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Biomedical waste generation and its management in hospitals of NCR-Delhi,

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 ¤ 2018 RELS, p-ISSN: 0974-4908 Publication Info
Home page: http://rels.comxa.com Paper received: 02.02.18
e-mail: [email protected] Revised received: 01.03.18
Res. Environ. Life Sci., Paper Accepted: 03.03.18
ESTD: 2000 11(03) 75-83(2018) Category: Original paper

Biomedical waste generation and its management in hospitals of NCR-Delhi, India

Abstract Author Info

The quantity of waste generation and its quality along with treatment mechanisms has Aastha Dhingra* , Sirajuddin Ahmed 2,
1

become a matter of concern. Bio-medical waste management is an integral part of future Weqar Ahmed Siddiqui1, Siddhartha
sustainability. The paper is aimed at evaluating the solid bio-medical waste generation Gautam3 and Nadeem A. Khan 2
pattern according to the bed strength of hospitals and to analyse the water consumption and 1
Department of Applied Science and
effluent generation pattern in hospitals of Delhi. The questionnaire survey was done in Humanities Jamia Millia Islamia (Central
seventy five hospitals and thirty six hospitals were visited to achieve the objectives of the University) New Delhi 110025, India
study. In Delhi, the waste generation on a per bed per day basis range from only 110 grams 2
Department of Civil Engineering Jamia
to 2783 grams. The yearly solid biomedical waste generation in Delhi is approximated to Millia Islamia (Central University) New
9200 tonnes. The average water consumption per bed per day in a hospital of Delhi ranges Delhi 110025, India
between 500-600 LPD. The annual water consumption in hospitals of Delhi is approximated 3
Delhi Pollution Control Committee,
to 9125 million litres. The impact of improper biomedical waste and hospital effluent on Delhi-110006, India
aquatic environment and society has also been discussed in the paper. Further, this paper *Corresponding author e-mail:
has highlighted the certain grey areas in the implementation of new Bio-medical waste [email protected]
management rules, 2016 by the hospitals. The deficiencies in the existing bio-medical waste
management system and compliance of BMW Rules, 2016 has also been assessed. It is Keywords
observed that the latest technologies like pulpmatic macerators, sharp blasters and dry heat Biomedical waste, hospital effluent,
sterilization and the best waste management practices can be adopted to control the menace management, generation pattern,
caused due to improper bio-medical waste management. hospitals

Introduction hazardous impact and economically viable pollution control

Although, the Bio-medical waste management rules are in technologies (Kishore et al., 2014). The best management practices
existence since, 1998 but effluent generated from hospitals has and appropriate technologies is an important tool for proper Bio-
remained in the grey area. There are no specific discharge medical waste management. The composition, generation pattern
standards for the probable contaminants emerging from the health and quantity of the medical waste is important to further decide on
care facilities like drug residues, formaldehyde, gluteraldehyde, the apt treatment of the health care waste (Acharya et al., 2014;
adsorbable organic halogens, hypochlorites etc. However, now Verma et al., 2008).
the new Bio-medical waste management rules, 2016 has laid The objective of the study is to assess the management of
attention on the pre-treatment of the liquid chemical waste generated the Biomedical waste and hospital effluent considering their
in the hospitals (Manasi et al. 2014). But still, there are challenges composition, generation pattern and impacts on society and
in the implementation of BMW Rules, 2016 which have been environment. The best waste management practices and
discussed in this paper. Further, the compliance of BMW Rules, technologies have also been discussed.
2016 has also been assessed. In view of the current situation, there Composition of solid bio-medical waste: Most of the waste
is a need to develop a scientific scheme for the processing, treatment from medical activities resembles the waste generated by other
and disposal of the solid bio-medical waste. Simultaneously an businesses and residences. Between 75-90% of the medical waste
emphasis should be given for the treatment of wastewater and its consists of the non-regulated solid waste, 10-25% of the medical
reuse. Basic philosophy towards sustainable approach for waste, however, requires special precautions because of the
Biomedical Waste (BMW) Management is governed by assessing associated risk of transmitting disease or of hazards from exposure
the quantum and pattern of generation of bio-medical waste, its to chemicals or radioactivity. The latter includes infectious and
segregation, categorization and treatment of respective category pathological waste and sharps such as used needles or scalpel
waste. Present scenario of effluent treatment and waste management blades. It may also include small quantities of hazardous material
demands triangulation methods viz waste reduction, prevention of such as discarded pharmaceuticals, cleaning products and chemical

