The advent of waste of “disposable” in the hospitals has brought in its wake attendant ills, that is, inappropriate recycling, unauthorised and illegal reuse and increase in the quantum of waste.

Waste can be defined as any unwanted residual matter arising from the hospital or activities related to the hospital. Bio-medical waste is defined as “any solid or liquid waste including its containers and any intermediate product, which is gathered during the diagnosis treatment or immunisation of human beings or animals in research pertaining there to, or in the production or testing”. This hospital solid waste can be classified into 8 main categories; general wastes, pathological wastes, radioactive wastes, chemical wastes, infectious and potentially infectious wastes, sharps, pharmaceutical waste and pressurised containers.

The quantity of hospital waste and proportion of infection waste is definitely higher than one would expect in India due to extensive use of medical and non-medical disposals. Most of the waste generated in hospitals, including food waste is no more hazardous than general municipal waste. Therefore, hospital waste should be segregated into risk wastes and non- risk wastes and disposed off accordingly. The last century witnessed the rapid mushrooming of hospitals in the public and private sector, dictated by the need of the expanding population, and the advent and acceptance of “disposable” has made the generation of hospital waste a significant factor in present hospitals.

In India, the rate of generation of hospital waste is estimated to be 1.59 to 2.2 kg/day/bed and out of which 10-15% is found to be bio-medical waste. A survey done in Bangalore revealed that the quantity of solid waste generated in hospitals and nursing homes generally varies from ½- 4 kg per bed per day. In government hospitals ½-2 kg bed per day, in private hospitals ½-1 kg per day. The total quantity of hospital waste generated in Bangalore is about 40 tonnes per day. During the year 1993-1996 a study was conducted in ten large hospitals in Mumbai, Kolkata, Delhi and Nagpur to obtain the average composition of waste In developed countries, the bio-medical waste is reported to be 20% of the hospital waste. A study conducted in Delhi revealed that the quantity of hospital waste generated was 1.5 kg/day/bed for an estimated 40000 beds in the city. Kerala is a model state in public health and healthcare infrastructures as compared to other states in India. With the increase in healthcare facilities, Kerala is now facing the problem of safe disposal of waste generated from medical institutions. Most of the hospitals are situated in city centres in limited areas. In this context, the safe disposal of waste generated from day to day activities is very difficult.

The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern, prompting hospital administration to seek new ways of scientific, safe and cost effective management of the waste, and keeping their personnel informed about the advances in this area. The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance. This topic has assumed great importance in our country, especially in the light of honourable Supreme Court Judgement and the notification of the Bio-medical waste (Management &handling) Rules, 1998. Proper hospital waste management ensures control of hospital infections as well as ensures that the hospital is not a source of infection or other type of hazards to the community. Though the major hospitals and health care establishments have started implementing poor waste management systems, there are a number of health care establishments, which dump their wastes in the municipal garbage dumps. Rack pickers, who can sort these wastes manually, to pick up plastics, disposable syringes and needles, other disposables like catheters, IV sets and tubing, regularly, visit these dumping sites. In the case of open dumping sites with open borders, wastes and their emissions are directly discharged in to the natural medium. This increases the contamination spread by air circulation and superficial and ground water flows and the health risks are increased due to men and animals having access to the site. These wastes pose numerous hazards and must be appropriately managed to avoid damage to the environment and human health.

Inadequate waste management thus will cause environmental pollution, unpleasant smell, growth and multiplication of vectors like insects, rodents and worms and may lead to the transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from syringes and needles contaminated with human. Although there are no exhaustive documented studies on health hazards associated with poor hospital waste management, some indicators like progressive increase in hospital infection rate, increasing resistance to wide variety of antibiotics are the pointers to the way in which poor hospital waste management can contribute to the ill health plaguing the health care institutions. In addition to health risks associated with the poor management of bio-medical waste, due consideration must be given to the impact on environment, especially to the risks of pollution of water, air and soil. Hence, collection and disposal of waste in the proper manner is of great importance as it can decrease directly and indirectly health risk to people, and damage to flora, fauna and the environment (Centres for Disease Control and Prevention, 2001).

Inability to follow minimum standards of hospital waste management not only decreases the quality of life and health in a society but also increase the workload of health services. Abating pollution, a major problem with regard to the quantum and variety of hospital waste, where manual disposal without the support of appropriate system, cannot find a solution everlasting. It worsens the condition and the public and the nature brought to the close of the lethal unhygienic condition or left off us eco-friendship. During the last couple of decades, the public has increasingly become aware of one of the major consequences of development, that is, the quantity and diversity of hazardous wastes that is generated.

The Government of India (notification, 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities. This involves management of range of activities, which are mainly engineering functions, such as collection, transportation, operation or treatment of processing systems, and disposal of wastes. However, initial segregation and storage activities are the direct responsibility of nursing personnel who are engaged in the hospital. If the infectious components get mixed with the general infectious wastes, the entire mass becomes potentially infectious (Info Nugget, 2003). It has now become mandatory for hospitals to dispose of biomedical wastes as per the low. The onus lies with the hospital and the other health care institution to ensure that there are no adverse health and environmental consequences as a result of their waste handling, treatment and disposal activities.

