
|
Total |
2560 beds |
|
|
2 |
Private Hospitals (with beds) |
285 Nos |
|
Beds |
7500 (approx) |
|
|
Total Beds |
10,000 (approx) |
|
|
3 |
Private Clinics (without beds) |
85(approx) |
|
4 |
Dental Clinics |
More than150 |
|
5 |
Laboratories |
More than 60 |
INFECTIOUS WASTE GENERATION
| GOVERNMENT HOSPITAL | |
| E.S.I. HOSPITALS | |
|
Total Bed Strength |
151 |
|
Average Occupancy |
145 |
| WASTE GENERATION | |
|
Female surgical ward |
35 (ave.) |
|
Yellow Bag (Infectious wastes, cotton swabs, blood stained clothes, pathological wastes) |
3850gms |
|
Red Bags) Blood bags, syringes, tubes, catheters) |
1150gms |
|
Blue Bags (Sharps) |
700gms |
|
TOTAL |
5,700gms |
|
Per patient per day |
170gms |
|
Black Bags (Kitchen wastes) |
3,500gms |
|
Syringes used |
20(average) |
|
Syringes used in the Central Lab |
100 syringes (105 patients) |
|
Syringes used in Casualty (40 patients) |
40 syringes (average) |
| Infectious
waste generation PRIVATE HOSPITAL – URBAN AREA |
|
|
Number of Beds |
40 |
|
Average Occupancy |
20 |
|
Average O.P |
33 |
| INFECTIOUS WASTES | |
|
Human wastes, Blood stained cotton, Dressing Theater wastes.-(Yellow Bags ) |
2500kg |
|
I V Sets, plastic syringes, Tubes etc-(Red Bags ) |
1,000kg |
|
Sharps-(Blue bags ) |
500gms |
|
Kitchen wastes |
2.5kg |
|
Syringes used |
55nos |
|
Total inpatients |
20nos (ave.) |
|
Infectious waste per day/patient |
4000gms/20 |
|
200gms |
|
| Infectious
waste generation PRIVATE HOSPITALS - RURAL |
|
|
Number of Beds |
15 |
|
Average Occupancy |
10 |
|
Average O.P |
45 |
| INFECTIOUS WASTES | |
|
Human wastes, Blood stained cotton, Dressing, Theater wastes. - Yellow Bags |
1 kg |
|
I V Sets, plastic syringes, Tubes etc- Red Bags |
650gms |
|
Sharps-Blue bags |
300gms |
|
Kitchen wastes |
1500gms |
|
Syringes used |
35nos |
|
Infectious waste produced per day/per patient |
1950gms/10 |
|
195gms |
|
| Infectious
waste generation DENTAL CLINICS Three Dental Clinics were selected for study. The amount of waste generated in each was identical and quantities of wastes generated almost same per chair. One result is given below. |
|
|
No of Dental chairs |
3 |
|
Total OP/per day |
135 |
|
No of Dental Specialists |
4 in two shifts |
| WASTE GENERATION | |
|
No of Syringes used |
20 (ave) |
|
Infectious wastes- swabs, gloves |
2,000gms |
|
Other wastes |
850gms |
|
INFECTIOUS WASTE PER CHAIR - 650GMS. Infectious Waste Generation |
|
|
Average infectious waste generation per bed per day in hospitals |
180gms |
|
Dental Clinics – infectious wastes per day per chair (Each Dental clinic with one chair may be considered equivalent to 5 beds in a hospitals) |
650gms |
|
Total waste produced in hospitals per day |
180 x 10,000 / 1000 = 1,800 kg |
|
Wastes from Dental Clinics & Labs |
200kg |
|
Total |
2,000kg |
| This is when proper segregations were done with the help, assistance and guidance of trained personnel. Practically, this could be a bit more than 2 Tones per day. | |
|
Total wastes produced per day |
2,000kg |
|
I.V Tubes, Blood Bags etc (20%) |
400kg |
|
Waste for incineration |
1600kg |
|
Waste for autoclaving |
400kg |
|
*More than 367 Hospitals & Clinics. 285 Hospitals have beds. 130 Dental Clinics 56 Laboratories. *More than 10,000 Hospital beds in Kollam district *The average biomedical waste generation per bed per day is 180gms. *Dental facilities produce about 650gms of probably infectious wastes per day. |
|
|
Total number of beds have increased by |
3567 x 100 ------------- = 55% 6463 |
|
Increase in Government Hospitals |
581 x 100 1979 = 30% |
|
Increase in Private Sector |
3000 x 100 4500 = 66% |
|
Private Clinics without beds |
85nos |
RECOMMENDATIONS
Biomedical Waste Management rules insist that every bit of infectious hazards waste should be properly treated and disposed off. About 2000 kg of infectious wastes are produced in the health care facilities of Kollam district. A properly planned Project for the Management and disposal of these hazards wastes should be implemented and carried out at the earliest.