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Dhingra et al. Biomedical waste generation and management

solvents. In addition, nuclear medicine departments may generate Impact of improper hospital waste management: Only 10-
small amounts of low-level radioactive wastes from diagnostic 15% of the total medical waste is hazardous but it has the potential
procedures (Col et al., 2003). to convert even the non-hazardous waste into hazardous. Thus,
Composition of hospital effluent: The hospital effluent is loaded the quantity of hazardous waste increases manifold because of
with numerous chemicals, drug residues, hormones, personal care improper segregation. There are certain risks associated with mis-
products, disinfectants, microbes, infectious fluids, pathogens, handling of waste from hospitals (Acharya et al., 2014; Verma et
radioactives, nuclear medicine residues etc which adversely impacts al., 2008; Gupta et al., 2009; Manasi et al., 2014; Zhou et al., 2009;
the environment. There is an ample literature support regarding Verlicchi et al., 2010; Deblonde et al., 2015; Fent et al., 2006;
occurrence of drug residues including that of antibiotics, Emmanuel et al., 2002; Pinto and Garcy, 2014)
antidepressants and even cytotoxics, chemicals, disinfectants, Materials and Methods
hormones affecting the reproductive behaviour of fishes The twenty five hospitals were selected from each category
(Mesdaghinia et al., 2015). The detrimental effects of the emerging of hospitals having bed strengths 10-49, 50-99 and more than 100.
contaminants present in untreated hospital effluent on aquatic In total, the questionnaire survey was done in 75 hospitals. The
environment are known through literature. questionnaire asked about the water consumption in various water
Considering the composition of medical waste, the medical utility heads in the hospitals to assess the water consumption pattern.
facilities can adopt various approaches to treat and manage the medical The data on wastewater generation and its utility has also been
waste. The appropriateness and effectiveness of these approaches gathered. The questionnaire also emphasized on the areas of
will, however, depend upon the local regulations and priorities. Another reutilization of wastewater, the capacity and treatment technology of
key issue is the ability and willingness of the responsible parties and the sewage treatment plant. The data on category wise solid bio-
adopt prevention of waste generation as a priority. It is possible for medical waste generation was procured from the operators of the
creative and flexible administrators including organizations to common bio-medical waste treatment facility namely SMS Water
implement innovative waste prevention and management techniques Grace pvt ltd. Howsoever, 36 hospitals were visited including 12
in fulfilment of rules even without abundant financing. hospitals from each category of bed strength to understand the
Status of bio-medical waste generation: The per capita bio- existing bio-medical waste management and to assess the deficiencies
medical waste generation varies from country to country on the in the existing system. The various stakeholders have been
basis of facilities available in the hospital, number of beds, average interviewed including operators, doctors, nurses, waste handlers.
occupancy and footfall, number of employees etc. The per capita The meetings were also conducted with representatives of
bio-medical waste generation is higher in developed countries. companies providing the waste management tools and academicians
International scenario of BMW generation: Hospital waste to come up with the best waste management practices and
generated in developing countries (per patient) is much less as technologies available in the market. The important mechanism for
compared to the volume generated in the developed countries. existing system has also been discussed.
Volume of waste generated from a medical facility in developing
countries ranges from 1-3 kg/day/bed as compared to 3-8kg/day/ Result and Discussion
bed in developed countries. The quantum of infectious waste Solid bio-medical waste management: Delhi, the capital city of
accounts to 250-750 g/day/bed. For instance, the solid bio-medical India is a major hub of health care facilities. In India seventy five
waste generation in USA is as high as 4.5 kg, in Spain 3kg Bio- percent of the health facilities and hospitals are located in urban
medical waste is generated per bed. The UK and France also areas where only twenty seven percent of the total population lives.
generates high quantum of waste i.e. 2.5 kg/bed. In western Europe There are around 48,000 beds in health care facilities of Delhi. The
3-6 kg BMW is generated per bed per day. In Asia, the high income average number of beds per 1000 inhabitants in Delhi is 2.58. The
countries generate more waste (2.5-4 Kg) in comparison to low hospital beds are increasing in Delhi day by day due to rapid
income countries that generate 1.8-2.2 kg/bed/day (Babu et al., development in the health care facilities which has put Delhi among
2009). The reason of such huge amount of waste generated in the top cities with advanced medical facilities in the country. The medical
developed countries is that they follow “dispose after use” for every facilities are negligible in rural areas where more than 70% of our
durable item used in the hospitals. The single use of certain population lives. The same is represented in fig. 1. The average
consumables is a must for infection control but not for every item water consumption per bed per day is 560 LPD. Since, Delhi
(Deblonde et al., 2015). provides better health care facilities, patients from all over India
Indian scenario of BMW generation: The total bio-medical comes here for treatment. The average occupancy of hospitals is
waste generation in India is 484 TPD. However, the Biomedical around 75% -80% throughout the year. The BMW generation also
waste treated per day in India is 447 TPD. This waste is generated has an increasing trend with respect to population of Delhi. The
by around 1,68,869 HCFs in India. The number of operators or BMW per bed per day has increased from 306 grams in 2001to
common bio-medical treatment facilities in India are 198. The 432 grams in 2011 and 520 grams in 2017.
upcoming CBWTFs in India are 32. In India the quantity of bio- Analysis of bio-medical waste in Delhi -
medical waste generated in the hospitals has been estimated to be Generation Pattern: The Bio-medical waste management rules,
1.5 kg/ bed/day (Pollution and Board 2015). 2016 has demarcated the waste into four categories namely yellow

