Aj Last

“A STUDY ON BIOMEDICAL WASTE MANAGEMENT
AT STARCARE HOSPITAL, CALICUT”
Project submitted in partial fulfilment of the

Requirements for the Award of the Degree
MASTER OF BUSINESS ADMINISTRATION

OF
BENGALURU NORTH UNIVERSITY
Submitted By:
Mr. ARJUN P P
REG NO: P19BU21M0029
Under the guidance of
DR. SUDARKODI P
Associate Professor
Department of MBA
KOSHYS INSTITUTE OF MANAGEMENT STUDIES
BENGALURU NORTH UNIVERSITY

2021-2023
COLLEGE CERTIFICATE
This is to certify that the project work titled “A STUDY ON BIOMEDICAL WASTE
MANAGEMENT AT STARCARE HOSPITAL, CALICUT” Submitted to Bengaluru
North University, Bangalore in the partial fulfilment of the requirement for the award of the
Master of Business Administration is a record of the original work done by Mr. ARJUN P P
(Reg No: P19BU21M0029), under my supervision and guidance. It is their original work and
it has not been previously submitted for the award of any degree and diploma.
Dr SUDARKODI P Dr PRAKASH B NAYAK
(Head of the Department) (Director)
Place: Bangalore
Date:
DECLARATION
I, ARJUN P P, Third Semester MBA Student of KOSHYS INSTITUTE OF MANAGEMENT

STUDIES do hereby declare that this project work entitled “A STUDY ON BIOMEDICAL
WASTE MANAGEMENT AT STARCARE HOSPITAL, CALICUT”
under the guidance of HOD DR. SUDARKODI P is the result of my original work. The study
was undertaken in partial fulfilment of the requirements of the degree of MASTER OF
BUSINESS ADMINISTRATION by B E NGAL URU NORTH UNIVERSITY. This
work has not been the basis for the award of any Degree/Diploma or other similar title to any
candidate of any other university.
PLACE: BANGALORE ARJUN P P
DATE: P19BU21M0029
ACKNOWLEDGEMENT
First, I remain thankful to the God without which I could not have completed the work
successfully. My deep sense of gratitude to our beloved director Dr. PRAKASH B NAYAK
for his supportive encouragement. I express my sincere thanks to Dr. SUDARKODI P HOD
of MBA and who is also my internal guide of KOSHY’S INSTITUTE OF MANAGEMENT
STUDIES for the guidance and her valuable suggestions in this study and all the faculty
members and technical staff for their support and encouragement for completion of the Project.
I am extremely happy to point out the love and support of my parents that energized me to
complete this study. I also extend my wholehearted gratitude to all those who have directly and
indirectly helped me during the course of work. Finally, I would like to thanks my entire dear
and nearest person who directly and indirectly supported and encouraged for the completion of
the project.
Thanking You All
ARJUN P P
INDEX
SL.NO CHAPTERS PAGE

NO
1-7
1 INTRODUCTION
8-48
2 REVIEW OF LITERATURE AND RESEARCH DESIGN

49-58
3 INDUSTRY PROFILE
59-75
4 DATA ANALYSIS AND INTERPRETATION

76-78
5 FINDINGS, SUGGESTIONS AND CONCLUSION

79-81
6 BIBILIOGRAPHY
82-84
7 ANNEXURE
SL.NO PARTICULARS PAGE
NO
2.1 CATEGORIES OF BIO MEDICAL WASTE 40
2.2 SEGREGATION AND COLLECTION OF BIOMEDICAL 43

WASTE
3.4 HOSPITAL DETAILS 56
4.1 CLEANLINESS OF HOSPITAL 60
4.2 COLLECTION OF WASTE BY HOSPITAL 61
4.4 DISPOSAL OF WASTE FROM WARDS IN HOSPITAL 62
4.9 DOES THE HOSPITAL HAVE AN ENVIRONMENT POLICY 64

THAT INCLUDES RECYCLING AND WASTE
PREVENTION PROCEDURE
RESPONSIBILITY OF DEPARTMENT IN CASE OF SOLID 65

4.10 WASTE
4.11 SEGREGATION OF SOLID WASTE 66
4.12 PLACE OF SEGREGATION OF WASTE FROM 67

OPERATORY ROOM AND LABORATORY
4.13 PRIMARY STORAGE OF WASTES 68
4.14 STORAGE OF SOLID WASTE 69
4.15 DISPOSAL OF WASTE WATER 70

4.16 DIFFERENT SOURCES OF WATER SUPPLY 71
4.17 THE TIME SPAN OF WATER TESTING 72
4.24 THE SATISFACTION REGARDS TO DISPOSAL OF 73

TRANSPORTATION OF SOLID WASTES
4.25 THE SATISFACTION REGARDS TO DISPOSAL OF 74

RECYCLING OF WASTE WATER
4.26 THE DETAILS ABOUT MANUAL OR GUIDELINE 75

DOCUMENT ON WASTEMANAGEMENT
“A STUDY ON BIOMEDICAL WASTE MANAGEMENT AT STARCARE
HOSPITAL, CALICUT”
CHAPTER 1
INTRODUCTION
1
INTRODUCTION
Hospital waste is now recognized as a major public health hazard. According to World
Health Organization, each year half a million people globally die due to infections such as
Hepatitis B, and C, HIV and hepatocellular cancer transmitted through unsafe healthcare
practices. There is no information as to what component of this figure comprises healthcare
workers. There are also alarming disclosures about used medical devices and other items
getting recycled and repacked by unscrupulous traders in countries such as ours. This happens
when the hospitals do not take adequate steps to disinfect and mutilate the medical waste as
required under the law. Despite the statutory provision of Biomedical Waste Management,
practice in Indian Hospitals has not achieved the desired standard even after ten years of
enforcement of the law. Biomedical waste has become a serious health hazard in many
countries, including India. Careless and indiscriminate disposal of this waste by healthcare
establishments and research institutions can contribute to the spread of serious diseases such
as hepatitis and AIDS (HIV) among those who handle it and also among the general public
All over the country, unsegregated and untreated biomedical waste is being
indiscriminately discarded into municipal bins, dump sites, on roadsides, in water bodies or is
being incompletely and improperly burnt in the open. All this is leading to rapid proliferation
and spreading of infectious, dangerous and fatal communicable diseases like hepatitis, AIDS
and several types of cancers. In urban and rural areas alike, incidence and prevalence of several
such human diseases has increased and the per capita medical expenditure has also gone high
several folds. Although, yet to be proven, morbidity or illness amongst both urban and rural
dwellers has increased albeit for different reasons.
Biomedical waste management has recently emerged as an issue of major concern not
only to hospitals, nursing home authorities but also to the environment. the bio-medical wastes
generated from health care units depend upon a number of factors such as biomedical 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.
2
The proper management of biomedical waste has become a worldwide humanitarian

topic today. Although hazards of poor management of biomedical waste have aroused the
concern world over, especially in the light of its far-reaching effects on human, health and the
environment.
Now it is a well-established fact that there are many adverse and harmful effects to the
environment including human beings which are caused by the “Hospital waste” generated
during the patient care. Hospital waste is a potential health hazard to the health care workers,
public and flora and fauna of the area. The problems of the waste disposal in the hospitals and
other health-care institutions have become issues of increasing concern.
The improper handling, treatment, storage, transport and disposal of waste can lead to
serious problems like:
The entire waste from a healthcare establishment, which includes non-infectious as well
as infectious waste, if unsegregated and untreated is mixed with the rest of the waste in a
healthcare establishment, will convert the entire non infectious general waste (75-80%) also
into infectious waste.
The indiscriminate disposal of sharps within and outside institutions leading to

occupational hazards like needle stick injuries, cuts, and infections among hospital employees,
municipal workers and rag pickers.
Injuries due to the sharp especially among rag pickers and hospital / municipal workers
increases the incidence of Hepatitis B, C, E and HIV among these groups who transmit these
diseases to others in the community and also succumb to such fatal diseases.
The problem with medical waste lies in the fact that it is not handled and treated
according to its type, which leads to hazardous working conditions for hospital personnel and
exorbitant investment in technology that creates more problems.
3
Hospital waste is generated during the diagnosis, treatment, or immunization of human

beings or animals or in research activities in these fields or in the production or testing of
biologicals. It may include wastes like sharps, soiled waste, disposables, anatomical waste,
cultures, discarded medicines, chemical wastes, etc. These are in the form of disposable
syringes, swabs, bandages, body fluids, human excreta, etc. This waste is highly infectious and
can be a serious threat to human health if not managed in a scientific and discriminate manner.
It has been roughly estimated that of the 4 kg of waste generated in a hospital at least 1 kg
would be infected.
Undestroyed needles and syringes being circulated back to Recycling, through

unscrupulous traders who employ the poor and the destitute to collect such waste for
repackaging and selling in the market.
Reuse of disposable like syringes, needles, catheters, IV and dialysis sets are causing
spread of infection from healthcare establishments to the general community.
Disposal of hospital waste and veterinary hospital waste in municipal dumpsite

resulting in animals especially cows feeding on the blood-soaked cotton and plastics, and this
in turn leading to diseases like bovine tuberculosis which through milk can infect humans.
The indiscriminate dumping of untreated hospital waste in municipal bins increasing

the possibility of survival, proliferation and mutation of pathogenic microbial population in the
municipal waste. This leads to epidemics and increased incidence and prevalence of
communicable diseases in the community.
Incidence and prevalence of diseases like AIDS, Hepatitis B&C tuberculosis and other
infectious diseases increasing due to inappropriate use, storage, treatment, transport and
disposal of biomedical waste.
Chances of vectors like cats, rats, mosquitoes, files and stray dogs getting infected or
becoming carriers which also spread diseases in the community.
4
Biomedical waste management is a complex problem with detrimental effect and one
has to implore the intricacies of management and practices by health care personnel.So this
study is being under taken with the objective to identify and analyze various factors related to
biomedical waste management and to evaluate existing facilities for biomedical waste
management and suggest improvements.
The study was undertaken at Starcare Hospital Calicut. On the topic “a study on waste
disposal and management” The duration of the study was two months. The study was fully
based on well-defined objectives. The data collection is purely based on both primary and
secondary data.
Over the past two decades, health care wastes have been identified as one of the major
problems that negatively impact both human health and the environment when improperly
stored, transported and disposed. For many years, the World Health Organization has
advocated that medical waste be regarded as special waste and it is now commonly
acknowledged that certain categories of health care waste are among the most hazardous and
potentially dangerous of all waste arising in communities. There are many institutions which
pollute the environmental but recently the ignored field which produce the pollution by way of
health care wastes and attracts the attention of the environmentalists are the hospitals,
dispensaries, medical shops, medical clinics of doctors and other paramedical staff. Hospital
waste is defined as any type of waste generated by health care institutions, including hospitals,
medical laboratories, animal experimentation units, and clinics. Hospital waste is not only
hazardous and pollute the environment but dangerous for human beings, animals and plants by
other ways also. Every day, the countries numerous hospitals and other medical institutions
churn out millions of tons of waste. An alarming percentage of the waste lies on open space
creating environmental problems. Health care wastes are hazardous in nature. These damage
the environment even at low concentration. Hence it is necessary to take precautionary
measures so that hazardous components in the waste are rendered harmless through proper
treatment by technology and safe disposal methods. The problem of health care waste has
acquired gargantuan proportion in today's cities. About 1.50 kg of waste was produced per
head/per day of the total hospital waste, which was contaminated with disease carry pathogens.
environment. He needs oxygen. But the environment of hospitals, especially of Government
5
hospitals was so polluted by the hospital wastes that it becomes very difficult even for a normal
man to go in the hospitals and give a visit to his concerned patient. Most of the hospital they
are dumping the hospital waste to open place or municipal solid waste it affects the
environmental and human health. The wastes generated from health care units are generally
classified as infectious and non-infectious. The infectious health care wastes are termed as
hospital wastes and are considered to be potentially hazardous in nature. The disposal of
untreated health care wastes mixed with non-infectious hospital wastes or other general
municipal wastes poses an environmental threat and public health risk. Indiscriminate disposal
of untreated health care waste is often the cause for the spread of several infectious diseases. It
was also responsible for the nosocomial diseases i.e., the hospital acquired diseases to the
health care personnel who handle these wastes at the point of generation. Moreover, this is
equally harmful to persons involved in the health care waste management i.e., segregation,
storage, transport, treatment and disposal. Apart from the above, a good amount of health care
wastes such as disposable syringes, saline bottles, I.V. fluid bottles etc. are picked up by rag
pickers and are recycled back into the market without any disinfection. It is imperative,
therefore, to adopt an appropriate environmentally safe method for the disposal of the health
care wastes
The new rules are meant to improve the segregation, transportation, and disposal
methods, to decrease environmental pollution so as to change the dynamic of BMW disposal
and treatment in India. For effective disposal of BMWM, there should be a collective teamwork
with committed government support in terms of finance and infrastructure development,
dedicated health-care workers and health-care facilities, continuous monitoring of BMW
practices, tough legislature, and strong regulatory bodies. The basic principle of BMWM is
segregation at source and waste reduction.
6
Besides, a lot of research and development need to be in the field of developing

