Waste Management 29 (2009) 812–819

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Waste Management
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Rules and management of biomedical waste at Vivekananda Polyclinic: A case study

Saurabh Gupta a,*, Ram Boojh b, Ajai Mishra c, Hem Chandra d
a
Environmental Sciences, Department of Geology, University of Lucknow, Lucknow 226 007, India
b
Ecological and Earth Sciences, UNESCO, New Delhi 110 029, India
c
Department of Geology, University of Lucknow, Lucknow 226 007, India
d
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow 226 001, India

a r t i c l e i n f o a b s t r a c t

Article history: Hospitals and other healthcare establishments have a ‘‘duty of care” for the environment and for public
Accepted 2 June 2008 health, and have particular responsibilities in relation to the waste they produce (i.e., biomedical waste).
Available online 5 August 2008 Negligence, in terms of biomedical waste management, significantly contributes to polluting the environ-
ment, affects the health of human beings, and depletes natural and financial resources. In India, in view of
the serious situation of biomedical waste management, the Ministry of Environment and Forests, within
the Government of India, ratified the Biomedical Waste (Management and Handling) Rules, in July 1998.
The present paper provides a brief description of the biomedical waste (Management and Handling)
Rules 1998, and the current biomedical waste management practices in one of the premier healthcare
establishments of Lucknow, the Vivekananda Polyclinic. The objective in undertaking this study was to
analyse the biomedical waste management system, including policy, practice (i.e., storage, collection,
transportation and disposal), and compliance with the standards prescribed under the regulatory frame-
work.
The analysis consisted of interviews with medical authorities, doctors, and paramedical staff involved
in the management of the biomedical wastes in the Polyclinic. Other important stakeholders that were
consulted and interviewed included environmental engineers (looking after the Biomedical Waste Cell)
of the State Pollution Control Board, and randomly selected patients and visitors to the Polyclinic. A gen-
eral survey of the facilities of the Polyclinic was undertaken to ascertain the efficacy of the implemented
measures. The waste was quantified based on random samples collected from each ward. It was found
that, although the Polyclinic in general abides by the prescribed regulations for the treatment and dis-
posal of biomedical waste, there is a need to further build the capacity of the Polyclinic and its staff in
terms of providing state-of-the-art facilities and on-going training in order to develop a model biomedical
waste management system in the Polyclinic. There is also a need to create awareness among all other
stakeholders about the importance of biomedical waste management and related regulations.
Furthermore, healthcare waste management should go beyond data compilation, enforcement of regula-
tions, and acquisition of better equipment. It should be supported through appropriate education, train-
ing, and the commitment of the healthcare staff and management and healthcare managers within an
effective policy and legislative framework.
Ó 2008 Elsevier Ltd. All rights reserved.

1. Introduction
Hospitals and other healthcare establishments have a ‘‘duty of
care” for the environment and for public health, and have particu-
lar responsibilities in relation to the waste they produce, i.e., bio-
medical waste (Pruss et al., 1999). Negligence regarding
biomedical waste management significantly contributes to envi-
ronmental pollution, affects the health of human beings, and de-
* Corresponding author. Tel.: +91 522 2740015x5532; fax: +91 522 2740013.
E-mail addresses: sguptalko@rediffmail.com (S. Gupta), r.boojh@unesco.org (R.
Boojh), ajaimishra2007@yahoo.co.in (A. Mishra), hchandra55@yahoo.com (H.
Chandra).
pletes natural and financial resources (Henry and Heinke, 1996;
Oweis et al., 2005). The impact of waste generated from the health-
care establishments on human health and the environment has of-
ten not been given significant attention from either the affected
people or the concerned authorities.
The biomedical waste generated during diagnosis, treatment,
and immunization processes in healthcare establishments includes
wastes such as sharps, human tissue or body parts, and other infec-
tious materials, and is often considered to be a subcategory of hos-
pital waste (Baveja et al., 2000; Gupta and Boojh, 2006). It is also
‘‘potentially’’ infectious (Levendis et al., 2001; Lee et al., 2002a),
and certain categories of waste are potentially hazardous (Karad-
emir, 2004; Defra, 2005; Bdour et al., 2006). The indiscriminant

