D.6 (2)

Aug. 2014 – Oct. 2014, Vol. 4, No. 4; 3790-3797. E- ISSN: 2249 –1929

Journal of Chemical, Biological and Physical Sciences

An International Peer Review E-3 Journal of Sciences
Available online atwww.jcbsc.org

Section D: Environmental Sciences

CODEN (USA): JCBPAT Research Article

Biomedical Waste Management in Patna, Bihar

Vijai Krishna1*, Vishnu Murari2 and Sadhana Chaurasia3

1Institute of Environment and Sustainable Development, IESD, (BHU), Varanasi, (U.P) India
2Rajiv Gandhi South Campus, IESD, (BHU), Mirzapur, India

3Mahatma Gandhi ChirtrakootGramodya University, Chitrakoot, Satna, (M.P.) India

Received: 26 July 2014; Revised: 08 August 2014; Accepted: 03 September 2014

Abstract: There is an estimation that more than 700 biomedical waste generators are in
Patna. These include hospitals, clinics, nursing homes, laboratories, funeral homes, dentists
and veterinarians. Patna has several major hospitals. Hundreds of nursing homes and clinics
have mushroomed in various residential colonies. Besides these dispensaries, local
practitioner’s shops and veterinary hospitals are also there to cure ailing people and animals.
These aseptic sanatoriums are visited by thousands of people every day ranging from sick
children to accident victims to get cured. It has been observed during the survey of health
care centers/facilities that medical institutions generate huge quantities of dangerous and
infectious biomedical wastes. Many hospitals just dump their biomedical wastes in the
common municipal garbage bin outside the hospital posing grave danger to community
residing in surrounding areas in general and rag pickers in particulars, besides considerably
affecting environment. Study has shown that lack of facilities for disposal of hospital waste
and improper use of incinerator in hospitals and nursing homes pose a major environment
problem in Patna. Most of the hospitals and nursing homes, surveyed in Patna depend on the
municipal corporation to dispose their garbage and have no disposal system of their own.
There are total 11 hospitals,1 blood bank and 5 pathological labs are taken under study, these
hospitals are of various classes means 4 are of governmental category, 2 are of charitable,1 is
military and rest 4 are of private type.

Key words: Bio-Medical Waste, Rag Pickers, Incinerators, hazardous waste, hospitals

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Biomedical … Vijai Krishna et al.

INTRODUCTION

Due to hazardous substances of Medical waste serious threats to environmental health takes places1,2. The
hazardous substances of several types like pathological and infectious material, sharps, and chemical
wastes3-6. The re-use of syringes can spread the infections such as AIDS and hepatitis7. Resale and
potential re-use of syringes without sterilization could cause a serious disease burden8. The safe
disposable and further destruction of medical waste is a very important step in the reduction of illness or
injury due to contact with this hazardous material and in the prevention of environmental
contamination9.The transmission of blood-borne viruses and respiratory, enteric, and soft tissue infections
through improper medical waste disposal is not well described10. Presently Patna having more than 700+
bio medical waste generating centers, it includes Hospitals, Nursing homes, Clinics, Pathological Labs,
Diagnostic centers etc. which generates a lot of Bio medical wastes, and the segregation, handling,
transportation, disposal of that bio medical waste is of very indiscriminate type. Above centers are
generating waste which includes Mercury from the broken Thermometer, Sphygmomanometers,
manometers etc. which are usually handled by housekeeping means and residue from the surplus
chemicals, culture media. Medical waste creates high risk to doctors, nurses, technicians, visitors and
patients11, 12.Discarded medicines, stains used by testing centers for the diagnosis.Environment can be
polluted; humans and animals can be impacted by hospital wastes. Human and animal waste releases from
the surgical operation along with blood soaked cotton, surgical and autopsy wastes, plasters, dressing
items, gloves, urinal bags, body fluids, syringes, needles, surgical blades etc. which provided a suitable
environment for the growth of bacteria. When these wastes are disposed improperly then the risk of
infection and spread of diseases are increases to a very much extent to the all the sectors of society, most
often rag pickers, lower and poor class of society are generally very much prone to the infection because
of their standard of living, area of living, lack of education, lack of awareness towards the possible
infection etc. Improper condition of incinerator and operation of incineration without air pollution control
devices are also poses threat on the ambient air quality. During the period 1981–2005, the number of
hospitals and the number of beds increased at the rate of 5 and 2.6 per cent, per year, respectively13.

