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BioSanitizer
An Effective Alternative Medical Waste Disposal Technique


Dr.Nirmala Ganla Om Prasuti Graha and Dr.Renu Bharadwaj Prof. Microbiology Dept. BJMC Pune

Abstract

Hospitals are socially obligated to dispose and maintain a clean environment and to dispose of medical waste in order to prevent pollution and infection within and near the hospital. To this end the Bio-Medical (Waste management & Handling) rules 1998 recommend that all infectious waste must be incinerated. Incineration though an effective method of waste disposal is associated with various environmental hazards which has resulted in on site incinerators from various parts of the world from shutting down. Alternatives to incinerators are being looked at. This study attempts to analyze the suitability of an alternative method for dealing with hospital waste by using Bioconversion in the form of Sujala Biosanitiser. Over a four-year period waste from a 12 bedded maternity hospital was treated with this product. It resulted in a 99% reduction in volume with no aesthetic nuisance. The end product was also monitored microbiologically for its safety. It was similar in its microbial content to soil and no pathogens were detected. In order to be doubly sure, we spiked samples of treated hospital waste and garden soil with Hepatitis B positive blood and salmonella cultures. Follow studies revealed early disappearance of the Hepatitis virus from the treated samples. It thus seems a promising cost effective alternative technique for handling of infectious waste.

INTRODUCTION

The effective management of medical waste poses a wide range of unresolved queries. Medical waste disposal is associated with health, environmental and aesthetic hazards. The Ministry of environments and Forests, Govt. of India has issued the Bio-Medical waste act, which issued guidelines for the management of hospital waste in India. It makes it mandatory for all infectious waste from hospitals to be incinerated. [1] This involves a large capital investment, recurring cost, handling, transportation and land filling.

We as doctors were being blamed for not taking care of the hospital waste and contributing to the spread of disease. The truth is, only 5% of all hospital waste generated is infectious [2] and mere presence of pathogens does not necessarily mean that disease is certain. Unless the triad of host, agent and environment is complete, a person cannot fall sick. We also know that not all infectious patients are hospitalised. If incineration is the answer to halting the spread of infection in society, the logical extension is to decide the mode of disposal of a dead body by studying the cause of death. A person’s little finger, even if not infected has to be burnt by law, but a whole body can be buried. Only because it came out from a hospital and not a home. So what is the purpose of incineration?

Are we aware that the side effects of the process are so terrible that they and are going to have far reaching damaging effects not only on our present lives but the future generations as well?

Incinerators do not make waste disappear, they reduce it to ash and to atmospheric emissions. Since 1985 in U.S. more than 300 trash incinerators have been put on hold [3]. In a study from Great Britain it was demonstrated that the incidence of adult cancers increased upto a radius of 7 kms around the site of the incinerator. [4]

Incinerator companies falsely argue that modern incinerators do not generate dioxins and furans. However, a hundred times more dioxin may leave the incinerator on the fly ash than is emitted into the air from the smokestacks. This consists of residues captured before going up the smoke stacks. Also a number of toxic compounds, including dioxins and furans, are actually created on the fly ash in a process called post combustion formation. Ironically, this means that the better the air pollution control, the more toxic the ash! Toxic metals are also trapped in the fly ash. The ash from these incinerators is disposed of in land - fills and will eventually contaminate groundwater. The heavy metals from this ash can produce neurological disorders in children and reproductive problems in women. Acid gases like sulfur dioxide aggravate symptoms of lung and heart disease. Nitrogen gases can be fatal in high concentrations and increase susceptibility to respiratory infections.

In our hospitals technologies like incineration fail due to unavailability of trained personnel to run them Poor operation and maintenance result in incinerators which not only do not destroy waste, but also require a lot of fuel to run and are often out of order.

So, what are the alternatives? Hydroclaving and Microwaving are finding some place in affluent countries but do not seem financially viable solutions for us. Non Government Organisations(NGOs) have been working to find solutions within the community. They have highlighted the role of the ragpicker and emphasized the separation of biodegradable from nonbiodegradable wastes at home. NGO’s have studied and promoted low-cost technologies such as composting and vermiculture. More study needs to be done to ascertain their role in the management of Medical waste.

This article offers a low cost, safe solution to the vexed problem of medical waste. It is based on the principle of BIOCONVERSION.

- We are pleased to share with you our experience of treating biodegradable hospital waste from our 12 bedded maternity home, with Dr. Bhawalkar’s Sujala biosanitiser. This works on the principle of aerobic breakdown of waste rather than anaerobic decomposition, which normally occurs [5]. The present study was done to study the feasibility and aesthetics of this biosanitiser. Microbiological studies were undertaken to ascertain the effect of the product on decreasing the infectious health hazards associated with medical waste The results have been reassuring.

METHODOLOGY

I) Construction:
We constructed two concrete bins 3ft.widex3ft in height x3ft.depth against the compound wall. They had two openings each- on top and in front to serve as inlet and exit respectively. The top was covered with a wire mesh. The front had an openable door. To begin with, we spread coconut fibre, added hospital waste, kitchen waste, sujala powder and covered everything with dry leaves. We put in sanitary napkins, placentae and dressings from surgeries. The system was kept moist at all times.

II) Microbiological follow up:
In the present study 20 samples each of treated hospital waste, untreated hospital waste and garden soil from the same area were subjected to aerobic, anaerobic and fungal culture to determine the microorganisms present in them.

The aerobic isolates were identified by standard techniques described in Macky and M’Cartney [6]. The anaerobic isolates were identified by techniques described by Willis [7]. The fungal isolates were identified on the basis of their macroscopic and microscopic morphology by standard techniques [8].

