INSTITUTE OF MANAGEMENT STUDIES

To Assess Current Practises Of BIOMEDICAL WASTE

MANAGEMENT In a Tertiary Hospital

SUBMITTED BY- SUBMITTED TO-

SUSHMA VERMA DR.MEGHA JOSHI
MA'AM

1
 CERTIFICATE

This is to certify that SUSHMA VERMA student of Hospital Administration BBA (HA) – VI th SEM of
Institute of Management Studies, Devi Ahilya University, Indore has undergone his training on project
entitled “TO ACCESS CURRENT PRACTISES OF BIO MEDICAL WASTE MANAGEMENT
INCLUDING generation, collection ,transportation, storage, treatment and disposal technologies in
tertiary hospital at INDEX MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTER ,
INDORE.

She has successfully completed the project, his study and performance during the period of 30 days has
been found to be satisfactory.

I wish her all success in his future endeavors.

MR. SANJEEV MISHRA (SIR)

Date:

Place: INDEX MEDICAL COLLEGE HOSPITAL AND RESEARCH CENTER , INDORE

2
 ACKNOWLEDGEMENT

I would like to sincerely acknowledge my deep thanks to Dr. SURESH SINGH BHADORIYA
(Chairman sir) and Mr. Nishikant Waikar (Training and Placement Officer).

I express my feeling of gratitude to Dr.PAVAN BAMBANI (Medical Director, INDEX MEDICAL

College and Hospital) for granting me the opportunity to undergo departmental training from their
renowned hospital.

I am thankful to Dr MEGHA JOSHI MA'AM who guided me at every step and has motivated me to put
sincere efforts despite various constraints without which, this project could not have been completed.

I convey my sincere thanks to the staff of the hospital that supported me in routine activities required for
completion of project and spared their precious time for guiding me in respective field of concern.

Last but not the least I would like to thank all those who have directly or indirectly helped me in completing
this project.

SUSHMA VERMA.

3
 DECLARATION

I, SUSHMA VERMA, student of BBA (Hospital Administration) VI th SEM, Institute of Management

Studies DAVV University, Indore hereby declare that this project has been completed by me and is a part of
my Research Project. This report has not been submitted anywhere else to the best of my knowledge.

4
 HOSPITAL PROFILE

INTRODUCTION-

Index Medical College, Hospital & Research Centre is the latest avenue in Medical advancements where
young enthusiastic minds are taught the Science & art of Medicine. Index Medical College, Hospital &
Research Centre in built on empirical values & pragmatic approach of dedication and commitment to
excellence. Index Medical College, Hospital & Research Centre in Collaboration with Mayank Welfare
Society is dedicated to Excellence in Medical Education research and Patient care. Woven throughout all
these pursuits is a strong commitment towards public service and a collaborative work ethics of providing
care for our diverse population. In the year 1996 the visionary promoters of this Institute committed to
advancement of Medical Education Health Care and Research set upon this great journey towards greater
level of excellence in all these fields.

LOCATION
The Campus is situated at Gram Morodhat, Near Khudel Villege, Nemawar Road Indore. The Campus is
situated on 30 acres of land with four lush green garden and is soon going to be connected with four lanes
and sufficient numbers of sub-lanes.

Address: NH-59A, Nemawar Road, Post- Bavliya Khurd, Index City, Indore
Mobile: 9630098980, Landline: 0731 4013604
Email: deanmed@indexgroup.co.in

FACILITIES

The building is built such that there is abundant fresh air and spacious complex designed to meet all
future expansions and requirements. The serene and healthy environment comprises of the college
building including lecture galleries block, separate hostel building for Boys & Girls, Multi Gym &
dedicated diet centre for Hostel inmates.

5
AT A GLANCE :

 Hospital Established in 2006 catering rural, suburban and urban populations with free diagnostic and
treatment modalities.

 1st batch MBBS was admitted in 2007 & passes out in March 2012.

 Post graduate (MD/MS) courses started in 2011.

 GOI & MCI permitted PG degree programmes in Non clinical subjects in 2011 .