0956-053X/$ - see front matter Ó 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.wasman.2008.06.009
 S. Gupta et al. / Waste Management 29 (2009) 812–819
and unscientific management of biomedical waste poses serious
threats to human health. This also involves hazards and risks, not
only for the generators and operators, but also for the general com-
munity (Sandhu and Singh, 2003).
Studies on the waste management system in Indian hospitals
are very few (Lakshmi, 2003; Patil and Pokhrel, 2005). One of the
studies on the biomedical waste management practices of a spe-
cific hospital (Balrampur) in Lucknow, India, has recommended
the need for strict enforcement of legal provisions and a better
environmental management system for the disposal of biomedical
waste (Gupta and Boojh, 2006). The present study focuses on the
analysis of the biomedical waste management system in Viveka-
nanda Polyclinic in Lucknow, mainly from a regulatory point of
view.
Vivekananda Polyclinic is one of the ideal medical centres in the
North Indian State of Utter Pradesh, which provides extensive
modern diagnostic facilities and specialized treatment for various
diseases not only to local people, but also to those from other parts
of Uttar Pradesh and from far-off places like Nepal. It is believed
that, in the Polyclinic, the level of responsibility is higher than at
any other polyclinic/hospital in the state.
The objective of this study was to analyse the biomedical waste
management system, including policy, practice (i.e., storage, col-
Fig. 1. Location of the study area.
813
lection, transportation and disposal), and compliance with the
standards prescribed under the regulatory framework.
In light of all of the above, this study was initiated and intended
as a case study at Vivekananda Polyclinic in Lucknow, India (Fig. 1).
Lucknow, India, the state capital of Uttar Pradesh, is situated
123 m above sea level. It is located at 26.30 and 27.10 North lati-
tude and 80.30 and 81.13 East longitude. It covers an area of
2528 km2, and the river Gomti flows through the city. The popula-
tion of the Lucknow district, as of a 2001 census, was 3.68 million.
Lucknow is well connected by rail, road, and air with all the major
cities of the country.
1.1. Management of biomedical waste
The management of hospital waste first became an issue of con-
cern in the 1980s in the United States when a huge uproar was
raised about hospital waste floating along east coast beaches and
children playing with used syringes. This led to the enactment of
the US Medical Waste-Tracking Act of 1988, which came into force
on November 1, 1988 (Dayananda, 2004). In India too, there was
public outcry against hospital waste disposal practices, and several
public interest litigations (PILs) were filed in different courts that
put pressure on the government to enact a law governing health-
814 S. Gupta et al. / Waste Management 29 (2009) 812–819

care waste management (HCWM). Finally, in view of the serious Table 2

situation involving biomedical waste management, the Ministry Categories of biomedical wastes and methods of their treatment and disposal

of Environment and Forests of the Government of India created Category Type of waste Treatment and
the Biomedical Waste (Management and Handling) Rules, which No. disposal
came into effect on 20th July, 1998. These rules have been framed 1 Human anatomical waste: Human tissues, Incinerationa/deep
as an application of the powers conferred by Sections 6, 8 and 25 of organs, body parts burial
the Environment (Protection) Act 1986. These rules have six sched- 2 Animal waste: Animal tissues, organs, body Incinerationa/deep
parts, carcasses, fluid, blood; experimental burial
ules. A brief summary of the contents of each schedule is presented animals used in research, waste generated
in Table 1: by veterinary polyclinics
Under schedule I of these rules, biomedical waste has been clas- 3 Microbiology and biotechnology waste: Waste Autoclave/microwave/
sified into ten categories, which are listed in Table 2, along with from laboratory cultures, stocks or incinerationa
specimens
their corresponding treatment and disposal options, as prescribed
of micro-organisms, live or attenuated
in schedule V (The Gazette of India, 1998). vaccines, human and animal cell cultures
The colour-coding scheme and type of containers used for dif- used in research, infectious agents from
ferent categories of biomedical wastes are described under sche- research and industrial laboratories, waste
dule 2, and are presented in Table 3. The categories are grouped from production of biologicals, toxins, dishes
and devices used to transfer cultures
together to facilitate waste handling by unskilled staff.
4 Waste sharps: Needles, syringes, scalpels, Disinfection (chemical
The containers used for the storage and transportation of bio- blades, glass, etc. capable of causing treatment)c/
medical waste should be labeled with the appropriate biohazard punctures and cuts. This includes both used autoclaving/
or cytotoxic symbol, as described in schedules III and IV. In the case and unused sharps microwaving and
mutilation/shreddingd
of off-site transportation, the vehicle should be covered and se-
5 Discarded medicines and cytotoxic drugs: Incinerationa/
cured against accidental opening of a door, leakage/spillage, etc. Waste destruction and drugs
Schedule VI mandates that every hospital, polyclinic, nursing comprising outdated, contaminated and disposal in secured
home, veterinary institution, animal house, or slaughterhouse gen- discarded drugs and medicines landfills
erating biomedical waste needs to install an appropriate facility for 6 Contaminated solid waste: Items Incinerationa/
contaminated autoclaving/
managing waste on the premises, or should set up a common facil-
with blood fluids including cotton, dressings, microwaving
ity, which requires authorization from the appropriate authority. soiled plaster casts, linens, bedding
Table 4 indicates the time limit for the creation of the waste man- 7 Solid waste: Disposable items other than the Disinfection by
agement facilities at various healthcare establishments. waste sharps, such as tubing, catheters, IV chemical
sets treatmentc autoclaving/
The State Government can grant authorization for the collec-
etc. microwaving and
tion, segregation, storage, treatment, and disposal of biomedical mutilation/shreddingb
wastes via the: (a) Directorate of Health Services, (b) Directorate 8 Liquid waste: Waste generated from Disinfection by
of Animal Husbandry or Veterinary Services, (c) State Pollution laboratories, washing, cleaning, chemical
Control Boards/Committees, and (d) Municipal Authorities. housekeeping treatmentc and
and disinfection activities discharge into drains
It is the responsibility of a generator or an operator of a biomed-
9 Incineration ash: Ash from incineration of any Disposal in municipal
ical waste facility to take all measures necessary to prevent dam- medical wastes landfill
age or adverse effects to the environment and to human health. 10 Chemical waste: Chemicals used in Chemical treatmentc
The generator of waste is responsible for the segregation, labeling, production and discharge into
of biologicals, disinfection, insecticides, etc. drain
packing, storage, transportation, and disposal of the waste in such
for liquids and secured
a manner so the waste will not harm the public’s health. The gen- landfill for solids
erator is also required to submit detailed information on form II of
the schedule about the types and quantities of biomedical waste The Gazette of India (1998).
a
There will be no chemical treatment before incineration. Chlorinated plastic
collected or handled on an annual basis. shall not be incinerated.
Due to criticism and feedback from healthcare institutions, b
Deep burial shall be an option available only in towns with population less than
three amendments have been made to the Biomedical Waste five lakhs and in rural areas.
c
(Management and Handling) Rules 1998. The first amendment Chemical treatment using at least 1% hypochlorite solution or any other
equivalent chemical reagent. It must be ensured that chemical treatment ensures
was ratified on March 6, 2000 and is referred to as the Biomedical
disinfection.
d
Mutilation/shredding must be such as to prevent unauthorized reuse.

