Bio-Medical Waste Management Project at Apollo Hospital, Mysore:

BMW Project is aimed at reducing the Bio Medical Waste that is generated in Apollo Hospital
BGS Mysore by employing Lean management principles.
Objectives:

To reduce the biomedical waste significantly, thereby reducing associated costs of

handling and disposal of wastes.
To make processes cleaner, simpler and cost efficient.

Literature Review:

Introduction to Waste Management in Hospitals:

According to World Health Organization, 80-85% of total amount of waste generated by
healthcare activities is the general waste. Only 15-20% waste is considered hazardous which may
be infectious, injurious, toxic or radioactive. Poor management of healthcare waste exposes
healthcare workers, waste handlers and the community to infections, toxic effects and injuries.
Lack of awareness about the health hazards related to healthcare waste, inadequate training in
proper waste management, absence of waste management and disposal systems, insufficient
financial and human resources and the low priority given to the subject are the most common
problems connected with healthcare waste management.
Waste minimization means -the reduction, to the extent feasible, in the amount of hazardous
waste generated prior to any treatment, storage, or disposal of the waste. Because waste
minimization efforts eliminate waste before it is generated, disposal costs may be reduced, and
the impact on the environment may be lessened.
WM usually benefits the waste producer: costs for both the purchase of goods and for waste
treatment and disposal are reduced and the liabilities associated with the disposal of hazardous
waste are lessened.
Waste minimization usually benefits the waste producer: Costs for both the purchase of goods
and for waste treatment and disposal are reduced and the liabilities associated with the disposal
of hazardous waste are lessened.

Process Discovery:
Biomedical Waste Management Policy of Apollo Hospitals, gives clear direction about the waste
disposal process, provides practical guidance to hospital staff on safety at all stages of waste
handling to avoid nosocomial infections and physical injuries and encourages safe working
practices among healthcare workers.

Classification of Healthcare Waste:

Classifying biomedical waste is another important aspect for effective handling and further
disposal. Healthcare waste may be classified into clinical waste, sharps, chemical waste,
pharmaceutical waste, radioactive waste, laboratory waste, cytotoxic/genotoxic waste, food &
general waste etc. Each category of waste has to be treated and further be disposed of in different
ways.
Practice followed at Apollo hospitals, as followed, is in-line with the Bio-Medical Waste
Management Rules, 2016 (Published by Government of India, Ministry of Environment, Forest
And Climate Change), as follows:

Biomedical wastes categories and their segregation, collection, treatment, processing and
disposal options (2016)

Category

Yellow

Type of Waste

(a) Human Anatomical

Waste:
Human tissues, organs,
body parts
(b) Soiled Waste:
Items contaminated
with blood, body fluids
like dressings, plaster
casts, cotton swabs and bags
containing residual
or discarded blood and
Blood components.
(c) Expired or
Discarded Medicines:
Pharmaceutical waste
like antibiotics,
cytotoxic drugs
including all items
contaminated with
these
(d) Chemical Waste:
used or discarded
Disinfectants.

Type of Bag or
Container to be
used
Yellow coloured
non-chlorinated
plastic bags

Treatment and
Disposal options
Incineration, ashes for
deep burial*

(e) Discarded linen,

mattresses, beddings contaminated
with
Blood or body fluid.

Red

Blue

(f)
Microbiology,
Biotechnology and
other clinical
laboratory waste:
Blood bags, Laboratory
cultures, stocks or
specimens of microorganisms
Wastes generated
from disposable items
such as tubing, bottles,
intravenous tubes and
sets, catheters, urine
bags, syringes (without
needles and fixed needle
syringes) and
vaccutainers with their
needles cut) and gloves
Glassware:

Red colored
non-chlorinated
plastic bags or
containers

Autoclaves,
Shredding/Mutilation

Boxes

Chemical disinfection,

Process Flow of Waste Management:

Major Steps:
Sources: Waste generation from different departments or sections
Local disposal or collection in each departments (segregated category wise)
Collection by housekeeping staff
Transportation to Centralized Local Storage area(segregated category wise)
Transportation to Final Disposal Site, Treatment & Disposal

Department
1

Local waste
generation,
segregation and
collection [both
general (black) and
biomedical wastesYellow, Red, Sharps

Department
2

Local waste
generation,
segregation and
collection [both
general (black) and
biomedical wastesYellow, Red, Sharps

..

