114 CHAPTER 4 MATERIALS AND METHODS 4.1 GENERAL The Bio-Medical Waste (Management and Handling) Rules, 1998 norms state that, at no point of time the bio-medical waste should be mixed with ordinary garbage. However, it has been the case for years as the entire bio-medical wastes find place in the compost yards of the Corporation. So the Coimbatore Corporation has decided not to collect garbage from private hospitals and nursing homes which are not signing up the common bio- medical waste treatment facility project. Following the action made by Coimbatore Corporation, most of the hospitals from 200 beds signed MoU with the Corporation. 4.2 DESCRIPTION OF THE STUDY AREA Coimbatore is one of the fast developing cities in South India. Coimbatore is the second largest city in the state of Tamilnadu. It lies between latitudes 11°1ƍƎN and longitudes 76°58ƍ29ƎE. The general slope of the district is towards west. It is located at an elevation of 411.2 m above sea level and occupying an area of 105.5 km². The temperature during both summers and winters varies between 37°C to 14°C.Coimbatore has semi-arid climate with annual rainfall is 61cm and potential evapo-transpiration of 1500 – 2000 mm /year.
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114
CHAPTER 4
MATERIALS AND METHODS
4.1 GENERAL
The Bio-Medical Waste (Management and Handling) Rules, 1998
norms state that, at no point of time the bio-medical waste should be mixed
with ordinary garbage. However, it has been the case for years as the entire
bio-medical wastes find place in the compost yards of the Corporation. So the
Coimbatore Corporation has decided not to collect garbage from private
hospitals and nursing homes which are not signing up the common bio-
medical waste treatment facility project. Following the action made by
Coimbatore Corporation, most of the hospitals from 200 beds signed MoU
with the Corporation.
4.2 DESCRIPTION OF THE STUDY AREA
Coimbatore is one of the fast developing cities in South India.
Coimbatore is the second largest city in the state of Tamilnadu. It lies between
latitudes 11°1 N and longitudes 76°58 29 E. The general slope of the
district is towards west. It is located at an elevation of 411.2 m above sea
level and occupying an area of 105.5 km². The temperature during both
summers and winters varies between 37°C to 14°C.Coimbatore has semi-arid
climate with annual rainfall is 61cm and potential evapo-transpiration of 1500
– 2000 mm /year.
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The population becomes very dense due to migration of rural
people. As per the 2001 census, Coimbatore had a population of 1,461,139
within city limits. Males constitute 52% of the population and females 48%.
Water supply for the city is 219Mld-1
. There are more than 35000 small,
medium large and tiny industries and textile mills.
Apart from the Government hospital, the total number of hospitals in
the private sector in Coimbatore Urban area is 76. The district's health
department is amongst the best in terms of implementing government-
initiated health schemes. Also, several rare surgical procedures are being
done. The city also has numerous homeopathic clinics. Fast pace of
industrialization, spiraling population and the increase in the health awareness
have led to the growth of the healthcare industry in Coimbatore. The city
stands second to Chennai in the State of Tamilnadu for highly affordable and
quality healthcare deliveries of international standards. Coimbatore is also the
preferred healthcare destination to the floating population from nearby towns
and districts and also the state of Kerala. The first healthcare centre that was
started in 1909, later became the Coimbatore Medical College Hospital
(CMCH) during 1960s. The Coimbatore medical college hospital has 1200
beds while private hospitals in Coimbatore have 3000beds, corporate
hospitals have 2000 beds and Employee’s state Insurance corporation
hospitals have around 800 beds. With the city corporation hospital beds
added, the total strength is estimated to be a little more than 7500 beds.
Tirupur, Pollachi and Mettupalayam jointly have bed strength may go upto
11,000.
To know the quantity and characteristics of hospital waste
generation, a study was carried in one of the hospitals in Coimbatore. The
hospital founded in 1975 is perhaps the most benevolent of the Trust’s
projects with a great scope of achieving the mission’s prime objective namely
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“Service to Humanity”. The hospital has now grown into an all under one roof
hi-tech medical complex with 400 beds and covering all specialties. Free
medical treatment is provided to the needy poor and with charges for those
who cannot afford the full cost of treatment.
The hospital is well equipped with modern Intensive Coronary Care
Unit (ICCU), Intensive Pulmonary Care Unit (IPCU), Complete diagnostic
and treatment facilities, Modern Kidney Transplant Unit with Heamodialysis
Machine working at very low cost. The hospital also has its own Pharmacy
that serves round the clock and is always well stocked. 24 Hours Cardiac Care
and Accident Care Ambulance unit is also available. A canteen is also
attached for the use of patients and other visitors. The hospital is running with
fully qualified and experienced consultants/ Super specialist Doctors, 46,
Junior Doctors, 49, Staff Nurses, Technicians, Pharmacists and other hospital
menial staffs totaling 580 numbers.
Hospital Statistics
Bed strength : 400
Bed Occupation : 90-110%
Out Patient attendance : over 450/day
Lab Investigation : Around 50000 investigations for OP and
IP Patients / year
Operations : Around 5000 major and 4000 minor / year
4.3 QUANTITY OF BIOMEDICAL WASTE GENERATION
It is important to know the quantity of waste generated in order to
examine the various treatment options. However, estimating the quantity of
the produced waste stream is a difficult task. Waste production depends on
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the hospital’s capacity, the number of medical staff, and the applied practices.
Therefore, an on-site evaluation of the hospital waste generated is considered
most appropriate. In this study, the quantity and characteristics of waste
produced was investigated by personal observations daily for a period of 2
months (May-June 2006). The number of beds in different wards for each
department, as well as the quantity of BMW generated each day as per its
character was recorded and percentages are presented by weight. Precautions
like wearing an apron, face mask and use of thick impermeable gloves were
taken. The principal investigator and the BMW handlers involved in the study
were inoculated against tetanus. Brain storming sessions were held with
health care workers 2 times during the study period. As per the study, inspite
of high sickness rate among the sanitation staff dealing with health care
waste, the awareness regarding the protection of their bodies and manual
handling was found to be missing. The sanitation staff does understand the
relation of waste and diseases but they replied that they have been doing the
same for a very long time so they have become immune to many health
problems. As a protective measure the municipal collection staff wears a head
gear to protect the waste falling on their bodies while loading it in the refuse
van. The sanitation staff working in hospital and health care facilities gets free
medication from their place of work. The interviews revealed that to avoid
absenteeism from work and probably sickness due to handling of waste, the
scavengers get the injections once a week or a prior dose of medicines. And
also they were not fully aware of the BMW management rules. Personnel
responsible for the disposal of BMW were not adequately trained which led to
inappropriate collection, separation of BMW and insufficient implementation
of the regulation. These practices contaminate noninfectious waste as
infectious.
Various departments of study are Anesthesiology, Cardiology ,
Cardiac Surgery, Clinical Lab and Pathology , Dental Surgery, Dermatology,
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Diabetology, ENT Surgery, General Medicines, General Surgery,
Laparoscopic Surgery, Nephrology, Neurology, Neurosurgery, Obstetrics and