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How to Dispose of Medical Waste

Biomedical waste disposal is not just an issue that hospitals and medical facilities face each day. Many homes also have to dispose of medical waste including bandages, wound cleaning solutions and even sharp items like needles and syringes. Use this guide to dispose of medical waste properly.

Disposal of Medical Waste Common to The Home

There are several types of medical waste that are disposed of in separate containers or via different disposal methods. Sharps are medical waste items that include needles, broken glass, ampules, guide wires and staples. These used items should be placed in a red sharps container. Biohazard waste includes IV tubing, infectious waste, blood products and contaminated personal protective equipment. These items are to be placed in a red bag within a red container. Trace Chemo waste includes chemical containment items like empty IVs, gowns, gloves and tubing. These items are placed in a yellow container.

Disposal of Medical Waste Common in Medical Facilities

Resource Conservation and Recovery Act (RCRA)-associated hazards are medical waste items that include hazardous bulk medications, half or partial doses of medications, pathological waste for incineration or simple hazardous medications. These are to be placed in a black container. Pharmaceutical waste is placed in a blue container. This includes antibiotics, pills and injectables. Radioactive medical waste is placed in a shielded container with a radioactive symbol clearly marked. This waste includes Iodine-131, Strontium-89 and Cobalt-60 among other items. Each medical waste product must be contained in its proper disposal unit prior to actual disposal.

Medical Waste Disposal Without Incineration

The collection of medical waste in specific containers is just the start of the process of American waste disposal. Some of the medical items are first decontaminated or treated with chemicals or radiation prior to disposal in a landfill. Items that have been contaminated by human bodily fluids are processed with chemicals, radiation or a thermal heat process that kills bacteria that is dangerous to the environment and other people. Disposal of biohazard waste always includes this step prior to exiting the waste facility to a landfill.

Incineration for Biomedical Waste Disposal

Many items that are not treated chemically or with heat to kill bacteria are incinerated completely to destroy the waste items. Controlled air, a rotary kiln or the multiple hearth type of incinerator is used according to the disposal of waste regulations provided by the Occupational Safety and Health Administration (OSHA) compliance regulations and the United States Environmental Protection Agency (EPA). Items treated with incineration are released as ash, gases or water vapor.

Get Help With Your Medical Waste Disposal Issues

When you’re faced with the task of hazardous waste disposal, you may get help following waste disposal regulations by contacting local waste management facilities. For example, Waste Management online offers residential and business solutions for your waste disposal needs. Med Waste Services is another option for hazardous waste disposal with mail-back programs for small amounts of medical waste or compliance services for businesses.

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biomedical waste management research papers

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Biomedical Waste Management and Its Importance: A Systematic Review

Himani s bansod.

1 Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND

Prasad Deshmukh

2 Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND

The waste generated in various hospitals and healthcare facilities, including the waste of industries, can be grouped under biomedical waste (BMW). The constituents of this type of waste are various infectious and hazardous materials. This waste is then identified, segregated, and treated scientifically. There is an inevitable need for healthcare professionals to have adequate knowledge and a proper attitude towards BMW and its management. BMW generated can either be solid or liquid waste comprising infectious or potentially infectious materials, such as medical, research, or laboratory waste. There is a high possibility that inappropriate management of BMW can cause infections to healthcare workers, the patients visiting the facilities, and the surrounding environment and community. BMW can also be classified into general, pathological, radioactive, chemical, infectious, sharps, pharmaceuticals, or pressurized wastes. India has well-established rules for the proper handling and management of BMW. Biomedical Waste Management Rules, 2016 (BMWM Rules, 2016) specify that every healthcare facility shall take all necessary steps to ensure that BMW is handled without any adverse effect on human and environmental health. This document contains six schedules, including the category of BMW, the color coding and type of containers, and labels for BMW containers or bags, which should be non-washable and visible. A label for the transportation of BMW containers, the standard for treatment and disposal, and the schedule for waste treatment facilities such as incinerators and autoclaves are included in the schedule. The new rules established in India are meant to improve the segregation, transportation, disposal methods, and treatment of BMW. This proper management is intended to decrease environmental pollution because, if not managed properly, BMW can cause air, water, and land pollution. Collective teamwork with committed government support in finance and infrastructure development is a very important requirement for the effective disposal of BMW. Devoted healthcare workers and facilities are also significant. Further, the proper and continuous monitoring of BMW is a vital necessity. Therefore, developing environmentally friendly methods and the right plan and protocols for the disposal of BMW is very important to achieve a goal of a green and clean environment. The aim of this review article is to provide systematic evidence-based information along with a comprehensive study of BMW in an organized manner.

Introduction and background

The amount of daily biomedical waste (BMW) produced in India is enormous [ 1 ]. People from all segments of society, regardless of age, sex, ethnicity, or religion, visit hospitals, which results in the production of BMW, which is becoming increasingly copious and heterogeneous [ 2 ]. BMW produced in India is about 1.5-2 kg/bed/day [ 3 ]. BMW include anatomical waste, sharps, laboratory waste, and others and, if not carefully segregated, can be fatal. Additionally, inappropriate segregation of dirty plastic, a cytotoxic and recyclable material, might harm our ecosystem [ 4 ]. Earlier, BMW was not considered a threat to humans and the environment. In the 1980s and 1990s, fears about contact with infectious microorganisms such as human immunodeficiency virus (HIV) and hepatitis B virus (HBV) prompted people to consider the potential risks of BMW [ 5 ]. BMW is hazardous in nature as it consists of potential viruses or other disease-causing microbial particles; it may be present in human samples, blood bags, needles, cotton swabs, dressing material, beddings, and others. Therefore, the mismanagement of BMW is a community health problem. The general public must also take specific actions to mitigate the rising environmental degradation brought on by negligent BMW management. On July 20, 1998, BMW (Management and Handling) Rules were framed. On March 28, 2016, under the Environment (Protection) Act, 1986, the Ministry of Environment and Forest (MoEF) implemented the new BMW Rules (2016) and replaced the earlier one (1988). BMW produced goes through a new protocol or approach that helps in its appropriate management in terms of its characterization, quantification, segregation, storage, transport, and treatment.

According to Chapter 2 of the Medical Waste Management and Processing Rules, 2016, “The BMW could not be mixed with other wastes at any stage while producing inside hospitals, while collecting from hospitals, while transporting, and should be processed separately based on classification.” The COVID-19 pandemic has now transformed healthy societies worldwide into diseased ones, resulting in a very high number of deaths. It also created one significant problem: improper handling of the medical waste produced in the testing and treatment of the disease [ 6 ]. In India, BMW generated due to COVID-19 contributed to about 126 tonnes per day out of the 710 tonnes of waste produced daily [ 7 ]. 

The basic principle of the management of BMW is Reduce, Reuse, and Recycle-the 3Rs. Out of the total amount of BMW generated, 85% is general (non-hazardous) waste, and the remaining 15% is hazardous. As BMW contains sharps and syringes, the pathogens can enter the human body through cuts, abrasions, puncture wounds, and other ways. There might also be chances of ingestion and inhalation of BMW, which can lead to infections. Some examples of infections are Salmonella, Shigella, Mycobacterium tuberculosis, Streptococcus pneumonia, acquired immunodeficiency syndrome (AIDS), hepatitis A, B, and C, and helminthic infections [ 8 ]. This systematic review is conducted to obtain essential, up-to-date information on BMW for the practical application of its management. The highlight of the management of BMW is that the “success of BMW management depends on segregation at the point of generation” [ 9 ].

The findings have been reported following the principles and criteria of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). The systematic review has been conducted according to these standards and principles.

Search Sources/Search Strategy

We used the MeSH strategy to obtain articles from PubMed and ResearchGate employing the following terms: (“Biomedical/waste” [Majr] OR “Biomedical Waste/source” [Majr] OR “Biomedical Waste/hazards” [Majr] OR “Biomedical Waste/segregation” [Majr] OR “Biomedical Waste/rules” [Majr] OR “Biomedical Waste/laws” [Majr] OR “Biomedical Waste/environment” [Majr]). Specifically, for management-related studies, the search terms (“Management/steps” [Majr] OR “Management/handling” [Majr] OR “Management/coding” [Majr] OR “Color coding/segregation” [Majr] OR “Treatment/method” [Majr] OR “Autoclaving/waste” [Majr] OR “Incineration/waste” [Majr]) were used. We obtained the most pertinent research papers and used them in different arrangements using the Boolean operators “AND” and “OR.”

