November, 2018/ Vol 4/ Issue 7 Print ISSN: 2456-9887, Online ISSN: 2456-1487

Original Research Article

A study on evaluation of biomedical waste management in a tertiary

care hospital in South India
Ramalingam A. J.1, Saikumar C.2

1
Dr. Aishwarya J Ramalingam, Assistant Professor, 2Dr. Chitralekha Saikumar, Professor, both authors are affiliated with
Department of Microbiology, Sree Balaji Medical College & Hospital, Bharath Institute of Higher Education and
Research (BIHER), N0-7, CLC Works Road, Chennai, Tamil Nadu, India.

Corresponding Author: Dr. Aishwarya J Ramalingam, Assistant Professor, Department of Microbiology, Sree Balaji
Medical College & Hospital, Bharath Institute of Higher Education and Research (BIHER), N0-7, CLC Works Road,
Chennai, India. E-mail: [email protected]
...................................................................................................................................................................................................

Abstract
Introduction: Bio-Medical wastes are classified based on their source of generation which includes various risk factors
relatedto their handling and final disposal. The segregation of waste at the source of generation is the significant step.The
compliance in various categories of biomedical waste management in a tertiary care hospital was evaluated. Materials
and Methods: A checklist containing 17 parameters related to biomedical waste management such as ‘condition of waste
containers’, ‘segregation of waste’, ‘mutilation of recyclable waste was prepared and observed for compliance in 25
different patient care areas such as 9 Operation theatres, 1 casualty, 11 wards and 4 ICU. Each area was visited on any 3
non-consecutive days in the study period of 6 months from August 2017 to January 2018. Thus, a total of 6 visits were
made to each area and mean percentage scorewas analysed for each area and each category of biomedical waste
management. Results: For OTs, the mean percentage for ‘condition of waste containers’, ‘segregation of waste’,
‘mutilation of recyclable waste’ was 90%, 97% and 93% respectively. In casualty, the mean percentage was 89%, 94%
and 87% respectively. For wards, the meanpercentage for these categories was 88%, 93% and 89% respectively; and for
ICUs, the meanpercentage was 88%, 100% and 92% respectively. Conclusion: It was determined that more importance
needs to be rested for ‘mutilation of recyclable waste’ especially in wards.

Keywords: Bio-Medical Waste, Bio-medicalwaste segregation, Waste disposal, Biomedical waste management
...................................................................................................................................................................................................

Introduction
Biomedical waste (BMW) is defined as any waste generated when patient care activities are carried out in a health- care
setting, which has the potential to cause harm to human beings and environment. It is also known as clinical waste,
medical waste and health-care waste. It constitutes about 15 to 25% of total waste generated in a hospital [1]. In order to
avoid harm to human beings, animals and the environment special precautions and treatment modalities are required for
BMW [2]. Most common pathogens found to be transmitted by biomedical waste [3] are Human Immunodeficiency
Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV). It is therefore one of the top priorities for the
Hospital management and the healthcare professional to implement a proper policy and to ensure that the waste
management practices are being followed. Hence, due care is taken while handling and disposing it [1].

The World Health Organization (WHO) has classified medical waste into eight categories [1] which includes general
waste, pathological, radioactive, chemical, infectious to potentially infectious waste, sharps, pharmaceuticals, pressurized
containers as described in Table 1. Hospitals generate waste, which is growing over the years in its volume and type
poses a threat to public health and environment in addition to the risk for patients and workers who handle them. The
sources for biomedical waste management includes hospitals,primary health centres, research centres, blood banks,
mortuaries, animal houses, slaughter houses, blood donation camps.
Manuscript received: 07th November 2018
Reviewed: 16th November 2018
Author Corrected: 23th November 2018
Accepted for Publication: 30th November 2018

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November, 2018/ Vol 4/ Issue 7 Print ISSN: 2456-9887, Online ISSN: 2456-1487
Original Research Article
Table-1: Classification of biomedical waste
Category Waste type Treatment and disposal
Category 1 Human anatomical waste Incineration and deep burial
Category 2 Animal waste Incineration and deep burial
Category 3 Microbiology and biotechnology waste Incineration/microwave/autoclaving
Category 4 Sharps Disinfection/microwaving/autoclaving/shredding
Category 5 Discarded medicine and cytotoxic drugs Incineration/landfill
Category 6 Contaminated solid waste Incineration/microwave/autoclaving
Category 7 Solid waste (other than sharps) Disinfection/microwaving/autoclaving/shredding
Category 8 Liquid waste Disinfection and discharge in drains
Category 9 Incineration ash Disposal in municipal landfill
Category 10 Chemical waste Disinfection and discharge in drains and secured
landfill for solid wastes