environmentally friendly medical devices and BMW disposal systems for a greener and cleaner
environment.
1.1 SIGNIFICANCE OF THE STUDY
Biomedical waste has become a serious health hazard in many countries, including India.
Careless and indiscriminate disposal of this waste by healthcare establishments and research
institutions can contribute to the spread of serious diseases. The proper management of
biomedical waste has become a worldwide humanitarian topic today. Although hazards of poor
management of biomedical waste have aroused the concern world over, especially in the light
of its far-reaching effects on human, health and the environment. Biomedical waste
management is a complex problem with detrimental effect and one has to implore the
intricacies of management and practices by health care personnel. So this study is being under
taken with the objective to identify and analyse various factors related to biomedical waste
management and to evaluate existing facilities for biomedical waste management and suggest
improvements.
7
CHAPTER – 2
REVIEW OF LITREATURE AND RESEARCH DESIGN
8
2.1 REVIEW OF LITERATURE
Bio-medical waste: “Bio-Medical Waste” is any waste, which is generated during the
diagnosis, treatment or immunization of human beings or animals. These wastes are also
generated during research activities or in the production or testing of biological material.
Redefining it scientifically, Biomedical waste is defined as “any solid, fluid or liquid waste,
including its container and any intermediate product, which is generated during its diagnosis,
treatment or immunization of human beings or animals, in research pertaining thereto, or in the
production or testing of biological and the animal wastes from slaughter houses or any other
like establishments.” (Mukesh Yadav, 2011).
“Any waste that is generated in the diagnosis, treatment or immunization of human
beings or animals, in research pertaining thereto, or in the production or testing of biologicals.”
(Singh et al, 2014)
Infectious wastes are those biomedical wastes which contain sufficient population of
infectious agents that are capable of causing and spreading infections among people, livestock
and vectors. Infectious wastes include human tissues, anatomical waste, organs, body parts,
placenta, animal waste (tissue / cell cultures), any pathological / surgical waste, microbiology
and biotechnology waste (cultures, stocks, specimens of microorganism, live or attenuated
vaccines, etc.), cytological, pathological wastes, solid waste (swabs, bandages, mops, any item
contaminated with blood or body fluids), infected syringes, needles, other sharps, glass, rubber,
metal, plastic disposables and other such wastes (Akter, 2011).
9
2.2 STATEMENTS OF THE PROBLEM
The research has been conducted on the topic entitled “a study on biomedical waste
management at Starcare hospital Calicut”
Hospital waste management constitutes special category of wastes because they contain
potentially harmful materials. The collection storage and disposal of medical solid wastes are
a growing environmental problem in Indian cities which need immediate attention before it
goes out of hand. While the Govt. of India is making effort to expand medical services by
allowing private hospitals in the country, the management of medical waste has received little
attention despite their potential environmental hazards and public health risks. This research
discusses the results of a study on management of wastes in Starcare hospital Calicut
2.3 SCOPE OF THE STUDY
The study focuses on the biomedical waste management in Starcare Hospital. The scope of the
study encompasses biomedical waste management in Starcare hospital, techniques used in
waste management including solid and waste water treatment. The scope of the study limited
to Starcare Hospital in Calicut
2.4 OBJECTIVES OF THE STUDY
• To examine the types and methods of hospital waste management
• To study about the waste disposal system followed by Starcare hospital Calicut
• To analyse the existing conditions which will reduce amount of waste in Starcare
hospital
10
• To study about the patient’s perception and opinion about waste management in the
hospital.
• To identify whether is there is any relationship between collection and disposal
period and overall satisfaction of waste disposal
• To identify whether there is any relationship environment policy of hospital and
pollution free environment to the public
2.5 RESEARCH METHODOLOGY
• Methodology is the key to any kind research. It helps to maintain a track of
what to do and not to do. It has various approaches to it. A good methodology
works as a strong plan for collecting both primary and secondary data. There are
different ways of adopting good methodology. There are two main ways to collect
data, which is, primary and secondary. In fact, both are necessary to provide a
balanced study on any kind of research.
• Research design is the conceptual structure with in which research is
conducted. The research design used in this study is descriptive and empirical in
nature
2.6 SAMPLING DESIGN
• The sample for the study includes staffs of Starcare Hospital
• Sample Size: The sample size is 100 for each questionnaire.
• Sample unit: Includes nurses, and other employees
2.7 SAMPLING TECHNIQUE
• Convenience sampling technique have been used in the data collection
11
2.8 SOURCE OF DATA
• Both primary and secondary data were examined to know the waste disposal
and management in hospital.
• PRIMARY DATA
• In order to collect data from staffs and patients, following data gathering
method was used.
• QUSTIONNAIRE
• Once the participants had been selected, they were given a questionnaire to
complete. A questionnaire is a pre- structured from with questions the participate
is asked to answer honestly and completely and does not require the researcher to
be present a benefit of using the questionnaire is that, as they are not completed
anonymously, participants usually answer honestly. The sample size for this study
is 50. The questionnaire provided to staffs and other hospital employees consists
of 20 questions and the questionnaire given to patients includes 10 questions.
• SECONDARY DATA
• Secondary data is obtained through

• 1. Company bye-law
• 2. Company magazines
• 3. Websites.
2.9 TOOLS FOR ANALYSIS
The collected data will be analysed in tabular form and present in pie diagrams and bar
charts.
12
Percentage is obtained when ratio is multiplied by 100. The percentage of respondents

coming under the same category was found out as it helped to know the option of
respondents clearly.
Cytotoxic substances, as the word suggests are toxic to cells and are often anti-neoplastic which
inhibit cell growth and multiplication. These drugs when come in contact with normal cells can
damage them and cause severe disability or even death of those affected. These drugs could be
present in the waste generated from the treatment of cancer patients or from other work related
to testing and control of cancerous cells.
Infected plastics are those biomedical plastics which have been used for administering
patient care or for performing related activities and may contain blood or body fluids or are
suspected to contain infectious agents in sufficient number which may lead to infections among
other humans or animals. These generally include IV tubes / bottles, tubings, gloves, aprons,
blood bags / urine bags, disposable drains, disposable plastic containers, endo-tracheal tubes,
microbiology and biotechnology waste and other laboratory waste. As regards its type and
composition, most hospital waste is similar to household waste and can be disposed of in the
same way. In addition to this, however, hospitals generate certain special types of waste which
should not be handled by domestic refuse collection services, because of the risk of infection,
because they are hazardous in other ways, or for ethical reasons. Such waste must be collected
separately at the places where it is generated, and disposed of in specially approved plants, e.g.,
incinerators. Hence, types of hospital waste may be classified according to the disposal methods
appropriate for them, as follows:
Figure: 2.1
13
2.1 HISTORY OF HOSPITAL WASTE MANAGEMENT
GENERAL INTRODUCTION
Waste management is one of the important public health measures. If we go into the
historical background, before discovery of bacteria as cause of disease, the principle focus of
preventive medicine and public health has been on sanitation. The provision of potable water,
disposal of odour from sewage and refuse were considered the important factors in causing
epidemics. The invention of water closet by John Harrington (15611612) facilitated flushing
away human waste and helped to keep some dwellings clean, but flow from those indoor privies
ran into cesspools and ultimately into waterways and wells. In 1848, the description by Edwin
Chadwick of the sanitary conditions and health of English workers however had a great impact
on the upper class and the governing bodies. His standard for proper removal of sewage and
the protection of water supply was a stimulus to the govt. of Britain as was Rudolph Virchow’s
militant advocacy of public health measures in Germany. The great glories of Roman hygiene
were the water supply and the sanitation system. In several areas of Europe, public health
remains primarily the responsibility of the inhabitant (for example—street cleaning and
drainage) but laws were created and inspectors were assigned for enforcement. ‘Scavengers’
were appointed to collect the garbage and space outside was assigned for dumping (Mukesh
Yadav, 2011)..
THE ORIGIN OF BIO-MEDICAL WASTE MANAGEMENT IN THE INDIAN SUB-
CONTINENT
In the Indian Sub-continent, until Sir Mortimer Wheeler’s work at Harappa in 1946,
nothing was known with certainty of the way in which this people dispose of their dead, but
from a cemetery than discovered, containing at least 57 graves, each appears-the burial was a
usual rite. The whole cemetery has not been excavated and the evidence is not yet fully
assessed, but it is clear that the dead were buried in an extended posture with pottery and
personal belongings. Coming back to modern age, in the 21st century with increased use of
disposable material and the presence of dreaded disease like Hepatitis – B and AIDS, it is
utmost important to take care of the infected and hazardous waste to save the mankind from
disaster. The Health care institution or hospitals which are responsible for care of morbid
population are emitting voluminous quantity of rubbish, garbage and Bio Medical Waste matter
14
each day from wards, operation theatre and outpatient areas. Proper management of hospital
waste is essential to maintain hygiene, aesthetics, cleanliness and control of environmental
pollution. The hospital waste like body parts, organs, tissues, blood and body fluids along with
soiled linen, cotton, bandage and plaster casts from infected and contaminated areas are very
essential to be properly collected, segregated, stored, transported, treated and disposed of in
safe manner to prevent nosocomial or hospital acquired infection. 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 in the hospital, 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 (Singh et al, 2014).
With the proliferation of blood born diseases, more attention being focus on the issue
of infectious medical waste and its disposal. Health care institutions must be aware of the
potential risk in handling infectious waste, and adhere to the highest standard of transport &
disposal. Education of the staff, patients and community about the management of the
infectious waste is crucial in today’s health care arena .
TYPES OF BIO-MEDICAL WASTE:
Type A: Waste which does not require any special treatment.
This is the waste produced by the hospital administration, the cleaning service, the
kitchens, stores and workshops. It can be disposed of in the same way as household waste.
Type B: Waste with which special precautions must be taken to prevent infection in the
hospital.
This is usually taken to include all waste from inpatient and casualty wards and doctors'
practices, e.g. used dressings, disposable linen and packaging materials. It only constitutes a
risk for patients with weakened defences while it is still inside the hospital. Once it has been
removed from the wards it can be handled by the local domestic refuse collection service.
15
Type C: Waste which must be disposed of in a particular way to prevent infection.
This is waste from isolation wards for patients with infectious diseases; from dialysis wards
and laboratories, in particular those for microbiological investigations, which contains
pathogens of dangerous infectious diseases, e.g. tuberculosis, hepatitis infectious diarrhoeal
diseases and which constitutes a real risk of infection when disposing of this waste. It includes
needles and sharp objects coated with blood, or disposable items contaminated with stool.
Type D: Parts of human bodies: limbs, organs etc.
This waste originates in pathology, surgical, gynaecological and obstetric departments.