Inclusion and exclusion criteria

We focused on papers written in the English language, published within the last decade, relevant to the central questions of this review article, and that are systematic reviews such as randomized clinical trials and observational studies. We, however, excluded papers published in languages other than English, irrelevant to the questions, and related to topics other than BMW.

Search outcomes

After the initial screening, we narrowed the search results down to 264 papers. A total of 42 duplicate papers were removed. Subsequently, publications were refined by the title/abstract, and we eliminated a few studies due to the lack of full text and/or related articles. Finally, after assessing 27 items for eligibility, we included 11 papers in our review. Figure ​ Figure1 1 is the flow chart for article selection formulated on PRISMA.

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PRISMA: Preferred Reporting Items for Systematic Review and Meta-analysis, PMC: PubMed Central

Need for BMW management in hospitals

BMW threatens the health of medical staff, hospital-visiting patients, and people in the nearby community. Improper disposal leads to severe hospital-acquired diseases along with an increased risk of air and water pollution. Due to open-space waste disposal practices, animals and scavengers might get infected, leading to the scattering of waste and the spreading of infections. In countering such activities, four major principle functions of BMW management are applicable: the placement of bins at the source of generation of BMW, segregation of BMW, removal or mutilation of the recyclable waste, and disinfection of the waste [ 10 ]. BMW management methods aim predominantly to avoid the generation of waste and, if generated, then recover as much as possible [ 11 ].

BMW management rules in India

On March 28, 2016, under the Environment (Protection) Act, 1986, the MoEF notified the new BMW Rules, 2016 and replaced the earlier Rules (1988). BMW produced goes through a new protocol or approach which helps in the appropriate management of waste, i.e., its characterization, quantification, segregation, storage, transport, and treatment, all of which aim to decrease environmental pollution [ 12 ]. Problems with the improper management of BMW also shed light on the scavengers who, for recycling, segregate the potentially hazardous BMW without using gloves or masks. Strict rules have been implemented to ensure that there is no stealing of recyclable materials or spillage by some humans or animals and that it is transported to the common BMW treatment facility [ 10 ]. The first solution to stop the spread of hazardous and toxic waste was incineration. Incineration is required in all hospitals and healthcare facilities that produce BMW. However, due to the absence of services that provide certified incinerators in a few countries, BMW has to be sent to landfills, which leads to land contamination and harms the environment [ 13 ]. Incinerators used for disposal might also lead to environmental pollution. Numerous toxins are formed during incineration, which are the products of incomplete combustion. Thus, some new standards have been issued to resolve this problem and safeguard the environment and public health [ 14 ].

Steps in the management of BMW

BMW management needs to be organized, as even a single mistake can cause harm to the people in charge. There are six steps in the management of BMW [ 15 ]: surveying the waste produced; segregating, collecting, and categorizing the waste; storing, transporting, and treating the waste. Segregation is the separation of different types of waste generated, which helps reduce the risks resulting from the improper management of BMW. When the waste is simply disposed of, there is an increased risk of the mixture of waste such as sharps with general waste. These sharps can be infectious to the handler of the waste. Further, if not segregated properly, there is a huge chance of syringes and needles disposed of in the hospitals being reused. Segregation prevents this and helps in achieving the goal of recycling the plastic and metal waste generated [ 16 ]. According to Schedule 2, waste must be segregated into containers at the source of its generation, and according to Schedule 3, the container used must be labeled. The schedules of BMW (Management and Handling) Rules, 1998, which were initially ten in number, have now been reduced to four [ 17 ]. The collection of BMW involves the use of different colors of bins for waste disposal. The color is an important indicator for the segregation and identification of different categories of waste into suitable-colored containers. They must be labeled properly based on the place they have been generated, such as hospital wards, rooms, and operation theatres. It is also very important to remember that the waste must be stored for less than 8-10 hours in hospitals with around 250 beds and 24 hours in nursing homes. The storage bag or area must be marked with a sign [ 16 ]. 

Figure ​ Figure1 1 shows the biohazard signs that symbolize the nature of waste to the general public.

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Biohazards are substances that threaten all living things on earth. The biohazard symbol presented in Figure ​ Figure1 1 was remarked as an important public sign, signaling the harms and hazards of entering the specified zone or room [ 18 ]. Along with the biohazard sign, the room door must have a label saying “AUTHORISED PERSONNEL ONLY.” The temporary storage room must always be locked and away from the general public's reach. The waste is then collected by the vehicles daily. A ramp must be present for easy transportation. The waste collected is then taken for treatment. The loading of wastes should not be done manually. It is very vital to properly close or tie the bag or the container to avoid any spillage and harm to the handlers, the public, and the environment. The transport vehicle or trolley must be properly covered, and the route used must be the one with less traffic flow [ 19 ].

BMW handling staff should be provided with personal protective equipment (PPE), gloves, masks, and boots. BMW retrievers must be provided with rubber gloves that should be bright yellow. After usage, the importance of disinfecting or washing the gloves twice should be highlighted. The staff working in or near the incinerator chamber must be provided with a non-inflammable kit. This kit consists of a gas mask that should cover the nose and mouth of the staff member. The boots should cover the leg up to the ankle to protect from splashes and must be anti-skid [ 16 ]. According to the revised BMW management rules, 2016, it is mandatory to provide proper training to healthcare facility staff members on handling BMW. The training should be mandatorily conducted annually. Along with the management step of the color coding for segregation, it is also important for the staff to be trained in record keeping. This practice of record-keeping helps track the total amount of waste generated and the problems that occurred during the management process, thus helping improve segregation, treatment, and disposal [ 20 ].

Color coding for segregation of BMW

Color coding is the first step of BMW management. Different wastes are classified into different types, and therefore, they must be handled and disposed of according to their classification. The bins used for waste disposal in all healthcare facilities worldwide are always color-coded. Based on the rule of universality, bins are assigned a specific color, according to which the waste is segregated. This step helps avoid the chaos that occurs when all types of waste are jumbled, which can lead to improper handling and disposal and further result in the contraction of several diseases [ 21 ]. The different kinds of categories of waste include sharp waste such as scalpels, blades, needles, and objects that can cause a puncture wound, anatomical waste, recyclable contaminated waste, chemicals, laboratory waste such as specimens, blood bags, vaccines, and medicines that are discarded. All the above-mentioned wastes are segregated in different colored bins and sent for treatment [ 22 ]. Yellow bins collect anatomical waste, infectious waste, chemical waste, laboratory waste, and pharmaceutical waste, covering almost all types of BMW. Different bins and various types of sterilization methods are used depending on how hazardous the waste is. The best tools for sterilization are autoclaves. Red bins collect recyclable contaminated wastes, and non-chlorinated plastic bags are used for BMW collection. Blue containers collect hospital glassware waste such as vials and ampoules. White bins are translucent where discarded and contaminated sharps are disposed of. Sharp wastes must always be disposed of in puncture-proof containers to avoid accidents leading to handlers contracting diseases [ 23 , 24 ]. 

Figure ​ Figure3 3 illustrates the different colored bins used for the segregation of BMW.

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BMW management refers to completely removing all the hazardous and infectious waste generated from hospital settings. The importance of waste treatment is to remove all the pathogenic organisms by decontaminating the waste generated. This helps in the prevention of many severe health-related issues that can be caused because of the infective waste. It is a method used to prevent all environmental hazards [ 25 ].

Methods for the treatment of BMW

There are many methods that are used for the treatment of BMW. One of the most economical ways of waste treatment is incineration, which is just not some simple “burning” but the burning of waste at very high temperatures ranging from 1800℉ to 2000℉ to decrease the total mass of decontaminated waste by converting it into ash and gases, which is then further disposed of in landfills [ 25 , 26 ]. Important instructions associated with the use of incinerators are as follows: chlorinated plastic bags must not be put inside the incinerators as they can produce dioxin [ 26 ]. Metals should not be destroyed in an incinerator. The metals present in BMW are made of polyvinyl chloride. When these metals are burned, they produce a huge amount of dioxin. Dioxins are very toxic chlorinated chemical compounds, as dioxins, when released into the environment, can lead to environmental pollution and a higher incidence of cancer and respiratory manifestations [ 14 ].

