Notes

INTRODUCTION
Medical care is vital for our life, health and wellbeing. But the waste generated from medical activities can be hazardous, toxic and even lethal because of their high potential for diseases transmission. The concern for hospital waste management has been felt globally with the rise in infectious diseases and indiscriminate disposal of waste. Hospital’ is a place of Almighty, a place to serve the sick persons. Hospitals are committed to patient care and community health. On the one hand they cure patients and at the same time they have emerged as a source of several diseases but we are unaware of the adverse effects generated by them on ‘Man and Environment’. A modern hospital is a complex multidisciplinary system which uses thousands of items for delivery of medical care. All these items consumed in the hospital leave some unused leftovers i.e. hospital waste. Hospital waste is a potential health hazard to the health care workers, flora and fauna of the area. This problem has now become the threat for public health. Public is under a constant risk due to multifaceted problems of hospital waste. The problem of hospital waste is more of quality as compared to quantity. This issue of improper Hospital Waste Management in India was first highlighted on 27th July 98; under the provisions of Environment Act 1986. so as to ensure the safety of the staff, patients, public and the environment. These rules are now modified in 2011.When it comes to the importance of hospital waste management there are a few things that should be initiated like healthcare waste segregation, an understanding of different healthcare waste stream sources, and regular healthcare waste audit procedures. At its foundation, hospital waste management increases safety of employees and patients by reducing the potential to sustain a sharps injury potential, along with the costs of direct and indirect treatment as a result. It also reduces the risk of exposure to blood-borne pathogens and reduces hospital-acquired infections

Hospital waste is generated during the diagnosis, treatment, or immunization of humans or animals, as well as during research, biological production, and testing.
Soiled waste, disposables, anatomical waste, cultures, abandoned pharmaceuticals, chemical wastes, disposable syringes, swabs, bandages, body fluids, human excreta, and other wastes may be included under this category.
These are highly infectious and can pose a major hazard to human health if not handled scientifically and selectively.
Discarded blood, sharps, unwanted microbiological cultures and stocks, identifiable body parts (including amputation-related body parts), other human or animal tissue, used bandages and dressings, discarded gloves, and other medical supplies that may have come into contact with blood and body fluids are all examples of infectious hospital waste.
According to surveys conducted by several organizations, India's healthcare facilities are not paying enough attention to waste management.
Following the publication of the Bio-medical Waste (Handling and Management) Rules, 1998, these facilities are gradually streamlining the waste segregation, collection, treatment, and disposal processes


Classification of hospital waste
General waste: Largely composed of domestic or house hold type waste. It is non-hazardous to human beings, e.g. kitchen waste, packaging material, paper, wrappers, plastics.

Pathological waste: Consists of tissue, organ, body part, human foetuses, blood and body fluid. It is hazardous waste.

Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that could cause diseases. It is hazardous e.g. culture and stocks of infectious agents from laboratories, waste from surgery, waste originating from infectious patients.

Sharps: Waste materials which could cause the person handling it, a cut or puncture of skin e.g. needles, broken glass, saws, nail, blades, scalpels.

Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have been returned from wards, have been spilled, are outdated, or contaminated.

Chemical waste: This comprises discarded solid, liquid and gaseous chemicals e.g. cleaning, housekeeping, and disinfecting product.

Radioactive waste: It includes solid, liquid, and gaseous waste that is contaminated with radionuclide’s generated from in-vitro analysis of body tissues and fluid, in-vivo body organ imaging and tumour localization and therapeutic procedures.

Biomedical waste Any solid, fluid and liquid or liquid waste, including it's container and any intermediate product, which is generated during the diagnosis, treatment or immunisation of human being or animals, in research pertaining thereto, or in the production or testing of biological and the animal waste from slaughter houses or any other similar establishment. All biomedical waste are hazardous. In hospital it comprises of 15% of total hospital waste.

APPROACH FOR HOSPITAL WASTE MANAGEMENT
Approaches described in this paper are based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India).

Impacts Of Hospital Waste On Health
Microorganisms in healthcare waste can infect hospital patients, healthcare employees, and the general public.
Another possible threat is drug-resistant bacteria that spread from health care facilities into the environment.
Sharp injuries frequently happen due to discarded sharps such as needles, broken glasses, etc.
Toxic exposure to pharmaceutical products, particularly antibiotics and cytotoxic drugs released into the environment, as well as substances like mercury or dioxins, during the handling or incineration of health care wastes, causes numerous diseases such as cancer, lung failure, etc.
Chemical burns result from disinfection, sterilization, or waste treatment activities;
Air pollution is the common result of particulate matter released during medical waste incineration

Impacts Hospital Waste On Animals and Birds
Animals scavenging in open dumps can choke on plastic waste.
Sharps injuries are a typical incidence in animals.
Chemicals that are harmful to animals and birds, such as dioxins and furans, can cause major health problems.
Heavy metals can even harm an animal's reproductive health.
Antibiotic resistance is spreading due to changes in microbial ecology.