Table 1 Table 3
Schedule of Biomedical waste rules Colour coding and type of container for biomedical waste disposal
Schedule Contents Colour coding Type of container and waste category
Schedule I Classification of biomedical waste in various categories Yellow Plastic bag
Schedule Colour coding and type of containers to be used for each category of Cat. 1, Cat. 2, Cat. 3, Cat. 6.
II biomedical waste
Schedule Proforma of the label to be used on container/bag Red Disinfected container/plastic bag
III Cat. 3, Cat. 6, Cat. 7.
Schedule Proforma of label for transport of waste container/bag Blue/white Plastic bag/puncture proof
IV Cat. 4, Cat. 7. Container
Schedule Standard for treatment and disposal of waste
Black Plastic bag
V
Cat. 5, Cat. 9, Cat. 10. (solid)
Schedule Deadline for creation of waste treatment facilities
VI The Gazette of India (1998).
Form I Format of application for authorization
Form II Format of annual report
Form III Format of accident reporting Waste (Management and Handling) (Amendment) Rules 2000. The
first amendment extended the deadline for the implementation of
The Gazette of India (1998).
the rules. The second amendment to the rules was ratified on June
 S. Gupta et al. / Waste Management 29 (2009) 812–819
Table 4
Time limit for creation of waste management facility (Schedule VI)
Type of healthcare establishment
A Hospitals and nursing homes in towns with a population of
30 lakhs and above
B Hospitals and nursing homes in towns with population
below 30 lakhs
(a) with 500 beds and above
(b) with 200 beds and above, but less than 500 beds
(c) with 50 beds and above, but less than 200 beds
(d) with less than 50 beds
C All others institutions generating biomedical waste not
included in A and B above
The Gazette of India (1998).
2, 2000 and was called the Biomedical Waste (Management and
Handling) (Amendment) Rules 2000. Some of the major changes
made through this amendment included defining the role of the
municipal body, nominating pollution control boards/committees
as the prescribed authorities, and adding forms for seeking autho-
rization to operate a facility and for filing an appeal against orders
passed by the prescribed authority. The third amendment was rat-
ified in September 2003. It made the DGAFMS (Director General
Armed Forces Medical Services) the prescribed authority for med-
ical establishments under the Ministry of Defense (Toxics Link,
2005).
Before the existence of the Biomedical Waste (Management and
Handling) Rules 1998, it was the responsibility of the municipal or
governmental authorities to manage all types of waste properly,
but now it has become mandatory for every healthcare establish-
ment (HcE) to dispose of biomedical waste as per the rules (Patil
and Pokhrel, 2005).
Some HcEs use incineration to discharge waste. This method
has been the most common for treating combustible materials.
However, some types of biomedical waste are difficult to incinerate
(e.g., full urine bags and body parts) and need special attention.
It has been proven that incineration not only decontaminates
the waste by heat, but it also reduces the volume of total waste
to less than 10% of the original (Ferreira and Veiga, 2003). How-
ever, the incineration of biomedical waste is one of the major
sources of dioxin and furan pollution, partly due to the presence
of PVC products (Walker and Cooper, 1992; Lerner, 1997; Vesilind
et al., 2002).
It is the responsibility of healthcare establishments to ensure
that there are no adverse health and environmental consequences
of their waste handling, treatment, and disposal activities (The
Gazette of India, 1998). The installation of an incinerator is manda-
tory for hospitals with more than 50 beds. Any person can report
an alleged negligence regarding the management and handling of
biomedical waste to the appropriate authority, and it is the author-
ity’s responsibility to take action against the defaulting HcE under
section 15(1) of the Environment (Protection) Act 1996, which
says: Whoever fails to comply with or contravenes any of this
act, or the rules made or orders or directions issued hereunder,
with respect to each such failure or contravention, will be punish-