Autoclaving is an alternate method of incineration. The mechanism of this process involved sterilization using steam and moisture. Operating temperatures and time of autoclaving is 121℃ for 20-30 minutes. The steam destroys pathogenic agents present in the waste and also sterilizes the equipment used in the healthcare facility [ 25 ]. Autoclaving has no health impacts and is very cost-friendly. It is recommended for the treatment of disposables and sharps, but the anatomical, radioactive, and chemical wastes must not be treated in an autoclave [ 27 ]. Chemical methods are the commonest methods that include chemicals such as chlorine, hydrogen peroxide, and Fenton’s reagent. They are used to kill the microorganisms present in the waste and are mainly used for liquid waste, such as blood, urine, and stool. They can also be used to treat solid waste and disinfect the equipment used in hospital settings and surfaces such as floors and walls [ 28 ]. Thermal inactivation is a method that uses high temperatures to kill the microorganisms present in the waste and reduce the waste generated in larger volumes. The temperature differs according to the type of pathogen present in the waste. After the treatment is done, the contents are then discarded into sewers [ 29 ].

Very serious environmental and health hazards can be triggered if hospital waste is mixed with normal garbage, which can lead to poor health and incurable diseases such as AIDS [ 30 ]. The needle sticks can be highly infectious if discarded inappropriately. Injury by these contaminated needles can lead to a high risk of active infection of HBV or HIV [ 31 ]. The groups at increased risk of getting infected accidentally are the medical waste handlers and scavengers. Sharps must properly be disposed of in a translucent thin-walled white bin. If sharps are discarded in a thin plastic bag, there is a high chance that the sharps might puncture the bag and injure the waste handler [ 32 ]. It can also be the main cause of severe air, water, and land pollution. Air pollutants in BMW can remain in the air as spores. These are known as biological air pollutants. Chemical air pollutants are released because of incinerators and open burning. Another type of threat is water pollutants. BMW containing heavy metals when disposed of in water bodies results in severe water contamination. The landfills where the disposal takes place must be constructed properly, or the waste inside might contaminate the nearby water bodies, thus contaminating the drinking water. Land pollution is caused due to open dumping [ 33 ]. BMW must also be kept away from the reach of rodents such as black rats and house mice, which can spread the pathogens to the people living nearby [ 34 ].

Many promising steps were taken to minimize the volume of waste discarded from the source, its treatment, and disposal. The 3R system encourages the waste generators to reuse, reduce, and recycle. Everyone must be aware of the 3Rs because this approach can help achieve a better and cleaner environment [ 35 ]. Unfortunately, most economically developing countries cannot correctly manage BMW. Very few staff members of healthcare facilities are educated about proper waste management. The waste handlers are also poorly educated about the hazards of waste [ 36 ]. Every member helping in the waste management process must be made aware of the dangers of BMW to avoid accidents that harm the environment and living beings [ 37 ].

Conclusions

BMW is generated by healthcare facilities and can be hazardous and infectious. Improper handling can lead to health hazards. Collection, segregation, transportation, treatment, and disposal of BMW are important steps in its management. The color coding of bins, the use of technologies such as incineration and autoclaving, and attention to environmental impacts are also highly crucial. BMW management aims to reduce waste volume and ensure proper disposal. All those involved should strive to make the environment safer.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

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Biomedical Waste Management: A Study on Assessment of Knowledge, Attitude and Practices Among Health Care Professionals in a Tertiary Care Teaching Hospital

Divya Rao 1 , M. R. Dhakshaini 2 , Ameet Kurthukoti 3 and Vidya G. Doddawad 4

1 Department of Health System Management Studies, JSS University, Mysuru.

2 Department of Prosthodontics, Vice Principal, JSS Dental College, JSS University, Mysuru.

3 Dental Health Officer, Department of Health and Family Welfare, Government of Karnataka.

4 Department of Oral Pathology and Microbiology, JSS Dental College, JSS University, Mysuru.

Corresponding Author E-mail:  [email protected]

DOI : https://dx.doi.org/10.13005/bpj/1543

Biomedical waste (BMW) generated in our nation on a day to day basis is immense and contains infectious and hazardous materials.  It is crucial on the part of the employees to know the hazards of the biomedical waste in the work environment and make its disposition effective and in a scientific manner. It is critical that the different professionals engaged in the healthcare sector have adequate Knowledge, Attitudes and Practices (KAP) with respect to biomedical waste management. Many studies across the country have shown that there are still deficiencies in the KAP of the employees in the organizations and hence it is necessary to make the appraisal of the same. To ascertain the levels of and the expanse of gaps in knowledge, attitudes and practices among doctors, post graduates, staff nurses, laboratory technicians and house-keeping staffs in a tertiary care teaching hospital in Mysuru, Karnataka. A cross sectional study was carried out using questionnaire as the study tool among the health care professionals in a tertiary care teaching hospital. The study demonstrated gaps in the knowledge amongst all the cadres of the study respondents. The knowledge in relation to BMW Management including the hospital BMW protocols was more desirable among doctors, but practical facets were better in nurses and the lab technicians. Knowledge, Attitude and Practice amongst the different cadres of staff members were found to be significant statistically.

Attitude; Biomedical Waste; Healthcare personnel;   Knowledge; Practice

biomedical waste management research papers

Introduction

Health care waste is a unique category of waste by the quality of its composition, source of generation, its hazardous nature and the need for appropriate protection during handling, treatment and disposal. Mismanagement of the waste affects not only the generators, operators but also the common people too. 1

‘Bio-medical waste’ (BMW) means any solid and/or liquid waste including its container and any intermediate product, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research pertaining thereto or in the production or testing thereof. 2

Due to the increase in the procedures that are carried out at the various health care setups, excessive amounts of waste have been generated at the centers of care.

India approximately  generates 2 kg/bed/ day 3 and this biomedical waste encompasses wastes like anatomical waste, cytotoxic wastes, sharps, which when inadequately segregated could cause different kinds of deadly infectious  diseases like Human immunodeficiency virus(HIV) hepatitis C and B infections, etc, 4   and also cause disruptions in the environment, and adverse impact on ecological balance. 5,6

Adequate knowledge amongst the health care employees about the biomedical waste management rules and regulations, and their understanding of segregation, will help in the competent disposal of the waste in their respective organizations. 7

Acceptable management of biomedical waste management begins from the initial stage of generation of waste, segregation at the source, storage at the site, disinfection, and transfer to the terminal disposal site plays a critical role in the disposal of waste. Hence adequate knowledge, attitudes and practices of the staff of the health care institutes play a very important role. 8,4,9

Teaching institutes play a critical role in the health care setup as it is from these places that the future health care professionals and all those persons involved in the care giving to the community are trained. 10

Studies documented from different parts of the country; still convey that there are gaps in the Knowledge, lacunae in the attitudinal component and inconsistency in the practice aspects which are matters of concern among the health care professionals. 8,11-15  With this background, the study was carried out to assess the current knowledge, attitude and practices of the health care workers like doctors, post graduates, interns, staff nurses, laboratory technicians and house-keeping staff in a tertiary care teaching hospital with regard to the management of BMW.

To assess the levels of knowledge, attitudes and practices among doctors, post graduates, interns, staff nurses, laboratory technicians and house-keeping staff in the different departments of a tertiary care teaching hospital.

To assess the gaps in knowledge, attitudes and practices among these health care workers in the different departments of a tertiary care teaching hospital.

Methodology

Study design

Cross-sectional study.

Study setting

Tertiary care teaching hospital

Study population

Staff working in the different departments of the hospital.

Eligibility Criteria

All consenting individuals amongst the different cadres of staff were included into the study. There were 2056 eligible participants, which was taken as the sampling frame.

Sample Size

Expecting that 50% of the study population had precise knowledge (considering the outcome variable) about the rules and legislation of biomedical waste management, 16  with an allowable error of 10%, at 95% confidence interval, and accounting for the finite population correction for 2,056 participants, a minimum sample size of 472 was calculated.

Sampling Strategy

The study population was classified according to the different strata based on their designation as doctors, postgraduates (junior residents), interns, staff nurses, laboratory technicians and house-keeping staff. Allocation of the population according to the strata.

Ethical Approval

The ethical clearance for the study was obtained from the Institutional Ethics Committee.

Materials and Methods

The tool used for the study was a pre-tested, semi-structured closed ended questionnaire which encompassed 42 questions on Knowledge, Attitudes and Practices.

The questions on knowledge appraised the participant’s knowledge on attributes related to the colour coding and their implications, identification of biomedical hazard symbol, waste categories, and hospital policies for biomedical waste management.

The questions on attitude were related to matters like, was biomedical waste hazardous, its management additional burden on their work or if their appropriate management burden on the finances of the hospital, and also on legislative measures for waste management.

The questions on practice appraised if the study respondents had received any training on biomedical waste management, if they were immunized against hepatitis B and if disinfection of sharps were carried out at the point of generation.