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Dhingra et al. Biomedical waste generation and management

Table-1: Impact of improper bio-medical waste management

Solid waste Liquid waste
Waste related diseases like gastro enteric troubles, respiratory and skin diseases. Degrades water quality by altering pH, BOD, DO, COD etc.
Anatomical waste can effect waste handlers through direct contact of vectors. Deteriorates natural environment and cause imbalance
Microbial cultures from labs leads to health disorders like headache, DNA Damage and genotoxicity
cough, eyeburn and skin burn.
Needles, scalpels and syringes (sharp injuries) leads to spreading of tetanus, Ecotoxicity/ Toxicity
hepatitis, AIIDS and septicemia.
IV fluid and blood bags, urobags releases dioxin, furan, SPM, gases like SOx, NOx etc Microbial Resistance
Catheters, PVC gloves, tubes etc leads to formation of carcinogens and Disease outbreaks like diarrhoeal diseases,
may disturb function of hormones. gastroenteric disorders.
Cytotoxic chemical waste causes cytotoxicity, malignancy, ulcers, Bioaccumulation/ Biomagnification / Persistence of
anemia, teratogenecity, skin ailments etc. the emerging contaminants present in the effluent.
Radiation burns Cytotoxic contaminants in the effluent leads
injury to the cells, malignancy etc.
Poisoning and pollution by cytotoxic and genotoxic substances. Human blood and body fluids leads to diseases like typhoid,
tuberculosis, hepatits etc.
Pollution by toxic elements or compounds such as mercury or dioxins Radioactive substances in the effluent can come from body
that are released during incineration. organ imaging, radioimmunoassay, patients urine etc.

