Design and Development of NSUT Bio-Medical Waste

Management
Hitesh Bhakuni, Amrita Cholia, Hrishi Keshava Sharma KP, Gantavya Vivek Punj, Pratendra Singh

Department of Mechanical Engineering, Netaji Subhas University of Technology, Delhi, India

Abstract - Hospital waste management is one of the prime concerns of medical authorities as well as
concerned government bodies in different countries. Health care wastes are all the accumulated wastes
generated in health care facilities (HCF), research facilities, laboratories and other heath related
facilities. Even health care operations conducted in every household can result in generation of medical
wastes. The amount of medical waste generated per day is increasing day by day due to increase in the
health care facilities all over the world. This waste is sometimes very hazardous and can lead to dreadful
effects not only to the human beings and animals but also to the environment. So, the medical waste
should be treated with adequate treatment method before disposing of directly into the environment.
This paper presents the various techniques used for biomedical waste management around the world
along with a detailed comparison with the current practices being followed in NSUT campus.

Keywords – Hospital waste management, HCF (Health Care Facility), Hazardous, Treatment method.

I. INTRODUCTION

Waste in general can be defined as “Any substance be it a solid, liquid, or gas, that has no direct use and
is discarded permanently“. A waste can be considered hazardous if it shows any of the characteristics
such as being flammable, reactive, explosive, corrosive, radioactive, infectious, irritating or sensitizing
[1]. Hospital waste means all waste generated, discarded and not intended for further use in the
hospital. Most of the hospital wastes generated comes from administrative, regular housekeeping
functions and are mostly non toxic or non hazardous that is it can be compared to household wastes.
However, about ten to fifteen percent of the wastes in hospitals are hazardous and can create health
risks for the whole community if proper disposal/treatment procedures are not followed correctly.

According to World Health Organization (WHO) medical waste related reports and studies, around 85%
of hospital wastes are found to be nonhazardous, 10% infectious (biologically hazardous), and the
remaining 5% are toxic chemicals, pharmaceutical, and radioactive wastes[2]. This estimate, however, is
not consistent for many developing countries. The proportion for hazardouswaste varied from country
to country: Pakistan about 20%,Nigeria 26.5%, and in Sub-Saharan African countries about 2–10%. In
Bangladesh, 36.03% in diagnostic centers and higher clinics; and about 50% in urban health centers
ofTanzania constituted hazardous waste[3].

As per the compiled annual report information submitted by SPCB for the year 2018, there are about
2,70,416 no. of Health Care Facilities (HCFs) out of which 97,382 no. of HCFs are bedded and 1,73,831
no. of HCFs are non-bedded. 1,10,356 no. of HFCs are granted authorization under the BMW Rules.
2,01,137 no. of HCF utilizes CBWTF and 12,326 No. of HCFs are having captive bio-medical waste
treatment and disposal facilities0. The total bio-medical waste generation is about 614 tonnes per day
out of which about 57 tonnes per day are treated by captive treatment facilities and about 472 tonnes
per day are treated by CBWTF. As reported, 27,301 no. of HCFs/CBWTFs were observed to be violating
the regulations of the BMW Rules[4].

Table 1 - The detailed bio-medical waste management scenario in India (2018)

No. of HCFs 2,70,416

No. of bedded HCF 1,73,831

No. of beds 22,06,362

No. of CBWTFs 200* + 28**

No. of HCFs granted authorization 1,10,356

No. of HCFs having Captive Treatment Facilities 12,326

No. of Captive Incinerators Operated by HCFs 120

Quantity of bio-medical waste generated in Tonnes/day 614

Quantity of bio-medical waste treated in Tonnes/day 534

No. of HCFs violated BMW Rules 27,301

No. of Show-cause notices/Directions issued to 16,956

defaulter HCFs

Note: (i) * - CBWTFs in operation (ii) ** - CBWTFs under installation

The proper management of biomedical waste has become a worldwide topic today. The hazards of poor
management of biomedical waste have raised the concern of the whole world especially due to its far-
reaching and long lasting effects on human, health and the environment. Thus the waste management
need to be efficient, safe and environment friendly to protect people from voluntary and accidental
exposure to these waste while collecting, handling, storing, transporting, treating or disposing.