Presently individual waste management facilities in hospitals are not advised due to several reasons. The major ones being: -
a) They are not economical
b) Environmental problems
It is strongly recommended that a common waste treatment facility is established in the district which can cater to every health care facility. The financial requirements for such a facility include the following: -
*The initial investments
*The cost of packing and transportation from hospitals to the facility
*Treatment and disposal cost
*Maintenance of the facility and equipments
*Updating and modernizing the facility
Initial investments
The total cost of the land, equipments and vehicles will be more than Rs.1, 50,00,000.
Packing and Transportation
This will include containers, bags, trolleys etc to be provided inside the hospital, specially designed vehicles for carrying the waste bags to the facility, fuel and other costs, cost of labor etc.
Maintenance
Maintenance of the equipments, vehicles and the facility. Continuous maintenance of equipments such as Incinerators and Autoclaves is a must. A Break down of any equipment can be costly.
Updating and Modernizing
Continuous research is being carried out in the field of waste management and treatment. Methods with lesser pollution to the environment at lesser cost will be available in the near future. Funds are to be earmarked for modernizing the facility with the purchase of newer equipments such as Irradiation Equipments.
It is recommended that the funds for the initial investments and the maintenance and operation of the Common Facility may be obtained from: -
Non-government Organizations.
Cost sharing on the basis of volume of waste produced by each health care facility. Volume of waste could be easily calculated from the number of beds in a hospital.
The cost for the maintenance and operation of the common Waste Treatment Facility can also be o a cot sharing basis- the actuals being shared by the healthcare facility. His could be done on the lines of the IMAGE project, of Indian Medical Association, meant for Private Hospitals
Another advantage of Common Waste Treatment Facility is that monitoring can be done continuously regarding he proper management and disposal of these wastes. Since most of the hospitals have computers now, it could be easily carried out with the monitoring office at the District Health and family Welfare Agency.
Any corrective action could also be carried out with the minimum loss of time.
Such projects can be extended to other Districts too on the same conditions as above. For this purpose detailed studies must be carried out in each district.
Training Programmes
The infectious wastes produced in a health care facility amounts to about 30% of the total wastes. All the other wastes can be considered as harmless domestic wastes. The treatment of infectious wastes being very costly, segregation wastes at sources is necessary. Proper training o every on in the hospital is a must and such training should he apart of this programme.
Help and assistance may be obtained from suitable agencies such as Indian Medical Association for this purpose.
CHAPTER 7
Common Waste Treatment Facility
2000kg of infectious wastes have to be treated daily. The wastes to be incinerated as per the Biomedical Waste Management and Disposal Rules (1998) will be about 1,600kg per day. The balance 400kg is to be autoclaved and shredded before disposal. The machinery requirements will be as follows.
|
1 |
Incinerator |
250kg/per capacity |
1 |
|
2 |
Auto Clave |
100kg/hr |
1 |
|
3 |
Incinerator (as sand by) |
100kg/hr |
1 |
|
4 |
Shredder for plastics |
1 |
|
|
5 |
Effluent Treatment Plant |
1 |
|
|
6 |
30 M chimney |
1 |
|
|
7 |
Vehicles for transportation (4 small, 3 big) |
7 |
|
|
8 |
Other equipments such as Transformer, Water Pump, Air Compressor |
COMMON BIOMEDICAL WASTE TREATMENT FACILITY
Common Biomedical treatment Facilities are setup for the treatment and disposal
of Biomedical Wastes generated in a number of health care facilities. They
are likely to be more economical than individual waste treatment facilities.