The major problem associated with biomedical waste

 Risk associated with harmful chemicals, drugs to
includes non-compliance of Bio-medical waste
persons handling wastes at all levels.
regulation and disposal. Improper segregation, results in
mixing of hospital wastes with general waste making  “Disposable” being repacked and sold by immoral
the whole system hazardous. This in turn elements.
causesunpleasant odour, multiplication of insects and
 Risk of environmental pollution such as air, water
transmission of communicable diseases like typhoid,
and soil directly due to waste, or due to defective
cholera, hepatitis and AIDS through contaminated
incineration emissions and ash.
syringes and needles.Scavengers in the hospital are at a
greater risk of getting infections such as tetanus and
In India, the legislation governing Biomedical waste
HIV. The recycling of disposable syringes, needles and
management is called as Bio-Medical Waste
other medical devices without proper sterilization also
(Management and Handling) Rules, 1998 [6] and has
contribute to transmission of blood-borne infections
been propagated under Environment (Protection) Act,
such as Hepatitis, HIV. It is therefore essential to
1986 [7].
manage hospital waste in a most safe and eco-friendly
manner [4].
There are principally four functions for biomedical
waste management at source of generation. They are
The problem of bio-medical waste disposal in the
placement of waste containers or bins lined with waste
healthcare setting has become atopic of increasing
bags at source of generation, segregation of waste,
concern, encouraging hospital administration to pursue
mutilation of recyclable waste and disinfection of waste
new techniques of safe, systematic and cost-effective
[1, 2].
disposal of BMW. Biomedical waste treatment and
disposal includes incineration, autoclaving, microwave
The present study was conducted with the objective to
irradiation, chemical disinfection.
evaluate biomedical waste management practices at
source of generation in a tertiary care hospital of South
Need of biomedical waste management in hospitals
India.
[5]

The various reasons inviting a great need of Aims & Objectives

management of hospitals waste are:
To evaluate the practices of biomedical waste
 Injuries from sharps.
management such as condition of waste receptacles,
 Poor infection control activity leading to nosocomial
segregation of waste, mutilation of recyclable waste in
infections in patients.
different patient care areas in a tertiary care hospital in
 Risk of infection outside hospital for scavengers South India.The compliance in various categories of
handling BMW biomedical waste management in a tertiary care hospital
 Risk of infection to public living in the vicinity of was evaluated.
hospitals.
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November, 2018/ Vol 4/ Issue 7 Print ISSN: 2456-9887, Online ISSN: 2456-1487
Original Research Article

Materials and Methods

Sample size: 25 different patient care areas such as 9 Operation theatres, 1 casualty, 11 wards and 4 ICU. Each area was
visited on any 3 non-consecutive days in the study period of 6 monthsfrom August 2017 to January 2018. Areas were
visited during morning hours between 7 am and 10 am and evening hours of the same day between 3 pm and 5 pm
making a total of 6 visits to each area. All observations were made by same researcher. The chosen timings were such
thatpatient’s blood samples were withdrawn for lab diagnostic tests and maximum biomedical waste was generated in a
patient care area. Due to practical difficulties in visiting the patient care areas during evening and night hours when the
medications were given, such time period was excluded from the study.

Study design:A checklist was prepared containing the condition of waste containers, segregation of waste, mutilation of
recyclable waste (Table 2)

1. Condition of waste containers:

 Is red colour bin available in each area?

 Is yellow colour bin available in each area?
 Is blue colour bin available in each area?
 Is green colour bin available in each area?
 Is red colour bag placed in the red colour bin in each area?
 Is yellow colour bag placed in the yellow colour bin in each area?
 Is blue colour bag placed in the blue colour bin in each area?
 Is green colour bag placed in the green colour bin in each area?
 Is the biohazard symbol printed over waste bags?
 Are the colour bins covered?

2. Segregation of waste:

 Does the red bin with red bag contain only plastics?
 Does the yellow bin with yellow bag contain only soiled infectious waste?
 Does the blue bin with blue bag contain only glass-broken or unbroken, metallic and body implants?
 Does the green bin with green bag contain general waste?

3. Mutilation of recyclable waste:

 Is used hypodermic needle destroyed?