The objective of this paper is to analyze the various procedures and techniques of biomedical waste
management in India and to suggest the best optimal bio medical waste management techniques which
are both cost effective and efficient, that can be implemented within NSUT campus .

II. LITERATURE SURVEY

Dhananjai Rai, Naveen Patel and Amitabh Kumar Srivastava have studied the biomedical waste related
practices at three major hospitals of Rishikesh which includes AIIMS (All India Institute of Medical
Sciences), Government hospital and NAH (Nirmal ashram hospital) (private) starting from month of
October 2017 to February 2018. The data is analyzed to find variation in biomedical waste generation
over the study period. The cross-sectional study involves various issues like sources, container and color
coding types, qualitative and quantitative composition of infectious wastes along with different methods
of waste handling, collection, segregation, treatment and disposal methods.

The sampling and methodology they used were divided in three phase.
1) First phase includes post period i.e. the time before the actual study which includes the permission
from the authority, questionnaire designing.
2) Second phase includes the implementation of the methodology adopted on the field. Name of the
hospitals, bed capacity, classification of waste generation during one month, color coding, waste class,
average number of individual bags collection from the hospitals during six months (Avg. no. bags per day
per months), waste generation in three hospitals (generation rate kg/bed/day).
3) Third phase includes the collected data were tabulated, analyzed and presented by proper statistical
method

They observed that NAH had lower waste generation during November and October while government
hospital had highest during November and February. It is obvious that the AIIMS and government
hospital have highest amount of waste generation as these general hospitals are well known centers for
the accident victims. AIIMS having almost all facilities for efficient and effective treatment of various
diseases, therefore it have high number of daily patients, hence generations of waste bags is higher in it.

Table 2.Basic information related to the hospitals

Name of the Waste generation Avg. number of

Bed capacity
hospitals during one month patient per day

439
AIIMS 8318.1 1314.88

165
Government 3700.8 360.42

NAH 130
1935 120.1
Fig 1:- Average waste generated per day in three
hospitals of Hrishikesh.

(Kg/day)

III. DEFINITION OF BIO MEDICAL WASTE

Biomedical waste can be defined as the waste (solid, liquid or gas) produced by hospitals, clinics, nursing
homes, research institutes, laboratories and other health care units, that are main source of health
hazards and thus are needed to be treated and disposed of in a specific manner.

Bio-medical wastes mainly comprises of human anatomical waste i.e. human tissues, animal anatomical
waste (i.e. experimental animal carcasses, body parts, organs etc), items contaminated with blood,
expired or discarded medicines, blood bags, microbiology, biotechnology and other clinical laboratory,
disposable syringes, waste sharps, broken or discarded and contaminated glasses etc.

IV. CLASSIFICATION OF BIO MEDICAL WASTE

Hospital wastes can be of various types and these need to be classified first in order to determine which
type of disposal means can be adopted.

 First category of medical wastes is infectious wastes. These includes various pathogens such as
bacteria, viruses, fungi which may be found in cultures in laboratory work, in wastes from
surgeries or autopsies on patients who had contracted infectious diseases, wastes from such
infected patients and so forth.

 Second category of wastes is pathological wastes. Such wastes consist of tissues, organs, human
fetuses, animal carcasses, blood, body fluids, organs etc. Such wastes are inevitable part of
many hospital procedures such as surgeries, treatments, autopsies and so forth.

 Third category of wastes includes sharp objects such as needles, syringes, scalpel, blades,
knives, saws, broken glass, nails etc. These may or may not be contaminated but are considered
hazardous health care wastes.

 Fourth category of wastes consist of pharmaceutical wastes such as expired or unused drugs,
vaccines, gloves, masks, drug vials and others. These can prove toxic to the environment if not
handled properly and hence, their proper disposal is very important.
  Fifth category of wastes is genotoxic wastes which can be particularly hazardous to society.
These consist of cytostatic drugs or vomit, urine of patients being treated with cytostatic drugs
for chemotherapy and carcinogenic diseases.

V. PROBLEMS RELATED TO BIO MEDICAL WASTE

Within a health care facility or hospital, the main groups submitted to risks are: Doctors, medical nurses,
Patients, Visitors, Workers in ancillary services, Service workers dealing with waste treatment and
disposal of health unit. Regarding the health care workers, three infections are most commonly
transmitted: hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency (HIV) virus.