It has to be disposed of separately, not to prevent infection but for ethical reasons.
Type E: Other waste.
Hospitals provide a service, and hence have infrastructures which can also generate
hazardous waste products, e. 9. chemical residues from laboratories, as well as inflammable,
explosible, toxic or radioactive waste, which must be disposed of in accordance with statutory
provisions.
SHARPS HANDLING AND DISPOSAL:
Sharps consist of needles, syringes, scalpels, blades, glass etc., which have the
capability to injure by piercing the skin. As these sharps are used in patient care, there is every
chance that infection can spread through this type of injury. Nurses can get a sharp injury before
and after using a sharp on a patient. Further, sharps discarded without any special containment
or segregation can injure and transmit disease to those who collect waste (including safai
karamcharis, municipal sweepers and ragpickers). There have been reports that waste collected
from the hospitals are resold, this creates an additional occupational and community health
hazard.
PLASTICS IN HELTHCARE
Hospitals use plastics because they fear a spread of infection through the use of reusable
medical equipment. Thus, plastic use has grown with increasing concern for infection control.
16
However, there have been cases where even with the use of plastics there has been a spread of
infection in wards. Nurses complained of nosocomial infections in wards even though
disposable equipment was used — they related it to improper waste disposal of disposable
equipment within the wards (Akter, 2011).
PVC is a thermoplastic, with approximately 40 percent of its content being additives.
Plasticisers are added to make PVC flexible and transparent.
Medical equipment made from PVC:
Blood bags Breathing tubes
Feeding tubes Pressure monitor tubes
Catheters Drip chamber
IV Containers Parts of a syringe
IV Components Labware
Inhalation masks Dialysis tubes
MEDICAL WASTE INCINERATION
Incineration is a complex technology that is used to burn waste. The problem of medical
waste is one of disinfecting the waste and not of destroying it. With the increased use of
disposables in medicine, the amount of plastic going for incineration has increased manifold.
The burning of plastics, especially in unregulated incinerators, creates a new set of chemical
toxins, some of which, are super toxins even in extremely small quantities. Incineration thus
converts a biological problem into a chemical one.
17
MERCURY: A HEALTH HAZARD
Sources of Mercury in hospitals:
1. Thermometers
2. Blood pressure cuffs
3. Feeding tubes
4. Dilators and batteries
5. Dental amalgam
6. Used in laboratory chemicals like Zenkers solution and histological fixatives.
GLUTARALDEHYDE/ CIDEX
Glutaraldehyde is a colourless, oily liquid, which is also commonly available as a clear,

colourless, aqueous solution. It is a powerful, cold disinfectant, used widely in the health
services for high-level disinfection of medical instruments and supplies and available with trade
names such as: Cidex, Totacide, and Asep.
Glutaraldehyde is a widely used disinfectant and a sterilizing agent (commonly

available in 1 percent and 2 percent solutions) in medical and dental settings. It is used in
embalming (25% solution), as an intermediate and fixative for tissue-fixing in electron
microscopy (20 percent, 50 percent and 99 percent solutions) and in X-ray films.
RADIOACTIVE WASTE
Radiations are used for wide variety applications in research, industry, medicine,
manufacturing, agriculture, consumer goods and services. The common concern is that in all
these uses, care must be taken to ensure that everyone is protected from the potential hazards
of radiation.
EFFECTS OF BIO-MEDICAL WASTE
18
SHARPS HANDLING AND DISPOSAL
Sharps consist of needles, syringes, scalpels, blades, glass etc., which have the
capability to injure by piercing the skin. As these sharps are used in patient care, there is every
chance that infection can spread through this type of injury. Nurses can get a sharp injury before
and after using a sharp on a patient. Further, sharps discarded without any special containment
or segregation can injure and transmit disease to those who collect waste (including safai
karamcharis, municipal sweepers and ragpickers). There have been reports that waste collected
from the hospitals are resold, this creates an additional occupational and community health
hazard(Mukesh Yadav, 2011)..
Acid gases include nitrogen oxide, which has been shown to cause acid rain formation
and affect the respiratory and cardiovascular system. As large amounts of plastic are incinerated
hydrochloric acid is produced. This acid attacks the respiratory system, skin, eyes and lungs
with side effects such as coughing, nausea and vomiting.
Heavy metals are released during incineration of medical waste. Mercury, when
incinerated, vaporizes and spreads easily in the environment. Lead and cadmium present in the
plastics also accumulates in the ash. Acute and chronic exposure to lead can cause metabolic,
neurological and neuro-psychological disorders. It has been associated with decreased
intelligence and impaired neurobehavioral development in children. Cadmium has been
identified as a carcinogen and is linked to toxic effects on reproduction, development, liver and
nervous system.
PLASTICS IN HELTHCARE
Disposal of PVC via incineration leads to the formation of dioxin and furans. Dioxin
and furans are unwanted by-products of incineration with carcinogenic and endocrine
disrupting properties. They are toxic at levels as low as 0.006 picograms per Kg of body weight.
19
MERCURY HEALTH HAZARD:
When products containing mercury are incinerated, the mercury becomes airborne and
eventually settles in waterbodies from, where via bio-magnification in the food chain and
bioaccumulation, it reaches humans. If it is flushed, it enters waterbodies directly, and if it is
thrown in bins it could enter the body of animals via skin or inhalation, or permeate into the
ground causing soil and groundwater poisoning. This metal Accumulates in the muscle
tissues.
Three major types of mercury are found in the environment – methyl mercury, mercury
(zero), mercury (two). Out of these, methyl mercury is the most toxic; it bio accumulates and
has the capability to interfere with cell division and cross the placental barrier. It also binds to
DNA and interferes with the copying of chromosomes and production of proteins. Pregnant
women and children are most vulnerable to the effects of mercury. The Minamata disaster in
Japan is an example of mercury-poisoning via biomagnification and bioaccumulation. Mercury
exposure can lead to pneumonitis, bronchitis, muscle tremors, irritability, personality changes,
gingivitis and forms of nerve damage
Aqueous solution is not flammable. However, after the water evaporates the remaining
material will burn. During a fire, toxic decomposition products such as carbon monoxide and
carbon dioxide can be generated.
RADIOACTIVE WASTE
Accidents due to improper disposal of nuclear therapeutic material from unsafe

operation of x-ray apparatus, improper handling of radio-isotopic solutions like spills and left
over doses, or inadequate control of radiotherapy have been reported world over with a large
number of persons suffering from the results of exposure. In Brazil while moving, a
radiotherapy institute a left over sealed radiotherapy source resulted in an exposure. 249 people
of whom several either died or suffered severe health problems International atomic Energy
20
Agency, 1988). In a similar incidence four people died from acute radiation syndrome and 28
suffered serious radiation burns (Brazil, 1998)
COLLECTION AND TREATMENT OF BIO-MEDICAL WASTE
Akter, (2011) illustrated that the fight against hospital infection demands the
cooperation of all those employed in the hospital: doctors, technicians, nursing and cleaning
staff. This is why one of the most urgent tasks is to convince, train and monitor the personnel
responsible for refuse disposal. Unless they are convinced of the need, trained and monitored,
all efforts to improve the situation will be doomed to failure.
Hospital waste should always be collected in disposable containers which satisfy the
following requirements: they must be moisture-resistant and non-transparent; sellable in such
a way as to prevent egress of micro-organisms; safe to transport; and colour-coded to
distinguish them from household refuse bags. The waste must be collected in such containers
at the point where it is generated, and removed from the wards daily without being sorted or
transferred to other containers. The containers must be carefully sealed.
Generally, plastic bags are used for Type B and C waste, and plastic buckets for Type
D waste. The material these disposable containers are made of must be appropriate for the next
treatment stage. If the waste is subsequently incinerated, for example, combustible materials
with a low level of toxicity must be used; if it is heat-disinfected the materials must be steam-
permeable. This requirement also applies, incidentalIy, to all disposable items purchased by
hospitals.
The waste must be transported to a central incineration plant outside the hospital in
specially designed vehicles which do not compress it. The interior of the vehicle body must be
easy to clean and it must be adequately ventilated.
Generally speaking, hospital waste should be burnt in appropriate incinerators: this is a

recognized, proven method for disposing of all hospital waste. There are many different
incineration systems available on the market today. Basically, an incineration plant should
satisfy the following requirements:
• it should burn dry, wet and organic waste completely.
21
• glass, plastics and metals contained in the waste should not impair the
function of the plant in any way.
The combustion process should be fully automated, and exhaust gases should be within
the statutory limits even if there are considerable differences in the calorific values of the waste.
It should have an automatically closing charging sluice to prevent operating personnel

from coming into contact with the combustion chamber.
Plants which satisfy these requirements are now available in all sizes.
Alternatively, Type C waste can be disinfected and subsequently disposed of as

household refuse, or, in special cases, removed to guarded sanitary landfills and immediately
covered. Type D waste can be interred in an appropriate manner in cemeteries.
A variety of methods, chemical and physical, can be used for disinfection. To disinfect
waste, however, only thermal systems in which the waste is steam-treated at temperatures
above 105°C have so far proved successful. Disinfection in pressureresistant installations
involves approximately the same amount of work as incineration, but has the disadvantage that
it is not possible to check visually whether the treatment has been a complete success. With
incineration this is of course possible. For this reason incineration is to be preferred in countries
which have no trained inspection personnel.
There are also devices on the market which shred waste and then disinfect it with liquid
chemicals. These devices are only suitable for small quantities, mostly prone to breakdowns,
and there is no guarantee that the disinfectant fluid will reach all the waste.
They are not suitable for handling all the waste generated by a hospital (Singh et al,
2014).
SHARPS HANDLING AND DISPOSAL:
-Make needle reuse impossible: Auto disable syringes, like Solo Shot device, cannot be
used more than once and therefore cannot carry infection from one patient to another.
22
-Take the sharp out of sharps waste: Needle removers “de-fang” syringes, immediately
removing the needles after injection and isolating them in secure containers. The syringe cannot
be reused, and there’s no risk of accidental needle sticks.
-Keep needles away from vulnerable hands: Special stickproof containers capture used
needles and other medical waste until they can be destroyed. PATH is working to increase
access to these “safety boxes,” identifying low-cost options and making them available for all
types of injections.
Using a needle cutter/destroyer:
1. Place used needle in the cutter/destroyer.
2. Cut/destroy the needle and the nozzle of syringe in the destroyer/cutter.
3. Separate syringe’s barrel and plunger and put in liquid disinfectant.
4. After every shift empty the contents of needle container/destroyer into liquid
disinfectant, remove through pouring out contents through a sieve.
Due to poor operation and maintenance, these incinerators do not destroy the waste,
need a lot of fuel to run, and are often out of order. There is a lot of difference between the
theory and practice of incinerator operation. This is true around the world. The problem of
medical waste needs a systematic approach, with investments in training of staff, segregation,
waste minimization and safe technologies, as also centralised facilities.
Merely investing in unsafe incinerators cannot solve it.
23
PLASTICS IN HELTH CARE
Do’s and Don’ts:
Ensure
1. That the used product is mutilated.
2. That the used product is treated prior to disposal.
3. Segregation.
Do not
1. Reuse plastic equipment.
2. Mix plastic equipment with other waste.
3. Burn plastic waste.
Alternatives to mercury-based instruments
Digital instruments are available as substitutes to the mercury containing instruments.

