Navaz Clement
Manager - Housekeeping
Aravind Eye care system

AEH has contributed to society in a big way in the field of eye care. It has also been a pioneer in developing processes and technology in the medical field, and systems in training, and human resource development.

It is therefore but natural to expect AEH to have a clean, systematic and environment friendly waste management system.

Impact of poor waste management systems

On People

1. Infections: This is the most common health hazard associated with poor Hospital Waste Management. Those exposed to this hazard are
   1. Patients attending the health care institution
   2. People visiting the patients in the health care institution
   3. Medical and paramedical persons who are providers of medical care
   4. Sanitation staff involved in collection, segregation, transportation and final disposal of waste
   5. Staff working in support services of the hospital
2. Physical injury: This occurs due to the improper handling of various biomedical wastes at various stages of waste management. Out of various categories of waste, the sharps are the most prone to cause physical injury, especially when intermixed with other waste
3. Chemical injury: This results from hazardous, toxic, corrosive, flammable, reactive and genotoxic wastes which can produce burns on accidental exposure, or cause toxicity to cells,
4. Radiation injury: This occurs due to exposure to various forms of radioactive waste such as that from the chemotherapy and X-ray rooms.

1. Water pollution: Measures should be taken to reduce the quantity and strength of incompatible pollutants in wastewater flow. If not connected to municipal wastewater treatment plant, an on-site treatment should be started. Sludge from such a plant should be managed with the same precautions as for municipal waste sludge ie. It should not be put on food crops unless treated properly. For chemicals, which are a potential source of pollution, an on-site chemical waster survey is a pre-requisite to the development of an effective waste management system. Waste chemicals, as far as possible should be recycled, and more hazardous chemicals should be substituted wherever possible with less hazardous chemicals. Use of disinfectants should be limited and alternatives used wherever possible.
2. Air pollution: Most of the air pollution results from incineration. It should be ensured that incinerators for health care institutions be designed specifically for that purpose and must comply with the accepted norms of emission. Fume hoods, which are another outlet for air pollution should be fitted with filters.
3. Soil Pollution: General waste along with properly treated infectious waste can safely be disposed off in a specialized landfill. Properly operated incinerators produce sterile ash, which can safely be put in a specialized landfill.

1. No untreated biomedical waste shall be stored beyond a period of 48 hours
2. If, for any reason it becomes necessary to store waste beyond such period, the authorized person must take permission of the prescribed authority and take measures to ensure that the waste does not affect human health and the environment.

1. Made up of hard plastics / metal which should be sturdy and leak proof
2. The size of the containers will depend upon the quantity of waste generated
3. Should have a secure lid which can be shut down after the waste is collected. It should not allow insects and animals to go inside
4. Should be puncture proof, reusable, colour coded, labeled and not easily destroyed by rodents and other animals
5. The inner surface should be smooth and rounded without any sharp edges which can tear the plastic bags kept inside

1. Should be large enough to accommodate all the waste of that particular category. It should completely line the container and a portion of it should be outside.
2. Should be sturdy enough to withstand the weight of the load of waste without tearing or giving way
3. Should be leak proof and water proof, without any weak areas or tears
4. Should be colour coded. Labeled and marked clearly with labels.

1. Should be an area specifically marked for collection and storage of waste, pending treatment and final disposal
2. Should be covered and protected from all sides against humans and animals
3. There should be a proper facility for locking of the area to prevent tampering by rag pickers. The key should be kept with a responsible person at all times.
4. There should be a clear warning sign with symbols
5. Location should be away from public places and food preparation areas
6. Construction should be robust with drainage system, lights and ventilation.

1. Push cart An open push cart designed so that one or two bins/containers of waste can be moved from rooms to the garbage trolley parked outside the ward
2. Waste trolley A large trolley made of iron/ stainless steel with 4 revolving castors and of sturdy construction. It should be covered so that insects, flies, etc. do not have access inside.
3. Wheel barrow Can be used for small amount of general/non-hazardous waste.

1. Cycle rickshaw can be used if the site of final disposal is close to the hospital. It should be covered on all sides and can be divided into 2 compartments, for infectious and non-infectious waste.
2. Van / lorry It should be earmarked for waste transportation with the label Bio medical Waste on both sides and at the back. It should be fully covered and lined internally with aluminum or metal to give it a smooth impervious finish. It should have rounded corners without edges or angles for effective cleaning and disinfection. The drivers cabin should be fully separated from the bulk head, and the load compartment should be securely locked during transit. If the journey to the site of final disposal is long, roof vents need to be provided for ventilation