Outside the hospital there is a good amount of risks to the neighborhood and to the people who carry
waste to the locations where they are treated. Any leakage or accident can lead to a health hazard[5].

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 biological, chemical and
radioactive.

Environment problems can arise due to the mere generation of bio-medical waste and from the process
of handling, treatment and disposal. Some of them are as follows

● 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.

● 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. The
pathogens present in the waste can reach 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

● Land Pollution is caused by the final disposal of all bio-medical waste. Even liquid effluent after
treatment is spread on land. Hence, pollution caused to land is inevitable. Open dumping of bio-
medical waste is the greatest cause for land pollution.

From our study we found some challenges as follows:

● Awareness need to be strengthened with regards to biomedical waste management.

● Treat large amount per day of bio medical waste in accordance with Bio-Medical Waste Rules.
 ● Number of Common Bio Medical Waste Treatment Facilities (CBWTF) is not adequate to handle
all the bio medical wastes generated.

● Promotion of public private partnership.

● New technologies to be promoted for destruction of toxic bio medical wastes.[5]

VI. Material and Methods

The information related to the generation, segregation, treatment, collection,storage,
disposal,transportation and its management were carefully studied and collected.

Methods adopted for data collection are shown in Table-2.

Table 3. Methods adopted for data collection.

Regarding Methods

Generation, segregation,
treatment, Personal observation and
Primary source collection,storage, investigation at the site,
transportation and disposal questioner, interview.
of the medical waste.

Topic related research paper

Secondary source E-journal, internet.
collection.

Study Area
The study was limited to NSUT ( Netaji Subhas University of Technology ) medical center. The bio-waste
management practices in the university were carefully observed, studied and information regarding the
management, generation, treatment, segregation, collection, storage and disposal of wastes were
obtained.

 Present Practice
After the visit to the campus facility our team has observed the following:

 On an average approximately 1-2kg biomedical waste per day is generated in NSUTwhich

mainly comprises of waste like used cotton,bandages, syringes, medicines etc.
 The medical centre is not a primary health care centre and the biomedical waste generated
is not separated/segregated properly and is directly mixed with general waste and then
finally handed over to MCD.
 There is no separate storage facility for hazardous/infectious bio-medical waste.
 Staff is not using proper PPE kits while collecting the waste.
 Bio-Medical waste management rule, 2016is not being properly implemented.
 Sodium hypochlorite (NaOCl)/Bleach is used for disinfection purpose.
  Suggestions

 Color coded bins/containers should be used to ensure appropriate separation of wastes (Yellow,
red, white and blue category bins).The type of waste that should be added in each bin is
mentioned below.
 Biomedical waste management rules should be followed.
 Conduct waste audits -Do periodic spot checks to see if medical waste is being disposed of
correctly and that the plan is being followed.
 The bar coded system and sophisticated tracking device (GPS) should be used to check proper
collection and disposal of bio-medical wastes from hospital to treatment facility. It will help in
preventing environmental damage and health hazards.
 To ensure occupational safety of all its health care workers and others involved in handling of
bio-medical waste appropriate and adequate personal protective equipments (PPE) should be
provided.
 For liquid waste treatment, closed disposal systems should be mounted (ex-
Hypogermishedmachine). It is a semiautomatic machine that disinfects the waste with
hydrochloride.
 Weekly awareness meetings and employee training program need to be organized for proper
segregation, disposal and transportation of biomedical waste.
 Green fuel (CNG) vehicle should be used for transportation instead of tractor, trolleys or the
petrol and diesel fueled vehicles.
 After ensuring treatment by autoclaving or microwaving, the recyclables from the treated bio-
medical wastes such as plastics and glass, shall be given to recyclers having valid consent or
authorization or registration from the respective State Pollution Control Board or Pollution
Control Committee.

Table4:- Current practices and suggestions

Current Practice Suggestions /Possible changes

 No use of color coded bin  Use of color coded bins are suggested

 BMW management rules are not followed  BMW management rules should be followed

 Data of the waste collection is not  Proper data should be recorded and uploaded in the
uploaded in NSUT website NSUT website regularly

 Tracking of waste is not done  Bar coded system can be used

  No storage room for infectious BMW  Dedicated waste storage room should be made for
this

 Liquid waste treatment is not done  Automated liquid waste treatment system for pre-
treatment of effluents can be implemented.