The literature review was done based on which the questionnaire was formulated according to the requirements of the study. The questionnaire was pretested and validated by a post-test and a pilot survey was conducted with a sample of 60 respondents, with representations from the various strata of the study respondents. The study tool consisted of 12 questions assessing the knowledge with yes/no/not sure responses, 10 questions assessing the attitude with agree/disagree/no comment as answers and 20 questions assessing the practices with yes/ no responses.

The participants filled up the self-administered questionnaires without scope for undue help.

The questionnaire was adapted from English to local language by an experienced professional who is involved in translating of health survey questionnaires to accommodate the housekeeping staff. The questionnaire was also back translated to English for checking of possible discrepancies and incorporating if any changes were required. The identity of the study respondents were maintained anonymous   at various stages of the study.

The results were evaluated across 3 domains for all the cadres of the study population.

The results are Displayed as Under

Statistical Methods

Data was analysed using MS-Excel and R version 3.4.3.  Percentages (with 95% confidence intervals) were calculated and the same are presented graphically. Chi-square test was performed to test the association between the different cadres related to their knowledge, attitude and practices towards BMW

Knowledge Score

The knowledge regarding general information about HCW was assessed, the mean score was highest in doctors (10) followed by nursing staff (9.3) and least in housekeeping staff (7.5). This is found to be statistically significant.

Table 1: The participant’s knowledge on biomedical waste management.

Overall, the study respondents showed satisfactory knowledge regarding biomedical waste management. The knowledge about BMW among doctors was the distinctively better, followed by that of nurses, technicians, post graduates, interns and housekeeping staff (in order). The gaps in knowledge were in the areas regarding the fate of the waste after it was segregated, and as well as who was the regulator for the safe transportation of biomedical waste from the hospital.

Table 2: The participant’s attitudes towards biomedical waste management.

The mean attitude score was 9.20 for the nurses and 9.18 out of 10 for the doctors. Favourable attitude was shown by most of the study respondents towards biomedical waste management. The best attitudes were displayed by the nurses showed, subsequently by doctors, interns, postgraduates, the laboratory technicians, and house keeping staff (in order). It was concerning that the lacuna in this domain was that biomedical waste management was considered as additional burden on work.

Table 3: The participant’s practices regarding biomedical waste management.

The mean practice score was 17.30 for the nurses and 16.50 for the housekeeping staff and 15.27out of 20 for the doctors, in the study. Though greater number of the study respondents displayed favourable biomedical waste management practices, it was noted that the nurses had the best practices, followed house keeping staff, doctors, technicians, interns and junior residents (in order). It was noted that the staff ware following the preventive measures of immunisation against Hepatitis B, and also routine health check-ups were conducted for the staff. Explicit training on BMW management was desired by most of the staff.

Chi-Square Test

The null hypothesis which was to be tested here was “The two attributes were independent”. Here three hypotheses were there to be tested:

Cadre and knowledge are independent.

(Chi-square = 160.8,  Degrees of freedom=10, p-value < 0.0001)

Cadre and attitudes are independent.

(Chi-square = 95.6, Degrees of freedom=10, p-value < 0.0001)

Cadre and practices are independent.

(Chi-square = 538.45, Degrees of freedom=15, p-value < 0.0001)

The present cross-sectional study recognized certain inadequacies in the knowledge component amongst the different cadres of health care workers, though greater than 50% of the study respondents, across cadres, demonstrated satisfactory or good knowledge, attitudes and practices. The knowledge component of the doctors was more desirable compared to their practices whereas visa versa was true for nurses and lab technicians. The knowledge component was low amongst the housekeeping staff; which was identical to the results from other similar studies conducted previously. 10,13,16 

The attitude towards BMW management of housekeeping staff was low. Low level of knowledge was mainly attributed to new staff coming on rotation to the hospital and also to comparably low educational levels of the housekeeping staff. Training of all cadres of staff will help in the analytical evaluations for suitable and applicable management of biomedical waste. 10,13,16 

The practice of recapping the needles was very low across cadres. Recapping of needles is one of the important risk factor for needle stick injuries; the prevalence was very low in the organization. This may be associated to the awareness of the staff and also due to the adequate number of needle cutters in the various patient care areas of the hospital.

Higher practice scores found in the house keeping staff and nursing staff in the present study may be due to higher responsibilities assigned to them in handling of BMW which was similar to findings of previous studies. 1,17 Overall 8.1 % of the study respondents attended the external training programmes on BMW management on their own accord, but others too (~ 59%) of them communicated their willingness to do the same if opportunities arose in the future. 10,13,16

Conclusions

Overall, the knowledge, attitudes and practices towards biomedical waste management among the study respondents was satisfactory.

Knowledge, attitudes and practices toward biomedical waste management were better among the nurses and doctors than the other cadre of staff.

Knowledge, Attitudes and Practices of the study respondents are dependent on the cadre that they belong too.

This study was a modest attempt to evaluate the KAP of the health care workers towards BMW. We recommend further studies on a larger stratum across hospitals to evaluate the awareness of health care workers towards BMW.

Recommendations

Training programs need to focus on empowering the healthcare professionals on biomedical waste management with broad scope and practical knowledge in all aspects. The ethical requirements and the institutional level policies form the directional pathway for the practical components in the organization. The right practices and other activities of BMW management and its ramifications in the form of avoiding of injuries, importance of vaccinations and following of universal precautions can be achieved when adequately supported by IEC (information, education and communication) strategies like handouts, stickers, charts, celebrations of various days like hand hygiene day and other days etc can help in bettering the practices of the employees of the organizations. Training the staff with checklists and regular inspections can bring about accountability in the staff.

All health care professionals regardless of their designation, experience and qualification , designation must be included in these interventions, so that it can avoid  cross infections among the professionals and patients in the health care sector.

Conflicts of Interest

There is no conflicts of interest.

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EVALUATION OF BIOMEDICAL WASTE MANAGEMENT A CASE STUDY OF THE MATER HOSPITAL IN NAIROBI COUNTY KENYA

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DR. LAKSHMI P R I Y A VINJAMURI

ARTICLE INFO ABSTRACT The management of healthcare wastes is receiving much attention owing to the multiple risks it rendered both to health in particular and the environment in general. The health care wastes (HCW) pose immense danger due to the inadequate waste disposal management practices in both the rural and urban sectors. Health and medical care waste is often mixed with municipal waste including domestic wastes and is finally disposed off in residential waste landfills or improper treatment facilities. The two primary challenges to any waste disposal are primarily the technique of disposal and secondly the treatment methodology. (For example, incinerators) Regulatory intervention by the government and health care agencies is very crucial to control and check the health care waste management especially for medical waste incineration specifically in an ecologically friendly method failing which this is considered pollution for the environment and a simultaneous threat to health. This situation maybe overcome with the help of an organized system of health care waste management to curb public health risks as well as occupational hazards among health care workers as a result of poor waste management. This paper is an attempt to present a general overview of the current management practices of health and medical wastes in the hospitals in India with emphasis on the urban sector. The data is primarily secondary collected from reports and information regarding the generation, composition, segregation, transportation and disposal of health care and medical wastes is discussed. The pilot analysis is intended to be implemented as a full-fledged study in the city of Visakhapatnam and extrapolated to similar cities in India. The study also focuses on the impact of poor management of HCW to handlers, public health and environment.

opiew ochalla

Carl Bartone

Sushil Kumar Karki

Health Care Waste Management is becoming a problem for Solid Waste Management to individual and municipalities with the increase of health care institutions, advancement of technology and generation of large quantity and different types of health care waste. The main purpose of study was to identify current health waste management practice of Dolakha district along with quantity of Health care waste produced and learn perception of health care staffs towards HCWM. The study was conducted in three hospitals of Dolakha district ie. Jiri hospital, Dolakha Community Hospital and Tsho Rolpa General Hospital. Assessment of waste production was done for consecutive eight days in all three hospitals including clearing and coding on first day. Orientation to support staffs, identification and coding of existing buckets and waste container, clearing of the container, pre separation weighing and volume measurement, separation of waste, post separation weighing and volume measurement, syringe count, observational checklist and IRAT survey were used to characterize waste generation by weight and volume. On average 0.931 kg of waste was found to be generated per patient per day. Analyzing the total authorized capacity of beds i.e. 115 in 5 hospitals of the district, the average daily hospital waste generation during 100% occupancy was found to be 107.139 kg which equals to 0.48 m3 in volume. 79.64% of total waste was found to be hazardous waste in pre separation stage which reduces to 32.57% after proper segregation. Though all the hospitals of the district have health care waste management policy, health care wastes were not found to be managed according to it. Almost all the HCWM staffs and medical staffs were found aware about HCWM and 79% of them were found practicing segregation of waste at source but in the absence of proper transportation, storage, treatment and disposal facilities all the wastes are found to be mixed together which increases the quantity of hazardous waste. Generally risk HCW are incinerated in low temperature and are either disposed with general non-risk wastes or provide to municipality for final disposal at dumping site. Hospital management need to provide special attention on proper management of HCW and should train their staffs on HCWM so that risk on human health and environment can be reduced. Key Words: Health Care Waste Management, Health Care Waste, Individual Rapid Assessment Tool