waste which includes anatomical, microbiological waste etc; blue radiology and kitchen and laundry activities. The effluent generated
waste including sharps; white waste includes sharps with metals from hospitals constitutes domestic wastewater as well as infectious
and red waste includes infected waste (Bio-Medical Waste and hazardous wastewater since it contains pathogenic microbes,
Management Rules, 2016) (Katoch and Kumar 2015). drug residues, chemicals, biological tissues, cultures, chemical toxins
The Bio-medical waste from hospitals of Delhi is treated etc (Mesdaghinia et al., 2015; Sciences et al., 2015; Tsai et al.,
by two common bio-medical waste treatment facilities namely SMS 2015). The composition of hospital effluent is presented in fig 3.
Water Grace BMW Pvt. Ltd. that caters to West, South west, Central, The health care is one of the major water consuming sectors.
East, Shahdara and North East parts of Delhi and Biotic Waste The water consumption in a hospital varies from 400-1200 litres/
Solutions Pvt. Ltd. which caters to North, North west, New Delhi, bed/day (Sule et al., 2010). In America, the amount of hospital
South and South East areas of Delhi. Available stats reveal that effluent generated is approximately 1000 l/person/day. Through a
around 25 metric tons of Bio-Medical Waste is being processed questionnaire survey conducted in 75 hospitals of Delhi, it is found
by two Bio-Medical waste Facilities each day. On analysis of total that the water consumption in hospitals of Delhi varies from 450-980
quantum of bio-medical waste treated by both the operators of Litres/bed/day(Singh et al., 2013).On the basis of data collected,
CBWTFs in Delhi, it was found that on an average, 59% the water consumption and wastewater generation has been
component of total BMW is incinerable, 8.0% is glass, 30% is evaluated.The quantum of wastewater generated from hospitals is
autoclavable, and 3% are sharps. The percentage wise bio- huge and poses a great threat to environment and thus human health.
medical waste generation is presented in fig. 2. The major water consuming units in a hospital are wards,
On the basis of the data collected through questionnaire kitchen, laundry, laboratories, operation theatres, haemodialysis
survey it was found that the waste generation on a per bed per day units etc (Singh et al., 2013).The maximum water is consumed in
basis ranges from 110 to 2783 grams per bed per day. The variation wards followed by toilets, laboratories and floor washing. The water
in range is attributable to factors like, type of HCF, occupancy, consumption pattern in the hospitals is shown in fig. 4.The wastewater
number of beds, category of hospitals like government or private discharged from laboratories, wards, operation theatres and trolley
and effectiveness of segregation. The analysis of data also reveals washing areas may have emerging contaminants in their discharge.
the following: According to the questionnaire survey, it is found that 56% of the
• The bio-medical waste generation in hospitals having bed strength total effluent is expected to have emerging contaminants. The effluent
50-99 is 5.3 TPD. generation pattern is presented in the fig. 5.Thus, it is very important
• The bio-medical waste generation in hospitals having bed strength to impart adequate treatment to hospital wastewater before
100 and above is 18 TPD. discharging into drain.
• Study reveals that the waste generation in 100 bed and above in As per the data collected from hospitals of Delhi, it is found
capital is ranging from 0.028 to 1.669 kg/bed/day with an average that the quantum of water consumption and wastewater generation
of 0.486 kg/bed/day. increases with the increase in bed strength. The same is represented
Hospital effluent management: The hospital effluent is the in the Fig. 6. The total water consumption by hospitals having bed
wastewater being generated in the premises of health care facilities strength above 50 is 31.09 MLD and in turn the wastewater generated
from all the activities including medical and non-medical activities. is 24.79 MLD. However, the treated water has to be characterized
The effluent is generated in the hospitals from wards, operation with respect to various chemicals and other priority contaminants
theatres, laboratories, dialysis units, emergency and first aid, wards, that could be probably present in the effluent to explore its reuse

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Dhingra et al. Biomedical waste generation and management

Fig. 1a: Composition of solid bio-medical waste Fig.1b: Trend of Bio-medical waste generation, population and hospital beds

Fig. 3: Composition of hospital effluent

Fig. 2: Category wise Bio-medical waste generation

Fig. 5: Effluent generation pattern

Fig. 4: Water consumption pattern

hospitals. The issue needs in depth knowledge for executing a plan
potential. However, before this certain contaminants have to be to implement the provisions of the rules (Katoch and Kumar 2015).
identified which must be analyzed in the effluent discharged from the There are three dimensions of the Bio Medical Waste Management,
hospitals. Though, it is recommended to use this treated water for Rules 2016. First, to prevent harm to the environment, to the
non-consumptive purposes like washing pavements, flushing etc. community, and public health. Secondly, to protect health and safety
Current bio-medical waste management practices: of the healthcare workers (handlers) and lastly, to prevent incidents
The bio-medical waste management has become a and injuries which sometimes can become like minor emergency
daunting reality for the healthcare administrators specially in large (Kumari et al., 2012).

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Dhingra et al. Biomedical waste generation and management

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1- Segregation; 2- Bins; 3-Package material; 4-Schedule IV label; 5-Bin Trolleys; 6-barcoding;
7-Internal treatment record; 8-Training record; 9-Waste generation record; 10-Immunisation
Fig. 6: Water consumption and wastewater generation in hospitals of Delhi record; 11-Segregation labels; 12-Isolated storage sites; 13-Trolly washing area; 14-Pretreat-
ment of solid waste; 15-Preatement of liquid waste; 16-STP/ETP; 17-PPEs