 Is used hypodermic needle disposed in white puncture-proof containers?
 Is used hypodermic needle re-capped?

Each desirable observation was assigned ‘1’ mark and each undesirable observation was assigned ‘0’ mark. There were
some parameters, observations which could be in part desirable and in part undesirable in a given area, such observation
was assigned ‘0.5’ mark. For example, if all the used hypodermic needles were destroyed and disposed in white
puncture-proof container it is considered to be desirable and allotted “1” mark. If none of the used hypodermic needles
were destroyed and disposed in white puncture-proof containers it is considered to be undesirable and allotted “0” mark.
If some of the used hypodermic needles were destroyed and some were not destroyed it was allotted “0.5” mark.

In the finalscore-sheet, there were 10 parameters noted under category “condition of waste containers”, 4 parameters
were notedunder category “segregation of waste” and 3 parameters were notedunder category “mutilation of recyclable
waste”. Thus, a total of 17 parameters were observed in each study area.

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November, 2018/ Vol 4/ Issue 7 Print ISSN: 2456-9887, Online ISSN: 2456-1487
Original Research Article
Table-2: Sample checklist
S. No Parameter Observation
Yes No
1. Condition of waste containers:
 Is red colour bin available in each area?
 Is yellow colour bin available in each area?
 Is blue colour bin available in each area?
 Is green colour bin available in each area?
 Is red colour bag placed in the red colour bin in each area?
 Is yellow colour bag placed in the yellow colour bin in each area?
 Is blue colour bag placed in the blue colour bin in each area?
 Is green colour bag placed in the green colour bin in each area?
 Is the biohazard symbol printed over waste bags?
 Are the colour bins covered?
2. Segregation of waste:
 Does the red bin with red bag contain only plastics?
 Does the yellow bin with yellow bag contain only soiled infectious waste?
 Does the blue bin with blue bag contain only glass-broken or unbroken,
metallic and body implants?
 Does the green bin with green bag contain general waste?
3. Mutilation of recyclable waste:
 Is used hypodermic needle destroyed?
 Is used hypodermic needle disposed in white puncture-proof containers?
 Is used hypodermic needle re-capped?
Data analysis: The mean percentage score was calculated for all categories of biomedical waste management and for all
the areas. In order to obtain the score for a particular biomedical waste management category, the marks attainedin 6
visitswas summated and the mean percentage score was calculated. The overall score of the particular category of
biomedical waste management and overall score of a particular area were analysed. StatisticalPackage for Social
Sciences (SPSS Inc., Chicago, IL, version 15.0 for Windows) was used for statistical analysis. All the quantitative
variables were analysed using mean, median (measures of central location) and standard deviation, 95% confidence
interval (measures of dispersion).

Results
Analyzation & interpretation of data: For OTs, the mean percentage score for ‘condition of waste containers’,
‘segregation of waste’, ‘mutilation of recyclable waste’ was 90%, 97% and 93% respectively. In casualty, the mean
percentage score was 89%, 94% and 87% respectively. For wards, the mean percentage score for these categories was
88%, 93% and 89% respectively; and for ICUs, the mean percentage score was 88%, 100% and 92% respectively (Table
3).

Table-3: Results

Category of Biomedical OT(n=9) Casualty Wards ICU (n=4) Overall score of

waste management (%) (n=1) (n=11) (%) category of Biomedical
(%) (%) waste management
(n=25)(%)
Condition of waste 90 89 88 92 90
containers
Segregation of waste 97 94 93 100 96
Mutilation of recyclable 93 87 89 92 90
wastes
Overall score of the area(%) 93 90 90 95 92