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In the 21st century the human beings have achieved a lot through their innovative character. Right to health has been guaranteed to all without any discrimination. But despite these all achievements every one is bound to face various adverse ramifications in respect of health among them hospital waste is very crucial. Earlier hospital wastes were not considered as a serious issue but with the advent of infectious diseases, it has become a very important issue as it has a risk factor to the health of patients, hospital staffs, waste handlers and extending beyond the boundaries of the medical establishment to the general population too. The persons involved in hospital waste are at more risk than others. Further, physical and health hazards are also associated with the high operating temperatures of incinerators and steam sterilizers and with toxic gases vented into the atmosphere after waste treatment. Hence, the collection and proper disposal has become a significant concern for both the medical and the general community. In this paper, an attempt has been made to outline the legal aspects of hospital wastes in India.

puspalata pal

Bio medical waste generated from five govt hospitals and two blood banks of Cuttack city was studied by field visits during June 2012 to May 2013. Assessment study was done at five govt run hospitals and and two blood banks having total 2,110 beds such as (1) SCB Medical College & Hospital , (2)Sardar Vallabhai P.G Institute of Paediatrics , (3)Cuttack District City Hospital ,(4)Acharya Harihar Cancer Research Centre,(5) Anti T.B. Demonstration & Training Centre,(6) Central Red Cross Blood Bank and (7)SCB Medical College Blood Bank. Data were collected with the assistance of (i)Field visit for personal observations to assess waste generation, collection, handling, segregation, transportation, treatment and disposal practices(ii)assessment of volume of toxic and nontoxic wastes (iii) assessment of knowledge ,attitude, temperament and motive towards safe, scientific management practices of working nursing & para medical staff ,house keeping personnel, waste handlers and BMW management personnel with the help of pre-structured questionnaires,interviews and discussions. The result from the assessment studies indicated –(i) inappropriate collection, improper segregation and transportation, unscientific treatment and unsystematic disposal practices(ii) absence of introduction of modern technological management options like advanced incinerator, microwave & autoclave in all the hospitals (iii) absence of dedicated institutional facilities for the treatment and disposal of solid and liquid wastes (iv) Lack of substantial knowledge, training, motivation,will and accountability even among qualified hospital staff (v) unauthorised and illegal reuse of contaminated disposables and other infected solid waste. The study also found that the major treatment method used for infectious waste at SCB Medical College Hospital was a old model incinerator which was not functioning properly while all other hospitals lacked that facility. Non-infectious waste was disposed off in land filling. Almost all the hospitals and blood banks did not follow standard management practice and disposed off both infectious and non-infcetious waste without having proper policy and plan. Therefore, proper implementation of biomedical waste management policy in these hospitals is the need of the hour to maintain the existing deficiency and requirements of biomedical waste management .

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Volume 11, Issue 01 (January 2022)

Review on bio-medical waste management.

biomedical waste management research papers

  • Article Download / Views: 5,481
  • Authors : Sahil Sanjeev Salvi , Shubhangi Waghmare , Vikas Thombare, Sagar Mandlik , Saurabh Veer, Prajwal Walke, Prathamesh Zambare
  • Paper ID : IJERTV11IS010038
  • Volume & Issue : Volume 11, Issue 01 (January 2022)
  • Published (First Online): 17-01-2022
  • ISSN (Online) : 2278-0181
  • Publisher Name : IJERT

Creative Commons License

Mr. Sahil Sanjeev Salvi1, Shubhangi Waghmare2, Vikas Thombare3, Sagar Mandlik4, Saurabh Veer5 , Prajwal Walke6, Prathamesh Zambare7

Assistant Professor1, Student234567 Department of Civil Engineering,

Pimpri Chinchwad Collage of Engineering and Research, Pune, India

AbstractThis review study aims at discussing the between COVID-19 and biomedical waste management. The ongoing COVID-19 pandemic has already turned healthy places around the world into a living hell with massive death tolls because of its fastest-spreading nature, and continuously leading to lockdowns in almost every part of the world. Amid all the problems so far it created, one significant problem that can create major havoc in this already devastating and contagious atmosphere in a densely populated city is, not handling medical waste properly. It was a systemic review study regarding the relationship between COVID-19 and biomedical waste management. We have gathered total 16 articles and newsletters related to COVID-19 and biomedical waste management using different search portal. After proper literature review only 10 articles and newsletters which were related to this study were taken for this systemic review purpose. If the massive number of medical wastages cannot be managed through maintaining proper and adequate guidelines, chances of community-based spreading of COVID-19 can exceed the limit and take more lives in the upcoming days. In simple term the preferred technique for the bio medical waste management is incineration. It is Adequate for all infectious waste, most chemical waste, and pharmaceutical waste.

KeywordsBio-medical waste management , pandamic covid –

INTRODUCTION

Many waste are produced as a result of human activities. Such waste may be dangerous and therefore need safe disposal. Industrial waste, sewage and agricultural waste pollute water, soil and air and it can also be dangerous to human beings and environment. Solid waste can be classified into different types depending on their source [1]. It includes

(a) House hold waste (b) Industrial waste (c) Biomedical waste or hospital waste or infectious waste. Hospital waste is considered as hazardous because they contain toxic substances. This waste is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities in these fields. Liquid waste can be divided into two components (a) Liquid reagents/ chemicals discarded and (b) the cleaning and washing water channel ed into the drain [2]. Until recently, medical waste management was not generally considered an issue. In the 1980s and 1990s, concerns about exposure to human immunodeficiency virus (HIV) and hepatitis B virus (HBV) led to questions about potential risks inherent in medical waste. Thus, hospital waste generation has become a prime concern due to its multidimensional ramifications as a risk factor to the health of patients, hospital staff and extending beyond the boundaries of the medical establishment to the general population [3]. Hospital waste refers to all waste, biologic or non-biologic that is discarded and not intended for further use. Medical waste is a subset of hospital waste; it refers to

the material generated as a result of diagnosis, treatment or immunization of patients and associated biomedical research. Biomedical waste (BMW) is generated in hospitals, research institutions, health care teaching institutes, clinics, laboratories, blood banks, animal houses and veterinary institutes Biomedical waste, also known as infectious waste or medical waste is defined as waste generated during the diagnosis, testing,

treatment, research or production of biological products for humans or animals. Biomedical

waste includes syringes, live vaccines, laboratory samples, body parts, bodily fluids and waste,

According to the Medical Waste (Management and Processing) Rules 2008, "medical wastes could not be mixed with other wastes at any stage while producing inside hospitals, while collecting from hospitals, while transporting, and would be processed separately based on classification". The ongoing COVID-19 pandemic has already turned healthy places around the world into a living hell with massive death tolls because of its fastest spreading nature, and continuously leading to lockdowns in almost every part of the world. Amid all the problems so far it created, one significant problem that can create major havoc in this already devastating and contagious atmosphere in a densely populated city is not handling medical waste properly. Chinas Wuhan, the first of the cities that got viciously brutalized by the pandemic, is home to 11 million people. Its hospitals produced more than

240 tons of medical waste daily during the peak of the outbreak compared with 40 tones before the epidemic occurred, according to Chinas Ministry of Ecology and Environments emergency office. To fight this enormous number of medical wastages, the central government deployed 46 mobile medical waste treatments facilitates to the city of Wuhan and built a new plant with a capacity of 30 tonnes within 15 days in March. Biomedical wastes are hazardous because they host potential virus particles that can be hidden beneath human tissues, items contaminated with blood bags, needles, syringes or any other sharp object, body fluids-remaining like dressings, plaster casts, cotton swabs, beddings contaminated with blood or body fluid etc. Experts say medical wastages are not like other wastes such as the household or industrial wastages. It can infect one directly through the skin or by ingestion and inhalation with objects like inhalers or ventilating pipes. Many contagious viruses including HIV and Hepatitis (B and C) can easily be generated from such wastes and can harm the ones who do not have the diseases. Germs and viruses, which are antibiotic-resistant (such as the COVID-19 at this point) can easily spread from medical waste. Biomedical wastes are

hazardous because they host potential virus particles that can be hidden beneath human tissues, items contaminated with blood bags, needles, syringes or any other sharp object, body fluids-remaining like dressings, plaster casts, and cotton swabs, beddings contaminated with blood or body fluid etc.1. The safe management of household waste is also likely to be critical during the COVID-19 emergency. Medical waste such as contaminated masks, gloves, used or expired medicines, and other items can easily become mixed with domestic garbage, but should be treated as hazardous waste and disposed of separately. These should be separately stored from other household waste streams and collected by specialist municipality or waste management operators2.