able by ‘imprisonment for a term that may extend to 5 years or
with a fine that may extend to 100,000 rupees [US$2500], or with
both and, in case of failure or continued contravention, an addi-
tional fine may be applied, which may extend to 5000 rupees
[US$125] for every day during which such a failure or contraven-
tion continues after the conviction for the first such failure or con-
travention (Yadav, 2001).
815
1.2. The Vivekananda Polyclinic
Deadline In 1914, a group of young volunteers, inspired by the lofty ideals
30th June, 2000 preached by Swami Vivekananda, the great patriot saint of India,
started a small group for conducting humanitarian services. Over
the course of time, the group has grown to become the Rama-
krishna Mission Sevashram, Lucknow. Later, the Sevashram ac-
30th June, 2000
31st December,
quired a plot of land in the Aminabad area in the old city and
2000 constructed its own building with the help of a generous public
31st December, and devotees. The Ramakrishna Mission has continued to function
2001 for nearly 43 years in Aminabad.
31st December,
In order to fulfill the public need, the Sevashram envisaged
2002
31st December, expansion. During the years 1961–62, the group secured a 4-ha
2002 plot of land in the Trans-Gomti area with the help of the State Gov-
ernment. So as to continue its service activities on a bigger scale, it
constructed the Vivekananda Polyclinic in Lucknow.
From all social strata, patients come to the Polyclinic for ser-
vices, but the majority are from middle and lower middle eco-
nomic classes. They fall under the ‘general’ category, whereas
poor are placed in the ‘welfare’ category. Other general patients
are charged at a highly subsidized rate on a ‘no profit-no loss’ basis.
The Polyclinic has been recognized by the Government of India as a
Polyclinic for the treatment of Central Government employees and
members of their families. It has also been recognized for the treat-
ment of patients under the Central Government Health Scheme.
Many other bodies and government agencies send their employees
to the Polyclinic for treatment, and reimburse the treatment ex-
penses according to its rules and orders.
2. Methodology
The authors conducted a general survey of the operating proce-
dures practiced in handling and managing the biomedical waste in
the Vivekananda Polyclinic to assess its compliance level in terms
of standard legal norms and procedures under the Biomedical
Wastes (Management and Handling) Rules 1998. The methodology
also consisted of performing interviews with the authorities and
personnel involved in the management of the biomedical wastes
in the Polyclinic, as well as environmental engineers (monitoring
the biomedical waste cell) of the state pollution control board.
The information was collected using the guidelines derived by
the Biomedical Waste (Management and Handling) Rules 1998.
Site visits were conducted to support and supplement the informa-
tion gathered in the survey. Interviews and site visits were helpful
in obtaining information about the management of the biomedical
waste (i.e., collection, segregation, transportation, storage, treat-
ment, and the disposal procedures) at the Polyclinic. Data on the
quantities of waste generated by different wards were obtained
from the Polyclinic records. The average daily values of the gener-
ated waste were computed from the above records, which formed
the basis for weekly and yearly projections, as given in Table 8.
3. Biomedical waste management and implementation of rules
in the Vivekananda Polyclinic
The Vivekananda Polyclinic is a five-story building with a total
capacity of 350 beds (22 gynecology and obstetrics wards, 36
maternity wards, 32 neurology wards, 50 surgical wards, 43 corpo-
rate wards, 34 pediatric wards, 8 nephrology wards, 8 post inten-
sive care unit wards, 12 neonatal intensive care unit (NICU)
wards, 12 intensive care unit (ICU) beds, 8 welfare wards, 27 eye
wards, and 58 emergency rooms). Out of 75 doctors and 98 nursing
staff, there are six resident doctors who look after the patients
around the clock. The Polyclinic provides various types of impor-
tant facilities, which are listed in Table 5.
816 S. Gupta et al. / Waste Management 29 (2009) 812–819

