Cost Analysis of Outsourcing Bio-Medical Waste Management Services in a Tertiary Level Multispecialty Government Hospital

By Koushal, Vipin; Sharma, Raman et al. | International Journal of Education and Management Studies, September 2013 | Go to article overview

Cost Analysis of Outsourcing Bio-Medical Waste Management Services in a Tertiary Level Multispecialty Government Hospital


Koushal, Vipin, Sharma, Raman, Yadav, Ravinder, Saini, Varinder, Sharma, Meenakshi, Aggarwal, Pallvi, International Journal of Education and Management Studies


Hospitals are health institutions providing patient care services. It is the duty of hospitals and health care establishments to look after the public health. This may directly be through patient care or indirectly by ensuring a clean, healthy environment for their employees and the community. In the delivery of health care, Bio-Medical waste (BMW) is generated which may be hazardous or nonhazardous.

Before the notification of BMW (Management and Handling) Rules 1998, waste from houses, streets, shops, offices, industries and hospitals was the responsibility of Municipal or Governmental authorities, but now it has become mandatory for hospitals, clinics, other medical institutions and veterinary institutions to dispose of BMW as per the Law. The onus lies on health care institutions to ensure that there are no adverse health and environmental consequences as a result of their waste handling, treatment and disposal activities.

In accordance to Rules (Rule 4), it is the duty of every "occupier" i.e. a person who has the control over the institution and or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment. The health care organizations are therefore required to set in place the biological waste treatment facilities. It is however not incumbent that every institution has to have its own waste treatment facility. The rules also envisage that common facility or any other facilities can be used for waste treatment. However it is incumbent on the occupier to ensure that the waste is treated within a period of 48 hours.

The various technologies have been evaluated using comparable health, environmental and economic criteria for BMW handling. Importantly, the feasibility and desirability of most waste treatment options will likely depend on waste volumes currently generated and trends for the near-term (say 5 years). For example, in rural areas (SCs, PHCs), with low bed strength deep burial is taken as the method of BMW disposal. Two types of pits viz. one for sharps disposal a "pucca" (concrete) pit, of the size of 2 X 2 meters with concrete roof with an outlet and for decomposable material a "kuchha" pit of the same size covered with a steel structure are constructed.

In their evaluation, waste generators ideally should undertake a waste audit, formulate appropriate indicators to assess and forecast waste generation trends (e.g., waste generated per type of procedure) and assume moderate-to-intensive efforts to manage and minimize waste (depending on current minimization efforts).

Cost of biomedical waste management

Biomedical waste management costs a significant part of overall budget of a hospital if the BMW handling rules 1998 have to be implemented in their true spirit. Two types of costs are required to be incurred by hospitals for BMW management, internal and external. Internal cost is the cost for segregation, mutilation, disinfection, internal storage and transportation including hidden cost of protective equipment. External cost involves off site transport of waste, treatment and final disposal.

The present study was conducted with the objectives to do the cost analysis in outsourcing of BMW management (outsourced basis) in a multispecialty tertiary hospital. The study was descriptive and observational in nature, carried out in Government Medical College and Hospital (GMCH), Chandigarh, a premier multispecialty hospital of North India.

Process

The waste is segregated separately, according to its characteristics, at the point of generation, mainly from the patient care areas. Non-infectious waste/municipal waste and domestic type of waste is collected in black polyethylene bag, placed in bins while the infectious waste is collected in red, yellow and blue colour coded polyethylene bags labelled as per BMW Handling Rules and Regulations (1998). The waste is collected in colour coded trolleys and transported to the central collection site in three shifts. …

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