 GOI & MCI permitted PG degree programmes in clinical subjects in 2014. Ecologically friendly lush green
campus habitat.

 ISO certification 9001-2008.

 Recognized by Medical Council of India, New Delhi.

 Affiliated to DAVV University, Indore , MPMSU, Jabalpur, & Malwanchal University, Indore

 Approved for 150 Admission per year in MBBS & 103 MD/MS admission per year in various departments.

 Now IMCHRC is a constituent unit alongwith Dental, Nursing, Pharmacy & Paramedical College of
Malwanchal University.

 Cater rural, suburban as well as urban area students as an opportunity for professional growth.

 Create international standards of academic excellence in all fields.

 Motivate students and working professionals to overcome barriers and move uphill towards bright
horizons.

6
VISION AND MISSION

VISION
To emerge as a pioneer in a quality healthcare and medical education center.

MISSION

To take strides in revolutionizing the health care scenario as a tertiary care center in Madhya
Pradesh.

To provide highest quality of medical education , training and services.

To conduct approved research related to patient management.

CORE VALUES

 Our existence depends on patient satisfaction.

 The most important person in our hospital is our customer
 Our chief aim is continuous improvement in medical khowledge and skill
 To safeguard and preserve patient/client right during the course of clinical care and other services
provided to the patients
 To inform all patients about their rights in a manner that they can understand.

7
Literature Review-
Introduction
Biomedical waste is highly hazardous and infectious in nature of utmost
importance due to its hazardous and infectious nature and therefore requires
proper disposal techniques. Realizing its utmost significance, the Government
of India (GOI) has passed the Biomedical Waste (Management and Handling)
rules 1998 under the Environmental Protection Act 1986 and which is to be
strictly followed while disposal of biomedical waste. In this study, the
procedure of handling of biomedical waste followed by INDEX hospitals
(public and private) has been carried out through a questionnaire study for
Indore city. The questionnaire utilized for this purpose has been presented.
Further, the results of this questionnaire will be analyzed and utilized to
observe the similarities and differences of the waste management procedures
of the hospital on the basis of Pre and Post survey and current practises
under progress.

WHAT IS BIOMEDICAL WASTE?

8
Biomedical waste is any kind of waste containing infectious (or potentially infectious) materials.[1] It may
also include waste associated with the generation of biomedical waste that visually appears to be of medical
or laboratory origin (e.g., packaging, unused bandages, infusion kits, etc.), as well research laboratory waste
containing biomolecules or organisms that are restricted from environmental release. As detailed below,
discarded sharps are considered biomedical waste whether they are contaminated or not, due to the
possibility of being contaminated with blood and their propensity to cause injury when not properly
contained and disposed of. Biomedical waste is a type of biowaste.

Biomedical waste may be solid or liquid. Examples of infectious waste include discarded blood, sharps,
unwanted microbiological cultures and stocks, identifiable body parts (including those as a result
of amputation), other human or animal tissue, used bandages and dressings, discarded gloves, other medical
supplies that may have been in contact with blood and body fluids, and laboratory waste that exhibits the
characteristics described above. Waste sharps include potentially contaminated used (and unused discarded)
needles, scalpels, lancets and other devices capable of penetrating skin.

Biomedical waste is generated from biological and medical sources and activities, such as the diagnosis,
prevention, or treatment of diseases. Common generators (or producers) of biomedical waste
include hospitals, health clinics, nursing homes, emergency medical services, medical research laboratories,
offices of physicians, dentists, and veterinarians, home health care, and morgues or funeral homes. In
healthcare facilities (i.e., hospitals, clinics, doctor's offices, veterinary hospitals and clinical laboratories),
waste with these characteristics may alternatively be called medical or clinical waste.

Biomedical waste is distinct from normal trash or general waste, and differs from other types of hazardous
waste, such as chemical, radioactive, universal or industrial waste. Medical facilities generate waste
hazardous chemicals and radioactive materials. While such wastes are normally not infectious, they require
proper disposal.

