Waste management at hospitals: Ensuring optimum use of resources
While planning a hospital, conscious efforts must be made to minimise harmful waste generation. Whether it is the infrastructure assistance or identifying standard operating procedures that will ensure compliance; today hospitals have indeed come a long way in effective waste management.
“Let every individual and institutions now think and act as a responsible trustee of Earth, seeking choices in ecology, economics and ethics that will provide a sustainable future, eliminate pollution, and poverty, and awaken the wonder of life and foster peaceful progress in the human adventure,” said John McConnell, Founder, International Earth Day.
No other statement can be as close to ‘need of the hour’ than this. It is the responsibility of all industries to strike a fine balance between essential consumptions and perils of usage. The goals are twofold; optimisation of resources usage and minimising effects on environment. And like all service sectors, even the healthcare industry is taking serious efforts right from ‘policy making’ level to its grass root level ‘policy implementation’, in order to address the issue of minimising harm to the environment.
Healthcare sector is critical in this regards as apart from general waste, it produces a unique type of waste – biomedical waste. Also known as medical waste, it is defined as solid waste generated during the diagnosis, testing, treatment, research or production of biological products for humans and includes syringes, live vaccines, laboratory samples, body parts, body fluids and waste, sharp needles, cultures etc. In no other sector, the gamut of waste generation is as varied as in hospitals.
Role of the government
Similar to the global scenario, Government of India too has initiated policies way back in 1986, which direct healthcare organisations, pharmaceuticals, testing & research labs etc to maintain safe generation, usage, handling and disposal of all possible products that has a potential to cause harm to human settlements & ecology at large. These policy decisions have evolved as statutory law, with multiple by-laws & regulations at many levels of administration. They in turn are revised and updated regularly based on scientific studies.
These regulations not only define what is desired of healthcare in this scope, but also ensures that the permission to start a healthcare unit is only given after due clearance from its licensing authority. After this the authorised bodies enforce that there is strict adherence to such regulations by means of regular inspections and periodic renewal of licensure.
Most hospitals too have developed smart systems that minimise harmful waste generation while they are planning the hospital. Whether it is the infrastructure support to this cause, or identifying standard operating procedure that will ensure compliance; modern day hospitals have come a long way in waste management.
Action at the right time
When designing a hospital, meticulous plan is drawn for possible waste generating areas, its transport channel, central storage and treatment, before it is handed over to government authorised agencies that takes care of the final disposal, etc of the waste. Simple ideas such as having drainage lines planned with minimal angles, easy accessibility for regular cleaning, etc helps to maintain a smooth flow of waste to a central location. Here also one can indigenously design an effluent treatment plant keeping all the basic principles of sewage treatment flow and future workload in mind. One such ETP is built in-house at HCG Cancer Center, Bengaluru, at approximately 60 per cent of the cost of a similar setup with added advantages like no-foul smell, usable by-products, etc. Other ideas include having a separate special storage facility for radioactive waste.
A leading healthcare setup in India has a unique equipment called hydroclave, which treats the waste in a combination of physical fragmentation, extreme physical pressure, vacuum, high temperature steam & heat, dehydration and autoclave of the waste generated, resulting in sterilisation of biological waste. This renders hospital waste like any other regular waste and can be then disposed off with ease like general waste.
The same waste management principles are applied by most when it comes to purchasing of products. Having a centralised purchase system enables one to evaluate products with regards to the waste generated by them. Also, this enables hospital to have an upper hand while receiving items/consumables, etc such as glucose bottles, reagents, medicines etc and carry out a random inspection of the lot received even before they are accepted in the stores. In case of a contaminated/spurious item found, the same is returned to the vendor and a remark made on his vendor evaluation file, which would be considered during subsequent purchase. This prevents and eliminates a contaminated product from entering our system.
One can make a ‘near expiry return’ policy, where scheduled regular audits of these items in use, identify such items that are due for expiry after three months. Such items are returned to the vendor to avoid its accidental usage. This too is possible when one has a centralised purchase & stores system and subsequent good vendor relations.
All consumables are segregated into categories as defined by statutory bodies based on its potential harmful nature and all hospitals need to segregate these wastes at the point of generation itself, ie, at nursing stations, operation theatres, intensive care settings, laboratories, etc. The guideline clearly defines what waste goes into which colour coded bin/bag. These colour coded bin/container/bag covers general waste like office supplies, paper, kitchen waste, etc to special medical waste like cytotoxic drugs, sharps & needles, blood & body fluids.
There is intensive training given to all staff members especially nursing and housekeeping to segregate these waste judiciously at the time of usage itself. Thrice daily clearance of all the bins are monitored before it is transferred to a central segregation and storage facility. Some special wastes like infective wastes etc have special protocols where the waste is neutralised using chemicals before they are sent to central storage unit. Unique wastes like cytotoxic drugs that are primarily used in cancer care, are either processed at a central location to avoid multiple points of waste generation or are stored in special bags with warning labels. All these trainings are reinforced regularly through repeat training sessions, bedside training to staff, poster displays at waste bin areas, and evaluation by supervisors. In fact, some hospitals have included waste management training to its entire staff during its induction programme, irrespective of their work nature as its prudent to be careful at the time of initial disposal at individual level rather than segregating the waste later.
While solid waste generated is handled in the above mentioned fashion, liquid waste is managed at effluent treatment plant where it is treated through multiple filtration levels, biological organisms, chemicals, etc before it is released into central sewerage system.
Similarly the solid waste is appropriately checked for proper segregation at central waste storage, stored under defined acceptable conditions under lock and key, and handed over to a government authorised agency. This agency in turn weighs each type of waste, counter checks the records maintained at hospital, and documents on a daily basis. Even the weigh balance is calibrated by a government agency to avoid any malpractice. The certification is issued on a periodic basis. The waste, thus, is taken to a common treatment facility on the city limits and scientifically disposed by either incinerating (using extreme high temperature) or deep burial.
The entire gamut of waste management activity is minutely monitored, reported by a hospital infection control team, which is headed by a qualified microbiologist and trained infection control nurses. They update the Infection Control Committee on the efficacy of waste management system and develop improvement plans. Accredited hospitals even pre plan the detailed costing of entire activity in their annual budgets so that the efforts are sustained on a continuous basis.
A beautiful example of seamless liaison between government and public –private sector, for once there is no ambiguity in the focus of regulatory authority and the user end. Whether it is the fear of law or concern towards a safer society, the organised healthcare Industry is collectively contributing to safe disposal of hospital waste and acting responsibly towards public and environment.
-Dr Samir Singh
Manger – Operations