MATERIAL AND METHODS

The study area; Patna: Study area situated at on the southern bank of river Ganga. Length and breadth
of Patna is about 25 k.m. long and about 9-10 k.m. wide and having area of about 3202 k.m2. The
average rain fall is 1,100 mm, average temperature is about 26⁰C, in summer the temperature is about
30⁰C and in winter it is about 17⁰C. Population of Patna city is 1,683,200 out of which 8, 94,158 are male
and 7, 89,042 are female.Number of Medical Colleges in India 242, Number of Dental Colleges is 205,
Number of Colleges of Indian System of medicine and homeopathy is 440 in 2005. Number of
Government Allopathic Hospitals is 7,008 (2005) and Number of beds in Government Allopathic
hospitals is 469,672 (2005). Number of Doctors per Lakh Population is 70 (2005). 10,14,15

Methodology:

1. Generation of data is based on the set of questionnaire which was prepared for this survey.

2. Interviewing authorities which are responsible for the management of the waste.

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Biomedical … Vijai Krishna et al.

3. Interviewing staff, employees, safaikarmcharis etc. who are directly or indirectly involved in the Bio
medical waste disposal and treatment that what are the problems they are facing while handling,
collection, transportation etc.

4. Visit the site to collect the actual scenario of the management system.

RESULTS AND DISCUSSION
Findings from these hospitals/Pathological labs are following intable 1and table 2.

Table- 1: Details of hospitals

Name of hospital Type of Number of Amount of
BMW/Day (k.g.)
P.M.C.H hospital bed
N.M.C.H
I.G.I.M.S Government 1675 700+
Kurji holy family
Military Hospital Government 750 350(approx)
Sahyog Hospital
ViklangBhawan Government 360 120+
Magadh Hospital
Nidan nursing home Charitable 300 100+
Chand Memorial
Blood Bank Military 189 <80
Mahavir Cancer
Sansthan Private 30 10(approx)

Government 35 No Waste

Private 100 30-40

Private 10 <5

Private 10 <8

Government No Beds <10

Charitable 300 80-85

Table -2: Details of Pathological Labs

Name of lab Number of Tests/Day BMW Disposal
(approx) Strategy
RohitPatho Lab 40-50 No
Nidan test center 50+ No
Sanjeevani labs 50-55 No
RahatPatho lab 25 No
Singh Patho labs 18-20 No

Hospitals and Availability of Equipment: Availability of equipment are the essential for the safe
collection, handling and disposal of biomedical waste, it includes Incinerator, Needle cutter/destroyer,

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Biomedical … Vijai Krishna et al.

autoclave, microwave etc. These equipment are very helpful in the safe disposal of the waste by the
process of disinfection and volume reduction. These processes are essential and useful for the ultimate
disposal.