Costs: The cost of the blood pressure instruments ranges from Rs 2000 to 7000 and the cost of
thermometers ranges from Rs 200 to 300
Why are the alternative technologies better?
These less harmful, non-toxic substitutes pose no environmental or health hazards and
last for a longer duration. The life span of the mercury instruments, on the other hand, is short
because of their fragility. Even though the initial investment cost of the alternative technologies
is high, the assets associated with them are lifelong.
24
Identify All Usage Locations: All departments that use glutaraldehyde must be
identified and included in the safety program. Eliminate as many usage locations as possible
and centralize usage to minimize the number of employees involved with the handling of
glutaraldehyde
Monitor Exposure Levels: Measurement of glutaraldehyde exposure levels must be

conducted in all usage locations.
Training: An in-depth education and training program should be conducted for all
employees who work with hazardous chemicals.
Use Personal Protective Equipment: All employees who work with glutaraldehyde must
be provided appropriate personal protective equipment. This equipment includes proper
eye/face protection, chemical protective gloves, and protective clothing.
Engineering controls: Rooms in which glutaraldehyde is used should have a minimum

of 10 air exchange rates per hour.
General room ventilation: A neutralizing agent will, over time, chemically inactivate
the glutaraldehyde
SAFETY MEASURES:
A chain is as strong as the weakest link in it, thus, not even one person in the hospital
should be missed while training is given. The entire staff is involved in waste management at
some point or the other, including administrators, stores personnel and other, seemingly
uninvolved, departments. To ensure that the waste is carried responsibly from cradle to grave,
and to see that all the material required for waste management is available to the staff, it is
important to involve everyone, including:
• Doctors
• Administrators
• Nurses
25
• Technicians
• Ward Boys and safai karamcharis
INFECTION CONTROL
1. Universal Precautions: All the healthcare workers being exposed directly or

indirectly to infectious diseases must take Universal Precautions to reduce the chance of spread
of infection.
2. Sterilization and cleaning: Ensure that the hospital has adequate procedures for
the routine, cleaning, and disinfection of environmental surfaces, beds, bed rails, bedside
equipment, and other frequently touched surfaces, and ensure that these procedures are being
followed. Routine microbiology tests for air and water contamination should be carried out in
all parts of the hospital. Sterilize and disinfect instruments that enter tissue, or through which
blood flows, before and after use. Sterilize devices or items that touch
intact mucus membranes. In all the autoclave cycles, spore strips need to be placed to
check the efficacy of the machine. Recommended chemical disinfectants should be used for
the storage of instruments and fumigation of rooms. All the rooms must have proper
ventilation.
3. Managing Body Fluid Spillages: Urine, Vomit & Faece: All spillages of body
fluids (urine, vomit or faeces) should be dealt with immediately. Gloves (ideally disposable)
should be worn, spillage should be
mopped up with absorbent toilet tissue or paper towels: this should be disposed of into
the waste bin meant for soiled waste. Pour 10 percent hypochlorite solution and leave it for 15
min. Clean the area with a swab. For spillages outside (e.g. in the playground) sluice the area
with water. Do not forget to wash the gloves and then wash your hands after you have taken
the gloves off.
4. Patient Placement: A separate room is important to prevent direct/indirect

contact transmission when the patient is with highly transmissible microorganisms, or the
patient has poor hygienic habits.
26
5. Immunization programmes: Since hospital personnel are at risk of exposure to

preventable diseases, maintenance of immunity is an essential. Optimal use of immunizing
agents will not only safeguard the health of personnel but also protect patients from becoming
infected by personnel. The most efficient use of vaccines with high risk groups is to immunize
personnel before they enter high-risk situations.
Facilities and procedures described in the rules:
(a) Collection: It is mandatory to mention the facilities available e.g. polythene

lined waste bins for collection of solid wastes, and corrosion resistant cardboards or delay tanks
for collection of liquid wastes.
(b) Transfer: it is important to state the type of container employed during transfer
of waste/sources
e.g. cardboards, sturdy polythene bags, radio-graphy camera
(d) Disposal: Identify the disposal methods for solid, liquid and gaseous wastes briefly
such as for:
i). Solids: Burial pits, municipal dumping site or waste management agency e.g. BRIT
etc.
ii). Liquids: Sanitary sewerage system, soak-pit, waste management agency etc.
iii). Gaseous wastes: Incineration facility, fume hood etc.
Safety Clothing: A set of safety clothing and equipment for waste handlers was
identified and provided. It included cap, eye protection goggles, mask, apron, gloves and boots.
Disposable caps and masks were used. Gloves and aprons selected were of nonpermeable
material to prevent contact with blood & body fluids. However gloves selected were malleable
enough to permit finger movement.
Handling, segregation, mutilation, disinfection, storage, transportation and final

disposal are vital steps for safe and scientific management of biomedial waste in any
27
establishment. The key to minimisation and effective management of biomedical waste is

segregation (separation) and identification of the waste. The most appropriate way of
identifying the categories of biomedical waste is by sorting the waste into colour coded plastic
bags or containers.
APPROACH FOR HOSPITAL WASTE MANAGEMENT
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) .
1. Segregation of waste
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 theatres, 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). The biomedical waste should be segregated as per categories
mentioned in the rules. (Annexure IV)
2. Collection of bio-medical waste
Collection of bio-medical waste should be done as per Bio-medical waste (Management

and Handling) Rules. At ordinary room temperature the collected waste should not be stored
for more than 24 hours.
3. Transportation
Within hospital, waste routes must be designated to avoid the passage of waste through
patient care areas. Separate time should be earmarked for transportation of bio-medical waste
to reduce chances of it’s mixing with general waste. Desiccated wheeled containers, trolleys or
carts should be used to transport the waste/plastic bags to the site of storage/ treatment .
4. Treatment of hospital waste
1) General waste
28
The 85% of the waste generated in the hospital belongs to this category. The, safe
disposal of this waste is the responsibility of the local authority.
2) bio-medical waste: 15% of hospital waste
1. Deep burial
2. Autoclave and microwave treatment
3. Shredding
4. Secured landfill
5. Incineration
5. Safety measures
a) All the generators of bio–medical waste should adopt universal precautions and
appropriate safety measures while doing therapeutic and diagnostic activities and
also while handling the bio-medical waste.
b) It should be ensured that:
1. Drivers, collectors and other handlers are aware of the nature and risk of the
waste.
2. Written instructions, provided regarding the procedures to be adopted in the
event of spillage/ accidents.
3. Protective gears provided and instructions regarding their use are given.
4. workers are protected by vaccination against tetanus and hepatitis B
29
6. Training
1. Each and every hospital must have well planned awareness and training programme for
all category of personnel including administrators (medical, paramedical and
administrative).
2. All the medical professionals must be made aware of Bio-medical Waste
(Management and Handling) Rules 1998.
3. To institute awards for safe hospital waste management and universal precaution
practices.
4. Training should be conducted to all categories of staff in appropriate language/medium

and in an acceptable manner.
7. Management and administration
Heads of each hospital will have to take authorization for generation of waste from
appropriate authorities as notified by the concerned State/U.T. Government, well in time and
to get it renewed as per time schedule laid down in the rules. Each hospital should constitute a
hospital waste management committee, chaired by the head of the Institute and having wide
representation from all major departments. This committee should be responsible for making
Hospital specific action plan for hospital waste management and its supervision, monitoring
and implementation. The annual reports, accident reports, as required under BMW rules should
be submitted to the concerned authorities as per BMW rules format .
8. Measures for waste minimization
As far as possible, purchase of reusable items made of glass and metal should be
encouraged. Select non PVC plastic items. Adopt procedures and policies for proper
management of waste generated, the mainstay of which is segregation to reduce the quantity of
waste to be treated. Establish effective and sound recycling policy for plastic recycling and get
in touch with authorised manufactures.
30
CHALLENGES TO HEALTH CARE WASTE MANAGEMENT PRACTICES IN
INDIA
The public outcry against health care waste disposal practices and several public interest
litigations (PILs) filed in various courts, exerted tremendous pressure on Government of India
to enact a law governing healthcare waste management (HCWM). Finally, in view ofthe serious
situation involving biomedical waste management, the Ministry of
Environment and Forests, Government of India created the Biomedical Waste (Management
and Handling) Rules, which came into effect on 20th July, 1998. Despite these rules and
initiations, a lot of challenges to health care waste management practices are faced by Indian
health care sector.
The major challenges identified are:
Lack of Segregation Practices 63 Segregation practice prevents non-infectious waste

to get mixed with infectious waste. Lack of segregation practices significantly increases the
quantity of infectious medical waste as mixing of infectious component with the general non-
infectious waste, makes the entire mass potentially infectious. There is inadequate practice of
segregation of the waste starting from generation to disposal as seen in Indian hospitals. Even
if the segregation of waste at the point of generation is effective, waste handlers are found
mixing it together during the collection and results in loss of ultimate value of segregation.
Lack of Proper Operational Strategy Operational plans should include the location and
capacity of the storage containers, frequency of collection for various types of wastes and
schedule of activities. Infectious wastes are to be stored in the designated colour coded leak-
proof containers for safe handling and can be disinfected / sterilized by the available facility in
the hospital. Transportation of waste within the hospital is to be carried out in closed handcarts
to avoid spillage of waste to a disinfection or treatment facility. After disinfection/sterilization
the waste is transported to a common treatment facility, such as an incinerator or controlled
landfill. In Indian hospitals wastes are collected in mixed forms, transported in open carts thus
allowing spillage to occur, and waste sharps are discarded without disinfection and mutilation,
which may result in their being, re-used thus spreading an infection.
31
Poor Regulative Measures In India, Central Pollution Control Board and the State
Pollution Control Boards, the agencies responsible to enforce these rules in hospitals are on
one hand lacking adequate power and on the other hand there is no commitment. As a result,
most of the large hospitals have not complied with these rules even after expiry of new
deadlines. Even the regulatory authorities have to take the blame for not doing enough to ensure
implementation. There is lack of coordination between the regulatory authorities (pollution
control boards/committees) and Department of Health who exercise functional control over all
healthcare facilities in one way or the other; and lack of will to enforce implementation. No
agency has been assigned the task of spreading awareness.
Moreover, the Rules have not been publicized as widely as required. Hence, smaller
HCUs may not be fully aware of them. A number of issues have not been dealt with in detail,
such as standards of collection and storage devices, equipment, etc..
Lack of Green Procurement Policy Personnel responsible for procuring health care
products and services (materials managers or purchasing agents) come from varying
backgrounds. Environmental background or training is not a prerequisite for the individuals
responsible for securing health care products and services. Waste minimization can be achieved
by purchasing reusable items made of glass and metals which can be disinfected and reused.
For example, a polyolefin intravenous (IV) bag does not contain chlorine, so it has less potential
to produce dioxins through incineration than an IV bag containing polyvinyl chloride (PVC).
Similarly mercury thermometers can be replaced with mercury free thermometers. Health care
units should stimulate the purchase of environmentally preferable products by mandating
certain practices in their purchasing policy.
Waste-picking and Reusing Reuse of plastic syringes and other plastic material used in
the health care is a thriving business of billions of Indian Rupees. More than one million people
are engaged in rag picking (more than 100,000 in Delhi alone). The estimated figure of business
on this score in Delhi alone is more than 50 million Indian Rupees per year. Lucrative monetary
returns and lack of awareness about the problems associated with biomedical wastes encourage
waste-picking and reusing activities. It would not be fair to blame the rag pickers only for this
as the circle of connivance starts from the hospital staff itself. It thereafter goes to the waste
handlers, then to the rag pickers, to the packaging outlets situated in a decrepit area of a 'basti
(slum)', to the medical shop, and finally sold to the unsuspecting patients or their relatives.
32
Lack of Top Management Commitment Governments and the health care providers
have gone in for one type of option for treatment of the waste. No health care provider wants
or has undertaken a base line survey to collect data regarding quantum of waste and its type
being generated, nor about the waste generation points in its premises. Budgetary support 64 is
poor in the government run hospitals, the corporate hospitals and the nursing homes. Therefore
they find it convenient to ignore the rules for monetary consideration. Top management in most
of Indian hospitals is showing inertia in dealing with the waste problem. The wastes are
therefore instead of being segregated, discharged in a mixed condition to the site of disposal,
separating only the saline bottles, which are sent for auctioning.
Lack of Adequate Facilities Efforts to provide facilities for storage, collection,

treatment and disposal of health care wastes as well as appropriate technologies have so far
been limited in India. Additionally, adequate and requisite number of sanitary landfills is
lacking in India. Therefore, the biomedical waste are openly dumped into the open bins on the
road sides, low lying area or they are directed into the water bodies; through which severe
disease causing agents are spread into the air, soil and water. Self-contained onsite treatment
methods may be desirable and feasible for large healthcare facilities but are impractical or
uneconomical for smaller institutes. An acceptable common system should be in place which
will provide free supply of colour coded bags, daily collection of infectious waste, and safe
transportation of waste to offsite treatment facility and final disposal with suitable technology.
Moreover available disposal techniques are neither able to meet disposal requirements nor
innovations in disposal options are in pace with the evolution of complexity of health care waste
streams.
Lack of Institutional Arrangements Management of health-care waste depends on the