TYPES OF BIOMEDICAL WASTES

The list below displays the most common waste categories as identified by the WHO.
Sharps.
This kind of waste includes anything that can pierce the skin, including needles, scalpels, lancets, broken
glass, razors, ampules, staples, wires, and trocars.

Infectious Waste
9
Anything infectious or potentially infectious goes in this category, including swabs, tissues, excreta,
equipment, and lab cultures.

Radioactive
This kind of waste generally means unused radiotherapy liquid or lab research liquid. It can also consist of
any glassware or other supplies contaminated with this liquid.

Pathological
Human fluids, tissue, blood, body parts, bodily fluids, and contaminated animal carcasses come under this
waste category.

Pharmaceuticals.
This grouping includes all unused, expired, and/or contaminated vaccines and drugs. It also encompasses
antibiotics, injectables, and pills.

Chemical.
These are disinfectants, solvents used for laboratory purposes, batteries, and heavy metals from medical
equipment such as mercury from broken thermometers.

Genotoxic Waste
This is a highly hazardous form of medical waste that’s either carcinogenic, teratogenic, or mutagenic. It can
include cytotoxic drugs intended for use in cancer treatment.

General Non-Regulated Medical Waste

It is Also called non-hazardous waste, this type doesn’t pose any particular chemical, biological, physical, or
radioactive danger

PROBLEM STATEMENT- INDIA

In India, though there are a number of different disposal methods, the situation is desultory and most are
harmful rather than helpful. If body fluids are present, the material needs to be incinerated or put into an
autoclave. Although this is the proper method, most medical facilities fail to follow the regulations. It is
often found that biomedical waste is dumped into the ocean, where it eventually washes up on shore, or in
landfills due to improper sorting or negligence when in the medical facility. Improper disposal can lead to
many diseases in animals as well as humans. For example, animals, such as cows in Pondicherry, India, are
consuming the infected waste and eventually, these infections can be transported to humans who consume
their meat or milk. Large number of unregistered clinics and institutions also generate bio-medical waste
which is not controlled.

10
Due to the competition to improve quality and so as to get accreditation from agencies like ISO, NABH,
JCI, many private organizations have initiated proper bio-medical waste disposal but still the gap is huge.

Many studies took place in Gujarat, India regarding the knowledge of workers in facilities such as hospitals,
nursing homes, or home health. It was found that 26% of doctors and 43% of paramedical staff were
unaware of the risks related to biomedical wastes. After extensively looking at the different facilities, many
were undeveloped in the area regarding biomedical waste. The rules and regulations in India work with The
Bio-medical Waste (Management and Handling) Rules from 1998, yet a large number of health care
facilities were found to be sorting the waste incorrectly.

GUIDELINES

The Bio-medical Waste (Management and Handling) Rules, 1998 and further amendments were passed for
the regulation of bio-medical waste management. On 28 th Mar 2016 Biomedical Waste Management Rules
2016 were also notified by Central Govt. Each state's Pollution Control Board or Pollution control
Committee is responsible for implementing the new legislation.

The latest guidelines for segregation of bio-medical waste recommend the following color coding –

Red Bag - Syringes (without needles), soiled gloves, catheters, IV tubes etc should be all disposed of in a red
colored bag, which will later be incinerated.

11
Yellow Bag - All dressings, bandages and cotton swabs with body fluids, blood bags, human anatomical
waste, body parts are to be discarded in yellow bags.

Blue bag - Glass vials, ampules, other glass ware is to be discarded in a cardboard box with a
bluemarking/sticker.

White Puncture Proof Container (PPC) - Needles, sharps, blades are disposed of in a white translucent
puncture proof container.

Black Bags - These are to be used for non-bio-medical waste/general waste. In a hospital setup, this includes
stationary, vegetable and fruit peels, leftovers, packaging including that from medicines, disposable caps,
disposable masks, disposable shoe-covers, disposable tea cups, cartons, sweeping dust, kitchen waste etc.