To analyze the impact of coronavirus on the production of bio medical waste Maintaining the Integrity of the Specifications

To decide to use proper technique for the bio medical waste management.

LITERATURE REVIEW

Healthcare waste comprises the waste generated by healthcare facilities, medical laboratories and biomedical research facilities. Improper treatment of this waste poses serious risks of disease transmission to waste pickers, waste workers, health workers, patients, and the community in general through exposure to infectious agents. Poor management of the waste emits harmful and deleterious contaminants into society. However, contamnation of highly contagious agents such as the COVID-19 virus has created enormous instability in healthcare waste handling and subsequent recycling because of the volume of the waste generated and its contagious nature. Several countries have adopted safety measures to combat this contamination and manage healthcare waste; however, these measures are insufficient and vary depending on the context of the country. In addition, the WHO has set out guidelines for management of healthcare waste. These guidelines are helping to manage the highly contagious healthcare waste resulting from the current pandemic. Proper healthcare waste management may add value by reducing the spread of the COVID-19 virus and increasing the recyclability of materials instead of sending them to landfill. Disinfecting and sorting out healthcare waste facilitates sustainable management and allows their utilization for valuable purposes. This review discusses the different healthcare solid waste management strategies practiced in different countries, the challenges faced during this management, and the possible solutions for overcoming these challenges. It also provides useful insights into healthcare solid waste management scenarios during the COVID-19 pandemic and a possible way forward.

Biomedical waste poses various health and environmental hazards. Hence, it should be handled with the utmost care and disposed off safely. Several lacunas exist in the management of biomedical waste in India, and the pandemic posed by the coronavirus has made it even more challenging. The sudden outbreak of the virus led to an exponential rise in the quantity of biomedical waste. Furthermore, the poor infrastructure and lack of human resources have aggravated this situation. To combat this serious problem in a timely manner, the government has formulated various standard operating procedures and has amended the existing rules and guidelines.

Biomedical waste (BMW) is generated in hospitals, research institutions, health care teaching institutes, clinics, laboratories, blood banks, animal houses and veterinary institutes. Hospital waste management has been brought into focus in India recently, particularly with the notification of the BMW (Management and Handling) Rules, 1998. This study was conducted in Sharda hospital, Greater Noida with the aim to find out bacteriological profile of BMW with study of practices being followed in management and disposal of this waste with standard procedure. Total 500 cases of biomedical waste samples were taken in the study for bacterial culture, 136 samples of biomedical waste showed growth of bacteria. Pseudomonas species was the predominant bacteria isolated from these cultures. This study also suggests about the optimum practice which is to be followed in management of biomedical waste.

Medical waste management problems are rising due to the crisis brought upon by the coronavirus disease 2019 (COVID-19) as a worldwide pandemic. The security management of medical care worldwide increases their attention due to the high risk of COVID-19 medical waste. This paper gives a review of medical waste management during the COVID-19 pandemic around the world. Furthermore, an effort has been made to prepare a review of the characteristics, generation, collection, transportation, disposal, and treatment technologies of solid waste management worldwide. Detailed data on medical waste management practices, including collection, recovery, and disposal, have been presented. The poor medical waste management in Iraq before and during COVID-19 causes a huge environmental risk and can be a possible reappearing infection source. Hence, the study also points out some recommendations for handling COVID-19 pandemic medical waste properly to reduce possible secondary effects on health and the environment and manage any possible pandemics in the future.

Considering the widespread transmission of Coronavirus disease (COVID-19) globally, India is also facing the same crisis. As India already has inadequate waste treatment facilities, and the sudden outbreak of the COVID-19 virus has led to significant growth of Bio-medical waste (BMW), consequently safe disposal of a large quantity of waste has become a more serious concern.

This study provides a comprehensive assessment of BMW of India before and during the COVID-19 pandemic. Additionally, this article highlights the gaps in the implementation of BMW rules in India. This study uses various government and non-government organizations, reports and data specifically from the Central Pollution Control Board (CPCB). The finding of the study demonstrated that most of the States/Union Territories (UTs) of India are lacking in terms of COVID-19 waste management. India has generated over 32,996mt of COVID-

19 waste between June and December 2020. During this period, Maharashtra (789.99mt/month) is highest average generator of COVID-19 waste, followed by Kerala (459.86mt/month), Gujarat (434.87mt/month), Tamil Nadu (427.23mt/month), Uttar Pradesh (371.39mt/month), Delhi (358.83mt/month) and West Bengal (303.15mt/month), and others respectively. We draw attention to the fact that many gaps were identified with compliance of BMW management rules. For example, out of all 35 States/UTs, health care facilitates (HCFs), only eight states received authorization as per BMW management rules. Moreover, the government strictly restricted the practice of deep burials; however, 23 States/UTs are still using the deep burial methods for BMW disposal. The present research suggests that those States/UTs generated on an average of 100mt/month COVID-19 waste in the last 7months (JuneDecember 2020) should be considered as a high priority state. These states need special attention to implement BMW rules and should upgrade their BMW treatment capacity

Objectives: Proper handling, treatment and disposal of biomedical wastes are important elements in any health care setting. Not much attention has been paid to the management of Biomedical Waste (BMW) in recent years, in dental colleges and hospitals in India. The present systematic review was conducted to assess knowledge and awareness regarding BMW management among staff and students of dental teaching institutions in India.

Material and Methods: A systematic review of relevant cross- sectional studies was conducted regarding BMW management in India in dental teaching institutions in India. Six studies were finally included in the present review after conducting both electronic and manual search like PubMed, EMBASE etc. and after making necessary exclusions. Potential biases were addressed and relevant data was extracted by the concerned investigators.

Results: Six studies were finally included in the review. Color coding of wastes was not done by 67% of the subjects in one of the studies conducted in Haryana. Almost all the subjects agreed to the fact that exposure to hazardous health care waste can result in disease or infection in another study. According to another study reports, none of the respondents was able to list the legislative act regarding BMW when asked.

Conclusions: The results of the present review showed that knowledge and awareness level of subjects was inadequate and there is considerable variation in practice and management regarding BMW. There is a great need for continuing education and training programmers to be conducted in dental teaching institutions in India.

The aount of biomedical waste generated per day is increasing day by day with increase in the healthcare facilities. This paper presents an analysis study of various techniques used for biomedical waste management along with the knowledge and attitude of people and healthcare workers. Along with this the scenario of biomedical waste management in various hospitals in India is discussed. This waste is sometimes very hazardous and can lead to dreadful effects. So, the waste is needed to be treated using adequate treatment method

Covid-19 Pandemic leads to medical services for the society all over the world. The Covid-19 pandemic influence the waste management and especially medical waste management. In this study, the effect of the Covid-19 outbreak on medical waste was evaluated via assessing the solid waste generation, composition, and management status in five hospitals in Iran. The results indicated that the epidemic Covid-19 leads to increased waste generation on average 102.2 % in both private and public hospitals. In addition, the ratio of infectious waste in the studied hospitals increased by an average of 9 % in medical waste composition and 121 % compared with before COVID-19 pandemic. Changes in plans and management measurement such as increasing the frequency of waste collection per week leads to lower the risk of infection transmission from medical waste in the studied hospitals. The results obtained from the present research clearly show the changes in medical waste generation and waste composition within pandemic Covid-

19. In addition, established new ward, Covid-19 ward with high-infected waste led to new challenges which should be managed properly by change in routine activities.

To discusses the different healthcare solid waste management strategies practiced in different countries, the challenges faced during this management, and the possible solutions for overcoming these challenges.

