Medical Waste Management in Pondicherry Region - International ...

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Bio – Medical Waste Management in Pondicherry Region: A Case StudyIn the absence of the above, the adoption of the abovemethod becomes difficult. Jayanthi and Sanojini (2010) haveused ‘neem’ extract for destruction of pathogens in infectionsBMW collected from a hospital at Coimbatore, India, andhave reported that lime solution has effectively destroyed thepathogens with respect to time, where as, reduction inpercentage is better only in fresh neem leaves extract.However, the feasibility and performance of such treatmentmethods have to be established, by explaining the use ofsimilar types of materials either alone and in combination andbased on extensive studies carried out on BMWs generatedfrom HCEs of India.Hence, the focus of the present study is on: (i) to assess thequality of BMW generated in the Pondicherry region; (ii) toidentify the existing treatment / disposal systems andmanagement practices being followed in the various HCEsand critically evaluate them and (iii) to evaluate theperformance of using ‘neem and tobacco extract’ for thetreatment of BMW, obtained from a large private hospitallocated in Pondicherry.II. METHODOLOGYA. Details of study areaThe union territory (UT) of Pondicherry comprises of fourregions, and Pondicherry region located in the east coast ofIndia is the largest one and also the capital of U.T. It liesbetween latitudes 11⁰ 56’ and longitude 79⁰ 53’. The generalslope of the region is towards east. The total geographicalarea of Pondicherry is 492 sq km. Recently, it has witnessedtremendous growth in education, healthcare and tourism. It isalso home to several reputed hospitals under central, state andprivate sectors, which is a unique feature of the above region.In order to evaluate the performance of the chosen methodsof treatment of BMW, a large private hospital, which hasbeen in existence for nearly 15 years and having 310 bedswith good infrastructure facilities was chosen. The abovechosen hospital is referred as to 'the hospital', henceforth inthis paper.B. Field surveyA survey was conducted to indentify the various HCEslocated in Pondicherry region and the amount of wastegenerated including the number of beds available, in both theGovt. and private sectors. Further, the management practiceslike segregation, treatment and disposal methods that arebeing currently followed in all the indentified HCEs, werealso collected. The data thus collected was then analysed, todraw critical inferences there from.C. ExperimentalIn order to experimentally investigate the usefulness andperformance of the chosen methods on the treatment of‘infectious’ wastes, samples (i.e. cotton wastes) werecollected from ‘the hospital’ and stored in airtight containers.Tobacco obtained from local sources and neem (Azadirachtaindica) leaves extract solutions were used for treating theabove waste. The above two materials were used to prepare‘neem’ extract solution and a combination of ‘neem’ and‘tobacco’ extract solution. For brevity, ‘tobacco’ extractsolution is used in this paper to refer to the abovecombination. After treatment, various physico-chemical(COD, total solids, volatile solids, electrical conductivity,alkalinity) and biological parameters (microbial colonycount) were determined as per standard methods, (APHA,2005) at different stages of destruction of pathogens. Theresults obtained were critically analysed to evaluate therelative performance of the chosen treatment methods for the‘infections sample’.III. RESULTS AND DISCUSSIONTable 1: Generated BMW in the various HCEs ofPondicherry RegionSl. Name of the hospitals. No. of QuantityNo.beds (kg/day)I. Government hospitals1 General Hospital 698 1081.92 JIPEMER 1112 1723.63 Chest clinic 80 1244 Mahatma Gandhi Govt. LeprosyHospital138 213.95 ESI hospital 75 116.256 Primary Health Centre (PHCs) 108 103.68(27Nos)7 Govt. Maternity Hospital 330 511.5Total (A) 3875II. Government and private medical colleges1 Govt. Medical College 300 4082 Sri manakula vinayagar medical 320 425.2college3 AarupadaiVeedu Medical College &Hospital4 Pondicherry Institute of MedicalSciences (PIMS)5 Mahatma Gandhi Medical Collegeand Research Institute6 Mahatma Gandhi Dental College &Hospital7 Sri Lashminarayanan MedicalCollege400 544310 421.6300 40830 40.8220 299.28 Venkatewara Medical College 280 380.8Total (B) 2928III. Private health care centres1 St. Joseph of Cluny Nursing Home 200 2722 Nallam Clinic 75 1023 Sedhu Nursing Home 65 88.44 New Medical Centre 42 57.125 Sri Mahalakshmi Nursing Home 20 27.56 Sri Krishna Nursing Home 20 27.57 Aswin Maternity Hospital 08 10.888 Rani Hospital 24 32.649 A.G. Padmavati Hospital 120 163.210 Sri Devi Nursing Home 10 13.611 Jagadesh Eye Clinic 02 2.7212 Aurobindo Ashram Nursing 30 40.813 Jothi Eye Care Centre 10 13.614 VKN Hospital 17 23.1215 Kamala Nursing Home 08 10.8816 Madhava hospital 25 3417 Aravind eye hospital 265 360.4Total (C) 1280A. Field survey(i) Total BMW GenerationThe total amount of BMW generated (in kg/day) from each ofthe HCEs are given in Table 1. HCEs of the region have beencategorized into: (i) Government hospitals, (ii) Governmentand private medical colleges and (iii) private healthcarecenters. Incidentally, the quantity of BMW generated alsoranks in that order, the highest by Govt. hospitals and thelowest by private health care centers.76