input from the administration and active participation by trained staff in segregation, storage,
collection, transportation, treatment and disposal. In India personnel responsible for these
activities are mainly ward attendants and other supporting staff. A committee consisting of the
head of the establishment, all the departmental heads, hospital superintendents, nursing
superintendents and hospital engineers should be formed with a waste management officer who
would be advised by an environmental control advisor and an infection control advisor is
required for proper waste management purposes. Studies showed lack of such kind hospital
waste management committee or a documented waste management and disposal policy in
Indian hospitals.
33
Financial Constraints With dedicated systems being installed in most of the HCUs,
financial provision is necessary for capital and recurring expenditure including funds for
sufficient manpower, disinfectants, devices and equipment. Normally, a separate allocation of
funds for waste management is not found in Indian hospitals. It is estimated that INR 3000–
4000 (US$ 70–93) per ton of hospital waste is required. Additionally, funds are required for
conducting training and awareness programs for health care staffs.
Smaller HCUs ignore waste management practices due to financial constraints.
Inadequate Awareness and Training Programs Awareness of appropriate handling and

disposal of health-care wastes among health personnel is a priority; it is essential that everyone
should know the potential health hazards. Regular programs will help prevent exposure of
health-care wastes and related hazards. Poster exhibition, proper labeling, and explanation by
staff are effective methods. Seminars and workshops, and participation in training courses are
also essential. Management in most of Indian hospitals is not aware of cost savings achieved
due to good waste management practices. It has also been estimated that disposal savings of
between 40% and 70% could be realized through the implementation of a healthcare waste
reduction program.
Reluctance to Change and Adoption Though now alternative technologies are permitted
as per the Biomedical Rules, it takes a long time to change the mindset of the people. Even now
most of the health care providers and decision making authorities talk of incinerator only
although autoclaves and other advanced waste handling equipments are available.
Indiscriminate throwing of the waste is still seen in most of the hospitals and the waste handlers
still are without protective clothing and gears. There is hardly any change in the applied
knowledge and awareness seen in Indian hospitals.
Inadequate Pressure from Societies 65 Previous studies show that pressure from various
Environmental advocacy groups forces, organizations to seriously think about their
environmental management programmes which is lacking in case of Indian organizations.
There is no doubt in the mind of any educated or enlightened person that improper hospital
waste management is the source of many communicable and infectious diseases. But when it
comes to doing anything there is a complete lack of will, and there is a lackadaisical attitude
towards the problem.
34
Strategy:
1. Already existing bins were used.
2. Hard plastic bins were purchased instead of cheap alternatives or pedal bins, as the
hospital, going by their experience, wanted to go in for bins which would last longer.
3. Initially, changing of bags was done on a regular basis. In case of infectious and plastic
waste, bags were changed once a day, and for general waste, bags were changed twice
daily. The cost of this exercise was coming to almost Rs. 100 daily. The hospital has
now decided to experiment with plastic reduction in its waste stream. Thus, only the
infectious waste bags are replaced daily, the bags meant for disinfected plastics and
general waste are retained till the bag remains intact and clean.
4. The plastic bags purchased by the hospital are cheaper alternatives to the expensive
bags available.
5. The hospital purchased extra stock in addition to its present needs, as done for other
items, to prevent any slack in the system.
6. To minimize the use of chemical disinfectant in the wards, two bins have been provided,
one for disinfection of plastics and one for disinfected plastics. After each shift, or when
the bin with disinfectant is full, the contents are transferred to the other bin (min.
residence period of any item in disinfectant is 2hrs)
Strategy adopted:
1. To reduce the load of plastics, the hospital is planning to go in for cloth lining. This
would cost them 1-2 Rs. / bag.
2. Microbiological studies in the hospital’s laboratory have shown that 10% bleach is
effective for two days, thus a new solution is prepared every alternate day.
35
BIO-MEDICAL/HOSPITAL WASTE MANAGEMENT SCENARIO IN HOSPITALS
THE ORGANIZATION-WISE INSTITUTIONS
There is a big network of Health Care Institutions in Delhi. Although, these are not
under one banner but these can be utilized by better coordination among different
organizations.
These Health Care Institutions are inclusive of Allopathy, ISM and Homeopathy. The
large chunk of hospitals and dispensaries are under Delhi Government, Municipal Corporation
of Delhi, New Delhi Municipal Council, Employees State Insurance Corporation and Central
Government Health Scheme. Equally important is the private sector comprising of major
hospitals, nursing homes, clinics, blood banks, diagnostic laboratories, and Unani, homeopathy
and Sidda Dava-khanas. At present there are 504 registered nursing homes registered under this
directorate in Delhi. Bed-wise Distribution these Nursing homes is as follows
CENTRALISED TREATMENT FACILITY-STEPS TAKEN BY THE GOVERNMENT

TO SOLVE THE PROBLEM
Keeping in view the difficulties faced by private hospitals/nursing homes in treatment

of biomedical waste, the Govt. of NCT of Delhi has allowed these units to avail the facility
through India Waste Energy Development ltd. at DDU hospital, LBS hospital, GTB hospital
and BJRM hospital. Currently IWEDL is operating the facilities at DDU hospital only. This is
an interim arrangement and government is planning for centralized facility.
The smaller Nursing Homes and Clinics, which cannot make their own arrangements
due to high cost involved in waste treatment facilities, require some alternative modalities.
To solve the problems of Nursing Homes/Clinics/Blood Banks/Diagnostic Laboratories

etc., Government is taking initiatives to establish centralized waste treatment facilities.
The Government of NCT of Delhi (GNCTD) has purchased land from Delhi
Development Authority (DDA) for establishment of Centralized Biomedical Waste treatment
facilities 1000 sq. meter each at Okhla and Gazipur in Delhi. The tenders for centralized facility
at Okhla have already been finalised.
36
THE BED STRENGTH IN DELHI GOVT. HOSPITALS
The Government of NCT of Delhi has planned to utilize the above two sites for
establishing Centralized Bio-Medical Waste Treatment facilities as a joint venture with the
private sector/NGO etc. to be identified and selected through a transparent process. For this
venture, Government of NCT of Delhi shall only provide infrastructural support to the selected
party/agency in terms of transfer of the above sites on such terms and conditions as shall be
approved by the Delhi Development Authority. Neither any additional capital expenditure for
the establishment of the facility nor any recurring revenue expenditure for operation and
maintenance of the facility will be forthcoming from the GNCTD. Given the above conditions,
the party for the joint venture shall be selected who is able to offer the services to the
Hospitals/Nursing Homes/Clinics etc. at the most reasonable rates conforming to all the
required statutory conditions. There are 26 Hospitals under Government of Delhi, out of which
11 are under DHS. Six hospitals are having Incinerators and 9 hospitals are having Autoclaves
and Shredders for Scientific Management of Bio-Medical Waste. Bio-Medical Waste from the
Hospitals, where such facilities are not available are segregated and transported in special van
to Hospitals where such facilities exist. Under Biomedical Waste (Management & Handling)
Rules 1998, all health care institutions are required to handle biomedical waste in a specified
manner. Delhi is generating approximately 6000 metric tons of waste out of which 60 tons are
Biomedical Waste. The Government hospitals and major private hospitals have their own
arrangement for treatment of biomedical waste. Total no of beds in hospitals under Government
of NCT of Delhi are 5641.
BIOMEDICAL WASTE GENERATED IN DELHI GOVERNMENT HOSPITALS
All the 26 Delhi Govt. hospitals and 167 Dispensaries under this Directorate have
obtained authorization from DPCC under Bio-medical Waste (Management & Handling) Rules
1998.
The govt. of national capital territory of Delhi had made adequate arrangements for
meeting any contingencies arising out of the handling, treatment and disposal of bio medical
waste much before any other government anywhere. Funds were made available to the
hospitals to procure incinerators, and state of the art autoclaves and shredders were imported
so that the prescribed methods of medical waste treatment under the law could be met. The
37
vacuum type of autoclaves procured by Delhi govt. are the best available anywhere. These are
ideal to disinfect plastic, PVC and other categories of medical waste. Adequate funds have
always been provided to all hospitals for purchasing accessories such as bags, trolleys and the
disinfectants. So, there should be no excuse for not properly disposing bio medical waste.
Delhi govt. had signed a MOU with the Government of Australia in 1998 to have
experts visiting from that country and advising and assisting our hospitals to learn and
understand a variety of issues related to bio medical waste management. This collaborative
programme resulted in developing training modules, which have been made available to all.
INITIATIVES TAKEN FOR EFFECTIVE MANAGEMENT OF BIO-MEDICAL

WASTE
Twice a year inspections are conducted in the 100 bedded or more, hospitals which
contribute about 70% of the total waste generated.
Air and effluent quality analysis in these major hospitals is done by IIT, Delhi.
• Authorisation has been granted to 1365 healthcare establishments.
6800 health care professionals have been trained.
Efforts are being made to ensure that no medical unit in Delhi escapes the responsibilities
enjoined upon them for proper storage, treatment and disposal of biomedical waste generated
by it.
SERIOUS ISSUES OBSERVED AS A GENERAL TREND IN THE DELHI

HOSPITALS
(1) The segregation of waste in almost all hospitals is not satisfactory.
(2) Colour coding for various categories of waste is not followed.
(3) The storage of BMW is not in isolated area and proper hygiene is not
maintained.
38
(4) Personal protective equipment and accessories are not provided.
(5) Most of the hospitals do not have proper waste treatment and disposal facilities.
(6) In the cities where common treatment facilities have come up, many medical
establishments are yet to join the common facility.
(7) Emission monitoring of five incinerators indicated that they do not meet the
emission norms.
(8) Most of the incinerators are not properly operated and maintained, resulting in
poor performance.
(9) Sometimes plastics are also incinerated leading to possible emission of harmful
gases.
(10) Several hospitals have not applied to State Pollution Control Board for
authorization under the rules.
(11) General awareness among the hospital staff regarding BMW is lacking.
Classification of Healthcare Waste
Health Care Facilities (HCFs) are primarily responsible for management of the
healthcare waste generated within the facilities, including activities undertaken by them in the
community. The health care facilities, while generating the waste are responsible for
segregation, collection, in-house transportation, pre-treatment of waste and storage of waste,
before such waste is collected by Common Bio-medical Waste Treatment Facility (CBWTF)
Operator. Thus, for proper management of the waste in the
healthcare facilities the technical requirements of waste
handling are needed to be understood and practiced by each
category of the staff in accordance with the BMWM Rules,
39
2016. Waste generated from the healthcare facility is classified as:
• Bio Medical Waste

