HEALTH MANPOWER AND MANAGEMENT


https://doi.org/10.5005/jp-journals-10055-0064
AMEI’s Current Trends in Diagnosis and Treatment
Volume 3 | Issue 1 | Year 2019

An Overview of the Biomedical Waste Generation on Per Bed Basis in Some Hospitals of Punjab State of India


Gaurav Agnihotri1, Piyush Jindal2

1Guru Nanak Dev Hospital, Amritsar, Punjab, India; Department of Anatomy, Government Medical College, Amritsar, Punjab, India
2Punjab Pollution Control Board, Patiala, Punjab, India

Corresponding Author: Gaurav Agnihotri, Guru Nanak Dev Hospital, Amritsar, Punjab, India; Department of Anatomy, Government Medical College, Amritsar, Punjab, India, Phone: +91 9815542792, e-mail: anatomygaurav@yahoo.com

How to cite this article Agnihotri G, Jindal P. An Overview of the Biomedical Waste Generation on Per Bed Basis in Some Hospitals of Punjab State of India. AMEI’s Curr Trends Diagn Treat 2019;3(1):41–44.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Introduction: The biomedical waste management is an important issue and it also a challenging one. The present study was designed to assess the quantum of biomedical waste generated for some hospitals in Punjab. The study also intends to seek possible explanations for the different values obtained for different institutes.

Materials and methods: Ten hospitals with a bed capacity of 200 or more were selected for the study. The biomedical waste generated from these institutions for the months of September, October, and November 2018 was scrutinized. The biomedical waste generated per bed (assuming 100% bed occupancy and actual bed occupancy) was determined. The results were sent to the administrative officers of these institutes and possible explanations sought for the similarity/difference amongst institutes.

Results: From the results, it is evident that hospitals with larger bed strength are not necessarily generating more biomedical waste per bed. Rather, a careful observational analysis reveals that private institutes in general are generating more biomedical waste per bed occupied vis-a-vis the government institutes. This could in part be attributable to more disposables being used in these institutions and good practices of biomedical waste management followed in these institutes. The extent of biomedical waste generated by an institute also depends upon the number and type of patients admitted in departments. It is also influenced by the bed strength allocated to different departments. Still, the institutes with lesser biomedical waste generation should ensure that biomedical waste practices are strictly being followed and the record keeping is referable and meticulous.

Conclusion: The quantity of biomedical waste is increasing in its amount and type due to advances in scientific knowledge and this has an impact on human lives. So, it is imperative that efforts are continuously made in the right direction so that biomedical waste disposal goals are achieved to highest possible pinnacle.

Keywords: Bed occupancy, Biomedical waste generated, Biomedical waste practices.

INTRODUCTION

Biomedical waste is defined as any waste, which is generated during the diagnosis, treatment, or immunization of human beings or animals, or in research activities pertaining thereto, or in the manufacturing or scrutinization of biological materials.1 The biomedical waste management is an important issue and it also a challenging one.2,3 The awareness regarding biomedical waste management is continuously increasing amongst health personnel and due credit should be given to the continuous efforts being undertaken by the Punjab Pollution Control Board.

There are around 8,126 healthcare facilities (HCFs) which have made agreement with the common biomedical waste treatment facilities (CBWTFs) of the state. The bed capacity of these 8,126 HCFs is around 70,000 beds. Out of these 8,126 HCFs, 6,857 HCFs have bed capacity less than equal to 10 beds and 8 HCFs are having medical college facility. To understand the trends of any system put in place, it is very important to have normative data with which future and past comparisons can be made to have. These trends allow assessment of the scenario and pave way for guidelines to be formulated which could accentuate achieving of the desired outcome.

An overview of the literature indicates that the average hospital waste generated per bed per day in developing nations should be 1–2 kg.4 The present study was designed to assess the values for the state of Punjab. The study also intended to seek possible explanations for the different values if any obtained from different institutes.