Table 3: Hospitals and equipment available

Sl. No. Name of Hospital Equipment’s Available
1. P.M.C.H Incinerator, Autoclave, Needle destroyer.
2. N.M.C.H Incinerator, Autoclave, Needle destroyer.
Incinerator, Steam autoclave, Plastic shredder,
3. I.G.I.M.S Blood bag destroyer, Needle cutter.
Incinerator, Autoclave.
4. Kurji Holy Family Incinerator, Microwave, Autoclave, Needle cutter.
5. Mahavir Cancer Sansthan Incinerator, Autoclave, Needle cutter.
6. Military Hospital Needle cutter
7. Sahyog Hospital Needle cutter
8. Magadh Hospital Needle cutter
9. Nidan Nursing home No any equipments available
10. Chand Memorial No any equipments available
11. ViklangBhawan Needle cutter
12. Blood Bank

Table 4: Hospital with the disinfection strategy for Wards

Sl.No. Name of Hospital Disinfection Strategy
1. P.M.C.H Phenyl, Bleaching Powder
2. N.M.C.H Phenyl
3. I.G.I.M.S Bleaching Powder
4. Kurji Holy Family Bleaching Powder
5. Mahavir Cancer Sansthan Phenyl, Bleaching Powder
6. Military Hospital Bleaching Powder
7. Sahyog Hospital Bleaching Powder
8. Magadh Hospital Phenyl
9. Nidan Nursing home Phenyl
10. Chand Memorial Bleaching Powder
11. ViklangBhawan Bleaching powder
12. Blood Bank Bleaching Powder

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There are six hospitals/blood banks which do not have any biomedical waste treatment facility on site it
includes. 1. MagadhHospital 2. SahyogHospital 3. Bloodbank 4. Nidan Nursing home 4.
ViklangBhawanand 5. Chand Memorial hospital. Out of these six hospitals three i.e.Magadh, Sahyog and
Blood bank send their waste to I.G.I.M.S which having the availability of common bio medical waste
treatment facility.AsViklangbhawan is not engaged in the any type of biomedical solid waste generation
due to the fact that it is only a rehabilitation center and therapy adopted here is the exercise and
physiotherapy, so the collected waste is Municipal Solid Waste (MSW) type only which is send to
Municipal Corporation.

Nidan Nursing home is also disposes its BMW into the common municipal bins which is very hazardous
for the rag pickers, waste handlers as they belongs to poor and uneducated society and often totally
unknown and unaware about the possible infection from these wastes similarly Chand memorial Hospital
also having no any strategy for the BMW treatment and its disposal. Chand memorial hospital handled its
waste directly to the rag pickers. Above all there are no any hospitals found in survey that having their
own liquid/fluid waste treatment facility, all the hospitals are just drained out their liquid waste through
the drainage to the public sewers. It is a horrible finding due to the reason that liquid discharge from
hospitals are often full with the pathogenic bacteria and it may be life threatening to the workers who are
engaged in the cleaning works of sewers, as well as these bacteria may create problem in proper
functioning of Effluent treatment Plant (E.T.P).

Segregation of Biomedical Waste: Segregation is very important part of the biomedical waste
management system as due to this process classification of waste becomes easier and ultimate treatment
can be done easily. All the government hospitals having very poor condition of the segregation due to
lack of proper number of bins, unawareness and unwillingness of ward boys/nurses, uneducated and
unaware patients and their attendants. Private hospital are cleaner than the government hospitals but they
having too lack of proper segregation system. Military hospital having an excellent example of waste
segregation facility, they are segregating all the 8 type of biomedical solid waste.

Incineration Facility: As per data, 11 hospitals/blood banks are generating the bio medical waste out of
12 (Viklang Bhawan is not generating any biomedical waste), out of these 11 hospitals/blood banks only
6 having incinerators, out of 6 incinerators only one is proper functioning with the air pollution control
equipment and certified by the Bihar State Pollution Control Board (B.S.P.C.B), this incinerator is
installed at Indira Gandhi Institute of Medical Sciences (I.G.I.M.S). The incinerator of I.G.I.M.S has
installed with the financial assistance from the Govt. of India & having capacity 220-250 k.g./hr, it is a
two chambered incinerator system and the maintained temperature is 850⁰C in first chamber & 1050⁰C in
second chamber at the time of operation, the entire set up is fitted with the digital recorder system for the
temperature, and the stack height is 30 meters from the ground, While the incinerator of the Kurji Holy
Family is single chambered and primitive type, as well as there is no any maintenance of temperature, the
same story is of N.M.C.H. In Military hospital; authorities are using earthen made incinerator when the
incinerator of Military hospital is out of order. Largest hospital of Patna is P.M.C.H and the incinerator of
P.M.C.H has been out of order since a long time. Incinerator of Mahavir cancer Sansthan is working
properly.