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1- Segregation; 2- Bins; 3-Package material; 4-Schedule IV label; 5-Bin Trolleys; 6-barcoding;
7-Internal treatment record; 8-Training record; 9-Waste generation record; 10-Immunisation
record; 11-Segregation labels; 12-Isolated storage sites; 13-Trolly washing area; 14-Pretreat-
ment of solid waste; 15-Preatement of liquid waste; 16-STP/ETP; 17-PPEs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Fig. 10: Percentage of compliance of parameters 1- Segregation; 2- Bins; 3-Package material; 4-Schedule IV label; 5-Bin Trolleys; 6-barcoding;
7-Internal treatment record; 8-Training record; 9-Waste generation record; 10-Immunisation
The deficiencies in the 36 hospitals with respect to record; 11-Segregation labels; 12-Isolated storage sites; 13-Trolly washing area; 14-Pretreat-
ment of solid waste; 15-Preatement of liquid waste; 16-STP/ETP; 17-PPEs
seventeen parameters for compliance of Bio-medical Waste
Fig. 11: Deficiencies in the existing BMWM
Management Rules, 2016 have been rated. One point was given
for compliance and zero for partial or non-compliance. The total 49; 50-99 and 100 &above. A checklist was made for recording the
compliance in each category was calculated and is represented compliance and deficiencies in the existing system. The checklist
in the graph. The seventeen parameters for compliance are focussed on details of general infrastructure and compliance of Bio-
presented in table 2. medical waste management rules with respect to these 17
The shortcomings in the bio-medical waste and effluent parameters. The visits to the hospitals and meetings with the stake
management in the hospitals has been studied by visiting 36 hospitals holders including officials of Delhi Pollution Control Committee and
including 12 hospitals of each category having bed strength of 10- nodal officers of bio-medical waste management made us clear

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Dhingra et al. Biomedical waste generation and management

about the following deficiencies in the compliance of Bio-medical faced by them due to certain grey areas in the new rules (Capoor
waste management rules, 2016. MR 2018; Kishore et al., 2014) have been highlighted below:
Evaluation of compliance of BMW Rules, 2016: Although in · The new rules have made it mandatory to pretreat the effluent
most of the countries, the medical waste is not being given a special probably containing chemicals, drug residues, disinfectants,
attention and it is not regulated under strict laws and rules. . In hazardous contaminants, microbial residues etc. Howsoever, our
European countries like Spain, the biomedical waste is being country has very few photocatalysis units which ensure 100%
regulated in various laws for example Law 10/98 on waste, Decree removal of microbes and decontamination of drugs specially
2263/1974, Royal Decree 1349/2003 for radioactive waste antimicrobials.
Ministerial Orders of 13 July 1998 and 21 July 2001 and Royal · The antibiotics and certain hazardous chemicals are capable to
Decree 833/1988 for hazardous waste have been implemented. pass through the existing treatment technologies like ozonation,
(Insa et al., 2010) . In India the biomedical waste has to be managed as reverse osmosis, membrane filtration, biological treatment,
per Bio-medical waste management rules, 2016. (Kishore et al., 2014) ultraviolet radiation etc.
On the basis of visits made to 36 hospitals of Delhi, the · The rules have mandated the use of non chlorinated blood bags,
grading in terms of compliance (C), partial compliance (PC) and howsoever; they have a disadvantage of decreasing the shelf life
non-compliance (NC) has been done for 17 parameters which are of blood corpuscles.
represented in the Table 3. The percentage of parameters complied, · The pre-treatment of chemical liquid waste includes urine of the
partially complied and non-complied with Bio-medical waste patients, body fluids etc. Collecting them separately and then treating
management rules, 2016 is represented in fig 10. It is found that them before discharging into sewage treatment plant is a challenge.
only 46% of the parameters are complied by the 36 hospitals. The · The use of sodium hypochlorite at such high concentration is
compliance, partial compliance and non-compliance of the costly as well as hazardous.