MATERIALS AND METHODS

The present study was conducted in medical hospitals in Punjab. Ten hospitals with a bed capacity of 200 or more were selected for the study. The biomedical waste generated from these institutions for the months of September, October, and November 2018 was scrutinized. The data were obtained from the records submitted by the institutions to Punjab Pollution Control Board. Hence, Ethical Approval from the Institutional Ethical Committee was not required for this study.

The biomedical waste generated per bed (assuming 100% bed occupancy) per day was determined for each of these institutes. To eliminate bias of variable occupancy rates in these institutes, a reality check was done to ascertain actual waste generated per bed occupied in these institutes. The results were sent to some of the administrative officers of these institutes and possible explanations sought for the similarity/difference amongst institutes.

RESULTS

Tables 1 and 2 demarcate the biomedical waste values in big and small set-ups. However, the data presented in these tables have restricted value due to the fact that it does not take into account the actual bed occupancy in these institutes for the period. A clearer picture emerges when we consider the actual bed occupancies and consider the biomedical waste generated per bed occupied in institutes.

From Table 3, it emerges that it is not necessary that hospitals with larger bed strength will account for more biomedical waste generated per bed. Rather, a careful observational analysis of Tables 1 to 3 reveals that private institutes in general are generating more biomedical waste per bed occupied vis-a-vis the government institutes. This could in part be attributable to more disposables being used in these institutions but still there are aspects in biomedical waste generated per bed occupied which cannot be explained on use of disposables alone. So, an opinion was sought from the administrators in these institutes regarding the variability in data obtained from different institutions.

Table 1: Biomedical waste generated per bed (assuming 100% bed occupancy) per day by hospitals with bed strength more than 400 in Punjab during a 3-months period
Hospital (bed capacity)MonthBlue*Red*Yellow*White*Others*Total in kg/bed/day
DMCH, Ludhiana (1625)September8316.3619816.0922992.93239.89    01.054
October8316.3619816.0922992.93239.89    00.997
November8316.3619816.0922992.93239.89    01.102
RH Patiala (1287) Patiala (1287)September1000.01    904.21  1434.52  37.59    00.09
October1056.14  1158.74  1606.71  42.13    00.10
November  857.25    954.71  1445.42  48.43    00.09
GNDH, Amritsar (951)September1222.64    796.88  1550.09  22.97    00.13
October  743.02  1012.02  1045.67  17.36    00.10
November  595.43    713.38    891.91  17.81    2.040.08
CMCH, Ludhiana (700)September1425.97  3563.01  2864.43  26.68157.490.38
October1885.01  3749.13  2967.2  51.18101.250.40
November1851.22  3639.53  2777.82  40.39  72.690.40
CH, Jalandhar (470)September  840.1    488.9  1007.86  95.12    00.17
October  571.07    468  1035.45  81.94    00.15
November  609.73    514.28    609.73  73.42    00.15

* Per month values in kg

Table 2: Biomedical waste generated per bed (assuming 100% bed occupancy) per day by hospitals with bed strength less than 400 in Punjab during a 3-months period
Hospital (bed capacity)MonthBlue*Red*Yellow*White*OthersTotal in kg/bed/day
Fortis Hospital, Mohali (350)September1963.2  8724.35562.11438.17196.231.61
October2361.8111232.477102.95411204.391.96
November2072.8  9244.276018.685370.64184.21.70
SGL Jalandhar (350)November  472.75    995.02  870.14  35.02156.230.33
September  723.31  1288.31458.17  29.81    00.34
October  844.44  1305.691483.97  42.22    00.32
Civil Hospital, Ludhiana (250)September  298.26    377.941063.82  33.07    00.24
October  284.77    363.111194.07  33.75    00.24
November  266.37    333.261093.05  20.91    00.23
M K Hospital Patiala (250)September  124.37    293.221132.73  13.02    00.21
October  102.19    246.66  925.53  11.75    00.17
November  105.18    217.02  940.07  12.61    00.55
Fortis Hospital, Ludhiana (200)September  343.95    953.88  752.4  30.11178.780.38
October  434.51    992.08  770.45  36.07183.60.39
November  472.75    995.02  870.14  35.02156.230.42