Department
n

Local waste
generation,
segregation and
collection [both
general (black) and
biomedical wastesYellow, Red, Sharps

Central collection of waste in temporarily storage area, category wise (in

Hospital)

General Waste

Disposed by
Municipal
Corporation

Bio-Medical waste

Disposed by Third
party agencies using
methods like
incineration, autoclave

Details:
Biomedical waste that is generated in Apollo BGS hospital varies from department to
department. The waste generated from various sources is segregated and collected waste
category wise (in different colored bins, viz. yellow, red and black), as per central guidelines.
These bins are cleared by housekeeping staff on a regular basis i.e., as and when its 3/4th fill or
during their shift timings (3 Shifts/Day). They collect it in separate bags, labelled with
parameters like department, shift, type of waste and weight etc. Later it is stored in BMW
department where the bags are stored in separate designated rooms and end of each day it is
cleared by third party partners for handling bio medical waste. Non Bio Medical Waste is
handled by Municipal Corporation.
This process of clearing biomedical waste management is managed under supervision of
Infection control department. Purchase department is responsible for the procurement and order
placing of the bio medical material. Accounting Department keeps a track all the costs associated
with the purchase of material and disposal of biomedical waste.
Infection control Department of Apollo BGS Mysore maintains the records of the biomedical
waste that is generated each day i.e. Average weight of the total waste generated per day and per
bed. Also updates the records on daily basis as well as keep monthly records in BMW register.

Problem definition:
Large amount of biomedical wastes generated increases the need of high amount of costs in
terms of efforts and resources for waste handling/management, thereby affecting bottom line.
Also the processes have become complex and less cost efficient due to the waste handling part
that needs to be simplified.

Action Agenda:

Source reduction measures such as purchasing restrictions to ensure the selection of

methods or supplies that are less wasteful or generate less hazardous waste.
Good management and control practices apply to commitment and support of managerial
team, set rules and regulations to reduce waste.
Management in stores of chemicals and pharmaceuticals products applies particularly to
the purchasing, keeping, storing, and using of chemicals and pharmaceuticals.
Careful Waste segregation (separation) of waste matter into different categories, which
helps to minimize the quantities of hazardous waste.
Recyclable products is use of materials that may be recycled, either on-site or off-site.

Planned Tasks:
Analyzing the pattern of bio medical waste generated (quantum, category wise), over the
past months and identifying the type of waste and departments which generated major bio
- medical waste.
Observing the sources of bio-medical waste generation that includes:
Understanding of procurement mechanism and supply chain to observe if there
are inventory related wastes(whether there is excess inventory of medicines or
other material, which are not usable after a certain period and are disposed of
without being used) and if there are certain alternatives like recyclable materials
that prevents wastes.
Observing processes or procedures followed in different departments of handling
patients, that generates wastes, and checklists or guidelines followed to prevent it,
if any.
Observing significant cost incurring wastes (associated with disposal of biomedical
wastes); Different wastes have different mechanisms of disposal and so costs may vary
significantly. Thereby, focusing on major wastes and related sources.
Target:
Identifying the measures and best practices which will help in minimizing the waste at source for
zero waste, or maximum waste reduction, which in turn will reduce the costs associated with its
disposal, and make processes cleaner and cost effective.

Observations:
Based on the records provided and interaction with BMW department, following are
certain observations Departments which generate most Bio Medical Waste, in order, are:
O.T
Cath Lab
Emergency
In patient wards
HaemoDialysis etc.
Most of the waste generated comes under the category of Yellow waste.
Although nurses and other staff are trained regarding handling of biomedical wastes,
there are no checklists in individual departments or wards based on practices for
prevention of generation of biomedical waste
Reuse: There are no sterilization or recycling practices regarding biomedical wastes.

Grey Areas:
Role of Procurement Function/Supply chain:

Pharmaceutical procurement and supply does not come under the Apollo Hospital
Management administration(managed by Apollo Pharmacy unit) and so is related
pharmaceutical waste management; The emergency medicines(stock) stored in hospital
unit are checked or updated regularly for their expiry period and the disposal is meagre or
very rare.
Purchase criteria for materials to be used in hospital and evaluation of the material
requiring no disposal (recyclable/reusable).

Prevention Measures: The training given to nurses and other staff includes what all, and if there
are any cautions followed to prevent wastes at its source.
Cost Awareness: Costs associated with the disposal of biomedical wastes (category wise).