 Proper PPE kits are not in use  PPE kits should be used

 Govt. rules and guidelines about BMW  Govt. rules and guidelines about BMW waste
waste treatment are not displayed treatment should be displayed

 Awareness program are not done  Awareness program could be conducted regularly
regularly about the risk of infections. about the risk of infections.

 Cost Estimation

Table 5 – Estimated cost

ESTIMATED PRICE Remarks

COMPONENTS Companies/Sources
(INR) (Best Source)

PPE KIT 500 Amazon/Flipkart Amazon

COLOUR CODED BINS

ARVS Equipment Private Ltd/HS
(PEDEL BINS (10Lt) + 2,150 ARVS equipment
Mediworld
SHARP CONTAINER(5Lt))
ARVS Equipment Private Ltd/HS
AUTOCLAVE (25 Lt) 20,000 Industrybuying.com
Mediworld/Industrybuying.com
BIO-MEDICAL LIQUID
WASTE TREATMENT ARVS Equpment Private Ltd/HS
2 LAKH/25k HS Mediworld
(HYPOGERMISHED-75Lt/ Mediworld
HYPODROP-60Lt)

VII. HOSPITAL WASTE MANAGEMENT BASIC PROCEDURES

According to Bio-Medical Waste Management Rules, 2016, for the effective and efficient waste
management system in any heath care facilities or research institutes following steps or procedures can
be implemented :-

⮚ 1. Identification of waste type.

 ⮚ 2. Segregation of the waste.
⮚ 3. On-site/Off-site treatment.
⮚ 4. Transportation and storage of waste.
⮚ 5. Proper disposal of waste.
⮚ 6. Proper training of above procedures along with awareness of use of personal protective
equipment among working staffs.

1. Identification of waste type

Bio-Medical waste typically include following types of waste:-

❖ Human/Animal anatomical waste

❖ Microbiology & biotechnology waste
❖ Sharps ( needles, knives, syringes etc. )
❖ Discarded Medicines ( Pharmaceutical waste )
❖ Cytotoxic and Genotoxic waste
❖ Incineration Ash
❖ Chemical waste

2. Segregation of the waste

Segregation of waste should be properly done through color coded system as per the BMW rules, 2016

YELLOW CATEGORY RED CATEGORY WHITE CATEGORY BLUE CATEGORY

❖ Anatomical ❖ All Recyclable ❖ Sharp Waste ❖ Broken &

Waste Waste Unbroken Glass
( Metals )
❖ Solid Waste ( Plastic ) ❖ Metallic Body
(plasters etc.) Implants

❖ Microbiology
Waste

❖ Discarded
Medicines

❖ Linen &
Beddings
 ❖ Blood Bags

❖ Chemical Waste

3. On-Site / Off-Site Treatment

3.1 On-Site Treatment.

3.1.1 Autoclaving

Autoclaving is a thermal treatment which is typically used for sharps and certain other types of
infectious waste. An autoclave is in a large pressure cooker that uses high temperatures and steam to
deeply penetrate all materials and kill any microorganisms. Depending on the type and amount of waste
you will need to sterilize, you can purchase an appropriately-sized autoclave for your facility. These
appliances range from 100 liters to 4,000+ liters in volume for bulk waste treatment[1]. Modern
autoclaves are also automated to minimize human involvement and therefore reduce needle-stick
injuries and contamination. Decontaminated sharps and other medical waste that’s been autoclaved can
then be handed over to your medical waste removal vendor to be disposed of as non-infectious waste.

However, keep in mind that medical wastes such as chemical waste, including chemotherapy waste, as
well as pharmaceutical waste can’t be decontaminated in an autoclave[4].