The total BMW generated has been assessed as 8.1 tons/day.Of the above, 70 - 80% can generally be considered to fallunder 'non - infectious' wastes.(ii) SegregationIt has been observed that there is a positive change in theattitude of hospital staff, where by, the importance ofsegregation has been felt and hence, more and more HCEs inthis region have presently implemented segregation insubstantial terms, which is expected to result in ‘completesegregation’, in future. Further, it was observed that the basicsystem followed is the usual 4 – bins combination (3 – binsfor infectious wastes and the fourth one for sharps). Thesegregation practices actually followed in all the HCEs canbe classified into any one of the four types, namely; (i) wellsegregated; (ii) substantial segregation (with poormonitoring); (iii) poor segregation and (iv) no segregation. Itis found most of the Government hospitals in the Pondicherryregion fall in the second category, whereas, the privatehospitals and nursing homes fall under the third category.(iii) Pre-treatmentMost institutions that adopt segregating of BMWs at source,also pre – treat (i.e. disinfect) the BMWs with 1% of sodiumhypochlorite solution, before sending the samples for furthertreatment and disposal. Apart from the above form ofdisinfection, use of calcium hypochlorite, bleaching agent /Dettol were also used.(iv) Treatment and disposalThe HCEs surveyed have been practicing autoclaving,incineration, and microwave irradiation.B. Case study(i) SegregationThe amount of BMW generated by ‘the hospital’ is about 397kg/day, which works to about 1.3kg/day/bed. This is slightlylower than the average quantity reported at national level (i.e.in India). [Shah and Ganguli, 2010]. It is found that theBMWs were carefully segregated at source itself and that thehospital staff were very much aware of the handling andsafety procedures. The solid waste from the hospitalconsisting of bandages, linen and other infection materialsconstituted 30 – 40 % of the total waste. In terms of quantity,infectious waste generated is about 159 kg/day.(ii) Present treatment methodsThe hospital has two incinerators, one operating on furnaceoil and the other using diesel. The capacity of the incineratoris about 500 kg, with an operating temperature of about900°C. The incinerators were found to be operating between6 to 9 pm and the ‘infectious waste’ generated is generallygets incinerated in about two hours. Control devices havebeen installed to prevent air pollution by particulate mattersand flue gases, as a result of incineration.(iii) Treatment of Neem and Tobacco extractsWithin 3 hours of treatment by both the methods (i.e. usingneem and tobacco extract), the bacterial colony count (BCC)has decreased by one order of magnitude and it continuous todecrease. At the end of 9 hours of treatment the BCC is only1% of the raw BCC. In other words there is a reduction ofthree orders of magnitude in the reduction of BCC, within 9hours of treatment by both the methods. At the end of 24hours of treatment BCC has reduced by three orders ofmagnitude, by both the methods and the trend continuous till120 hours of treatment, by which time the BCC has decreasedby atleast 6 orders of magnitude, with respective to itsoriginal BCC value of raw waste. Of the two methods, theInternational Journal of Engineering and Advanced Technology (IJEAT)ISSN: 2249 – 8958, Volume-2, Issue-4, April 2013performance of ‘tobacco extract’ has always and consistentlybeen better than with ‘neem extract’.COD continue to decrease from the instant of treatment, byboth the methods COD has reduced by atleast 50% at the endof 9 hours and 6 hours of treatment by ‘neem extract’ and‘tobacco’ extract, respectively. Rate of reduction in COD isslightly higher with ‘tobacco’ extract than with ‘neemextract’ and that about 99% of the raw BMW COD has beenreduced at the end of 120 hours. The same trend in the resultswere observed with respect to variation in total solids,alkalinity, when the sample was treated with the combinationof neem and tobacco. Reduction in total solids represent theready / easy biodegradable nature of huge amount of complexcellulose materials and the effectiveness of the method onthem. Reduction in alkalinity indicates the reduction of saltsof carbonates and bicarbonates. Reduction in electricalconductivity (EC) was found to vary from 191.2µs to 30.8µs(neem) and to 28.4µs (tobacco). In the case of reduction inEC, the influences of both the methods are quite comparable.The concentration of EC is found to be within desirable limitsand shows the presence of various dissolved ionic salts.(iv) Cost comparisonThe costs of treatment of ‘infectious waste’ by incineration(presently followed in the hospital) and by neem and tobaccomethods (the methods used in this study) were compared.For the above, it was assumed that: i) time of duration is 4hours; ii) amount of diesel required is 20 liters, for the‘incineration’ method. However, local market rate fortobacco was adopted. Based on the above, the cost is aboutRs. 5.03 and Rs. 1.67 for per kg of waste treated by‘incineration’ and ‘neem’ methods. In other words, treatmentby ‘neem’ methods is three time cost – effective, which isvery encouraging and promising.IV. SALIENT CONCLUSIONSBased on the field survey and the experimental investigationscarried out, following are the salient conclusions:i. The total BMW generated in the various healthcareestablishments of Pondicherry region is about 8.1 tonsday, out of which 30 – 40% can be considered as‘infectious’.ii.Importance of ‘segregation’ at source is seen to havebeen realized with the hope that ‘complete segregation’can become a reality, in future.iii. There is very high reduction in the chosenphysico-chemical and biological parameters using‘neem’ and ‘neem’ & ‘tobacco’ methods. After 120hours of treatment by the two methods, 99% of COD ofraw BMW has been reduced and the BCC (bacterialcolony count) has reduced by atleast 6 orders ofmagnitude with respect to raw BMW, which is very veryhigh.iv. In general, marginally better results are obtained whenthe waste is treated with a combination of neem andtobacco extract.v. Treatment with a combination of neem and tobaccoextract is three times cost – effective than theincineration method currently used for treatinginfectious wastes sampled from the HCE chosen for thecase study.vi. On overall assessment, the new method adopted isvery efficient and promising. However, itsefficiency for treating large quantities of BMWs,has to be assessed.77
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