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Biomedical … Vijai Krishna et al.

Table 5: Availability of Incinerators

S..No. Name of Hospital Availability of
incinerator
1. P.M.C.H
2. N.M.C.H Yes
3. I.G.I.M.S Yes
4. Kurji Holy Family Yes
Yes
Mahavir Cancer
5. Sansthan Yes
6. Military Hospital
7. Sahyog Hospital Yes
8. Magadh Hospital No
9. Nidan Nursing home No
10. Chand Memorial No
11. Blood Bank No
No

Training/Seminar for Staffs: Out of 11 biomedical waste generating centers, 4 hospitals are not
organizing any training/seminars for their staffs and 7 are organizes the seminar/training programmes. It
is really bad situation that two major hospitals are not organizing any seminar/training programme.

Table 6: Details of hospitals organizing seminar/Training

Sl.No. Name of hospital Seminar/Training
1. P.M.C.H No
2. N.M.C.H No
3. I.G.I.M.S Yes
4. Yes
5. Kurji Holy Family Yes
6. Military Hospital Yes
7. Sahyog Hospital Yes
8. Magadh Hospital No
9. Nidan Nursing home No
10. Chand Memorial Yes
11. Yes
Blood Bank
Mahavir Cancer Sansthan

In the result we found that the biomedical waste management is not satisfactory, even in the largest
hospital i.e. Patna Medical College & Hospital (P.M.C.H) segregation, storage, incineration etc. are not in
proper manner. It is due to the unwillingness of staff, lack of man power, financial problem and lack of
awareness among both the hospital staff and attendants of patients. Most often in wards nurses/ward boys
handled the used syringe, IV bottles, saline apparatus, glass vials etc. to the attendants to disposed of in
the proper bins & those attendants disposes it to randomly in any bins due to lack of knowledge and

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Biomedical … Vijai Krishna et al.

methodology of disposal. While in specialized hospitals like Mahavir Cancer Sansthan due to knowledge
that cancer is fatal diseases attendants are more attentive towards the waste while cancer in no more
infectious diseases. Military Hospital follows rules strictly for the segregation of wastes as well as
transportation of waste, protective gear handling to the sweepers etc., even the doctors and nurses are
using gloves for the each injection separately. Private Hospitals are engaged in the collection of waste
only prior to the handling of waste to the contractors. On the other hand most of Pathological laboratories
having no any management strategy for the safe disposal of the bio medical waste.

CONCLUSION

Communicable diseases as gastroenteritis, hepatitis, respiratory infections, and skin diseases are
associated with hospital waste either as a result of injuries or transmission channels15.it can be seen from
the study that there is extreme need for making legal, technical and practical arrangements for the BWM
in the city of Patna. Most of the hospitals in the Patna are not following the proper practices of BWM.
Most of the bio-medical waste is going in the municipal waste stream. Most of the hospitals do not have
bio-medical waste handling and treatment equipment and facility or if they have it is not working or
improperly working. People engaged in the BMW in Patna are working at the risk of infection as they do
not have proper training and cover like gloves, masks etc. There is need of proper training and
encouragement as well as awareness among people involve in the BMW. Common incinerators should be
made and maintained so that whole bio-medical waste can be treated at a single place.

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Corresponding author: Vijai Krishna;
1Institute of Environment and Sustainable Development, IESD, (BHU),

Varanasi, (U.P) India

3797 J. Chem. Bio. Phy. Sci. Sec. D, Aug. 2014 – Oct. 2014; Vol.4, No.4; 3790-3797