12
 MPPCB LATEST GUIDELINES FOR BIOMEDICAL WASTE
MANAGEMENT (2016)

Category Type of Waste Type of Bag or Treatment and

Container to be Disposal options
used
(1) (2) (3) (4)

13
Yellow (a) Human Yellow coloured Incineration or
Anatomical non-chlorinated Plasma Pyrolysis or
Waste: plastic bags deep burial*.
Human tissues,
organs,
body parts and fetus
below the viability
period (as per the
Medical Termination
of
Pregnancy Act 1971,
amended from time to
(time).

(b)Animal
Anatomical
Waste :
Experimental animal
carcasses, body parts,
organs, tissues,
including the waste
generated from
animals used in
experiments or testing Incineration or
in veterinary hospitals Plasma Pyrolysis or
or colleges or animal deep burial*
houses. In absence of above
facilities,
(c) Soiled Waste: autoclaving or micro-
Items contaminated wavinghydroclaving
with blood, body followed by shredding
fluids or
like dressings, plaster mutilation or
casts, cotton swabs combination of
and sterilization and
bags containing shredding. Treated
residual waste to be sent for
or discarded blood energy recovery.
and Yellow coloured
blood components. non-chlorinated Expired `cytotoxic
plastic bags or drugs and items
containers contaminated with
cytotoxic drugs to be
returned back to the
manufacturer or
supplier for
incineration at
temperature
(d) Expired or >1200 0C or to
Discarded common bio-medical
Medicines: waste treatment
Pharmaceutical waste facility or hazardous
like antibiotics, waste treatment,

14
cytotoxic drugs storage and disposal
including all items facility for
contaminated with incineration at
cytotoxic drugs along >12000C Or
with glass or plastic Encapsulation or
ampoules, vials etc. Plasma Pyrolysis at
>12000C.
All other discarded
medicines shall be
either sent back to
manufacturer or
Yellow coloured disposed by
containers or incineration.
non-chlorinated
plastic bags Disposed of by
incineration or Plasma
Pyrolysis or
Encapsulation in
hazardous waste
Separate treatment, storage and
collection disposal facility.
system leading
to effluent After resource
(e) Chemical Waste: treatment system recovery, the chemical
Chemicals used in liquid waste shall be
production of pre-treated before
biological mixing with other
and used or discarded wastewater. The
disinfectants. combined discharge
shall conform to
the discharge norms
given in Schedule-
(f) Chemical Liquid III.
Waste : (g) Discarded linen,
Liquid waste mattresses, beddings
generated contaminated with
due to use of blood or body fluid.
chemicals Non-chlorinated Non-chlorinated.
in production of yellow plastic
biological and used or bags or suitable
discarded packing material Non- chlorinated
disinfectants, chemical disinfection
Silver X-ray film followed by
developing liquid, incineration or
discarded Formalin, Plazma
infected secretions, Pyrolysis or for
aspirated body energy recovery.
fluids, liquid from In absence of above
laboratories and floor facilities, shredding
washings, cleaning, or mutilation or
house-keeping and combination of
disinfecting activities sterilization and
etc. shredding. Treated

15
 (g) Discarded linen, waste to be sent for
mattresses, beddings Autoclave safe energy recovery or
contaminated with plastic bags or incineration or
blood or body fluid containers Plazma Pyrolysis.

Pre-treat to sterilize
with nonchlorinated
chemicals on-site as
per
National AIDS
Control Organisation
or
World Health
Organisation
guidelines
thereafter for
Incineration.
(h) Microbiology,
Biotechnology and
other clinical
laboratory waste:
Blood bags,
Laboratory
cultures, stocks or
specimens of
microorganisms,
live or
attenuated vaccines,
human and animal
cell
cultures used in
research, industrial
laboratories,
production
of biological, residual
toxins, dishes and
devices used for
cultures.

