Dr. R. K. Mishra
World Laparoscopy Hospital, Gurugram, India

Abstract

Introduction: Hospitals are known for the treatment of sick persons but we are also knowledgeable about the adverse effects of the waste generated by them on human body and environment. It is now a well-established proven fact that there are lots of adverse and harmful effects towards the environment including human beings which are caused by the “Hospital waste” generated throughout the patient care. This article is comparing the amount of waste produced between open and laparoscopic surgery. A modern laparoscopy hospital is a complex, super specialty institute which consumes thousands of items for delivery of medical care and is a part of physical environment. All surgical products consumed in the hospital leave some unusable hospital waste. The last century witnessed the rapid mushrooming of hospital within the public and private sector, dictated through the needs of expanding population. The advent and acceptance of “disposable” has made the generation of hospital waste a significant factor in current scenario. Hospital waste is really a potential health risk towards the health care workers and public. Hospital acquired infection, transfusion transmitted diseases, rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of catching many diseases.

Conclusion: The overall mean general waste production rate was 0.095 kg/patient/day for open surgery facilities, higher than that obtained from laparoscopic surgery which has only 0.053 kg/patient/day. This study suggests that the waste generated at small medical facilities ranged widely.

Aims and Objective

Hospital waste refers to all waste generated, discarded and not intended for further use in the hospital. It is broadly categorized into the following categories:

1. General Waste of Dressing and Cleaning
2. Pathological Waste
3. Infectious Waste
4. Sharps
5. Pharmaceutical Waste
6. Chemical Waste
7. Radioactive Waste

The aim of this study was to compare the difference in waste production kg/patient/day between open and laparoscopic surgery and establish the fact that laparoscopy is more eco friendly compare to open surgery.

Material and Method

Within five year period we have calculated amount of waste produced by open surgery and laparoscopic surgery at World Laparoscopy Hospital, Tilak Nagar, New Delhi, India. All the patient selected were routine cases uncomplicated without any postoperative conversion or infection. The waste were calculated only during the hospital stay postoperatively for two days because most of the patient were discharge within first or second day after surgery.

Result:

Bio Medical Waste (BMW) is any solid, fluid and liquid or liquid waste, including it’s container and then any intermediate product, that is generated during the diagnosis, treatment or immunization of human being or animals, in research pertaining thereto, or perhaps in the production or testing of biological and also the animal waste from slaughter houses or any other similar establishment. All biomedical waste are hazardous. In hospital it comprises of 15% of total hospital waste .

Waste production in Laparoscopic Surgery

Waste production in Laparoscopic Surgery

Discussion:

The hospitals and bio medical facilities designed to ensure better health have unfortunately become a potential health risk due to mismanagement from the infectious waste. Waste from hospitals, nursing home and other health centers made up of variety of wastes like hypodermic needles, scalpels blades, surgical cottons, gloves bandages, clothes, discarded medicine, blood and the body fluids, human tissues and organs, radio-active substances and chemicals etc. El born area of waste management is grossly neglected.

AMOUNT AND COMPOSITION OF HOSPITAL WASTE GENERATED

(a) Amount Country Quantity overall hospital BMW (kg/bed/day)

• U. K. 2.5
• U.S.A. 4.5
• France 2.5
• Spain 3.0
• India 1.5

(b) Hazardous/non-hazardous

Hazardous 15%

1. Hazardous but non-infective 5%
2. Hazardous and infective 10%

Non-hazardous 85%

(c) Composition

1. By weight
2. Plastic 14%
3. Combustible
4. Dry cellublostic solid 45%
5. Wet cellublostic solid 18%
6. Non-combustible 20%

LANDMARK DECISIONS TO STREAMLINE HOSPITAL WASTE MANAGEMENT:

With increasing awareness in general population regarding hazards of hospital waste, public interest litigations were filed against erring officials. Some landmark decisions to streamline hospital waste management happen to be made in the past. They are:

1. Top court judgment dated 1st March 1996 regarding the safe disposal of hospital waste ordered that

(a) All hospitals with 50 beds and above should install either their own incinerator or perhaps an equally effective alternative method before 30th November 1996.

(b) The incinerator or the alternative method should be installed with a necessary pollution control mechanism conforming to the standard laid down by Central Pollution Control Board (CPCB).

(c) Hazardous medical waste ought to be segregated as source and disinfected before final disposal.

2. Secretary of state for Environment & Forest, Govt. of India issued a notification for Biomedical Waste(Management & Handling) Rules 1998 in exercise of powers conferred by Section 6, 8 & 25 from the Environment (Protection) Act, 1986 which was published within the Gazette of India Extraordinary, Part-II, Section 3-Sub-Section (ii) New Delhi, July 27, 1998 .

3. The Delhi Pollution Control Committee has been designated as Prescribed Authority to implement these rules in the National Capital Territory of Delhi. The Financial Commissioner continues to be designated as appellate authority in Delhi.

4. In exercise of the Powers conferred by Rule 9 of the Bio-Medical Waste (Management & Handling) Rules, 1998 the Lt. Governor of Delhi has constituted an Advisory Committee Vide No. F. 23 (322)/95/EN/99 to do something such authority underneath the said Rules. The composition from the Advisory Committee has 10 members with Pr. Secretary (Health), Govt. of Delhi as Chairman and Director Health Services as Member Secretary / Convener. Under Chairmanship of Principal Secretary (Health & Family Welfare) this Committee meets every once in awhile to discuss and decide about various issues associated with these rules. It's primary responsibility of the government to implement the recommendations and directions of the Top court and Biomedical Waste (Management & Handling) Rules 1998 in public interest, so that Bio-medical waste does not cause any injury to men, animal and environment. In clean surgery BMW production is less compare to Infection Ward, Orthopedic or Burn.

Conclusion:

This study suggests that the waste generated at various hospital ranged widely. The overall mean general waste production rate for simple clean uncomplicated surgery was 0.095 kg/patient/day for open surgery facilities, higher than that obtained from laparoscopic surgery which has only 0.053 kg/patient/day. This study suggests that the waste generated at small medical facilities ranged widely. Laparoscopic surgery generate roughly half the amount of biomedical waste compare to open surgery and it should be considered as more ecofriendly surgical procedure.