• General Waste
• Other Wastes
❖ Bio Medical Waste
Bio-medical waste means any waste, which is generated during the diagnosis,
treatment or immunization of human beings or animals or research activities pertaining thereto
or in the production or testing of biological or in health camps. Bio-Medical waste includes all
the waste generated from the Health Care Facility which can have any adverse effect to the
health of a person or to the environment in general if not disposed properly. All such waste
which can adversely harm the environment or health of a person is considered as infectious and
such waste has to be managed as per BMWM Rules, 2016
The quantity of such waste is around 10% to 15% of total waste generated from the
Health Care Facility. This waste consists of the materials which have been in contact with the
patient’s blood, secretions, infected parts, biological liquids such as chemicals, medical
supplies, medicines, lab discharge, sharps metallic and glassware, plastics etc. Bio Medical
Waste Management Rules, 2016 categorises the bio-medical waste generated from the health
care facility into four categories based on the segregation pathway and colour code. Various
types of bio medical waste are further assigned to each one of the categories, as detailed below:
1 . Yellow Category
2 . Red Category
3 . White Category
4 . Blue Category
These categories are further divided as per the type of waste under each category as follows:
Table 2.1: Categories of Biomedical Waste
40
❖ General Waste
General waste consists of all the waste other than bio-medical waste and which has
not been in contact with any hazardous or infectious, chemical or biological secretions and
does not include any waste sharps. This waste consists of mainly: (i) News paper, paper
and card boxes (dry waste) (ii) Plastic water bottles (dry waste) (iii) Aluminium cans of soft
drinks (dry waste) (iv) Packaging materials (dry waste) (v) Food Containers after emptying
residual food (dry waste) (vi) Organic / Bio-degradable waste - mostly food waste(wet waste)
(vii) Construction and Demolition wastes These general wastes are further classified as dry
wastes and wet wastes and should be collected separately. This quantity
41
of such waste is around 85 % to 90 % of total waste generated from the facility. Such waste
is required to be handled as per Solid Waste Management Rules, 2016 and Construction &
Demolition Waste Management Rules, 2016, as applicable.
❖ Other Wastes
Other wastes consist of used electronic wastes, used batteries, and radio-active
wastes which are not covered under biomedical wastes but have to be disposed as and when
such wastes are generated as per the provisions laid down under E-Waste (Management)
Rules, 2016, Batteries (Management & Handling) Rules, 2001, and Rules/guidelines under
Atomic Energy Act, 1962 respectively.
Figure 2.2: Categorization & Classification of Wastes in Health Care Facilities.
Steps involved in Bio-medical Waste Management
First five steps (Segregation, Collection, pre-treatment, Intramural Transportation and

Storage) is the exclusive responsibility of Health Care Facility. While Treatment and Disposal
is primarily responsibility of CBWTF operator except for lab and highly infectious waste,
which is required to be pre-treated by the HCF. Following are the responsibility of HCF for
management and handling of bio-medical waste:
42
1. Biomedical Waste should be segregated at the point of generation by the person who
is generating the waste in designated colour coded bin/ container
2. Biomedical Waste & General Waste shall not be mixed. Biomedical Waste &
General Waste shall not be mixed. Storage time of waste should be as less as possible
so that waste storage, transportation and disposal is done within 48 hours.
3. Phase out use of chlorinated plastic bags (excluding blood bags) and gloves by
27/3/2019. 4. No secondary handling or pilferage of waste shall be done at healthcare
facility. If CBWTF facility is available at a distance of 75 km from the HCF, bio-
medical waste should be treated and disposed only through such CBWTF operator.
5. Only Laboratory and Highly infectious waste shall be pre-treated onsite before
sending for final treatment or disposal through a CBWTF Operator.
6. Provide bar-code labels on all colour coded bags or containers containing segregated
bio-medical waste before such waste goes for final disposal through a CBWTF.
The management of bio-medical waste can overall be summarized in the following

steps; -
Waste Segregation in colour coded and barcode labelled bags/ containers at source of
generation
- Pre-treat Laboratory and Highly infectious waste
- Intra-mural transportation of segregated waste to central storage area
- Temporary storage of biomedical waste in central storage area
- Treatment and Disposal of biomedical waste through CBWTF or Captive facility
Bio Medical Waste Segregation
Bio- medical waste generated from a healthcare facility is required to be segregated at

the point of generation as per the colour coding stipulated under Schedule-I of BMWM Rules,
2016. Following activities to be followed to ensure proper waste segregation:
43
• Waste must be segregated at the point of generation of source and not in later stages.
As defined earlier too, “Point of Generation” means the location where wastes initially
generate, accumulate and is under the control of doctor / nursing staff etc. who is providing
treatment to the patient and in the process generating bio-medical waste.
• Posters / placards for bio-medical waste segregation should be provided in all the
wards as well as in waste storage area.
• Adequate number of colour coded bins / containers and bags should be available at
the point of generation of bio-medical waste.
• Colour coded plastic bags should be in line with the Plastic Waste Management Rules,
2016. Specifications for plastic bags and containers given at Annexure 1.
• Provide Personnel Protective Equipment to the bio-medical waste handling staff
Colour Coding and Type of Container/ Bags to be used for Waste Segregation &
Collection
As per Schedule I of the Bio Medical Waste Management Rules, 2016 following colour
coding and type of container/bags is needed to be used by the HCFs for segregation and
collection of generated Bio Medical Waste from the facility.
44
Table 2.2: Storage of Biomedical Waste
45
Bio Medical Waste Collection
• Time of Collection
a) • Bio-medical waste should be collected on daily basis from each ward of the
hospital at a fixed interval of time. There can be multiple collections from wards
during the day.
b) HCF should ensure collection, transportation, treatment and disposal of bio-
medical waste as per BMWM Rules, 2016 and HCF should also ensure disposal
of human anatomical waste, animal anatomical waste, soiled waste and
biotechnology waste within 48 hours.
c) Collection times should be fixed and appropriate to the quantity of waste
produced in each area of the health-care facility.
d) General waste should not be collected at the same time or in the same trolley in
which bio-medical waste is collected.
e) Collection should be daily for most wastes, with collection timed to match the
pattern of waste generation during the day. For example, in an IPD ward where
the morning routine begins with the changing of dressings, infectious waste
could be collected midmorning to prevent soiled bandages remaining in the area
for longer than necessary.
f) General waste collection, must be done immediately after the visiting hours of
the HCFs, as visitors coming to facility generate a lot of general waste and in
order to avoid accumulation of such general waste in the HCF. The collection
46
timings must enable the HCF to minimize or nullify the use of interim storage
of waste in the departments.
g) Bio-medical waste collected by the staff, should be provided with PPEs.
• Packaging
a) Bio-medical waste bags and sharps containers should be filled to no more than
three quarters full. Once this level is reached, they should be sealed ready for
collection.
b) Plastic bags should never be stapled but may be tied or sealed with a plastic tag
or tie.
c) Replacement bags or containers should be available at each waste-collection
location so that full ones can immediately be replaced.
d) Colour coded waste bags and containers should be printed with the bio-hazard
symbol, labelled with details such as date, type of waste, waste quantity, senders
name and receivers details as well as bar coded label to allow them to be tracked
till final disposal.
e) Ensure that Bar coded stickers are pasted on each bag as per the guidelines of
CPCB by 27 March, 2019
All the bags/ containers/ bins used for collection and storage of bio-medical
waste, must be labelled with the Symbol of Bio Hazard or Cytotoxic Hazard as
the case may be as per the type of waste in accordance with the BMWM Rules,
2016. Bio-medical waste bags / containers are required to be provided with bar
code labels in accordance with CPCB guidelines for “Guidelines for barcode
System for Effective Management of Biomedical Waste”.
47
• Interim Storage
a) Interim storage of bio medical waste is discouraged in the wards / different

departments of HCF.
b) If waste is needed to be stored on interim basis in the departments it must be
stored in the dirty utility/sections.
c) No waste should be stored in patient care area and procedures areas such as
Operation Theatre. All infectious waste should be immediately removed from
such areas.
d) In absence of dirty utilities/ sections such BMW must be stored in designated
place away from patient and visitor traffic or low traffic area.
48
CHAPTER-3
INDUSTRY PROFILE
49
3.1 INDUSTRY PROFILE
3.1.1 OVERVIEW OF HEALTHCARE INDUSTRY
The health care industry, or medical industry, is a sector that provides goods and
services to treat patients with curative, preventive, rehabilitative, or palliative care. The modern
health care sector is divided into many sub-sectors and depends on interdisciplinary teams of
trained professionals and paraprofessionals to meet the health needs of individuals and
populations. This article provides an overview of the medical industry
This section is an attempt to understand the definitions, cultural, political,

organizational, and disciplinary perspectives of this industry. This section is designed to help
learners understand key concepts, terminology, issues, and challenges associated with the
health care industry, and strategies employed to meet some of those challenges. It will identify
the main sectors of the health care industry and its business drivers, and review the key aspects
of the industry business model, its competitive environment, and the current trends in the
industry. The target audience for these tutorials is IT professionals working on the healthcare
domain, consulting houses, industry investors, and all size companies that sell products or
services to healthcare sectors and allied industries. This section will be useful for organizations
and professionals looking for knowledge and key business information in the health care
industry
3.1.2 WHAT IS HEALTH CARE?
Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury.
And other physical and mental impairments in humans. Health care is delivered by practitioners
in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers.
It refers to the work done in providing primary care, secondary care, and tertiarycare, as well as
in public health.
50
3.1.3 WHAT IS THE HEALTHCARE INDUSTRY?
The health care industry, or medical industry, is a sector that provides goods and
services to treat patients with curative, preventive, rehabilitative, or palliative care. The
healthcare industry is composed of establishments devoted to prevent ion, diagnosis, treatment,
and rehabilitation of medical conditions. Such treatment may be through providing products or
services and may be provided privately or publicly. The modern health care sector is divided
into many sub sectors and depends on interdisciplinary teams of trained professionals and
paraprofessionals to meet the health needs of individuals and populations. The health care
industry includes establishments ranging from small-town private practices of physicians who
employ only one medical assistant to busy inner-city hospitals that provide thousands of diverse
jobs. The Healthcare industry is littered with risks and challenges as it is an industry that
requires constant innovation under increased regulations.
3.1.4 IMPORTANCE OF HEALTHCARE INDUSTRY:
The health care industry is tremendously important to people around the word. This
industry comprises of different players including hospitals, doctors, nursing homes, diagnostic
laboratories, pharmacies, medical device manufacturers, and other components of the health
care system. This article provides an overview of the healthcare industry. Aging populations
and increasingly prevalent chronic diseases are the fundamental drivers creating demand for |
the expansion of lifestyle medical procedures and the healthcare industry. There will be a huge
demand for medical technology products for years to come.
3.1.5 IMPACT OF HEALTHCARE INDUSTRY ON ECONOMY:
The health care industry is tremendously important to people around the world as well
as to the national economies. It is one of the fastest-growing industries in the world. Consuming
over 10 percent of gross domestic product (GDP) of most developed nations, a correlation
exists between income levels and expenditure on health care in various countries. For example,
some of the large developing economies, such as Brazil, India, China, and Russia, spend less
on health care than more industrialized economies, such as the United States or France.
51
3.2 CLASSIFICATION OF HEALTHCARE INDUSTRY:
The modern health care sector is divided into many sub-sectors and depends on
interdisciplinary teams of trained professionals and paraprofessionals to meet the health needs
of individuals and populations. The health care industry is one of the world’s largest and fastest-
growing industries and forms an enormous part of a country’s economy. The delivery of
modern health care depends on groups of trained professionals and paraprofessionals coming
together as interdisciplinary teams. This includes professionals in medicine, nursing. Dentistry.
And allied health, plus many others such as public health practitioners, community health
workers, and assistive personnel, who systematically provide personal and population- based
preventive, curative, and rehabilitative care services. For purposes of finance and management,
the health care industry is typically divided into several areas. As a basic framework for
defining the sector, the United Nations International Standard Industrial Classification (ISIC)
categorizes the health care industry as generally consisting of
1. Hospital Activities
2. Medical and Dental Practice Activities
3. Other human health activities
1. Health care equipment and services