Red Contaminated Waste Red coloured Autoclaving or micro-

(Recyclable) non-chlorinated waving/
(a) Wastes generated plastic bags or hydroclaving
from disposable items containers followed by shredding
such as tubing, or
bottles, mutilation or
intravenous tubes and combination of
sets, catheters, urine sterilization and
bags, syringes shredding. Treated
(without waste to be sent to
needles and fixed registered or
needle authorized recyclers
syringes) and or for energy

16
 vaccutainers with recovery or plastics to
their diesel or fuel oil
needles cut) and or for road making,
gloves whichever is
possible.

Blue (a) Glassware: Cardboard boxes Disinfection (by

Broken or discarded with blue soaking the washed
and colored marking glass waste after
contaminated glass cleaning with
including medicine detergent and Sodium
vials Hypochlorite
and ampoules except treatment) or through
those contaminated autoclaving or
with microwaving or
cytotoxic wastes. hydroclaving and then
sent for recycling.

Cardboard boxes
with blue
colored marking
(b) Metallic Body
Implants

17
MANAGEMENT

Biomedical waste must be properly managed and disposed off to protect the environment, general public and
workers, especially healthcare and sanitation workers who are at risk of exposure to biomedical waste as an
occupational hazard.
Steps in the management of biomedical waste include: generation, accumulation, handling, storage,
treatment, transport and disposal.

On-site and off-site

Disposal occurs off-site, at a location that is different from the site of generation.
Treatment may occur on-site or off-site. On-site treatment of large quantities of biomedical waste usually
requires the use of relatively expensive equipment, and is generally only cost effective for very large
hospitals and major universities who have the space, labor and budget to operate such equipment.
Off-site treatment and disposal involves hiring of a biomedical waste disposal service whose employees are
trained to collect and haul away biomedical waste in special containers for treatment at a facility designed to
handle biomedical waste.

Generation and accumulation

Biomedical waste should be collected in containers that are leak-proof and sufficiently strong to prevent
breakage during handling. Containers of biomedical waste are marked with a biohazard symbol. The
container, marking, and labels are often red.
Discarded sharps are usually collected in specialized boxes, often called needle boxes. All the biomedical
wastes are to be dumped after proper treatment.
Storage
Storage refers to keeping the waste until it is treated on-site or transported off-site for treatment or disposal.
There are many options and containers for storage. Regulatory agencies may limit the time waste can remain
in storage.
Handling is the act of moving biomedical waste between the point of generation, accumulation areas,
storage locations and on-site treatment facilities. Workers who handle biomedical waste must
observe standard precautions.
18
Treatment
The goals of biomedical waste treatment are to reduce or eliminate the waste's hazards, and usually to make
the waste unrecognizable. Treatment should render the waste safe for subsequent handling and disposal.
There are several treatment methods that can accomplish these goals.

Biomedical waste is often incinerated. An efficient incinerator will destroy pathogens and sharps. Source
materials are not recognizable in the resulting ash. No matter where medical waste is processed, it’s
ultimately treated by incineration, autoclaving, microwave, biological, or chemical treatment.

Incineration.
Waste destruction in a furnace by controlled burning at high temperatures. Incineration removes water from
hazardous sludge, reduces its mass and/or volume, and converts it to a non-burnable ash that can be safely
disposed of on land, in some waters, or in underground pits. However, it is a highly contentious method
because incomplete incineration can produce carbon monoxide gas, gaseous dioxins, and/or other harmful
substances.

Autoclaving.
Steam sterilization renders biohazardous waste non-infectious. After it’s been sterilized, the waste can be
disposed of normally in solid waste landfills, or it can be incinerated under less-stringent regulation.

Microwaving.
Another way to render hazardous healthcare waste non-hazardous is to microwave it with high-powered
equipment. As with autoclaving, this method opens up the waste to normal landfill disposal or incineration
afterward.

Chemical.
Some kinds of chemical waste may be neutralized by applying reactive chemicals that render it inert. This is
generally reserved for waste that’s chemical in nature.

Biological.
This experimental method of treating biomedical waste uses enzymes to neutralize hazardous, infectious
organisms. It’s still under development and rarely used in practice.