parameters in 3 categories of hospitals is presented in fig 7,8&9 · Segregation as per color coding raises questions regarding many
respectively. Not even 50% hospitals having the bed strength of consumables of all the waste categories: In yellow category, the
10-49 & 50-99 are complying with these parameters in accordance caps, gowns, mask, shoe covers, blotting paper, paraffin blocks,
to the rules as shown in fig. 7. There is a maximum partial compliance swabs, indicator tapes, drugs dispensed in dextrose/ saline bottles
in middle strength hospitals as depicted in fig. 8. In hospitals having are still the grey areas. If the non-infective waste is sent for
more than 100 beds the compliance of maximum parameters is incineration it just adds to the concentration of dioxins and furans
more than 70%, however, maximum hospitals are still not pre- in the air. The disposal of vacutainers, eppendorf tubes, PVC
treating the liquid waste discharged by them as shown in fig. 9. gloves is still confusing in red category. In the white category, the
All people handling Bio-medical waste need to strictly follow mutilation of all sharps is not possible for example: laryngoscope
the colour coding segregation rules. Improper segregation of waste blade, all wires, metal insulin needle, eye needle, stab knife.
may increase the chance for infection and cross contamination. The In the blue category, the grey areas include glass slides coverslip,
Occupier has the responsibility to train, guide and help the health glass chambers, sternal wire, orthopaedic splint etc.
care facility and workers to achieve 100% segregation of waste. Suitable management practices and treatment
The deficiencies in the existing Bio-medical waste management technologies: The spirit of the law demands three things, firstly all
system are presented in the fig 11. It is found that the nursing infected waste has to be disinfected. Secondly all items that can be
homes/ hospitals having low bed strength ranging from 10-49 beds reused, have to be disfigured /mutilated /destroyed and lastly and
are poor in compliance of the rules. More than 70% are deficient in most important is prevention and control of harmful impacts on
all the parameters. Only 40% hospitals in these categories are environment. For achieving these, it is essential to adopt the most
maintaining the waste generation records. In the second category suitable waste management practices and technologies (Kumari et al.,
of hospitals having 50-99 beds, it is found that 50% of the hospitals 2012; Gautam et al., 2010). For solid bio-medical waste treatment and
are not able to efficiently comply with the norms prescribed in the management, the following treatment technologies should be used:
bio-medical rules. In hospitals having more than 100 beds, the Autoclave is the wet steam sterilization process in which waste is
compliance is still better. The compliance with respect to most of the subjected to temperatures around 160oC and pressure upto 6 bars
parameters is more than 70%, however it is still lacking in terms of for 45 minutes. The autoclave process gives a very high pathogen
maintenance of ETP/STP, record keeping and displaying of BMW and virus kill rate, although the fibrous products which come from
segregation labels. Thus, it can be concluded that the rate of the process are susceptible to bacteria and fungus as they are high
compliance improves with the increase in size and bed strength of in starch, cellulose and amino acids.
the hospitals. Dry Heat Sterilization (killing or removal of all microorganisms,
Implementation challenges in the Bio-medical waste including bacterial spores) technique requires longer exposure time
management rules, 2016: The new Bio-medical waste management of 1.5 to 3 hours and higher temperatures than wet heat sterilization.
rules were notified on 28th march, 2016. Since, then health care Dry heat does most of the damage by oxidizing molecules. The
facilities are in process of implementing these rules. These rules essential cell constituents are destroyed and the organism dies.
have made the key stakeholders to be responsible for pretreatment The temperature is maintained for almost an hour to kill the most
of waste in addition to segregation but there are certain challenges difficult of the resistant spores.

