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Approach For The Assessment and Ranking of Hospitals Based On Waste Management Practices Using RIAM, Sustainability, and EPI Techniques
Approach For The Assessment and Ranking of Hospitals Based On Waste Management Practices Using RIAM, Sustainability, and EPI Techniques
Approach For The Assessment and Ranking of Hospitals Based On Waste Management Practices Using RIAM, Sustainability, and EPI Techniques
Abstract: An environmental impact assessment (EIA) tool is used to assess any proposed development activity. It is beneficial for a detailed
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study of large projects, but less feasible for quick assessments of a smaller project. The rapid impact assessment matrix (RIAM) serves the pur-
pose of quick quantitative assessments of any project. In this study, the RIAM technique used to assess waste management practices of various
hospitals in the city of Prayagraj, India. Based on RIAM scores, the level and nature of the sustainability of waste management practices in
hospitals are checked by the model of sustainability. In addition, the environmental performance index (EPI) is applied with RIAM scores
for comparative study. Hospital “A” was ranked as the most promising sustainability option, with sustainability value (S-value) of 0.2815
and EPI of 211.921, indicating good sustainability. Strict abidance to rules and regulations and regular monitoring is needed to substantially
improve waste management in hospitals. DOI: 10.1061/(ASCE)HZ.2153-5515.0000583. © 2020 American Society of Civil Engineers.
Author keywords: RIAM; Environmental performance index; Sustainability analysis; Waste management; Hospitals.
Fig. 1. Study area: Prayagraj, India. (Reprinted with permission from Prayagraj Municipal Corporation.)
Prayagraj has about 30 hospitals; only five hospitals are govern- Methodology
ment hospitals and the rest are private hospitals. Most hospitals
have a tie-in with a private agency to manage solid waste, including
Survey and Baseline Data Collection
biomedical waste. The Ferron Agency collects waste from the hos-
pitals and transfers it to the incineration plant near Naini, Prayagraj. The 13 hospitals were surveyed through questionnaires in the city
For this study, 13 hospitals are considered out of which two are of Prayagraj. The questionnaire consisted of questions based on
government hospitals and rest (i.e., 11) are private hospitals physical, chemical, biological, ecological, sociological, cultural,
(AMC, unpublished data, 2018). As per the confidentiality policy economic, and operational aspects of solid HWM practices in hos-
of the survey, which protects the identities of hospitals under this pitals. Several times to visit these hospitals for questionnaire sur-
study, fictitious names were used for hospitals (e.g., A, B, C). veys and collected baseline data for study. The list of questions
The list of hospitals and their details is presented in Table 1. In in questionnaire, as shown in the Appendix, were based on aspects
this paper, the waste management practices in hospitals were such as the quality of waste, hygienic condition, storage facility,
used to rank the hospitals in Prayagraj using the RIAM technique hospital follow waste management policy, waste transportation-
and EPI. The questionnaire, based on different aspects, was used related air pollution issues, trained waste handling staff, and treat-
for surveying hospitals to assess their solid hazardous waste man- ment cost of waste, for baseline data collection. Approximately 300
agement (HWM) practices covered several issues, such as HWM respondents, including patients, staff members of hospitals, and
policy & guidelines, and liquid healthcare waste management prac- waste collection workers, were approached (about 25 respondents
tices. The nature and level of sustainability of hospitals were indi- per hospital). Nearly 245 responded in all 13 hospitals. RIAM an-
cated and hospitals were ranked based on analysis of results alyzed all the 13 hospitals’ responses for the existing waste man-
compliance with Bio-Medical Waste Management (Amendment) agement practices and hygienic conditions of hospitals. Suitable
Rules (2018) conferred by the Environmental (Protection) Act weights were allotted to different components using the analytic
(1986), of the Government of India used as the standard. hierarchy process (Pastakia 1998; Pastakia and Jensen 1998).
BE5 18 18 18 18 9
BE6 81 54 81 81 27 −27 −54 54 54 54 27 27 54
SC1 18 9 27 18 18 9 −9 −9 27 18 18 9 18
SC2 12 6 −12 12 6 6 6 6 18 12 12 12 12
SC3 12 6 12 12 6 12 −6 −6 12 12 12 12 12
SC4 18 −18 18 36 −18 18 −36 −9 18 9 9 −9 18
SC5 54 −27 27 54 −27 −27 −27 −27 54 27 −27 −27 54
E01 27 27 18 27 27 9 27 9 18 9 9 9 18
E02 54 18 36 18 18 18 18 18 36 18 18 18 36
E03 24 8 16 8 8 8 8 8 16 8 8 8 16
E04 16 32 24 32 16 8 16 8 16 16 8 8 24
E05 6 0 0 0 0 0 0 0 12 12 0 0 12
Sn-value (%) 28.15 5.86 15.72 15.10 3.88 3.48 −6.32 1.85 23.73 16.44 9.35 6.34 23.41
EPI 215.16 40.28 109.77 88.57 24.89 4.00 −59.55 29.71 168.45 123.98 67.83 50.55 168.45
water pollution and prevent leakage of hospital liquid waste I Hospital is healthy and sustainable in all the four compo-
and waste exposure to rodents. It should pay more attention to proper nents. The ES obtained for I Hospital has significant positive
waste management and follow the HWM policy and guidelines and values in all the four aspects. The existing solid waste manage-
liquid healthcare waste management practices as given by the ment practices in I Hospital is better than most of the surveyed
Government of India. hospitals. J Hospital is sustainable in all but one BE component.