Hospital Waste- Management
Biological waste must be carefully managed and disposed of in order to safeguard the environment, the general public, and workers, particularly healthcare and sanitation personnel who may be exposed to biomedical waste as a result of their employment.
An estimated 16 billion injections are given each year around the world. However, not all needles and syringes are properly disposed of.
Segregation, collection, handling, storage, transport, treatment, and disposal are all steps in the management of biological waste.
The formulation and implementation of a national waste management policy can help a country's health facilities handle biological waste better.

Segregation
Segregation is the basic separation of different types of waste created at the source, lowering the hazards and costs of management and disposal.
Segregation decreases the amount of waste that requires special treatment and handling.
Hospital waste, such as sharps, is kept separate from normal municipal waste through effective segregation.
It prevents the unauthorized reuse of medical waste components such as old syringes, needles, and other plastics.
After a proper and complete cleaning, certain components of medical waste, such as plastics, can be recycled.

Collection
Biomedical waste should be collected in leak-proof containers that are strong enough to avoid breakage during handling.
The containers/bins should be situated in such a way that they collect 100% of the waste.
Sharps must always be maintained in puncture-proof containers to protect personnel from accidents and illness.
A biohazard symbol is placed on biomedical waste containers. Red is frequently used for containers, markings, and labels.

Storage and Handling
The term "storage" refers to the process of storing waste until it is either processed on-site or moved off-site for treatment or disposal.
For storage, there are numerous alternatives and containers.
Regulatory bodies may impose time limits on how long waste can be stored.
Moving biomedical waste from the point of generation, accumulation sites, storage places, and on-site treatment facilities is referred to as handling.
Workers who work with biomedical waste must follow conventional safety procedures.

Transportation
Trolleys or covered wheelbarrows should be used to transfer the garbage for treatment.
As far as possible, manual loading should be avoided.
Before transporting this kind of hospital waste, the bags/containers carrying them should be tied/ lidded.
Special vehicles must be utilized to protect transportation operators, scavengers, and the general public from having direct access to and contact with the garbage.
The driver should be instructed in the procedures to follow in the event of an accidental spillage, and the effects of traffic accidents should be considered in the design.
It should also be feasible to fully clean the containers' interiors.

Treatment and Disposal
The goals of biological waste treatment are to reduce or remove the waste's risks, and to make it unidentifiable in most cases.
After treatment, the waste should be safe to handle and dispose of.
These objectives can be fulfilled through a variety of therapeutic options.
Biomedical wastes can also be treated using an autoclave and microwave disinfection.
Alternative thermal treatment methods include gasification and pyrolysis, which combine energy recovery with waste volume reductions and pathogen eradication.
Biomedical waste can be disinfected with a 1–10 percent bleach solution for liquids and small amounts.
Biomedical waste is frequently incinerated. Pathogens and sharps will be destroyed by an efficient incinerator.
In most cases, the source components are undetectable in the ash

Hospital Waste Management - Colour Coding
In India, the following colour coding is recommended by the most recent guidelines for bio-medical waste segregation:

Red Bag: Syringes (without needles), filthy gloves, catheters, IV tubing, and other items should all be placed in a red bag that will be destroyed later.
Yellow Bag: All dressings, bandages, and cotton swabs containing body fluids, blood bags, human anatomical waste, and body parts should be discarded in yellow bags.
Cardboard Box with Blue Marking: Glass vials, ampules, and other glassware should be discarded in a cardboard box with a blue marking/sticker.
White Puncture Proof Container (PPC): Needles, sharps, and blades are disposed of in a white translucent puncture proof container.
Black Bags: Non-bio-medical trash should be placed in black bags. This comprises Stationary, vegetable and fruit peels, leftovers, packaging from pharmaceuticals, disposable caps, disposable masks, disposable shoe-covers, disposable tea cups, cartons, sweeping dust, kitchen waste, and so on.

CONCLUSION
Hospital wastes pose a significant impact on health and the environment. There is not enough information on hospital waste management technologies and impacts in developing countries. Practice of proper hospital waste disposal and management is also inadequate. However, from this study it can be said that there is an urgent need for raising awareness and education on Hospital waste issues. Proper waste management strategy is needed to ensure health and environmental safety. The most important component of Hospital waste management is to bring about a transformation in the mind sets and developing a system and culture through education, training and persistent motivation of not only the health care staff but public also. The cliché lies in segregation of the waste especially infectious waste from the non infectious waste, resulting in defining and limiting expenditures in developing countries like India. Therefore let us join hands to get rid of this problem of Hospital Waste