3.1.2 Chemical Treatment

Often used to deactivate liquid waste, chemical treatment is designed to decontaminate or deactivate
certain wastes on site rather than packaging and sending them to a separate facility. Since liquids are
highly susceptible to spills, it’s typically best to have them treated as close to the generation site as
possible. Chemical treatment can also be applied to some non-liquid infectious wastes, but they would
typically need to be shredded first to ensure that all portions of the waste are exposed to the chemicals.
Depending on the type of waste, chemicals like chlorine, sodium hydroxide or calcium oxide can be
used.
As per the guidelines issued by CPCB, chemical pre-treatment should not be used before incineration,
except for microbiological, lab and highly infectious waste[4].

3.1.3 Microwave Treatment

A microwave treatment system, similar to an autoclave, also uses heat to decontaminate medical waste.
These systems work best for waste that is not 100% dry or solid, as the moisture allows the heat to
penetrate deeper, and the steam sterilizes. Therefore, before microwaving, most types of medical waste
need to be shredded and mixed with water to achieve the desired effect. The bonus is that shredding
reduces the volume of the waste, so it can later be land-filled.

Microwave treatment should not be used for cytotoxic, hazardous or radioactive wastes, contaminated
animal carcasses, body parts and large metal items[4].
3.2 Off-Site Treatment.

3.2.1 Incineration

The main purpose of any medical waste incinerator is to eliminate pathogens from waste and reduce the
waste to ashes. However, certain types of medical wastes, such as pharmaceutical or chemical wastes,
require higher temperatures for complete destruction. Medical waste incinerators typically operate at
high temperatures between 900 and 1200°C. Incineration of medical waste should be performed in a
controlled facility to ensure complete combustion and minimize any negative effects for the
environment. The great thing about incineration is that it kills 99% of microorganisms and leaves very
minimal waste, if any.

3.2.2 Deep Burial / Land Disposal

Land disposal is typically used for shredded, treated and decontaminated waste. In certain cases, it can
also be used for hazardous waste or other untreated waste that cannot be decontaminated by other
means. Specialized sanitary landfill/deep burial sites exit to reduce the risk of soil and water
contamination and provide a safe space for medical waste disposal.

A pit should be dug about 2 meters deep. It should be half filled with waste, then covered with lime
within 50 cm of the surface, before filling the rest of the pit with soil[4].

3.2.3 Plasma Pyrolysis

Plasma pyrolysis is state-of-the-art technology that ensures safe disposal of medical wastes. It is a
environment friendly technology that coverts the biomedical waste into useful commercial byproducts.
Medical waste is pyrolyzed into CO, hydrogen and hydrocarbons when it comes in contact with plasma-
arc[6]. Direct use of waste products as combustion fuel or their indirect processing into another kind of
fuel helps in harnessing the energy contents.

4. Transportation

● Containers: puncture proof, leak proof,

● Bags: sturdy, properly tied
● Transport trolleys: designated & timely
● Staff protection: provided with protective clothing and other items
● Never put hands in a bag

5. Waste storage
 ● Closed covered area
● Away from the normal passages
● Easily accessible for transportation
● Radioactive waste special containers/ special treatment and disposal

6. Proper disposal of waste

● All infectious waste and sharps containers : Incineration

● All Domestic waste : Landfill
● All hazardous waste : Chemical treatment before disposal

VIII. CONCLUSION
This paper aims to analyze the procedures and techniques of biomedical waste management in India
and to suggest the best optimal techniques and procedures that can be implemented within NSUT
campus. Each and every health care facilities which generates biomedical waste needs to set up
requisite treatment facilities to ensure proper treatment of waste and its disposal so as to minimize risk
of exposure to staff, patients, doctors and the community from biomedical hazards. The infectious waste
that constitutes about 10% of the total waste generated on campus, it needs attention first. A system of
waste segregation, collection, disposal, transport, recycling, etc. is essentially required to be able to
upgrade the esteemed campus to a ‘zero-waste campus’. To achieve this goal, awareness must be
spread regarding the reduction of waste production, reuse, sanitary habits and careful handling of
waste, by inculcating the value of waste as a resource, into the minds of all. Management of the bio
medical waste is core responsibility of the hospital waste management team.

IX. FUTURE SCOPE

The paper can be extended to study the biomedical waste management of other educational institutions
like schools. According to the demand of the campus the authority may decide a combination of the
methods which might be best suitable. The paper can also be used to find the ways of reducing waste
management and also the ways of reducing risk to the people handling it in any suitable circumstances

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