C Hospital has 25% PC, 20% SC, and 33.33% BE impacts, in The ES of J Hospital shows a positive impact on physical, eco-
the negative range. It must improve the hospital and hazardous logical, and social components. It must check the exposure of
waste storage facility to prevent waste exposure to insects/rodents. waste to insects and rodents. K Hospital has 12.5% PC,
It must improve its aesthetic impact and check odor problems. D 33.33% BE, and 20% SC impact, in the negative range. It
Hospital has 33.33% BE and 12.5% PC impacts, in the negative must prevent leakage of hospital liquid waste and check odor
range. It must check leakage of waste, pay more attention to and air pollution issues; it must focus on storage and exposure
water pollution, and check the exposure of waste to insects/rodents. to rodents.
E Hospital has 25% PC, 50% BE, and 50% SC, in the negative The ES of L Hospital has a profoundly negative impact (i.e.,
range, respectively. It must check water pollution and prevent leak- 40% and 33.33% in SC and BE aspects, respectively). Few positive
age of waste. It must check the exposure of waste to rodents and values also noted in the PC and EO components due to contracts
address air pollution issues due to waste transportation. It should with Ferron Agency to collects waste from the hospitals. It needs
pay more attention to the prevention of the spread of diseases. improvement in the safe management of hazardous substances
F Hospital has 25% PC, 66.67% BE, and 20% SC impacts, in the and, thus, preventing the risk of diseases.
M Hospital is healthy and sustainable in all four components.
negative range. It needs to check the mixing of infectious waste in
The ES of M Hospital shows a highly positive impact on physical,
any form with general waste, prevent water pollution, and leakage.
biological, and ecological and social components compared with
It should prevent exposure to rodents and address air pollution issues.
other hospitals.
G Hospital has 80% SC, 50% BE, and 82.5% PC, in the negative
The sustainability waste management condition of hospitals is
range. It has high, unsustainable values. It must strictly follow
evaluated by the sustainability model for ranking of the hospitals.
waste management policies and work toward protecting the public The sustainability (S) of the hospitals concerning the environment
and environment by maintaining hygienic conditions and having tie- (E) with human need and interest (HNI) are calculated by the sus-
ups with proper waste disposal agencies. It must check the leakage of tainability model, as mention in Eqs. (4)–(6). Fig. 3(b) represents
waste and water pollution. It has high negative SC impacts and must the Sn values (%) of different hospitals.
immunize and train waste-handling staff, and do careful management Calculation of max ES totals:
of hazardous substances to prevent the spread of disease and keep
hygienic conditions. H Hospital has 50% PC, 33.33% BE, and
80% SC impacts, in the negative range. It must check the leakage PCmax = 8 × 216 = 1,728
of waste and water pollution. It has high negative SC impacts. It
SCmax = 5 × 216 = 1,080
must train staff in proper waste handling and do careful management
of hazardous substances, prevent disease spread, and keep hygienic BEmax = 6 × 216 = 1,296
conditions. EOmax = 5 × 216 = 1,080
(a) (b)
(c) (d)
(e) (f)
Fig. 2. RIAM analysis of hospitals: (a) A Hospital; (b) B Hospital; (c) C Hospital; (d) D Hospital; (e) E Hospital; (f) F Hospital; (g) G Hospital; (h) H
Hospital; (i) I Hospital; (j) J Hospital; (k) K Hospital; (l) L Hospital; and (m) M Hospital.
(i) (j)
(k) (l)
(m)
Fig. 2. (Continued.)
The pair-wise comparisons are performed systematically using relationships, as mention in Table 3. The comparison matrix re-
the concept of analytic hierarchy process. This includes all sults for finding the weight or priority vector of each aspect are
the combinations of physical/chemical, biological/ecological, given in Table 4. It was using all the values in Eq. (7) for finding
social/cultural, and economical/operational components the EPI. It helps in the exact identification of the environmental
(a)
(b)
Fig. 3. (a) The relative representation of RIAM based environmental scores (ES); and (b) Sn values (%) and EPI values of different hospitals.
PC 1 0.5 3 2
BE 2 1 4 3
SC 0.34 0.25 1 0.5 Appendix. Questionnaire on Waste Management
EO 0.5 0.34 2 1 Practices in Hospitals
Sum 3.83 2.08 10 6.5
The questionnaire consisted of criteria based on physical/chemical
(PC), biological/ecological (BE), sociological/cultural (SC) and
Table 4. Normalized relative weight and priority vector economic/operational (EO) aspects concerning the hospital's
Standardized criteria PC BE SC EO Weights solid waste management practices.
PC 0.26 0.24 0.3 0.30 0.277
BE 0.52 0.48 0.4 0.46 0.465 Questionnaire on Waste Management Practices
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https://doi.org/10.1016/S0195-9255(98)00018-3.
Data Availability Statement Phillips, J. 2009. “The development and application of a geocybernetic
model of sus-tainability.” Ph.D. thesis, Dept. of Geography
All data generated during the study appear in the published article. (Streatham Campus) and Camborne School of Mines (Cornwall
Campus), Univ. of Exeter.
Phillips, J. 2010. “The advancement of a mathematical model of sustainable
development.” Sustainability Sci. 5 (1): 127–142. https://doi.org/10
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