The management of biomedical waste in the Polyclinic is looked Table 7

In-patient statistics
after by a 20 member (15 male and 5 female) committee. It admin-
isters medical waste handling in the Polyclinic. Particulars Total
The Polyclinic adopts four systems of treatment (i.e., allopathic, 1 Remaining patients from prior year 129
homeopathic, Ayurvedic, and naturopathic) for the treatment of 2 New admissions 10,396
patients. Tables 6 and 7 show the out-patient and in-patient statis- Total treated 10,525
3 Discharge 10,150
tics. As shown in Table 6, the total number of patient treatment
4 Death 247
days was 802,912 in the year reported. Out of 119,672 patients, Total discharged 10,397
116,711 patients received only allopathic treatment, followed by 5 Remaining patients at end of year 128
1713 patients who came for homeopathic treatment and 1248 pa- 6 Total number of in-patient days 61,417
tients for Ayurvedic treatment. Table 7 reveals that the number of 7 Average duration of stay (days) 6
8 Average daily census of in-patients 168
new patients in the Polyclinic was 10,396, and that the number of
9 Daily rate of occupancy (%) 112
in-patient days was 61,417. 10 Gross death rate (%) 2.38
The amount of waste generated and its contribution to the gross
quantity of waste (both infectious and non-infectious) are pre-
sented in Table 8. The highest quantity of waste is generated in
the operating theatre (3.5 kg/day), followed by the intensive care regation, transportation, treatment, and disposal of biomedical
unit (ICU), the neonatal intensive care unit (NICU) (3.4 kg/day), waste at the Polyclinic is described below:
and the medical ward (2.8 kg/day). The quantity of waste gener-
ated by the family planning and gynecology wards are included 3.1. Collection
in the operating theatre ward. The details of the waste generation
in other wards are presented in Table 8. The collection of infectious and non-infectious waste in the
The data shows that infectious wastes are not generated by the Polyclinic is undertaken by two teams of two members. One per-
out-patient department (OPD) or the plaster room, as the instru- son pulls the cart and the other replaces the filled bags with
ments used for diagnosis are reused after sterilization. The yearly empty polyethylene bags. These persons are aware of the poten-
and weekly projections for the average quantity of waste genera- tial hazards of the waste and take the requisite protective mea-
tion from the different wards are computed from the data. As sures during waste handling. They wear personal protective
shown in Table 7, the average daily number of in-patients is 168, equipment (apron, impervious gloves, masks, and boots) during
while the occupancy rate is 112% and the gross death rate is collection of the infectious waste, segregation of various col-
2.38%. Fig. 2 depicts the current status of the biomedical waste dis- our-coded containers, and transportation of the waste in the des-
posal of the Vivekananda Polyclinic. The process of collection, seg- ignated cart.
The collection cycle occurs four times a day: in the morning
at 8 am, at noon, at 4 pm, and at 8 pm. After filling up approxi-
Table 5 mately 75% of the volume of the polyethylene bags, the workers
Available medical facilities at the Vivekananda Polyclinic collect it to avoid an overload of waste, which could lead to di-
1. Ayurveda 10.General Medicine 18. Obstetrics Clinic rect exposure to the waste handlers. The waste from the Opera-
(including Gastrointestinal tion Theater (OT) and Intensive Care Units (ICU) was collected
Disease) more frequently, depending on the number of operations and
2. Anesthesia and 11. General Surgery 19. Orthopedic Clinic
cases attended to in any particular day. All containers kept for
Operating (including Laparoscopy Ophthalmology Clinic
Theatre Clinic) Pediatric Clinic the collection of hazardous waste were labeled with biohazard/
3. Blood Bank 12. Gynecology Clinic 20. Pathology including cytotoxic symbols as per the Biomedical Wastes (Management
Biochemistry and Handling) Rules 1998.
4. Dermatology 13. Homeopathy 21. Physiotherapy and
(including Accupressure Pranic
Leprosy) Clinic Healing
3.2. Segregation
5. Dialysis Unit 14. Infertility Clinic 22. Rural Health
Programme with At the point of generation, the waste is segregated according to
Telemedicine its characteristics. The Polyclinic uses colour-coded, high-density
6. Dentistry Clinic 15. Naturopathy 23. Radiology and
polyethylene bags (as prescribed in the schedule II of Biomedical
Ultrasonography, CT Scan
7. Ear, Nose and 16. Neurology Clinic 24. Urology Clinic Wastes (Management and Handling) Rules 1998) for the easy iden-
Throat Clinic tification and segregation of biomedical waste. Non-infectious and
8. Endocrinology 17. Non-tubercular Chest household types of waste are collected in black polyethylene bags
Clinic Disease (including that are placed in bins, while the infectious wastes are collected in
Cardiology Clinic)
9. Family Planning
red bags, sharp wastes are collected in puncture-resistant blue
Clinic polyethylene bags, and cytotoxic wastes are collected in yellow
polyethylene bags placed in bins. The details of the waste segrega-
tion in the coloured polyethylene bags are also shown in Table 8.