Health care equipment and services comprise companies and entities that
provide medical equipment, medical supplies, and health care services, such as
hospitals, home health care providers, and nursing homes.
2. Pharmaceuticals, biotechnology, and related life sciences
The second industry group comprises sector companies that produce
biotechnology, pharmaceuticals, and miscellaneous scientific services.
3. Healthcare Providers and Professionals
A health care provider is an institution (such as a hospital or clinic) or person
(such as a physician, nurse, allied health professional, or community health worker) that
provides preventive, curative, promotional, rehabilitative, or palliative care services in
a systematic way to individuals, families or communities.
52
3.3 HEALTHCARE SECTOR IN INDIA
Healthcare has become one of India's largest sectors, both in terms of revenue and
employment. Healthcare comprises hospitals, medical devices, clinical trials. outsourcing.
telemedicine. medical tourism, health insurance and medical equipment. The Indian healthcare
sector is growing at a brisk pace due to its strengthening coverage, services and increasing
expenditure by public as well private players
Indian healthcare delivery system is categorized into two major components public and
private. The Government, i.e., public healthcare system, comprises limited secondary and
tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the
form of primary healthcare centers (PHCs) in rural areas. The private sector provides majority
of secondary, tertiary, and quaternary care institutions with major concentration in metros and
tier I and tier Il cities.
India's competitive advantage lies in its large pool of well-trained medicalprofessionals.
India is also cost competitive compared to its peers in Asia and Western countries. The cost of
surgery in India is about one-tenth of that in the US or Western Europe.
Market Size
The healthcare market can increase three-fold to Rs. 8.6 trillion (USS 133.44 billion)
by 2022. In Budget 2021, India's public expenditure on healthcare stood at 1.2% as apercentage
of the GDP.
A growing middle-class, coupled with rising burden of new diseases, are boosting the
demand for health insurance coverage. With increasing demand for affordable and quality
healthcare, penetration of health insurance is poised to expand in the coming years. In FY21,
gross written premiums in the health segment grew at 13.7% YoY to Rs. 58,584.36 crore (USS
8.00 billion) The health segment has a 29.5% share in the total gross written premiums earned
in the country.
53
HEALTHCARE SCENARIO OF KERALA
Kerala has emerged as the best state in the India in terms of healthcare performance.
Kerala's health status is almost on a par with that of developed economies. The state has
succeeded in increasing life expectancy as well as reducing infant and maternal mortalities.
The implementation of land reforms improved the standard of living of the rural poor
The effective implementation of the public distribution of food played an important role in
improving nutritional status. Kerala's publicly funded healthcare system has helped in
providing treatment facilities to people. The high literacy rate, especially among the females,
also played a major role in improving the health scenario. The Kerala Model of Health is often
described as "good health based on social justice and equity".
Despite, better health outcomes on certain indicators, the much-proclaimed Kerala

model of health has been showing a number of disturbing trends. Although mortality is low,
the morbidity (those suffering from chronic/non-communicable diseases) levels in urban and
rural Kerala is high in Kerala compared to other Indian States. Thus the paradox is that on the
one side Kerala stands as the State with all indicators of better health care development in terms
of IMR, MMR, birth rate, death rate etc. On the other it outstrips all other Indian States in terms
of morbidity especially the chronic illness. Kerala may have the best health indicators but
necessarily not have the best public health care institutions. The success of Kerala health
indicators is more due to the investment in the social capital rather than only in the public
healthcare, resulting in a more accountable and integrated primary health care system.
The government of Kerala has taken up the Rashtriya Swasthya Bima Yojana scheme
of Government of India announced by Prime Minister, along with Comprehensive Health
Insurance Scheme for (CHIS) in October 2008. The objective of RSBY/ICHIS is to protect
54
below poverty line (BPL) households from major health shocks that involve hospitalization.
Specifically, BPL families are entitled to more than 700 in-patient procedures with a cost of up
to 30,000 rupees per annum for a nominal registration fee of30 rupees. The Scheme is jointly
implemented by departments of Labour & Rehabilitation, Health & Family Welfare. Rural
Development, and Local Self Govt. The Labour Department is the Nodal dept. for
implementation of CHIS. A separate agency 'Comprehensive Health Insurance Agency of
Kerala' (CHIAK) is created for implementation of the scheme. "United India insurance
Company Limited' is the insurance provider for all 14 districts. 140 government hospitals and
165 private hospitals have been empanelled towards implementing the scheme.
Challenges
Vector borne diseases like dengue striking fiercely every year and taking its toll on
people's health, successive governments in the state have not yet come out of their crisis
management mode to deal with the serious health issue.
The health department is overburdened with the responsibilities of running more than
1250 hospitals in the state& is finding it difficult to effectively manage the public health
challenges. There is a need for creating a separate public health directorate to tackle public
health issues including prevention and control of infectious discases.
CONCLUSION
Kerala is leading state in the India in terms of healthcare performance. Also, Kerala is leading
medical literacy rate compared to other states in India. Even though health indicators of lacking
in healthcare institutions. Hence, there is a lot of scope for Kerala are good, the state including
medical institutions in Kerala.
55
3.4 COMPANY PROFILLE
HOSPITAL DETAILS
HOSPITAL NAME STARCARE HOSPITAL
TYPE OF HOSPITAL MULTI-SPECIALITY HOSPITAL
ADDRESS NH Bypass Junction, Near Thondayad, Kozhikode,
Kerala - 673017, India.
EMAIL info@starcarehospitals.com
WEBSITE https://www.starcarehospitals.com/
DISTRICT KOZHIKODE
STATE KERALA
NATION INDIA
56
Starcare Hospital Kozhikode is a new generation multi-specialty hospital on NH

Bypass Road, Near Thondayad Junction in Calicut, Kerala. The Hospital is promoted by
Starcare UK (Starcare Health Systems Ltd) which was originally established in UK and later
moved to Dubai. Starcare UK also operates multiple Hospitals and Medical centers in the
Sultanate of Oman. The company is promoted by a group of Non-Resident Indians with roots
in Calicut.
We pride ourselves in upholding good values in healthcare, practiced by eminent and

trusted professionals, using leading edge technology.
The Starcare hospital building, designed as per JCIA and NABH standards by a team
of clinicians and engineers from Architectural Studio, Calicut, Starcare UK and Steve Van
Aelst Architects, Belgium is an elegant blend of aesthetics and efficiency creating a soothing
environment that enhances the recovery. Above all, we seek to infuse our world-class spaces
of medical practice with sensitivity and compassion.
We strive
• To offer international quality standards of healthcare services in Kerala.
• To nurture an atmosphere of trust between those in need of care and the care givers.
• To be the most respected healthcare destination in Kerala
Vision
To be the most renowned healthcare destination in Kerala for its advancement in technology
and innovative ways to enhance clinical and customer care delivered at a cost that the
community can afford.
Mission
Deliver easily accessible, cost effective and personalized health care of accreditation standards
57
by courteous and empathetic staff who continuously innovate the best of care processes To
make a positive contribution in the life of your loved ones by a professionally supported and
empowered team using leading edge technology and continuously updated knowledge base in
a soothing environment. Timely, appropriate, ethical, competent and patient centered care
Engineer processes effectively and apply technology where possible to provide affordable
healthcare.
Quality Policy
Starcare is committed to achieve highest level of quality through professionalism, innovation

and ethical practices in every aspect of patient care. Every employee in Starcare will strive to
achieve this by active planning, continuous improvement and team work.
58
CHAPTER 4
DATA ANALYSIS AND INTERPRETATION
59
INTRODUCTION
The chapter tries to attempt to analysis about the waste disposal of Starcare hospital in
Kozhikode district for analysing the data.
4.1 DATA ANALYSIS AND INTERPRETATION
Table 4.1
Table showing cleanliness of hospital
RESPONDENTS PECENTAGE
ITEMS
35 70
Strongly agree
15 30
Agree
0 0
Neutral
0 0
Disagree
0 0
Strongly Disagree
50 100
Total
Source of data : Questionnaire
CLEANLINESS
D
SNtisera rgealyel
Dis ree
Agree
30%
Strongly
agree
70%
Figure: 4.1
It could be observed that 70 percentage of staff are strongly agreed that the hospital daily
ensures cleanliness. 30 percentage of staff agreed.
60
4.2 WASTE COLLECTION
Table 4.2
Table showing collection of waste by hospital
ITEM RESPONDENTS PERCENTAGE

Daily 50 100
Weekly 0 0
Monthly 0 0
Total 100 100
Source of data: Questionnaire
WASTE COLLECTION
M
Woenetkhllyy
0%
Daily
100%
Figure: 4.2
It could be observed that the hospital collects and disposes its wastes daily. 100 percentage
of the respondents agree with tha
61
4.62 DISPOSAL OF GENERAL
Table 4.
Table showing disposal of waste from wards in hospital
Items Respondents Percentage
Strongly agree 45 90
Agree 5 10
Neutral 0 0
Disagree 0 0
Strongly Disagree 0 0
Total 50 100
StronDNgisleyaugDtrieasaelgree
Agree
0%
10%
Strongly agree
90%
Figure: 4.4
From the above diagram It is clear that the hospitalization waste (wards) are properly
disposing, Because 90% were strongly agreed and 10% of staff given agree
62
4.5 DISPOSAL OF WASTES FROM DRESSING ROOM
Table 4.6
Table showing disposal of waste from dressing room
Strongly agree 40 80
Agree 0 0
Neutral 10 20
Disagree 0 0
Total 50 100
WASTE FROM DRESSING ROOM
StronDgislyagDriesaegree
0%
Neutral
20%
Agree
0%
Strongly agree
80%
Figure: 4.6
It could be understood that 80% of respondents said that waste from dressing room is
properly disposed. 20% of respondents gave a neutral opinion.
63
4.7 ENVIRONMENTAL POLICY
Table 4.9
Table showing the result of does the hospital have an environmental policy that
includes recycling and waste prevention procedure
50 100
Agree 0 0
Disagree 0 0
Total 50 100
ENVIRONMENTAL POLICY
D
StA
isrgo
argnergelye
Dis0a% gree
0%
Strongly agree
100%
Figure: 4.9
The data shows that the hospital has an environment policy because 100% of staff are
strongly agreed.
64
4.8 RESPONSIBILTY OF DEPARTMENT IN CASE OF SOLID WASTE
Table 4.10
Table showing responsibility of department in case of solid waste
Items No. of Respondents Percentage
Yes 50 100
No 0 0
Total 50 100
RESPONSIBILITY OF DEPT IN SOLID WASTE

DISPOSAL
No
0%
Yes
100%
Figure 4.10
It could be observed that there is a separate department for waste disposal. 100% are said
that there is a separate department in the hospital for disposing wastes.
65
4.9 SEGREGATION OF SOLID WASTE
Table 4.11
Table showing is there any segregation of solid waste in hospitals
Items No. of Respondents Percentage
50 100
No 0 0
Total 50 100
SEGREGATION SOLID WASTE
No
0%
Yes
100%
Figure 4.11
It is clear that segregation of solid waste is there in the hospital 100% of staff said this
opinion
66
4.10 PLACE OF SEGREGATION
Table 4.12
Table showing place of segregation of wastes from operatory room and laboratory
Operating room 48 96
Laboratory 2 4
Total 50 100
PLACE OF SEGREGATION
Laboratory
4%
Operating room
96%
Figure: 4.12
From the table 4.12 results data 96% of staff said that segregation of solid waste taken
place in the operation room and other 4 percentage said that the waste arising from
laboratory are segregate through another place.
67
4.11 PRIMARY STORAGE OF WASTES
Table 4.13
Table showing the primary storage of wastes
45 90
Container without plastics 5 10
Total 50 100
PRIMARY STORAGE OF WASTE
Container without
plastics
10%
Container with
plastics
90%
Figure: 4.13
The study shows that the container with plastics is used for primary storage of waste.
Because 90 % agreed that and other were disagreed
68
4.12 STORAGE OF SOLID WASTES
Table 4.14
Table showing the storage of solid wastes
In a closed environment 40 80
Open to the air 5 10
Open to the air with brick outskirt 5 10
Total 50 100
STORAGE OF SOLID WASTE
Open to the air with

brick outskirt
10%
Open to the air
10%
In a closed
environment
80%
It could be observed that 80% of staff said that storage of solid wastes is in a closed
environment 10% said that it is open to the air. And 10% said that wastes are stored open
to the air with brick out skit.
69
4.13 DISPOSAL OF WASTE WATER
Table 4.15
Table showing the disposal of waste water
Municipal sewer 45 90
Soakage pit 3 6
Open drain 2 4
Total 50 100
DISPOSAL OF WASTE WATER
Open drain
Soakage pit 4%
6%
Water treatment
plant
90%
Figure: 4.15
It is clear that the hospital disposes its water through water treatment plant. And only
6% said that disposal of waste water is through soakage pit and 4% said that open drain
is used for this.
70
4.14 TYPES OF WATER SUPPLY SOURCES
Table 4.16
Table showing different sources of wa ter supply
Direct pumping form ground 20 40
Municipality water 30 60
Total 50 100
WATER SOURCE
Direct pumping form

ground
40%
Municipality water
60%
Figure: 4.16
The water supply source is both direct pumping from ground and municipality water. 60%
said that they use municipality water and 40 said that it is Direct pumping form ground.
71
4.15 WATER TESTING
Table 4.17
Table showing the time span of water testing
Quarterly 40 80
Half yearly 10 20
yearly 0 0
Total 50 100
WATER TESTING
Half yearly
20%
Quarterly
80%
Figure 4.17
It could be understood that the water is tested on quarterly basis. Because majority (80%)
of staff agreed. 20% of staff said that the water is tested on half yearly basic .
72
4.16 SATISFACTION REGARD TO DISPOSAL OF TRANSPORTATION

