|Year : 2015 | Volume
| Issue : 3 | Page : 383-386
Safe transportation of biomedical waste in a health care institution
A Kumar, S Duggal, R Gur, SR Rongpharpi, S Sagar, M Rani, D Dhayal, CM Khanijo
Department of Microbiology, Dr. Baba Saheb Ambedkar Hospital, Rohini, Delhi - 110 085, India
|Date of Submission||10-Mar-2014|
|Date of Acceptance||03-Mar-2015|
|Date of Web Publication||12-Jun-2015|
Department of Microbiology, Dr. Baba Saheb Ambedkar Hospital, Rohini, Delhi - 110 085
Source of Support: None, Conflict of Interest: None
Introduction: The chances of health care waste (Biomedical waste) coming in contact with the health care workers, patients, visitors, sanitary workers, waste handlers, public, rag pickers and animals during transportation are high. Materials and Methods: The study was conducted over a period of seven months (April 2013-October 2013) in a 500-bedded hospital where the average quantum of biomedical waste is 0.8 kg/bed/day. The issues related to transportation of health care waste from 39 generation sites to the health care waste storage site inside the hospital (intramural transfer) were addressed and analysed in a predesigned proforma. Results: The biomedical waste management team inspected the generation sites in the hospital on a daily basis and conformance to the procedures was checked. It was found that waste was collected at scheduled timings in 99.6% occasions; however, compliance to wearing personal protective equipment (PPE) was poor and ranged from 1.22−1.84%. Conclusion: Transportation of health care waste is a crucial step in its management. Regular training program for all the sections of health care workers with special emphasis on waste handlers is needed.
Keywords: Generation site, health care waste, storage site, training, transportation
|How to cite this article:|
Kumar A, Duggal S, Gur R, Rongpharpi S R, Sagar S, Rani M, Dhayal D, Khanijo C M. Safe transportation of biomedical waste in a health care institution. Indian J Med Microbiol 2015;33:383-6
|How to cite this URL:|
Kumar A, Duggal S, Gur R, Rongpharpi S R, Sagar S, Rani M, Dhayal D, Khanijo C M. Safe transportation of biomedical waste in a health care institution. Indian J Med Microbiol [serial online] 2015 [cited 2020 Jul 3];33:383-6. Available from: http://www.ijmm.org/text.asp?2015/33/3/383/158559
| ~ Introduction|| |
The collection of properly segregated waste and safe transportation within the health care facility is of utmost importance in health care waste management. The objective of this study was to address the issues arising during in-house transportation of biomedical waste. Our Hospital is a 500-bedded tertiary care centre and has a multidisciplinary Hospital Infection Control Committee (HICC) with a dedicated team posted in Biomedical Waste Management (BMW) cell. The BMW cell has a Nodal Officer, three full-time trained nurses and one trained nursing assistant. This team supervises the segregation, collection, transportation and treatment of health care waste. There are four dedicated waste handlers for collection and transportation of waste. Waste should be collected and transported in a manner so as to avoid any possible hazard to human health and environment. Within hospital, routes must be designated and timing should be followed for proper transportation of waste so as to avoid the patient care areas. Dedicated wheeled containers, trolleys or carts should be used to transport the waste to the site of storage.  Care should be taken to ensure that the segregated waste, handed over by the health care units, reach the storage site without any damage and spillage.
| ~ Materials and Methods|| |
The study was conducted over a period of seven months (April 2013-October 2013) regarding transportation from 39 generation sites inside the hospital to the health care waste storage site. The study included the measures to be taken during transportation of health care waste from generation site to waste storage site. The handing over of the biomedical waste from storage site to CBWTF was recorded in a predesigned pro forma [Figure 1]. During the study period, the following parameters were evaluated - unsent waste collection bags in morning shift, unlabelled bags, wearing of personal protective equipment (PPE) by waste handlers, uncovered and overloaded trolleys, and improperly closed sharp containers.