SHARPS WASTE

‘Sharps waste’ is defined and classified as ‘special waste’ under Schedule 1 of the Protection of the
Environment Operations Act 1997 and the EPA’s Waste Classification Guidelines.
What is sharps waste?

Under NSW environment protection legislation, sharps waste is defined as any waste collected from
designated sharps waste containers used in the course of business, commercial or community service
activities. This includes any waste resulting from the use of sharps for any of the following purposes.

human health care by health professionals or health care providers (either at health facilities or at home)
19
medical research or work on cadavers
veterinary care or veterinary research
skin penetration or the injection of drugs or other substances for medical or non-medical reasons.

‘Sharps’ means items that have sharp points or edges capable of cutting, piercing, or penetrating the skin
(such as needles, syringes with needles or surgical instruments) are designed for the purpose of cutting
piercing or penetrating the skin have the potential to cause injury or infection.
Sharps are devices or objects with corners, edges, or projections capable of cutting or piercing skin or
regular waste bags. State and local laws regulate disposal of sharps to protect waste handlers from both
physical and contamination hazards.
Examples of sharps include:
Hypodermic needles, syringes, tubing
Blunted needles
Pasteur pipettes
Blades(scalpels, razors,)
Broken lab glassware
Glass capillary tubes

How these objects should be disposed of –

For disposal purposes, there are 3 kinds of sharps:

Non-contaminated (except needles, syringes and lancets

Biohazardous (includes non-contaminated needles, syringes, and lancets)
Chemically contaminated

Disposing of sharps and syringes

 Discard sharps items and complete needle and syringe units directly into sharps box immediately
after use.
 Where possible, used sharps should not be taken to the sharps box, the box should be taken to the
patient.
 Place sharps boxes at eye level and within arm’s reach.
Establish means for the safe handling and disposal of sharps devices before the beginning of a
procedure.

20
AIM:
This study aims at examining healthcare waste management practices by surveying the current practices
followed.

OBJECTIVE:
To determine the:

1) amount of waste generated

2) waste types
3) sources of waste generated

4) segregation of healthcare waste

5) waste storage, transportation, and disposal and;

6) adherence to regulations

RESEARCH DESIGN:

Research design for conducting this study consisted of four major tasks:

1) developing a questionnaire

2) identifying the hospital to be visited for data collection

3) Applying appropriate statistical analysis method to evaluate pre and post survey .

3) To make recommendations regarding sound healthcare waste management.

21
DEPARTMENTS:

LABOUR WARD
A maternity ward specializes in caring for women during pregnancy and childbirth. It also provides care for
newborn infants, and may act as a centre for clinical training in midwifery and obstetrics. It is called a labor,
delivery, and recovery room (LDR). This is the type of room that some hospitals and almost all birth centers
use for their care. This is the place which is used for the labor and birth, including the initial hours of
recovery of both mother and child.

The labour ward is located at the ground floor of the hospital.

PRIVATE WARD

A private room is to maintain privacy. Unlike general wards private wards are designed in a hospital to give
more space to a patient. Private wards contains rooms that are allotted to patients as per their will where he
can have better facilities . It is less occupied and noisy then general wards. This will be very beneficial when
it comes to rest and recuperation after surgery,

ICU
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU)
or critical care unit(CCU), is a special department of a hospital or health care facility that
provides intensive treatment medicine .Intensive care units cater to patients with severe and life-
threatening illnesses and injuries, which require constant, close monitoring and support from specialist
equipment and medications in order to ensure normal bodily functions. They are staffed by highly
trained doctors and nurses and a higher staff-to-patient ratio and access to advanced medical resources and
equipment that is not routinely available elsewhere.

22
DIALYSIS
A ward or part thereof for dialysing patients with advanced renal disease.

OPERATION THEATRE

An operating theatre (also known as an operating room, operating suite, operation

theatre, operation suite) is a facility within a hospital where surgical operations are carried out in a sterile
environment.