Several countries have adopted safety measures to combat this contamination and manage healthcare waste; however, these measures are insufficient and vary depending on the

context of the country. In addition, the WHO has set out guidelines for management of healthcare waste. These guidelines are helping to manage the highly contagious healthcare waste resulting from the current pandemic provides useful insights into healthcare solid waste management scenarios during the COVID-19 pandemic and a possible way forward

The most populous cities like Delhi, Mumbai, Bangalore, Chennai, Hyderabad, etc. are the most affected cities by COVID-19. According to data published by NDTV on September 18, 2020, the country is generating a considerable amount (Above 100 tones/day) of COVID-19 related biomedical waste in the country. Maharashtra contributes for approximately 17% of total COVID-19 related BMW. Now the national daily waste generation is reaching around 850 tones/day.10,11 The details on the monthly generation of COVID-19 related BMW across several state of India (From June 2020December 2020) is referenced in Table 1. The country does not have sufficient infrastructure and human resources to handle this huge amount of BMW. The presence of 198 CBMWFs and 225 captive incinerators was insufficient to dispose off 700 tonnes of waste generated in a day. This additional BMW stirred up havoc in the disposal of BMW. The workers involved in BMW management are pitching in extra hours to cater to this need.11 According to the Supreme Court report, there is an increment in the quantity of BMW ranging from 25 to 349tonnes/day during the month of MayJuly and it is expected to have doubled during the months of AugustOctober. Presently, there is a poor practice of segregation at the site of generation due to the exponential rise in the generation, thus elevating the risk to the environment. Additionally, inadequate safety measures for the BMW workers continue to remain another major challenge in the Indian

METHODOLOGY

Generally, the waste generated from healthcare facilities, research centers, and laboratories relating to medical procedures is considered healthcare waste. Approximately 7590% of healthcare solid waste is similar to waste produced in households, and is thus categorized as non- hazardous or general healthcare waste. In reality, this waste is generated from the administrative, kitchen, and housekeeping functions of medical and healthcare facilities. The remaining 1025% of waste is designated hazardous waste, which poses serious environmental and health risks (Yves charter et al., 2014). It has been observed that the composition of healthcare solid waste during the COVID-19 pandemic is more or less similar to that produced in normal circumstances, except for the generation of a huge quantity of plastics/ micro-plastics. However, the pandemic has seen the generation of a vastly increased quantity of waste (Singh et al., 2020a). As observed during normal circumstances, the composition of healthcare solid waste is very important, as this dictates its ability to be recycled and sustainably managed, which is vital during the current pandemic

Hazardous healthcare waste

Chemical waste

Chemicals are omnipresent in healthcare facilities. As major consumers of chemicals, the chemical waste these facilities generate can have deleterious impacts on health and the environment. This type of waste accounts for about 3% of waste originating from healthcare activities (Ilyas et al., 2020). Waste that contains chemical substances, i.e. laboratory reagents, film developing reagents, expired/unused disinfectants, solvents, and waste containing heavy metals (batteries, broken thermometers, blood-pressure gauges, etc.) is considered chemical

healthcare waste (Yves charter et al., 2014). Due to serious health concerns, a growing number of hospitals have substituted some of their most hazardous substances with safer alternatives and adopted careful management strategies.

However, there are plenty of facilities in both

developing and developed countries that still use these toxic chemicals and have poor chemical waste management strategies.

Infectious waste

Waste that contains infective pathogens, resulting in disease incidence and progression, is defined as infectious healthcare waste; it comprises materials contaminated with blood and body fluids, human excreta, laboratory cultures, and microbiological products (Askari net al., 2010; Yves charter et al., 2014). PPE, i.e., boots, long-sleeved gowns, heavy- duty gloves, masks, goggles, and face shields are also considered infectious waste, and waste generated from these materials has increased by a substantial amount during the COVID-19 pandemic

(WHO, 2020b). Therefore, there is a tremendous challenge in managing this type of waste during the pandemic (Rowan and Laffey, 2021).

Pathological waste

Pathological waste is typically a smaller portion, part, or slice of any tissue, organ, or body part, taken from surgical or microbiological specimens from animal or human bodies

(Yves charter et al., 2014). This type of waste originates from tissues or samples of tissues that are

inspected and/or examined in a laboratory to diagnose or study abnormality or diseased tissues. In essence, this type of waste is similar to infectious waste, and careful handling is required to manage it during the current pandemic. It can spread infection in a similar fashion to infectious waste because of the presence of infective viral particles in the tissue samples (WHO, 2020b)

Radioactive waste

Radioactive waste is a by-product of various nuclear technologies used in healthcare facilities, including nuclear medicine, radiotherapy, and reagents for research This waste contains radioactive substances, i.e., unused liquids from radiotherapy or laboratory research. Radioactive contaminated glassware, packages/absorbent paper, urine, and excreta from patients treated or tested with unsealed radionuclides also constitute radioactive waste (Yves Chertier et al., 2014). Exposure to radioactive elements can cause serious health problems and also poses a risk to the environment if not managed properly. The outbreak of the COVID-19 pandemic has compromised the containment of radioactive waste, and special measures need to be put in place to manage this toxic waste so that its exposure to humans and the environment can be minimized.

Sharps waste

Sharps waste is another type of healthcare solid waste; it is composed of used sharps including used or unused hypodermic, intravenous, or other needles, auto-disable syringes, syringes with attached needles, infusion sets, scalpels, pipettes, knives, blades, and broken glasses (Askari an et al., 2010; Halogenide et al., 2018; Mato and Cassena, 1997; Yves Chertier et al., 2014). Generated sharps healthcare waste should be treated with extra care and properly managed during the COVID-19 pandemic (WHO, 2020b), as it has been found that SARS-CoV-2 can survive on different surfaces for a certain period. Waste workers could be easily infected by sharps contaminated with the virus, and this could increase community transmission.

Pharmaceutical waste

Pharmaceutical waste can be generated from many activities and locations in healthcare facilities, i.e., pharmacies, distribution centers, and hospitals. Expired and contaminated pharmaceutical products are considered pharmaceutical waste (Yves Chertier et al., 2014). Used biological products for therapy and transdermal patches, and contaminated pharmaceuticals including vaccines, are also listed as pharmaceutical waste (Mascaro, 2020). The amount of pharmaceutical waste has increased substantially during the COVID-19 pandemic due to the increased number of hospital admissions. Waste workers who collect this type of waste from pharmacies, distribution centers, and hospitals can easily be infected with SARS-CoV-2 if they come into contact with COVID-19 patients and virally contaminated pharmaceutical waste during its collection from designated treatment units.

Non-hazardous healthcare waste

Used plastic water bottles, office paper, magazines, newspapers, food waste, and food packaging are considered

non-hazardous healthcare solid waste (Askari an et al., 2010; Halogenide et al., 2018) if not contained alongside hazardous waste. Non-hazardous waste is comparable to domestic waste and can be recycled for sustainable waste management. It is probable that both asymptomatic and symptomatic COVID- 19 patents generate a huge amount of non-hazardous SARS- CoV-2 contaminated healthcare waste during their daily actions in healthcare facilities, which poses a serious risk of community transmission.

Other waste

The test kits and waste generated from different diagnostic methods for COVID-19 are another additional type of healthcare waste that has been generated in substantial amounts during the COVID-19 outbreak, as global transmission and prevalence have necessitated the detection of infections to aid with appropriate social distancing and quarantine measures. The use of rapid test kits for identifying an infected person produces additional waste in the waste stream, as each kit is used only once. There is always a chance that this waste could be contaminated with SARS- CoV-2 and contribute to further spread if not managed properly

Treatment and disposal techniques for biomedical waste There are several methods that have been successful in the treatment of infectious waste. The following are the methods that will show the treatment that may be available at your facility. The methods are: Autoclaving, Incineration, Thermal inactivation, Gas/Vapor Sterilization, Chemical Disinfection etc.

Autoclaves are closed chambers that apply both heat and pressure, and sometimes steam, over a period of time to sterilize medical equipment. Autoclaves have been used for nearly century to sterilize medical instruments for reuse. Autoclaves are used to destroy microorganisms that may be present in medical waste before disposal in a traditional landfill. Autoclaves can be used to process up to 90% of medical waste, and are easily scaled to meet the needs of any medical organization [15]. Small counter-top autoclaves are often used for sterilizing reusable medical instruments while large autoclaves are used to treat large volumes of medical waste. Steam sterilization is most effective with low-density material such as plastics, metal pans, bottles, and flasks [16]. High-density polyethylene and polypropylene plastic should not be used in this process because they do not facilitate steam penetration to the waste load. Plastic bags should be placed in a rigid container before steam treatment to prevent spillage and drain clogging. Bags should be opened and caps and stoppers should be loosened immediately before they are place in the steam sterilizer. Care should be taken to separate infectious wastes from other hazardous wastes. Infectious waste that contains noninfectious hazards should not be steam-sterilized [17]. Waste that contains anti neoplastic drugs, toxic chemicals, or chemicals that would be volatilized by steam should not be steam-sterilized.