| ~ Results|| |
The BMW team inspected the various areas of the hospital and found that the waste bags had not been collected in the morning shift by the sanitary staff and this varied from 0-0.11% of incinerable waste (yellow), 0.44-0.82% for other infectious waste (red), 0.55-0.71% of general waste (black) and 0.22-0.41% of sharps [Figure 2]. The percentage of unlabelled bags varied from 0.66-1.12%, while overloaded trolleys varied from 1.0-2.05% [Figure 3]. The percentage of uncovered trolleys varied from 1.22-2.25% [Figure 3]. The percentage of improperly closed sharp containers varied from 0 to 0.3% [Figure 4]. The percentage of staff wearing PPE varied from 1.22 to 1.84% [Figure 5]. The waste is transported in separate colour-coded trolleys [Figure 6] as per the BMW rules.  The liquid waste is disinfected by chemical treatment and drained, which is then finally connected with sewage treatment plant (STP), present in our facility. Non-compliance to the protocols in our study was noted in 11.58% occasions. This reduced to 0.72% if PPE usage was to be excluded. Compliance to PPE was major constraint, which can be overcome by regular training of BMW staff.
|Figure 6: Colour-coded trolleys used for transportation of biomedical waste from generation to storage site|
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| ~ Discussion|| |
Transportation of health care waste is one of the most crucial steps in its management and has scientifically evolved over the years. In a multi-centric analysis by IPEN study group, in-house transportation of health care waste has been considered as one of the performance indicators of biomedical waste management.  Psychological stress is common to public and health care workers due to anatomical waste handling during segregation like human body parts, etc. Hence, health care waste should be transported in such a manner that it does not cause any stress at site and en route. In our study, the trolleys were uncovered or overloaded approximately on 1-2% occasions. Separate biomedical and general waste routes have been assigned. Waste should never be transported directly by hand due to risk of accidental injury from infectious material or incorrectly disposed sharps that may protrude from a container. In our study, PPE were not worn by waste handlers in most of the cases possibly due to lack of understanding of its importance and climatic variations. Management of sharp waste is a critical issue since needle stick injuries poses risk of transmission of blood-borne diseases like HIV, hepatitis B and hepatitis C. Waste handlers are exposed to greatest risk of occupational injuries by nature of their work. Limited data is available on needle stick injuries. ,,, Apart from psychological stress to the health care workers, needle stick injuries have financial implications. This includes cost of testing for HIV, hepatitis B and hepatitis C, and post-exposure prophylaxis. For a single episode of needle stick injury, the estimated cost burden may range from INR 3,000-15,000. The cost of testing of source and exposed person can vary from INR 3,000-6,000; post-exposure prophylaxis for hepatitis B in an unimmunised person can vary from INR 5,000-6,000. The cost of HIV post-exposure prophylaxis may vary from INR 1,500-7,500 depending on the regimen. Sharps must be disposed in puncture proof/resistant containers with biohazard symbol and properly secured before transportation. In our study, it was found that they had been closed in 99.7% cases. The management of health care waste is done by waste handlers (contractual services) who have received the requisite training and vaccination. The health care workers, including doctors, nursing staff, paramedical staff and sanitary workers in our hospital are regularly trained about the occupational exposure, spillage policy and importance of wearing PPE. PPE, hepatitis B vaccine, Tetanus toxoid vaccine and post-exposure prophylaxis for HIV are available for the prevention of risk associated with occupational exposure. In our hospital, hepatitis B vaccination is provided to all health care staff free of cost.
According to the median BMW management colour code category for health care facilities, our hospital would qualify for colour code 'Green', which means good system in place for BMW management.  There are 39 generation sites in our hospital. All health care workers generate hospital waste while doing therapeutic and diagnostic activities. They should adopt standard precaution and safety measures while handling and disposing the health care waste.
Segregation of health care waste is of paramount importance. At the generation sites, we have three colour-coded bins for different categories of waste. These are foot-operated for ease of use. These coloured containers are strong enough to withstand any possible damage that may occur during loading or unloading of such containers. These containers/trolleys prominently display the biohazard symbol as per schedule.  Sharps are collected in puncture-resistant containers as prescribed.  Each bin is lined by a corresponding colour-coded bag which is labelled as per Schedule III and IV of the Biomedical Waste (Management and Handling) Rules, so that at any time, the health care units can be tracked back if not segregating health care waste as per BMW rules.  These bags are 36" × 36" in size, bio-degradable, non-chlorinated, leak proof with thickness of 40 microns with monogram of biohazard symbol on red bag and yellow bag. We have introduced zip-lock facilities in the waste collection bags. The bags are zip-locked at the generation sites and handed to the waste handlers who collect them in colour-coded trolleys. The zip-locking ensures that waste bag seals are in place and intact at the end of transportation.