The advent of waste of “disposable” in the hospitals has brought in its wake attendant ills, that is, inappropriate recycling, unauthorised and illegal reuse and increase in the quantum of waste. Waste can be defined as any unwanted residual matter arising from the hospital or activities related to the hospital. Bio-medical waste is defined as “any solid or liquid waste including its containers and any intermediate product, which is gathered during the diagnosis treatment or immunisation of human beings or animals in research pertaining there to, or in the production or testing”. This hospital solid waste can be classified into 8 main categories; general wastes, pathological wastes, radioactive wastes, chemical wastes, infectious and potentially infectious wastes, sharps, pharmaceutical waste and pressurised containers. The quantity of hospital waste and proportion of infection waste is definitely higher than one would expect in India due to extensive use of medical and non-medical disposals. Most of the waste generated in hospitals, including food waste is no more hazardous than general municipal waste. Therefore, hospital waste should be segregated into risk wastes and non- risk wastes and disposed off accordingly. The last century witnessed the rapid mushrooming of hospitals in the public and private sector, dictated by the need of the expanding population, and the advent and acceptance of “disposable” has made the generation of hospital waste a significant factor in present hospitals. In India, the rate of generation of hospital waste is estimated to be 1.59 to 2.2 kg/day/bed and out of which 10-15% is found to be bio-medical waste. A survey done in Bangalore revealed that the quantity of solid waste generated in hospitals and nursing homes generally varies from ½- 4 kg per bed per day. In government hospitals ½-2 kg bed per day, in private hospitals ½-1 kg per day. The total quantity of hospital waste generated in Bangalore is about 40 tonnes per day. During the year 1993-1996 a study was conducted in ten large hospitals in Mumbai, Kolkata, Delhi and Nagpur to obtain the average composition of waste In developed countries, the bio-medical waste is reported to be 20% of the hospital waste. A study conducted in Delhi revealed that the quantity of hospital waste generated was 1.5 kg/day/bed for an estimated 40000 beds in the city. Kerala is a model state in public health and healthcare infrastructures as compared to other states in India. With the increase in healthcare facilities, Kerala is now facing the problem of safe disposal of waste generated from medical institutions. Most of the hospitals are situated in city centres in limited areas. In this context, the safe disposal of waste generated from day to day activities is very difficult. The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern, prompting hospital administration to seek new ways of scientific, safe and cost effective management of the waste, and keeping their personnel informed about the advances in this area. The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance. This topic has assumed great importance in our country, especially in the light of honourable Supreme Court Judgement and the notification of the Bio-medical waste (Management &handling) Rules, 1998. Proper hospital waste management ensures control of hospital infections as well as ensures that the hospital is not a source of infection or other type of hazards to the community. Though the major hospitals and health care establishments have started implementing poor waste management systems, there are a number of health care establishments, which dump their wastes in the municipal garbage dumps. Rack pickers, who can sort these wastes manually, to pick up plastics, disposable syringes and needles, other disposables like catheters, IV sets and tubing, regularly, visit these dumping sites. In the case of open dumping sites with open borders, wastes and their emissions are directly discharged in to the natural medium. This increases the contamination spread by air circulation and superficial and ground water flows and the health risks are increased due to men and animals having access to the site. These wastes pose numerous hazards and must be appropriately managed to avoid damage to the environment and human health. Inadequate waste management thus will cause environmental pollution, unpleasant smell, growth and multiplication of vectors like insects, rodents and worms and may lead to the transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from syringes and needles contaminated with human. Although there are no exhaustive documented studies on health hazards associated with poor hospital waste management, some indicators like progressive increase in hospital infection rate, increasing resistance to wide variety of antibiotics are the pointers to the way in which poor hospital waste management can contribute to the ill health plaguing the health care institutions. In addition to health risks associated with the poor management of bio-medical waste, due consideration must be given to the impact on environment, especially to the risks of pollution of water, air and soil. Hence, collection and disposal of waste in the proper manner is of great importance as it can decrease directly and indirectly health risk to people, and damage to flora, fauna and the environment (Centres for Disease Control and Prevention, 2001). Inability to follow minimum standards of hospital waste management not only decreases the quality of life and health in a society but also increase the workload of health services. Abating pollution, a major problem with regard to the quantum and variety of hospital waste, where manual disposal without the support of appropriate system, cannot find a solution everlasting. It worsens the condition and the public and the nature brought to the close of the lethal unhygienic condition or left off us eco-friendship. During the last couple of decades, the public has increasingly become aware of one of the major consequences of development, that is, the quantity and diversity of hazardous wastes that is generated. The Government of India (notification, 1998) specifies that Hospital Waste Management is a part of hospital hygiene and maintenance activities. This involves management of range of activities, which are mainly engineering functions, such as collection, transportation, operation or treatment of processing systems, and disposal of wastes. However, initial segregation and storage activities are the direct responsibility of nursing personnel who are engaged in the hospital. If the infectious components get mixed with the general infectious wastes, the entire mass becomes potentially infectious (Info Nugget, 2003). It has now become mandatory for hospitals to dispose of biomedical wastes as per the low. The onus lies with the hospital and the other health care institution to ensure that there are no adverse health and environmental consequences as a result of their waste handling, treatment and disposal activities. Hence, there is an urgent need to plan and implement updated procedures and practices at different levels of medical waste management plan, which is associated with environmental health. This can be achieved through an effective decision making procedure. This is the time to pause and ponder over the matter because evidence is there for us to understand that hospital waste management is of great concern.