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Original Research Article
Discussion
The current practice of poor biomedical waste properlyattended. In a study in a tertiary care hospital in
management poses a huge threat to the community. Mumbai [10], it was found that waste segregation was
There is risk of transmission of various communicable less than 40% which was unsatisfactory. In studies
diseases such as gastro-intestinal infections, respiratory conducted in Egypt [11] and Ethiopia [12], the waste
tract infections, skin diseases due to various modes of segregation practices were found to be poor. Other
transmission such as injuries from sharps. Enterococcus studies from Lucknow and Belgaum, India showed
species, Staphylococcus aureus, Escherichia coli, good waste segregation practices. However, the precise
Klebsiella species, Pseudomonas species, Acinetobacter percentage of areas where segregation practices were
species Clostridium tetani, HIV, Hepatitis A, Hepatitis found good were not documented by the authors.
B are some of the most common microorganisms
responsible for infections [8]. As segregation of BMW is the most vital aspect of
BMW management more focus needs to be rested in
The assessment of scores of different areas showed that certain areas of hospital particularly in wards as the
score related to condition of waste containers and score (93%) was relatively less as compared to other
segregation of waste was not significantly different areas of hospital, though this difference was not
among various areas such as OTs, casualty, various statistically substantial. The high score in ICUs
wards and ICUs. couldpossibly be due to relatively good staff to patient
ratio compared to relatively less favourable staff to
The score related to ‘mutilation of recyclable waste’ patient ratio may be the cause for relatively lower score
was found to be considerably different between OTs in wards.
and casualty. The score in OTs (93%) was significantly
higher than casualty (87%). It was found that score of ‘mutilation of recyclable
waste’ in casualty and wards were significantly lower as
Segregation of waste is the most essential step for compared to OTs and Intensive care units. The
proper management of BMW as waste segregated into relatively poor score in these areas indicates that care
various colour-coded containers is eventually taken to has to be taken to sensitise the interns and nurses
different sites for disposal. Presence of anincorrect kind regarding BMW segregation. Further analysis
of waste in a particular container will apparently nullify of‘mutilation of recyclable waste’ showed that some
the efforts of appropriate disposal of waste. This implies health-care workersfailed to mutilate the used
that for proper segregation of waste, the waste bins in hypodermic needles prior to disposal in white puncture-
appropriate number, at appropriate places and with proof containers. It makes it vital to mutilate used
appropriate colour-code are necessary to be consigned recyclables right after use thus leaving no possibility for
at the source of generation of waste. their illegal re-circulation and reuse [13]. Astudy from
Pakistanshowed 60% compliance towards disposal of
The mean percentagescore of condition of waste sharps [14]. A study from China showed 8.9 to 23.3%
containers in all the patient care areas in this study was compliance towards disposal of sharps [15] as they
more than 80%. Several studies have found poor were inappropriately disposed. These findings were
condition of waste containers for waste disposal. In a very low compared to our study. In our country,
study conducted in South India, there were only white currently there are about 198 common BMW treatment
bins for all types of Bio-medical waste for visual facility (CBMWTF) in operation and 28 under
reasons making segregation practices difficult [9]. The construction [16]. Hence, there is a great necessity for
high score of condition of waste containers in all patient rapid development of many more CBMWTF to satisfy
care areas in present study indicates that the basic the requirements of BMW treatment and disposal [17].
organisation for proper segregation of waste at the point
of generation of waste was well in place in the hospital. Recommendations and follow-up: The following
However, it was found that most of the waste containers recommendations were made for the improvement of
were open without any lid over them. Waste receptacles biomedical waste management practices of the hospital.
should be covered with foot-operated lids [1] and so it  Adequate training and proper use of personal safety
is necessary to progressively replace the prevailing open equipment (PPE) should be offered to waste handling
type waste containers with the ones having foot- staff. 

operated lids.
 Segregation of waste should start at the source of
generation.
High score for ‘segregation of waste’ (96%) shows that
 Transportation of bags should be done separately and
this fundamentalpart of waste management was being
in closed trolleys.
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Original Research Article
 Periodic sensitisation of health-care workers and Management of Wastes From Health-Care Activities.
house-keeping staff should be done more consistently Geneva: WHO; 1999: Chapter 2, Definition; p 2.
in order to emphasize on the importance of usage of
personal protective equipment. 2. Manual on Solid Waste Management, Ministry of
 Periodic surprise inspection of the biomedical waste Urban Development, Government of India. Available
generating areas by authorities and implementation of from http://www.mohua.gov.in. Last accessed on
accountability for every personnel involved in 30/11/18.
biomedical waste management.
 Records onsource of waste generation, treatment, 3. Collins CH, Kennedy DA. Microbiological hazards
storage and disposal should be maintained by the of occupational needlestick and 'sharps' injuries. J
hospital. ApplBacteriol. 1987 May;62(5):385-402.

Conclusions 4. Centre for environment education and technology.