Probable reasons of observed deviations are –

1. Improper segregation of waste at site of generation (plastics, sharps and other wastes) were seen in
some departments of the hospital.
2. Proper (i.e. uniflow and puncture proof) containers, as per guidelines, were not yet introduced into
use in some departments of the hospitals.
3. Proper practicing of the steps for discarding of wastes, as per SOPs, was not followed by the staff.
4. Use of PPEs was lacking by the housekeeping staff.
5. Two cases were observed in two different wards of the hospital that could pose a risk of severe NSI.
6. Emptying time for the wastes generated and accumulated was improper and irregular.
7. Proper supervision was lacking as in one of the departments bucket for sharp disposal was cracked
and thus a flaw in provision of appropriate resources to be used.
8. Needle recapping was observed and hubs were not cut in some of the departments for which they can
be reused later, which is strictly against the guidelines issued.
9. In some departments delay in discard of sharps by the staff was observed.

FREQUENCY DISTRIBUTION TABLE FOR PRE-SURVEY OF BMW:

BMW Policies Correct Incorrect

23
Awareness regarding govt. Rules 15 15

biomedical hospital waste disposal policy 20 10

responsibility(BMW) 16 14

24
 BMW Policies
48
42

8
2 2 3 2 3
1 1

0 10 0 0 2 0 3

BMW correct Incorrect

PRACTISES
Are different coloured bags used for disposal 22 .8

used plastic items and catheter disposed in 10 20

soiled dressings disposed in io 12 22
used sharps and needlles disposed in 9 21
extracted teeth and human tissues disposed in 18 12
25
 plaster of paris disposed in 15 15

BMW Practises
25
20
15
10
5
0
SE
S al in in in in in
TI os ed se
d ed ed ed
AC sp os os os os
PR di s p po p s p s p
fo
r di is i s i di
W d er gsd esd esd ri s
BM se et in ll u
u th s ed tis
s pa
gs ca es e f
ba nd dr n an ro
d nd ste
ed sa ile sa u m
pl
a
ur m s o rp d
h
lo i te a an
co tic sh
nt as ed th
re l
us tee
ffe ed
p d
e di s cte
Ar u tra
ex

Employee education Correct Incorrect

&training
Health hazards due to 25 5
BMW
Maintaining BMW 22 8
records mandatory
seqential disposal of 20 10
BMW
26
 Regular training 19 11
programmes

EMPLOYEE education &trianing

25

20
Health hazards due to BMW
Maintaining BMW records
mandatory
15 seqential disposal of BMW
Regular training programmes

10

TRAINING SESSION ON BMW MANAGEMENT

To enhance and enrich the knowledge of hospital staff regarding bio medical waste
management practices by organising a training session on the topic of BIOMEDICAL
WASTE MANAGEMENT.

The seminar emphasized on the following aspects of waste management -

1) Biomedical waste statistics

2) Hazardous waste mismanagement result

3) Occupational hazards ( In Hospital)

27
4) Waste flow chart

5) Color coding(red,blue,yellow,white)

6) Staff safety

7) Accident Reporting.

FREQUENCY DISTRIBUTION TABLE FOR POST-SURVEY OF BMW:

BMW Policies Correct Incorrect

Awareness regarding govt. Rules 48 2
biomedical hospital waste disposal policy 42 8
responsibility(BMW) 45 5

BMW Policies
48

42

2 2 3 2 3
1 1

0 10 0 0 2 0 3

BMW PRACTISES correct Incorrect

Are different coloured bags used for disposal 50 0
used plastic items and catheter disposed in 44 6
soiled dressings disposed in 45 5
used sharps and needlles disposed in 47 3

28
extracted teeth and human tissues disposed in 49 1
plaster of paris disposed in 40 10

BMW Practises
50
45
40
35
30
25
20
15
10
5
0

29
 Correct Incorrect Incorrect
Health hazards due to BMW 49 1
Maintaining BMW records mandatory 44 6
seqential disposal of BMW 39 11
Regular training programmes 48 2

EMPLOYEE education &trianing

50
45 Health hazards due to
BMW
40
Maintaining BMW
35 records mandatory
30 seqential disposal of
BMW
25 Regular training
20 programmes
15
10
5
0

STATISTICAL ANALYSIS-

Common Applications: Comparing the means of data from two related sample-
observations before and after an intervention on the same participant; comparison
of Continuous data are often summarised by giving their average and standard
deviation (SD), and the paired t-test is used to compare the means of the two
samples of related data.