1. Landfill: This is the most satisfactory method of garbage disposal where suitable land is available. However, the site of landfill has to be chosen with utmost care and the following factors regarding construction should be kept in mind:
   • It should be avoided near sources of water
   • The site should be securely fenced and should have a gate away from public view with signboard stating Landfill site
   • Covered with at least 0.5m of suitable cover material.
   Landfill is done by any of the following methods:
   • Trench Method A long trench 2-3m deep and 3-10 m wide depending upon local conditions is made. The treated waste is ideally compacted, filled up to 2m and covered with excavated earth.
   • Ramp Method This is well suited where the terrain is moderately sloping, and excavation is done to secure the covering material.
   • Area Method This method is used for terrain land depressions, disused quarries and clay pits. The treated waste is deposited, packed and consolidated in uniform layers up to 2-2.5 m deep. Each layer is sealed on its exposed surface with a mud cover at least 12 thick to prevent infestation of flies, rodents etc.
   After the waste has been buried, chemical, bacteriological and physical changes occur and the temperature goes up to 600 C within 7 days hastening the decomposition process. Within 4-6 months complete decomposition of matter occurs into an innocuous mass. The potential use of filled land includes improvement of eroded areas, marshes and other marginal land.
2. Pit Burial: This is suitable for small camps or institutions, where in a small pit of size 2m by 2m waste is put there with 10cm, soil between each layer of waste. When the level is full, it is closed with a thick layer of soil. It is also fenced with secure gate for entry and exit. Contents get decomposed within 4-6months.
3. Composting: This is a method of combined disposal of refuse and night soil. It is a process whereby organic matter breaks down under bacterial action resulting in the formation of a relatively stable humus like material called compost which has considerable manorial value for soil as it contains nitrates and phosphates. The temperature achieved over a period of days destroys the eggs and larvae of flies and other insects. Vermiculture: In this process, the biodegradable wastes from the kitchen, houses and the cafeteria are converted into manure with the help of earthworms. Organic waste is kept in wooden boxes or earthen ditches with small amount of waste at the bottom. A small bunch of earthworms are placed in each part and covered with organic matter. This is sprinkled with water, and in due course gets converted into manure.

1. NADEP Composting: General refuse/waste can be converted into rich, soft, good smelling compost by using this simple, economical and non-polluting technology.
2. Pelletisation Technology: This process converts biodegradable wastes into fuel pellets by treatment with heat, humidity, and pressure by machine designed for this purpose. The fuel thus developed is cheaper, has less smoke emission but lasts longer.
3. Biopress Methods: This turns garbage into incinerable matter and produces methane gas. Methane is produced naturally in any landfill through decomposition of organic matter, over a period of 20-30years.It contains roughly 50% methane and 50% carbon dioxide. The recoverable gas is about 50-80% of the total gas which can be used for:
   • Generation of electricity in an internal combustion engine or gas turbine
   • Directly as a boiler fuel
   • Compressed for vehicle fuel or upgraded to pipeline gas
   Environmental effect of methane is about 10 times more potent than carbon dioxide, and it can be reduced to methane, which is recovered for energy production. The experience of waste to energy technology (WET) such as this has been encouraging in the developed countries, but not in the developing countries.
4. Environmental effect of methane is about 10 times more potent than carbon dioxide, and it can be reduced to methane, which is recovered for energy production. The experience of waste to energy technology (WET) such as this has been encouraging in the developed countries, but not in the developing countries. 4. Gasification technology (biogas from organic waste): Energy derived from anaerobic digestion of organic waste involves the production of biogas from organic waste. The technology involves the separation of wastes at source or mechanically prior to digestion and comprises the following steps: (i) pre-treatment (ii) digestion (iii) post treatment of waste. This process is eco friendly and recovers 100% methane, reduces odour, produces electricity and displaces carbon dioxide. It is a traditional source of energy and forms a suitable by-product, viz. compost which is an excellent manure.

• Waste from wards food waste, plastics, disposable coffee cups, paper, banana leaves IV bottles and tubes
• Waste from OPD disposal coffee cups, cotton, swabs, plastic bottles (used for drops) paper, vials, syringes, and needles.
• Waste from OT swabs, cotton, blades, syringes, lens covers, eyes, vials, syringes, needles, gloves, IV bottles and tubes.
• Waste from office areas papers, plastics
• Waste from kitchens, canteen and dining areas food waste, good food waste (remaining after dinner), vegetable waste, tea and coffee decoction, coconut shells, plastic milk packets, paper.
• Other general wastes jute sacs, tube lights and chokes, newspapers, water cans, old plates, old tumblers, wires, iron and aluminum leftovers, cartons, computer parts, old books, waste oil from machines, glass from photo frames, wood from old tree trunks and carpentry work, old taps in brass, phenyl cans, paint tins old buckets and mugs shampoo bottles, rings used for IV, coconut oil bottles, boxes from Aurolab old clothes old cassettes.