* Per month values in kg

Table 3: Biomedical waste generated per day by hospitals in Punjab taking the actual bed occupancy into consideration during a 3-months period
HospitalMonthTotal in kg/dayTotal in kg/bed/day (as per actual bed capacity)
DMCH, LudhianaSeptember1712.181.490
October1620.121.316
November1789.941.567
CMCH, LudhianaSeptember  267.920.88
October  282.380.86
November  279.390.88
Fortis Hospital, MohaliSeptember  562.802.28
October  687.502.62
November  596.362.50
Fortis Hospital, LudhianaSeptember    75.300.80
October    78.110.75
November    84.310.86
SGL, JalandharSeptember  116.650.66
October  118.590.54
November  112.140.55
Guru Nanak Dev Hospital, AmritsarSeptember  119.750.17
October    90.910.13
November    74.020.12
Rajindra Hospital, PatialaSeptember  112.540.10
October  124.640.11
November  110.190.10
Civil Hospital, JalandharSeptember    81.070.13
October    69.560.11
November    72.760.14
Civil Hospital, LudhianaSeptember    59.100.25
October    60.510.25
November    57.120.24
Mata Kaushaliya, PatialaSeptember    52.110.23
October    41.490.19
November  137.480.79

From the assertions made out by some administrators, the following features can be ascertained regarding variability of biomedical waste generated per bed in different institutes.

DMCH-Dayanand Medical College and Hospital; RH-Rajindra Hospital; GNDH-Guru Nanak Dev Hospital; CMCH-Christian Medical College and Hospital; CH-Civil Hospital.

SGL Hospital-Swami Gurbachan Lal Hospital; MK Hospital-Mata Kaushalya Hospital.

DISCUSSION

Proper management of biomedical waste generated in an HCF is one of the most important functions of a healthcare worker as its improper management poses risk to humanity and our ecosystem. Additionally, improper management could lead to initiation of legal proceedings against employees and administrative authorities of the hospital.5 Proper handling, treatment, and disposal of biomedical wastes are important elements of healthcare office infection control programme.6

The magnitude of biomedical waste generated per day per bed essentially depends upon variable factors like types of patients attending the health institution, the facilities provided for patient care, and of course the standards of biomedical waste management.7 It essentially fluctuates from 1 kg to 2 kg in developing countries like India up to 4.5 kg in more advanced countries like the United States of America.8,9 It has been observed that in developed countries, due to the advent of increased use of disposables, the waste generated is up to 5.24 kg per bed per day.

10% to 15% of the waste is infectious in developed countries.9 From Tables 1 to 3, it is evident that for Fortis Hospital, Mohali, the biomedical waste generated is the maximum. This can be attributed to increased use of biomedical disposables in more advanced institutes leading to a higher quantum of generated biomedical waste.10

A review of the literature by the authors reveals that in most medical hospitals the hospital waste generated in India is around 1–2 kg per bed per day. The quantum of waste generated in district hospital Kargil is 2.0 kg per bed per day. This is identical to studies conducted by various workers who have assessed the average quantity of hospital waste produced in India ranges from 1.5 to 2.2 kg per bed per day. Also a study conducted at AIIMS, New Delhi (a tertiary care hospital), in 1988 revealed the quantum of waste generated as 2.2 kg per patient per day.11,12

The hazardous nature of biomedical waste is due to its cytotoxic, chemical, infectious, and injurious properties.13 Biomedical waste is definitely a harmful hazard because it has the prerequisites which can spread infection both nosocomially within healthcare settings as well as to persons working outside HCFs, like waste handlers, scavenging staff, and also to the general public. It has been reported that 60% of all hospital staff sustain injuries from sharps during various procedures in various institutions providing much needed patient care.14

Medical care is vital for our life, health, and well-being. However, the waste generated from medical activities can be hazardous, toxic, and even lethal because of their high potential of diseases transmission. With the course of time, the waste is increasing in its amount and type due to advances in scientific knowledge and has an impact on human lives.15,16 So, it is imperative that efforts are continuously made in the right direction so that biomedical waste disposal goals are achieved to highest possible pinnacle.

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