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Dhingra et al. Biomedical waste generation and management

Table-2: Deficiencies in the existing Bio-medical waste management in hospitals of Delhi

Parameters Compliance as per BMW Rules, 2016 Deficiencies in the existing system (Partial/ Non- Compliance)
Segregation As per the color coding Segregation is not in accordance with color coding mentioned in the
prescribed in the rules. Rules, 2016.Beddings and linen contaminated by blood and other
infected fluid not discarded as per the norms. Voluminous materials
need to be cut to the size of the yellow colored waste bag.Bags,
boxes and sharp containers carrying waste have not been found
sealed in few hospitals.
Bins Should be color coded, pedal operated Pedal operated bins are still not used in all the hospitals.
and of appropriate volume.
Package Material Needs to be of certain specific size, grade, Color coded storage material (bags) not provided in all hospitals.
design, symbols, markings and should
comply with Bio-medical waste
management Rules, 2016.
Schedule IV Label For tracking the point of generation of waste. The stickers on the BMW bags are not in accordance with
Should be there on each bag carrying waste. Schedule IV.
Bin Trolleys Should be proper according to the bin volume. In few places, the bins have been found dirty as in they were not
being regularly washed with detergent and hypochlorite solution.
Barcoding To ensure there is no pilferage of waste Barcoding is yet to be implemented to track the waste from the
from point of generation to final disposal, source of generation to final disposal. Installation of a Barcode
it is important to implement barcoding of tracking system has been mandated to ensure no pilferage of waste
each bag. Has to be done in each HCF. happens from the point of generation upto final disposal.
Internal treatment record Regarding operation of all treatment Poor record maintenance.
equipment including microwave,
autoclave, STP, ETP etc.
Training records To ensure effective management. Gap among various stakeholders including policy makers,
academicians, hospital representatives.Lack of training among the
staff handling bio-medical waste.There is no clarification regarding
provisions of the
Waste generation record at ward To track the waste generation and its Poor record maintenance.
level and end point level quantum
Immunisation of handlers record To be provided as per their work profile. Poor record maintenance.
The records have to be maintained for 5 years
BMW Segregation labels Should be present at each point of Labels are not adequately provided at each segregation point.
waste generation
Isolated storage site It should be in an isolated space, well Isolated storage sites are not proper in terms of partitioning and in
partitioned and of appropriate volume some hospitals, they are located in open access areas.
Trolley washing area Should be separately allocated and Trolley washing areas are not separately allocated and not
connected to STP maintained.Trolley washing area is not connected with
STP/ ETP in some cases.
Pre-treatment of solid waste To be done by autoclaving, microwave, Sharp blasters and dry heat sterilization is not adopted in many
sharp blaster, dry heat sterilization etc hospitals. The spore tests in many hospitals are found to be positive.
Pre-treatment of liquid waste The liquid waste probably contains emerging The liquid waste from laundry and laboratories is being sent to
contaminants. It should be treated before Sewage treatment plant without imparting chemical treatment.The
discharging into STP laundry facility is lacking in terms of compliance.Untreated
wastewater generated from laboratories/tissue cultures containing
chemicals may hamper the biological treatment being imparted.
STP/ ETP Should be adequate and operational None of the visited hospitals ever got the characterisation of the
hospital effluent done with respect to the probable emerging
contaminants present.
Personal protective equipments The PPEs should be made available to The waste handling staff at storage site are not equipped with personal
waste handlers. protection equipments like masks, gumboots etc.
Sources: Gupta et al., 2009; Anon 2015
Microwave technology of clinical waste in the healthcare waste Incineration is a waste treatment process that involves the
sector is considered an alternative technology of the incinerator combustion of organic substances contained in waste materials.
and is a steam-based process, and electromagnetic waves with Incineration and other high-temperature waste treatment systems
frequencies between radio and infrared waves that use wet inside are described as “thermal treatment”. Incineration of waste materials
the wastes or by additional steam to sterilize wastes and destroy converts the waste into ash, flue gas and heat.
infectious agents and pathogenic organisms in the waste. Macerators of single use pulp items greatly reduce the risk of

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Dhingra et al. Biomedical waste generation and management