Bio–medical waste management – burgeoning issue;
The present study was done to evaluate the compliance 2008.
of biomedical waste management among different
patient care areas in a tertiary care hospital in South 5. Hem Chandra. Hospital waste- An Environmental
India based on a checklist. It was found that more Hazard and Its Management. Enviro news 1999;
importance needs to be rested for ‘mutilation of 5 (3).
recyclable waste’ especially in wards. Hospital
administrators may need to devise and implement a plan 6. Bio-medical Waste (Management and Handling)
for providing adequate and appropriate training to Rules, 1998, Ministry of Environment and Forests,
Health Care Workers (HCW) so as to tackle the Government of India. Available fromhttp://hspcb.gov.
deficiencies detected in the study. In order to protect in/BMW%20Rules.pdf.Last accessed on 05/12/18.
our environment and public health we must sensitize
ourselves to this important issue. 7. The Environment (Protection) Act, 1986, Ministry of
Environment and Forests, Govt. of India. Available
Input towards existing knowledge: Although the from http://envfor.nic.in/legis/env/env1.html. Last
knowledge of biomedical waste management is accessed on 05/12/18.
adequate among the doctors and other health care
workers, there was a deficit in practical implementation. 8. Blenkharn JI. The disposal of clinical wastes. J Hosp
Also, data about the knowledge and compliance was not Infect. 1995 Jun;30 Suppl:514-20.
adequate in the locality under study. Hence, this study
was done to analyse the compliance of biomedical 9. Blenkharn JI. Standards of clinical waste
waste management in our hospital so as to create management in hospitals--a second look. Public
awareness about safe practices from the point of Health. 2007 Jul;121 (7):540-5. Epub 2007 Feb 12.
generation to final disposal. Recommendations and DOI:10.1016/j.puhe.2006.12.005.
follow-up were made for the improvement of
biomedical waste management practices of the hospital. 10. Nataraj G, Baveja S, Kuyare S, et al. Report:
This would lead to a clean and safe environment to live Medical students for monitoring biomedical waste
in. segregation practices--why and how? Experience from a
medical college. DOI:10.1177/0734242X07081481.
Authors’ contributions: Aishwarya J Ramalingam
conceived, designed the study; collected data, 11. Talaat M, Kandeel A, El-Shoubary W, et al.
performed data analysis; drafted the manuscript. Occupational exposure to needlestick injuries and
Chitralekha Saikumar participated in data analysis and hepatitis B vaccination coverage among health care
helped in drafting the manuscript. workers in Egypt. Am J Infect Control. 2003 Dec;31
Findings: Nil; Conflict of Interest: Non initiated. (8): 469-74. DOI:10.1016/j.ajic.2003.03.003.
Permission from IRB: Yes
12. Debere MK, Gelaye KA, Alamdo AG, et al.
References Assessment of the health care waste generation rates
and its management system in hospitals of Addis
1. Pruss A, Cirouit E, Rushbrook P. Definition and Ababa, Ethiopia, 2011. BMC Public Health. 2013 Jan
Characterization of Health-Care Waste. 1st ed. Safe 12;13:28. doi: 10.1186/1471-2458-13-28.

Pathology Update: Tropical Journal of Pathology & Microbiology Available online at: www.pathologyreview.in 523 | P a g e
November, 2018/ Vol 4/ Issue 7 Print ISSN: 2456-9887, Online ISSN: 2456-1487
Original Research Article
13. Battersby A, Feilden R, Nelson C. Sterilizable 16. Bio-Medical Waste Management Rules. 2016
syringes: excessive risk or cost-effective option? Bull Published in the Gazette of India, Extraordinary, Part II,
World Health Organ 1999; 77(10):812–819. 
 Section 3, Sub-Section (i), Government of India
Ministry of Environment, Forest and Climate Change.
14. Janjua NZ. Injection practices and sharp waste Notification; New Delhi 2016. Available from
disposal by general practitioners of Murree, Pakistan. J http://mpcb.gov.in/biomedical /pdf/BMW_Rules _2016.
Pak Med Assoc. 2003 Mar;53(3):107-11. pdf. Last accessed on 05/12/18

15. Murakami H, Kobayashi M, Zhu X, et al. Risk of 17. Datta P, Mohi GK, Chander J. Biomedical waste
transmission of hepatitis B virus through childhood management in India: Critical appraisal. J Lab
immunization in northwestern China. Soc Sci Med. Physicians. 2018 Jan-Mar;10(1):6-14. doi: 10.4103
2003 Nov;57(10):1821-32. /JLP.JLP_89_17.

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How to cite this article?

Ramalingam A. J., Saikumar C. A study on evaluation of biomedical waste management in a tertiary care hospital in
South India.Trop J Path Micro 2018;4(7):518-524.doi:10.17511/ jopm.2018.i07.07.
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