Table 6 3.3. Transportation and storage

Out-patient statistics

S.N. Particulars Patients attended as out-patients Total The Polyclinic has pre-established routes for the transport of
medical wastes, which include specific corridors and elevators on
New Repeat days
each floor to transfer wastes from each ward to the storeroom in
1 Allopathic cases 116,711 648,406 765,117
the basement of the Polyclinic.
2 Homeopathic cases 1713 32,088 33,801
3 Ayurvedic cases 1248 2746 3994 The Polyclinic has a specially designed storage area that is
appropriately ventilated with fire protection facilities. The waste
Totals 119,672 683,240 802,912
is stored in this area for 24 h in the summer and 48 h in the winter.
 S. Gupta et al. / Waste Management 29 (2009) 812–819
3.4. Treatment/disposal methods
The Vivekananda Polyclinic uses on-site non-burn technologies
for the treatment of biomedical wastes. These treatment technolo-
gies are divided into the following categories:
(i) Chemical treatment. The Polyclinic uses a chlorine solution
mainly for the disinfection of sharps and plastic waste.
(ii) Thermal treatment. In this process, heat is used to decon-
taminate or destroy medical wastes. The commonly used
technologies in the Polyclinic are: autoclave, hydroclave,
and microwave. The types of waste commonly treated by
the waste management team in the autoclaves are cultures
and stocks, sharps, syringes, catheters, blood and urine bags,
material contaminated with blood and limited amounts of
fluids, isolation and surgery waste, laboratory waste
(excluding chemical waste), and soft waste (gauze, ban-
dages, drapes, gowns, bedding, etc.) from patient wards.
The hydroclave is used to treat the same waste as the auto-
clave, while the wastes treated by microwaves include syrin-
ges and other plastics, materials contaminated with blood
and body fluids, laboratory wastes (excluding chemical
waste), gauze, and bandages.The incineration process also
comes under the topic of thermal treatment but, due to its
toxic effects, the Polyclinic decided to make this treatment
technology an off-site process.
(iii) Mechanical treatment. The Polyclinic uses this technology for
compacting and shredding biomedical waste. The compac-
tion process involves compressing the waste into containers
to reduce its volume, and shredding includes granulation,
grinding, pulping, etc. The sharps are in the category of
waste that requires maximum precaution and care during
collection and segregation. The needles, which comprise
the bulk of the ‘‘sharps,” are destroyed by a needle destroyer
in the Polyclinic. Mutilated needles are disinfected in 0.5%
chlorine solution for about 30 min at the point of generation
and then sent for shredding and disposal in a sharps pit. For
the final disposal, the local municipal authority (i.e., Luc-
know Municipal Corporation) transports the segregated
waste daily to an off-site incineration plant.For incineration,
the Polyclinic administration pays 20,000 rupees (US$2500)
per year to the Lucknow Municipal Corporation. The Poly-
clinic secretary is the main person responsible for all the
Polyclinic activities, including waste management.
Table 9 shows the current status of biomedical waste manage-
ment and its compliance with the standards prescribed under the
regulatory framework.
4. Results and discussion
Based on the above study, the authors found that Polyclinic
abides by the Biomedical Waste (Management and Handling) Rules
1998 as prescribed for the treatment and disposal of biomedical
waste. The Polyclinic segregates its wastes into colour-coded poly-
ethylene bags (as prescribed in the schedule (I and II) of these
rules), and uses appropriate technologies for the treatment and
disposal of biomedical waste according to their physical appear-
ance (as mentioned in the schedule (II) of the rules). The process
of collection, segregation, transportation, treatment, and disposal
of waste is done by skilled personnel who are well-versed in man-
aging the biomedical waste generated at the Polyclinic.
The biomedical rules are properly followed by the trained per-
sonnel involved in biomedical waste management practices. Vive-
kananda Polyclinic had received assistance and sponsorship from
817