30
The paired t-test compares the mean difference of the values to zero. It depends

on the mean difference, the variability of the differences and the number of data.

Hypothesis:

The 'null hypothesis' might be:- H0: There is no difference in mean pre- and
post-survey.

And an 'alternative hypothesis' might be:- H1: There is a difference in mean pre-
and post-survey

Steps -

The data need to be entered in tabular format in 2 columns, where one column
indicates the pre-survey and the other has the post-survey – see over. [A third
column could include participant numbers]
Analyze > Compare Means > Paired Samples T-test

 Select the two paired variables as the Paired Variables, selecting the after
variable first (post), followed by the before variable (pre) – see below -

PAIRED T TEST-
T=di/S/√n
Where., , S=1/n-1{€di2-€(d/n)2} ,
d= (x-y)

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S.n o. Pre-survey(x) Post-survey(y)

1. 15. 28
2. 20 22
3. 16. 25
4. 22. 30
5. 10 24
6. 12 25
7. 9. 27
8 18. 29
9. 15 24
10. 25. 29
11. 22 24
12. 20 29
13. 19. 28
Total. 223. 344
Where, n=13

di (x-y). €di2

-13. 169

-2. 4

-9 81

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-8. 64

-14. 196

-13. 169

-18 324

-11. 121

-9. 81

-4. 16

-2. 4

-9. 81

-4. 16

-2. 4

-9. 81

-9. 81

-121 €1391

S=1/13-1{1391-(-121)2/(13)2}

S=10.4674.

T=di/S/√n

=9.307/10.467/√13

T=3.205

df = (n-1) at 5%(level of significance)

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(13-1)=12
Upper tail (p)=3.055(standard value)
Since , calculated value is more than standard value
i.e. 3.205>3.055
Hence, H0 is rejected.

That means there is a significant difference between the pre and Post survey.

Results:

The relevant results for the paired t-test are in bold.

From this row observe the t statistic, t =3.205, and p =3.055., ie, a very small
probability of this result occurring by chance, under the null hypothesis of no
difference.
The null hypothesis is rejected, since p <3.205 (in fact p = 3.055).

Conclusion of methodology method-

There is strong evidence (t = 3.205, p = 3.055) that the training intervention
improves survey.
In this data set, it improved survey result Of course, if we were to take other
samples of survey, we could get a 'mean paired difference' in survey results . This
is why it is important to look at the 95% Confidence Interval (95% )
If we were to do this experiment 100 times, 95 times the true value for the
difference would lie in the 95% confidence interval. In our case, the 95% CI is
from 0.7 to 3.4. This confirms that, although the difference in survey is
statistically significant, it is actually relatively small. You would need to consider

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if this difference in survey is practically important, not just statistically
significant.

CONCLUSION

During the training program at INDEX hospital and Research Centre I studied the overall biomedical waste
management process and disposal techniques, especially emphasising the discard .

I got an overall view of various departments and the generation of biomedical waste, their storage and
disposal. During my training session I got the opportunity to know the significance of proper given proper
waste management and the hazards of the same if not given appropriate attention.

The study also helped me to identify the specific problems during the management process in various
departments and to come out with the possible solutions and recommendations.

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36
 BIBLIOGRAPHY

o www.indexgroup.co.in.
o TEXTBOOK – BM SAKHARKAR INTRODUCTION TO HOSPITAL ADMNISTRATION
o Madhya Pradesh Biomedical waste management rules(2018) site- mppcb.gov.in
 Bio Medical waste -wikipedia
 Introduction to bio Medical waste management ppt
 Reference from scholarly Articles on Google
 Images added to project from Google.

 .

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