Resources can be utilized optimally in case of common Facilities.
How to Implement a Common Waste Treatment Facility?
The land for setting up CWTF has to be selected after detailed studies. The main considerations are:
1. Minimum area of 2.5 acres.
The buildings required for the Plant, Effluent Treatment, Vehicle parking, Offices etc could be managed in about 0.5 acres. But it is mandatory that such treatment facilities should have a landfill site and naught green cover. Again this plot of land should be as far away from habitation (This is definitely not because of any pollution from such facilities). Again it is better to have such facilities away from water bodies.
The facility will have the following equipments:
|
1 |
Incinerators |
2 nos |
|
2 |
Auto Claves |
One |
|
3 |
Microwave equipment |
(Optional) |
|
4 |
Shredders |
2 nos |
|
5 |
Chimney |
30 M |
|
6 |
Effluent Treatment Plant |
|
|
7 |
Vehicle Washing Equipments |
|
|
8 |
Water pumps, Storage, Air Compressors |
|
|
9 |
Generator for Electricity |
The Hospitals and Nursing Home are solely responsible for segregation packaging.
Storage and labeling of wastes as per the relevant schedules of Biomedical Waste (Managements & Handling) Rules.
The vehicles transporting the wastes to the facility shall be designed exactly as per the standards of Bureau of Indian Standards. They should also be labeled with symbols meant for hazardous wastes.
The common Treatment facilities should comply with all the emission and effluent standards of the pollution control Board. More over prior to installation of any CTF the operation of such facilities should obtain the authorization from the prescribed authorities.
Mobilization of funds for setting up such common facilities is a matter of concern. Each facility to cater to about 15,00 beds will need more than Rs. 1.5 crores. Funds for hospitals in the governments sector may be arranged from the Planned Budget of central or state governments. Hospitals in the private sector can join such common Treatment Facilities.
Private Health care facilities participating in the Common Facilities shall bear the expenses for treatment and transportation. The criteria for fixing the amount to be charged shall be worked out depending on the wastes produced. But it has been found ideal to charge on a per bed basis. The average per bed cost of treating and disposing the wastes will be more than Rs.100/- per months.
Indian Medical Association, Kerala State Branch has initiated and started a project named IMAG recently. This is meant primarily for treatment and disposal of wastes from Private Hospitals: IMA has already procured land in Paripally, Kollam district to set up a Common Facility for hospitals in the southern district of Kerala, from Thiruvananthapuram, Kollam, Pathanamthita and Alappuzha. IMA has already procured land in Paripally, Kollam district. More than 25 hospitals from Kollam District have already joined this programme.
This Common Biomedical Treatment facility to be set up at Paripally may be utilized by increasing the capacity of the plants. It could be possible to have an agreement with Indian Medical Association.
|
PROJECT
COST FOR A CAPACITY TO CATER 10000 BEDS
|
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|
Sl. NO |
Description |
Cost |
Total cost |
|
1 |
PLANT & MACHINERY INCINERATOR200Kgs/Hr 30 Mtr CHIMNEY WET SCRUBBER AUTO CLAVES 2 Nos SHREDDER 1 Nos BLOOD BAG SHREDDER 1 Nos ETP Plant OTHER UPKEEP EQUIPMENTS |
1500000 300000 300000 1200000 300000 300000 700000 1000000 |
5600000 |
|
2 |
LAND 2.3 Acres OTHER LAND RELATED EXPENSES |
600000 100000 |
700000 |
|
3 |
VEHICLES A) BIG TRUCKS – 3 NOS @ 6 LAKHS each B) SMALLERVEHICLES- 4 Nos @ 2.5each C) Bikes 2 nos @ 50000/- each D) Other vehicles for office purpose |
1800000 1000000 100000 50000 |
|