the World Health Organization (WHO) in 2003–2004 for proper
management of biomedical waste. As of now, the Polyclinic is oper-
ating in compliance.
The biomedical waste management facilities at the Polyclinic
take into consideration factors such as regulatory requirements,
operating concerns, occupational hazards, and environmental im-
pacts to dispose of the waste properly. The Polyclinic submits an
annual report to the prescribed authority, i.e., the State Pollution
Control Board, by January 31 every year. This report includes all
the information about the generated waste categories, quantities,
and the Polyclinic’s treatment methods during the preceding year.
The main purpose of waste treatment is to reduce the volume,
weight, and risk of infectivity and organic compounds of the waste
(Pruss et al., 1999). Incineration has been the most widely used
method of treating biomedical waste, however, with a growing
awareness of the environment and health hazards caused by the
use of incinerators, which release a wide variety of pollutants
including dioxins, furans, metals (such as lead and mercury), par-
ticulate matter, acid gases, carbon monoxide and nitrogen oxide.
The incineration of waste, as practiced in the Polyclinic, is in
compliance with the biomedical rules. Several studies have shown
that incineration is quite expensive for biomedical waste manage-
ment (Lee et al., 2004), especially in developing countries (Diaz
et al., 2005), and may result in the production of many toxic emis-
sions (Levendis et al., 2001; Lee et al., 2002b; Segura-Munoz et al.,
2004; Yong-Chul et al., 2006). For example, the medical waste
incineration process may release dioxins {polychlorodibenzo-p-di-
oxin (PCDD)} and furans {polychlorodibenzofuran (PCDF) (Lee
et al., 1995, 2004; Brent and Rogers, 2002; Fritsky et al., 2001; Mat-
sui et al., 2003; Yong-Chul et al., 2006) into the environment be-
cause medical waste typically consists of a small amount of
plastic materials containing polyvinyl chloride (PVC) products. This
may directly affect the healthcare workers and the atmosphere
(Glenn and Garwal, 1999; Soliman and Ahmed, 2007). Therefore,
the waste stream may require a different method of treatment
and disposal that is suitable to its own peculiarities. Other poten-
tial treatment technologies, such as plasma pyrolysis and electro-
thermal-deactivation (ETD), can also be examined and encouraged
as alternatives to incineration in order to better manage the bio-
medical waste (Sharma, 2005; Yong-Chul et al., 2006).
Klangsin and Harding (1998) have also reported that autoclav-
ing and microwaving are fully adequate disinfection technologies,
and that these techniques, if followed by shredding, can reduce
volume by 60–80%. The plasma pyrolysis technology provides a
complete solution for the safe disposal of medical waste, and it
does not require segregation of chlorinated hydrocarbons. In plas-
ma pyrolysis, the quantity of toxic residuals (dioxins and furans)
was found to be well below the accepted emission standards of
the Central Pollution Control Board. The gases remaining after
the pyrolysis process can also be used as energy resources (Nema
and Ganeshprasad, 2002). The main problem arises for the disposal
of sharps, such as needles. Presently, the Vivekananda Polyclinic
disposes its sharps waste in secured pits. However, smelting for
metal extraction needs to be examined as an alternative (Chitnis
et al., 2005).
It should be the goal for every HcE to maintain high standards of
hygiene, whilst reducing environmental pollution, consumption of
non-renewable resources, and costs. The necessary measures of
HcEs are the reduction of biomedical waste, the control of toxic
emissions, the avoidance of unnecessary disinfection procedures,
and the implementation of energy and water-saving technologies
(Escaf and Shurtleff, 1996; Dettenkofer et al., 1997; Ferreira and
Veiga, 2003).
On the basis of random interviews and consultations with the
doctors, patients, visitors and regulatory authorities, it can be con-
cluded that the Polyclinic is managing its biomedical waste effec-
818 S. Gupta et al. / Waste Management 29 (2009) 812–819

Table 8
Generation of biomedical waste in various wards/departments/procedure rooms (in kg)