cross contamination. This modern, hygienic and environmentally BMW is incinerable, 8.0% is glass, 30% is autoclavable, and 3%
friendly method of disposal has become the standard and best are sharps. Study reveals that the waste generation in 100 bed
practice in hospitals and increasingly around the world. Pulpmatic and above in capital is ranging from 0.028 to 1.669 kg/bed/day
range of machines offer a complete macerator system for the with an average of 0.486 kg/bed/day. The wastewater containing
disposal of medical pulp and human waste providing a hygienic, chemical residues, drugs and infectious substances constitutes
safe disposal system. 24% of the total effluent rest is domestic and grey effluent. As per
Sharp Blasters The unit processes the sharps in a metal container the data collected from hospitals of Delhi, it is found that the quantum
for up to two and a half hours at temperature reaching 185°C, of water consumption and wastewater generation increases with
sterilizing, mutilating the infectious wastes and encapsulating the the increase in bed strength. The total water consumption by
same into a sealed container for safe disposal. Computerized system hospitals having bed strength above 50 is 31.09 MLD and in turn
ensures maintenance of critical operational parameters not requiring the wastewater generated is 24.79 MLD. The compliance, partial
any manual handling (Kumari et al., 2012; Gautam et al., 2010). compliance and non-compliance of the parameters as per the
Dry heat sterilization, macerator and sharp blasters are newer Biomedical waste management rules, 2016 in 3 categories of
technologies having less adverse impacts on environment. These hospitals has been assessed and it is revealed that not even 50%
are more efficient in infection control and reducing sharp injuries. hospitals having the bed strength of 10-49 & 50-99 are complying
Till date they have been adopted only in few hospitals of Delhi. with the parameters in accordance to the rules. There is a maximum
The wastewater should be imparted tertiary level treatment partial compliance in middle strength hospitals. In hospitals having
for its reuse of water for cleaning, flush washing purposes to save more than 100 beds the compliance of maximum parameters is
money as well as water. The organic municipal solid waste should more than 70%, however, maximum hospitals are still not pre-
be composted through organic waste converter and reused as treating the liquid waste discharged by them. Thus, it can be
manure. A buffer zone should be created in the form of green belt. concluded that the rate of compliance improves with the increase
The gas based boiler should be preferred over oil fired/coal fired in size and bed strength of the hospitals.
boiler. The refillable pump spray bottles should be used rather It is important that if the total quantum of waste calculated
than single-use aerosol cans. The rain water harvesting system on a per bed per day basis is more than the benchmark of 250
should be installed on roof top. The gas based hot water generator grams/per bed/per day laid by Indian Medical Association, the total
and boiler should be used where possible. Hybrid type hot water cost of treatment by the Operator should increase and eventually
generator by using solar water heater should be encouraged. the hospital will have to pay more. This will encourage hospitals to
The conventional water heating systems must be replaced in a focus on waste minimisation and effective segregation. The average
phase manner and solar water heating system should be installed. bio-medical waste generation per bed per day in Delhi has been
The integrated HVAC system should be planned for all the heating, estimated to be 486 grams solid and 480 liters of wastewater per
ventilation and air conditioning requirements. The retrofit fixtures bed per day. It is therefore suggested that the HCF ensures proper
should be installed in wards and public rest rooms. The low flow segregation of waste as well as keep a track of the total BMW is
shower heads, bath and sink faucet aerators and low flow toilets generated as per Indian Medical Association standard. The
should be used. Restrict lawn watering to evening hours to successful implementation of a medical waste management rules
decrease evaporation and maximize effectiveness. The soaker requires significant cooperation among the concerned parties, and
hoses should be used instead of sprinklers in lawns to minimize commitment in terms of time and resources management. The main
evaporation. Water audit and energy audit must be conducted to problem relating to solid bio-medical waste management and disposal
save the water for future. The Occupier must conduct periodical is the sharp injuries and spreading of infections which can be
checks to ensure that no municipal waste is being mixed with Bio- controlled by using modern technologies like dry heat sterilization,
medical waste to keep service charges within the waste limit. macerators and sharp blasters. To protect the aquatic environment,
Waste reduction can be optimized through a comprehensive it is important to provide treatment to hospital effluent before it is
program to oversee its environmentally sound segregation discharged in the municipal sewage system. Sludge from effluent
techniques such as source separation, storage, transportation, treatment plants installed in hospitals should be managed with more
treatment and disposal(Rajkumar Joshi 2016). By providing training precautions as municipal waste sludge. There are still a lot of
to the staff whose responsibilities include materials handling and deficiencies in the implementation of new rules. Also, there are
waste management, health administrators can help reduce the certain grey areas in the rules, 2016 that needs further clarification.
impact of medical waste on humans and the environment (Anyinam In order to combat these issues it is important that a Policy Framework
2010; Emmanuel et al., 2013). should be worked out. Then next step is to make a plan. This can
It can be summarised that the BMW generation has an only be done after a ‘Situation analysis’ has been conducted so that
increasing trend with respect to population of Delhi. The BMW per gaps have been identified. This would require preparing a map of
bed per day has increased from 306 grams in 2001 to 432 grams all generation points, the work up of resources and materials
in 2011 and 520 grams in 2017. On analysis of total quantum of required, appointing a technically qualified Nodal officer. A list of
bio-medical waste treated by both the operators of CBWTFs in handlers should be prepared for Training, Occupational Health
Delhi, it was found that on an average, 59% component of total and Safety. The regular health check-ups should also be practiced

Research in Environment and Life Sciences 82 March, 2018

 Dhingra et al. Biomedical waste generation and management

for handlers. Depending upon the number of handlers and the Gautam, V., Thapar, R. and Sharma, M.: Biomedical waste management:
Incineration vs . environmental safety. 191–193 (2010).
nature of their job, selection of Personal Protective Equipment (PPE)
Gupta, S.: Rules and management of biomedical waste at Vivekananda
should be worked out. The immunization against tetanus and Polyclinic : A case study. Waste Management, 29: 812-819. (2009).
Hepatitis B must be offered within a fortnight to a worker joining Insa, E., Zamorano, M. and López, R.: Resources, Conservation and
duties. At least one person in every hospital must have a thorough Recycling Critical review of medical waste legislation in Spain.
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unknowingly the hospitals are violating the Rules. The new rules waste generation at healthcare facilities. 241–246 (2015).
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During this study, co-authors helped by motivating with for Wastewater Management in the Hospitals Wastewater
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