Incineration

Thermal inactivation

Thermal inactivation involves the treatment of waste with high temperatures to eliminate infectious agents. This method is usually used for large volumes [20]. Liquid waste is collected in vessel and heated by heat exchangers or a steam jacket surround the vessel. The types of pathogens in the waste determine the temperature and duration of treatment. After treatment, the contents can be discharged into the sanitary sewer in a manner that complies with State, Federal, and local requirements. This method requires higher temperatures and longer treatment cycles than steam treatment.

Gas/vapor sterilization

Gas/vapor sterilization uses gaseous or vaporized chemicals as the sterilizing agents. Ethylene oxide is the most commonly used agent, but should be used with caution since it is a suspected human carcinogen. Because ethylene oxide may be adsorbed on the surface of treated materials, the potential exists for worker exposure when sterilized materials are handled [20].

Chemical disinfection

Chemical disinfection is the preferred treatment for liquid infectious wastes. Consider the following: Type of microorganism, Degree of contamination, Amount of proteinaceous material present, Type of disinfectant, Contact time, Other relevant factors such as temperature, pH, mixing requirements, and the biology of the microorganism [20]. Ultimate disposal of chemically treated waste should be in accordance with State and local requirements

Disposal of treated waste:

Infectious waste that has been effectively treated is no longer biologically hazardous and may be mixed with the disposed of as ordinary solid waste, provided the waste does not pose other hazards that are subject to federal or state regulations.

EPA recommends:

Contacting state and local governments to identify approved disposal options.

  • <>Discharge of treated liquids and pathological wastes (after grinding) to the sanitary sewer system.

Approval of the local sewer authority must be obtained.

Health hazard from biomedical waste

The improper management of bio-medical waste causes serious environmental problems in terms of air, water and land pollution. The nature of pollutants can be classified into

Air Pollution can be caused in both indoors and outdoors. Bio-Medical Waste that generates air pollution is of three types – Biological, Chemical and Radioactive. Indoor air pollutants like pathogens present in the waste can enter and remain in the air in an institution for a long period in the form of spores or as pathogens itself. Chemical Pollutants that cause outdoor air pollution have two major sources- open burning and incinerators [21]. Open burning of biomedical waste is the most harmful practice and should be strictly avoided

Water Pollution is another major threat from Bio-medical waste. If the waste is dumped in low-lying areas, or into lakes and water bodies, can cause severe water pollution. Water pollution can either be caused due to biological, chemicals or radioactive substances [22]. The pathogens present in the waste can leach out and contaminate the ground water or surface water. Harmful chemicals present in bio-medical waste such as heavy metals can also cause water pollution.

Challenges of biomedical waste in India

(Bio-medical Waste (Management and Handling) Rules. Ministry of

Environment and Forests Notification, New Delhi. 1998)

To treat 420561 kg per day of bio medical waste in accordance with Bio-Medical Waste Rules.

Number of Common Bio Medical Wastes Treatment Facility (CBMWTF) to be increased manifold. Presently there are 157 facilities which are not adequate to handle all the bio medical wastes generated

CBMWTF is to be set up under public private partnership mode.

New technologies to be promoted for destruction of toxic bio medical wastes.

Which treatment is preferable?

Incineration is a high-temperature dry oxidation process that reduces organic and combustible waste to inorganic, incombustible matter and results in a very significant reduction of waste volume and weight. This process is usually selected to treat wastes that cannot be recycled, reused, or disposed of in a landfill site. The process flow is illustrated schematically in. The combustion of organic compounds produces mainly gaseous emissions, including steam, carbon dioxide, nitrogen oxides, and certain toxic substances (e.g. metals, halogenic acids), and particulate matter, plus solid residues in the form of ashes. If the conditions of combustion are not properly controlled, toxic carbon monoxide will also be produced. The ash and wastewater produced by the process also contain toxic compounds, which have to be treated to avoid adverse effects on health and the environment. Most large, modern incinerators include energy-recovery facilities. In cold

climates, steam and/or hot water from incinerators can be used to feed urban district-heating systems, and in warmer climates the steam from incinerators is used to generate electricity. The heat recovered from small hospital incinerators is used for preheating of waste to be burnt.

BMW is directly related to waste management which is indeed related environmental engineering as this targets environmental safety.

Objective of environmental engineering is to ensure societal development and use of land, water and air resources are sustainable. These targets are achieved by managing these resources so that environmental pollution and degradation is minimized.

The ongoing COVID-19 pandemic has already turned healthy places around the world into a living hell with massive death tolls because of its fastest-spreading nature, and continuously leading to lockdowns in almost every part of the world. Amid all the problems so far it created, one significant problem that can create major havoc in this already devastating and contagious atmosphere in a densely populated city is, not handling medical waste properly.

If the massive amount of medical wastages cannot be managed through maintaining proper and adequate guidelines, chances of community-based spreading of COVID-19 can exceed the limit and take more lives in the upcoming days In simple term the preferrable technique for the bio medical waste management is incineration. It is Adequate for all infectious waste, most chemical waste, and pharmaceutical waste and also very high disinfection efficiency.

BWM Relevance To Civil Engineering

Bio medical waste in itself is a huge problem. As developing countries are making transition into developed countries, need for healthcare is increasing and due to such economic advancements, BMW waste generation is also increasing at rapid pace.

In India BMW is a huge problem. There is lack of awareness and absence of stringent rules and regulations l, it is sometimes found that hospitals are dumping waste into ground or river which is very dangerous because it contains hazardous and infected substance like blood, skin, imputed organs, syringe, needles, etc.

As an aware citizen and a civil engineer, it is our responsibility to find efficient ways to properly treat BMW. As a civil engineer we need to work towards making structures so that BMW is properly treated so that the damage footprint is least on river or land. Our job is to make product reusable by transforming it into usable product.

Daljit Kapoor , Ashutosh Nirola , Vinod Kapoor , Ramandeep-Singh Gambhir 4 Journal of Environmental Health Science and Engineering (2021) 19:831836 https://doi.org/10.1007/s40201-021-00650-9

Dr Irin Hossain*1, Dr Ashekur Rahman Mullick2, Dr Shazly Bari3,Mohammad Tahsin Islam4 Dr Irin Hossain et al JMSCR Volume 08 Issue 05 May 2020

Kerkar, S. S., and S. S. Salvi. "Application of eco-enzyme for domestic waste water treatment." International Journal for Research in Engineering Application and Management 5.11 (2020): 114-116.

Lee B K, Ellenbecker M J and Moure-Ersaso R 2004 Alternatives for treatment and disposal cost reduction of regulated medical wastes, Waste management 24(2):143-51.

Michael Ugom, 2020 Managing Medical Wastes During the Covid-19 Pandemic in Nigeria,

Prüess A, Giroult E, Rushbrook P 1999 Safer management of wastes from Medical care Activities.World Health Organization, Geneva.

Ritchie H, Ortiz-Ospina E, Beltekian D, Mathieu E, Hasell J, Bobbie Macdonald B,Charliem Giattino C and Roser M 2020 Coronavirus (COVID-19) deaths. https://ourworldindata.org/covid-deaths

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

Salvi, Sahil & Mantute, Komal & Sabale, Rutuja & Lande, Siddhi & Kadlag, Akash & Professor, Assistant. (2021). A STUDY OF WASTE PLASTIC USED IN PAVING BLOCK. 2320-2882.

Sharma M. Hospital waste management and its monitoring, 2002; (1st Ed.), Jaypee Brothers Medical Publication.

Tudor T L, Noonan C L and Jenkin L E 2005 Medical care waste management: a case study from the National Health Service in Cornwall, United Kingdom, Waste management 25(6): 606-15.

Vichal Rastogi, Poja Rastogi, Shalini Bhatia. J Indian Acad Forensic Med. April-June 2011/ Vol. 33/ No. 2 ISSN 0971-0973

V. N. Kalpana, D. Sathya Prabhu, S. Vinodhini and Devirajeswari V. Journal of Chemical and Pharmaceutical Research, 2016, 8(4):670-676 Review Article ISSN 0975-7384 CODEN(USA)

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