S.N. Place Type 1 Type 2 Type 3 Total Total Total

(yellow bag) (red bag) (blue bag) (per day) (per week) (per year)
1 Medical Ward 2.23 0.44 0.16 2.83 19.81 1032.95
2 Surgical Ward 2.07 0.47 0.17 2.07 14.49 755.55
3 Maternity Ward 1.05 0.25 0.14 1.05 7.35 383.25
4 C.G.H.S. Ward 1.00 0.48 0.17 1.65 11.55 602.25
5 Pediatric Ward 1.01 0.27 0.20 1.48 10.36 540.20
6 ICU/NICU Ward 2.63 0.35 0.42 3.40 23.80 1241.00
7 Emergency Department 1.22 0.42 0.19 1.83 12.81 667.95
8 Operating Theatre 2.70 0.50 0.30 3.50 24.50 1277.50
9 Pathology Department 0.54 – 0.27 0.81 5.67 295.65
10 Sample Collection Room 0.30 0.35 0.14 0.79 5.53 288.35
11 Injection Room 0.22 0.20 0.09 0.51 3.57 186.15
12 Eye OPD 0.10 – – 0.10 0.70 36.50
13 ENT OPD 0.07 – – 0.07 0.49 25.55
14 Plaster Room 2.27 – – 2.27 15.89 828.55
15 Dental Clinic 0.31 0.22 0.10 0.63 4.41 229.95
16 Neuro Ward 1.57 0.48 0.20 2.25 15.75 821.25
Total 19.29 4.43 2.55 25.24 176.68 9212.6

General Waste

Municipal
BLACK Corporation for
BAG Incineration

Infected Plastic

Chemical Treatment
RED Microwave Shred
Recycle
BAG
Hypochlorite
Solution 2%

Infected Soiled
Solid Waste
YELLOW Autoclave Shred Municipal
BAG Corporation for
Incineration

Blood Bags

YELLOW Blood Bag Shred Municipal

BAG Hypochlorite Corporation for
Chemical Incineration

Sharps

Double Bin System

Shred Sharps Pit
BLUE
BAG
Chemical Treatment

Fig. 2. Current status of medical waste disposal at Vivekananda Polyclinic, Lucknow, India.

tively. However, most of the personnel involved in the biomedical 5. Conclusion

waste management expressed the need to further build the capac-
ity of the Polyclinic and its staff, equipping the staff with the latest
knowledge, skills, and techniques. The Polyclinic needs to balance
effective infection control with the maintenance of a good environ-
ment inside and outside the wards and on the entire premises.
However, in order to be effective, these actions should involve
and be supported by healthcare workers and staff. The biomedical
waste management rules are meant to protect all of society,
including the patients, attendants, healthcare workers, and com-
munity members in and around the healthcare facilities.
On the basis of the above discussion, the authors found that the
Vivekananda Polyclinic may be considered as a good example of
biomedical waste management from the viewpoint of compliance
with the regulatory provisions. The Polyclinic could easily be
developed as a model biomedical waste management facility for
the City and State owing to its commitment to the environment,
as envisaged in its policy document. In another study of the bio-
medical waste management practices at Balrampur hospital of
Lucknow by Gupta and Boojh (2006), it was observed that the
 S. Gupta et al. / Waste Management 29 (2009) 812–819
Table 9
Schedule of biomedical waste rules and compliance at Vivekananda Polyclinic
Schedule Status
Schedule I Yes
Schedule II Yes
Schedule III Yes
Schedule IV Yes
Schedule V Yes
Schedule VI Yes except incinerator
Form I Yes
Form II Yes
Form III Yes
Balrampur hospital, as well as many other healthcare establish-
ments in Lucknow and in other parts of the State, do not follow
the regulatory guidelines. The Vivekananda Polyclinic could set
an example for an ideal waste management system and offer train-
ing and internships to other such healthcare establishments.
Schedule V of the Biomedical Waste (Management and Han-
dling) Rules 1998 prescribes a specific method for the management
of each waste category. However, no single technology is suitable
for all types of medical waste management. It is crucial for any
HcE to individually select the most suitable technology and dis-
posal facility for the treatment of waste (Klangsin and Harding,
1998). The Government should also come forward and develop a
shared-use facility equipped with an autoclave, microwave, hydro-
clave, shredder, incinerator, plasma pyrolysis, etc. at a common
location to allow proper management of biomedical waste. Fur-
thermore, healthcare waste management should involve more data
compilation, enforcement of regulations, and the acquisition of
better equipment. It should also involve appropriate education,
training, and the commitment of the healthcare staff and manage-
ment within an effective policy and legislative framework (Gupta
and Boojh, 2006).
Acknowledgements
The authors wish to express their sincere gratitude to Dr.
Pankaj Seth, Secretary, Vivekananda Polyclinic, Dr. Anurag Shu-
kla, Senior Orthopedic Surgeon, and all of the health staff of
the Vivekananda Polyclinic for granting permission, their co-
operation, and assistance for undertaking this study. We grate-
fully acknowledge Dr. K.K. Sharma, the Chief Environmental
Engineer, the State Pollution Control Board, Lucknow for their
support and valuable suggestions.
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