OF SOLID WASTES
Table 4.24
Table showing the satisfaction regards to disposal of transportation of solid wastes
Corporation 20 60
Containers 15 30
Hospital employees 15 30
Total 50 100
Hospital employees
30%Neutral
Corporation
5%
40%
Highly satisfied
Satisfied Containers 50%
45% 30%
Figure: 4.24
From the above diagram it is clear that Corporation are responsible for final waste
disposal (60%). 30% of people said that Hospital employees is responsible and other
16% said that they use containers.
73
4.17 SATISFACTION REGARD TO DISPOSAL OF RECYCLING OF

WASTE WATER
Table 4.25
Table showing the satisfaction regards to disposal of recycling of waste water
Yes 40 80
No 10 20
Total 50 100
No
20%
Yes
80%
Figure: 4.25
The above diagram shows that 80% of people thought about recycling of water and other
20% were not.
74
4.18 MANUAL OR GUIDELINE DOCUMENT ON WASTE MANAGEMENT

Table 4.26
Table showing the details about manual or guideline document on waste management
In the ministry of health 20 40
In your hospital 30 60
Total 50 100
In the ministry of
health
40%
In your hospital
60%
Figure 4.26
The above diagram shows that 40% of people know about the manual or guideline document
on waste management in the ministry of health and 60% of the people know about the manual or
guideline document on waste management in their hospital
75
CHAPTER – 5
FINDINGS, SUGGESTIONS, CONCLUSION
76
FINDINGS
• 70% of staff are strongly agreed that the hospital daily ensures cleanliness
• 100% of staffs are strongly agreed that the hospital collects and disposes its
wastes daily.
• 80% of staffs strongly agreed that the general waste are properly disposed
• 90% strongly agreed that hospitalization waste are properly disposed
• 80% strongly agreed that waste from outpatient emergency rooms is properly
disposed.
• 70% strongly agreed that laboratory wastes are properly disposed
• 100% of respondents strongly agreed that the hospitals has a clear
environment policy to follow
• There is a separate department for waste disposal and management.
• Corporation are responsible for the waste management
• 100% respondents said that segregation of solid wastes are there
• Laboratory and operating room are the places used in segregation of waste.
• Container with plastics is used for covering wastes.
• 80% of respondents said that wastes are stored in a closed environment.
• 80% of respondents strongly agree that water tested on quarterly.
• As compared to other departments Infection control department which is
responsible for the management of biomedical waste is working effectively and
efficiently
CONCLUSION
From the study it could be observed that Starcare hospital provides clean and safe
environment to the public. The Infection control department which is responsible for the
proper and effective management of biomedical as well as hospital waste is one of the
effective and efficient department in that hospital. the complete all their stipulated work
77
under the circumstances of lack of availability of adequate number of staff and complete all
their work with the available manpower.
In the case of biomedical waste management and other hospital waste management
they try to utilise available resources with the maximum efficiency.
Proper segregation and classification of hospital waste are done without having huge
error and daily inspection is also carried by the infection controller and she evaluate the
condition, and if any problems or anything noticed it will be rectified within no time
With the help of IMAGE and other private parties the hospital collects and disposes
all of its hospital wastes including biomedical wastes effectively
With the help of the study, it is come to know that hospital waste management is one
of the complicated one and if any kind of error occurs it may cause huge aftereffects. How
effectively starcare hospital and infection control department solve this problem with
minimum amount of error and it should be appreciated.
RECOMMENDATION
• A new oncology department has been started in the hospital so that employees who
are dealing with biomedical Waste from oncology departments (like cytotoxic drugs
etc.) should give proper advices and guidance
• As per my knowledge the availability of man power in each and every department is
comparatively less .in a department that is responsible for biomedical Waste
Management should have adequate number of manpower
• Purchase of new product and use of one-time usable product may cause huge cost of
operation so that the use of reusable products should be promoted
• In the case of waste management one of the best methods of waste management is
that recycling. In the case of Hospitals there are lot of products that can be recycled
so it should be promoted
78
BIBILIOGRAPHY AND ANNEXURE
79
BIBLOGRAPHY
BOOKS
Mukesh Yadav (2011), Hospital Waste – A major problem, Hospitals Today, Vol. 8 No. 4
S.Gupta, R.Boojh, A.Mishra, and H. Chandra. Rules and management of biomedical waste at
Vivekananda Polyclinic: A case study. Waste Management. 2016, 29: 812–819.
Akter N. (2011). Medical waste management: a review, International Journal of science and
pharmaceutical educational research.1 (1);53-61
Mandal S. K. and Dutta J. , Integrated Bio-Medical Waste Management Plan for Patna City,
Institute of Town Planners, India Journal 6-2: 01-25 (2015).
Dinesh, K.S.Geetha, V. Vaishnavi, R. D. Kale and V. Krishna Murthy. Ecofriendly Treatment
of Biomedical Wastes Using Epigeic Earthworms. Journal of ISHWM. 2017, 9(1): 5-20.
Shalini Sharma and S.V.S.Chauhan, Assessment of bio-medical waste management in three
apex Government hospitals of Agra, Journal of Environmental Biology, 29(2), p. p 159-162
(2008)
Singh V. P., Biswas G., and Sharma, J. J., Biomedical Waste Management – An Emerging
Concern in Indian Hospitals Indian, Journal of Forensic Medicine & Toxicology, Vol. 1, No.
1. (2014-12).
Kothari CR, “Research Methodology”, New age international publishers, New Delhi,
Second Edition,2016
80
WEBSITES
➢ http://timesofindia.indiatimes.com/city/trichy/Hospitals-lag-behind-
inbiomedical-waste-management/articleshow/38442863.cms
➢ https://noharm-global.org/issues/global/waste-treatment-and-disposal
➢ www.wastemanagemanet hospital.com
➢ https://www.starcarehospitals.com/
➢ https://cpcb.nic.in
81
ANNEXURE
QUESTIONNAIRE
A study on biomedical waste management and viable model for safe disposal with respect to
Starcare hospital Calicut.
1. Does the hospital daily ensure cleanliness?
Strongly agree Agree neutral disagree
Strongly disagree
2. When does the hospital collect and disposes its wastes?
Daily Weekly Monthly
3. Hospital disposes the following wastes properly
Strongly neutral Strongly

items Agree disagree
agree disagree
General waste (office, dining room, garden)
Hospitalization waste (Wards)
Waste from outpatient room and emergency
Waste from dressing room
Laboratory waste
Warehouse
82
4. Does the hospital have an environment policy that includes recycling and waste prevention
procedure?
Yes No
5. Is there a department responsible for the solid waste management in the hospital?
Yes No
6. Is there any segregation of solid waste?
Yes No
7. Is there any segregation of chemical liquid waste?
Yes No
8. If yes from where is the segregation is taking place?
Operating room Laboratory
9. Primary storage of wastes
a) Container with plastic bags
b) Container without plastic bags
10.Storage of solid wastes
In a closed environment open to the air
open to the air with brick outskirt
11. Final disposal of waste water
Municipal sewer Soakage pit open drain
83
12. Type of water supply source.
Direct plumbing from ground corporation water
13. Water testing
Quarterly Half yearly Yearly
14. Rate your satisfaction with regard to the waste management of the following
15. Transportation of solid wastes for final disposition?
Corporation Containers Hospital employees
16. Is there any manual or guideline document on management of hospital wastes available
a) In the ministry of health
b) In your hospital
84
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“A STUDY ON BIOMEDICAL WASTE MANAGEMENT

AT STARCARE HOSPITAL, CALICUT”

Project submitted in partial fulfilment of the

MASTER OF BUSINESS ADMINISTRATION

KOSHYS INSTITUTE OF MANAGEMENT STUDIES

BENGALURU NORTH UNIVERSITY

Dr SUDARKODI P Dr PRAKASH B NAYAK

(Head of the Department) (Director)

I, ARJUN P P, Third Semester MBA Student of KOSHYS INSTITUTE OF MANAGEMENT

PLACE: BANGALORE ARJUN P P

Thanking You All

SL.NO CHAPTERS PAGE

2 REVIEW OF LITERATURE AND RESEARCH DESIGN

4 DATA ANALYSIS AND INTERPRETATION

5 FINDINGS, SUGGESTIONS AND CONCLUSION

2.2 SEGREGATION AND COLLECTION OF BIOMEDICAL 43

3.4 HOSPITAL DETAILS 56

4.1 CLEANLINESS OF HOSPITAL 60

4.2 COLLECTION OF WASTE BY HOSPITAL 61

4.4 DISPOSAL OF WASTE FROM WARDS IN HOSPITAL 62

4.9 DOES THE HOSPITAL HAVE AN ENVIRONMENT POLICY 64

RESPONSIBILITY OF DEPARTMENT IN CASE OF SOLID 65

4.11 SEGREGATION OF SOLID WASTE 66

4.12 PLACE OF SEGREGATION OF WASTE FROM 67

4.13 PRIMARY STORAGE OF WASTES 68

4.14 STORAGE OF SOLID WASTE 69

4.15 DISPOSAL OF WASTE WATER 70

4.17 THE TIME SPAN OF WATER TESTING 72

4.24 THE SATISFACTION REGARDS TO DISPOSAL OF 73

4.25 THE SATISFACTION REGARDS TO DISPOSAL OF 74

4.26 THE DETAILS ABOUT MANUAL OR GUIDELINE 75

The proper management of biomedical waste has become a worldwide humanitarian

The indiscriminate disposal of sharps within and outside institutions leading to

Hospital waste is generated during the diagnosis, treatment, or immunization of human

Undestroyed needles and syringes being circulated back to Recycling, through

Disposal of hospital waste and veterinary hospital waste in municipal dumpsite

The indiscriminate dumping of untreated hospital waste in municipal bins increasing

Besides, a lot of research and development need to be in the field of developing

1.1 SIGNIFICANCE OF THE STUDY

REVIEW OF LITREATURE AND RESEARCH DESIGN

2.1 REVIEW OF LITERATURE

generated during research activities or in the production or testing of biological material.

treatment or immunization of human beings or animals, in research pertaining thereto, or in the

like establishments.” (Mukesh Yadav, 2011).

“Any waste that is generated in the diagnosis, treatment or immunization of human

beings or animals, in research pertaining thereto, or in the production or testing of biologicals.”

(Singh et al, 2014)

and biotechnology waste (cultures, stocks, specimens of microorganism, live or attenuated

metal, plastic disposables and other such wastes (Akter, 2011).

2.2 STATEMENTS OF THE PROBLEM

management at Starcare hospital Calicut”

discusses the results of a study on management of wastes in Starcare hospital Calicut

2.3 SCOPE OF THE STUDY

study encompasses biomedical waste management in Starcare hospital, techniques used in

to Starcare Hospital in Calicut

2.4 OBJECTIVES OF THE STUDY

• To examine the types and methods of hospital waste management

• To identify whether is there is any relationship between collection and disposal

period and overall satisfaction of waste disposal

• To identify whether there is any relationship environment policy of hospital and

pollution free environment to the public

2.5 RESEARCH METHODOLOGY