The waste storage site of this hospital is approximately 500 meters away from patient care areas. We are using wheeled non-motorised trolleys, which are fuel efficient. They are made of high density polyethylene (HDPE) to provide strength and a smooth and impervious surface which can be cleaned. These are thoroughly cleaned and disinfected daily and in the event of any spillage.  Outside, they are supported by a stainless steel frame. These containers are designed for waste to be easily loaded, be easy to push and pull, appropriately sized (36" × 24" × 20") to accommodate up to 50 kg waste with height similar to those of the waste containers to facilitate minimal agitation and avoid spillages, be labelled and dedicated to a particular waste type, not have any sharp edges, easy to clean and disinfect and remains secured during transportation.  Spare trolleys are available in case of breakdowns and maintenance. The person responsible for collection of health care wastes carries a register with him to maintain the records such as name of generation site, the type and quantity of waste received, signature of the authorised person, day and time of collection, etc. Monitoring of transportation by dedicated personnel is essential. A separate elevator and ramp area has been dedicated for transportation of the biomedical waste.
The temporary waste storage site is situated 500 meters away from the hospital and has a iron grilled gate, which is kept locked at all times and opened only when required. The biohazard symbol is displayed prominently on the gate and entry is restricted to authorised personnel only. The storage site has three separate colour-coded chambers (8 m × 6 m × 2.5 m). These chambers are well-lit, well-ventilated, airy with impervious walls and floors and drainage facilities, and connected to the STP of the hospital. There is a separate washing platform for waste containers/trolleys/PPE and a basin for hand washing. There are two waste treatment rooms within the health care establishment for an autoclave and a shredder for the red bag waste to make it safe and unrecognisable. Other infectious health care waste is handed over to the government-authorised common biomedical waste treatment facility (CBWTF) for their respective treatment while the uninfected general waste is handed over to the municipal corporation. The waste from the generation site should reach the CBWTF within 48 hours as per the DPCC  and CPCB  guidelines. In India it was observed that 60% of injections were unsafe.  This could be attributed to reuse and high injection practices. Our study highlights the importance of proper transportation from the generation site to the authorised CBWTF, so that material pilferage and their reuse can be prevented.
Health care management team of our hospital is committed to follow the biomedical rules, and we have sufficient quantity of colour-coded containers and trolleys for transportation. The health care workers are trained regularly on issues related to biomedical waste management. The employees are regularly trained and encouraged for adopting safe health care waste management practices during segregation, transportation, treatment and disposal of health care waste.
| ~ Conclusion|| |
care should be taken to ensure that health care waste is transported from the generation sites to the storage site without any spillage and in an environment-friendly manner. Improper handling, transportation and disposal are now widely recognised as preventable causes of infection, which can be effectively minimised if we are conscientious and scientific in dealing with biomedical waste.
| ~ References|| |
Mathur P, Patan S, Shobhawat S. Need of biomedical waste management system in hospitals - an emerging issue - A review. Curr World Environ 2012;7:117-24.
Park K. Hospital waste management. In: Park K, editor. Preventive and Social Medicine: 22 nd
ed. Jabalpur: Banarasidas Bhanot; 2013. Vol I: p. 734-9.
INCLEN Program Evaluation Network (IPEN) study group, New Delhi, India. Bio-medical waste management: Situation analysis and predictors of performances in 25 districts across 20 Indian states. Indian J Med Res 2014;139:141-53.
Forbes BA, Sahm DF, Weissfeld AS. Bailey and Scott′s Diagnostic Microbiology. 12 th
ed. Philadelphia: Mosby; 2007.Vol I: p. 45-61.
Sharma R, Rasania SK, Verma A, Singh S. Study of prevalence and response to needle stick injuries among health care workers in a tertiary care hospital in Delhi, India. Indian J Community Med 2010;35:74-7.
Trim JC, Elliott TS. A review of sharp injuries and preventative strategies. J Hosp Infect 2003;53:237-42.
Pruss-Ustun A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health care workers. Am J Indian Med 2005;48:482-90.
Chartier Y, Emmanuel J, Pieper U, Pruss A, Rushbrook P, Stringer R, et al
. Safe Management of Wastes from Health-Care Activities. 2 nd
ed. Geneva: WHO Press; 2013. Vol I: p. 77-85.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]