Improve your skill of hospital management 14
Madhav Madhusudan Singh
S.No | Waste Class | Type of Containers | Colour Coding | Treatment Method |
| 1. | Human anatomical waste, blood and body fluids, animal waste, microbiological waste, highly infectious waste, isolated waste and biotechnology waste | Single use container / polythene holding bags | Red | Incineration |
| 2. | Waste Sharp | Reusable sturdy polythene / metal | Blue | Disinfection / autoclaving followed by shredding / crushing |
3. | Discarded glass wares | Do | White | Do |
| 4. | Disposable (PVC / plastics, cardboard & thermacol) | Reusable sturdy polythene / metal | Green | Do |
| 5. | Incineration Waste | Reusable sturdy polythene / metal | Black | Landfilling in secured landfill |
Standard for Incinerators and Autoclaving
A: Incinerators
The wastes falling in red category (Ref. 35.1) need to be incinerated. For this purpose, the incinerators could be of following two types :
i. | Incinerators of individual hospital / nursing homes / medical colleges / veterinary centre ; and |
ii. | Common incinerators to handle the wastes from a number of hospitals / nursing homes / pathological laboratories / medical colleges and veterinary centares. |
Incinerators should be installed at appropriate location, to avoid nuisance to patients and neighborhood. An incinerator shall consist of two chambers – primary and secondary. The incinerators shall meet the following emission standards: -
a. | Combustion efficiency (CE) shall be atleast 99.99%. It is computed as follows :- | |||||||||
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b. | The temperature of the primary zone shall be 800 � 50o C. The secondary combustion chamber gas residence time shall be at least 1 (one) second at 1050 o C � 50oC with the minimum of 3% O2 I the stack gas. | |||||||||
c. | Particulate matter - 100 mg/NM3 (12% CO2 correction) | |||||||||
d. | Sulfur dioxide - 150 mg/NM3 . (12% CO2 connection) | |||||||||
e. | Nitorgen Oxides - 450 mg/NM3 .do | |||||||||
f. | HCl - 50 mg/NM3 .do | |||||||||
g. | Minimum stack height shall be 30 metre. |
Note :-
i. | Waste heat recovery boiler is recommended to be installed to recover the sensible heat from exhaust gas. |
ii. | Suitable air pollution control devices shall be installed to meet the above mentioned emission standards. |
iii. | All hospitals shall install suitable shredders / crushers for the preliminary treatment of waste sharps, discarded glassware’s and disposables. |
iv. | For setting up of incinerator, necessary clearance / consent shall be obtained from the concerned state pollution control board / committee. Special care shall be taken while transporting the wastes from hospital to incinerator in closed containers. The protocol for transportation shall be finalised by local authority in consultation with the state pollution control board / committee. The vehicles carrying wastes would be labelled accordingly. The hospitals, nursing homes etc., which are unable to set up incinerators within their premises because of lesser quantum of incinerable waste generation or for other reasons, may collectively install common incinerators or avail the incinerator facility of other hospitals through a mutual agreement among themselves. |
B: Autoclaving
In this process, the wastes are heated at specified temperature and a period of time in a chamber into which pressurised steam is introduced. The steam penetration ensures destruction of bacteria and pathogenic micro-organisms. The technologies used during autoclaving are induced vacuum, where the steam entering the chamber displaces the air.
For decontamination of waste by autoclaving, loosely-packed material should be exposed at least for 1 hour at temperature not below 121o C and 15 psi pressure. Autoclaves shall be regularly monitored for adequate sterilisation performance as part of the regular quality control practice.
Liquid Waste
The effluents generated from the hospital shall conform to the following limits :-
| S.No | Parameter | Permissible Limit |
| 1. | pH | 6.5 – 9.0 |
| 2. | Suspended Solids | 100 mg/l |
| 3. | Oil and Grease | 10 mg/l |
| 4. | BOD (3 days at 27oC) | 30 mg/l |
| 5. | COD | 250 mg/l |
| 6. | Bio-assay test | 90 percent survival of fish after 96 hours in 100% effluent |
Note :- These limits are applicable to those hospitals which are either connected with sewers without terminal sewage treatment plant or not connected to public sewers at all. For discharge into public sewers having terminal treatment facility, the general standards as notified under the Environment (Protection) Act, 1986 shall be applicable.
Lt Col (Dr. ) Madhav Madhusudan Singh
MBBS (AFMC), MHA ( AIIMS ), MHA ( ICFAI ) MBA ( Hospital & Health care),PG Dip in Medical Informatics (Pune), Green Belt Six Sigma ( Hospital & Health care, SYMBIOSIS), PG Diploma in Hospital Administration ( Annamalai) , PG Dip in Telemedicine ( Bioinformaticus) , PG Dip in Medical Law ( National law sch of India Univ, B'lore)
Secretary & Executive Body Member , Managing Editor ( IJRFHHA)
Research Foundation of Hospital and Healthcare Administration (A initiative of AIIMS Hosp Adm Dept)
Ph :91- 9013455168
Web: www.rfhha.org
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