The treated samples were also examined microbiologically for the presence of ova and cysts of parasites.All samples were examined for the presence of Hepatitis B antigen using the Acon Biotech rapid kit. In order to ascertain the efficacy of the treatment procedure in dealing with infectious pathogens in the hospital environment 5 samples of treated hospital waste and garden soil were spiked with varying concentrations of Hepatitis B antigen and Samonella typhi and the samples were followed up at weekly intervals to detect their presence.

RESULTS

A) Physical appearance and aesthetics of Hospital Waste: Over a four-year period between Oct 97 and Oct 2001 the system has successfully converted 15,550 sanitary napkins, 1172 placentae and dressings from 1050 surgeries to a MUDLIKE END PRODUCT. The volume reduction has been amazing. Four bins of 50lts. capacity were converted to half a kg.of end product. The “bioreactor “ has worked silently. There is absolutely no nuisance of smell o r flies. 400 kgs. of manure has been harvested and used in our farm.

B) Microbiological Study: Treated hospital waste compared favourably with garden soil as far as its microbiological content.

The following chart shows the various organisms detected.

A) AEROBIC ORGANISMS

Sr. No. Name Of The Isolate Number
    THW UHW S
1 Ps. aeruginosa 0 1 0
2 Klebsiella sp. 2 12 0
3 E. coli 0 2 0
4 Staphylococcus sp. 9 9 7
5 Citrobacter sp. 1 1 0
6 Nonfermentors 7 6 5
7 Enterobacter sp. 1 0 0
8 Ps. sp. other than aeruginosa 10 6 0
9 Bacillus sp. 19 6 6
         
B) ANAEROBIC ORGANISMS
Sr. No. Name Of The Isolate

Number

    THW UHW S
1 Clostridium sp. 8 4 3
2 Bacteroids sp. 2 1 0
3 Fusobacterium sp. 2 0 0
4 Porphyromonas sp. 1 0 0
5 Prevotella sp. 0 1 0
6 Other gram negative bacilli 3 2 1
         
C) FUNGAL ISOLATES
Sr. No. Name Of The Isolate

Number

    THW UHW S
1 Candida albicans 0 2 0
2 Candida spp other than albicans 0 1 1
3 Aspergillus sp. 6 0 6
4 Gliocladium sp. 1 0 0
5 Cephalosporium sp. 1 0 0
6 Curvularia 1 0 0
7 Fusarium sp. 0 1 0
8 Phoma sp. 0 0 1
9 Phialophora dermatitidis 1 0 0
10 Unidentified fungii 6 2 6

TWH: Treated Waste  UWH: Untreated Waste   S: Soil

Aus.Ag :Absent in all the samples
Parasites: No ova or cysts were detected

The pathogenic organisms present in untreated waste decreased in the treated waste. The difference was statistically significant using the chi square test. (x2=8.44, p<0.05)

The fungi and nonpathogenic organisms were statistically similar in the treated waste and soil.

In order to check the efficacy of the system on major hospital pathogens i.e. Hepatitis B and salmonella, we “spiked” samples of treated waste and garden soil with various dilutions of hepatitis B virus and salmonella. Five samples of each were studied over three weeks.

The results were as follows for Hepatitis B:

Table 2: Showing the presence of HBs Ag in Treated hospital waste & garden soil

TWH: Treated Waste   S: Soil 

The HBsAg disappeared from the treated hospital waste by the end of the 2nd week while it persisted in the soil till 4 weeks. 

Samples were spiked with Salmonella in initial concentrations of 300million orgs./ml. per gram The results were as follows:

Salmonella were absent by 4 weeks in both treated hospital waste and garden soil.

DISCUSSION

Biodegradable waste has been converted successfully to an environmentally safe end product, which has been used as manure in our garden. Dr. Bhawalkar’s Sujala Biosanitizer was used to hasten nature’s biodegradation process. It was an ecologically friendly procedure. No smell, insect, or aesthetic nuisance was encountered through out the 3 years of the study. It has been a cost-effective technique

It has been a one-time investment. It cost Rs. 5100 to set up the system with no recurring costs. The Pune Municipal Corporation has now set up a new incinerator. As a small hospital we will be paying Rs 6960/ per year and these are likely to be raised in the future.

Though various modifications of vermiculture are being used in Pune for disposal of household waste, they have not been tried for medical waste. Doubts were expressed as to the safety of the end product .So the microbiological assay of waste and end product after decomposition was undertaken. The microbiological study has been revealing and reassuring. Microbiological analysis of the end product has shown that at the end of 4 weeks of treatment all pathogens were destroyed and the microorganisms present in the end product resembled those in the soil. If more hospitals try out this technique and give feed back of their experience we may soon have a simple alternatives for waste disposal, which are more suitable for our environment.

CONCLUSIONS

We in India are at the crossroads of making investment decisions about medical waste technologies. It is important that we make the right choices both in terms of cost as well as other impacts of these choices on society at large. We cannot turn a blind eye to the hazards of incineration. It is in the interest our future generations to search for alternative methods for Hospital Waste disposal that are safe for the community. The present study has evaluated an eco-friendly method of waste disposal, which requires minimal handling. It also involves only a one-time investment and the end product is safe and useful.

ACKNOWLEDGEMENTS

We would like to acknowledge the help given by Dr U.S. Bhawalkar in inspiring the study and providing the Sujala Biosanitiser.

REFERENCES:

  • BIO-MEDICAL WASTES(Management and Handling) RULES,1998 The Gazette of India Part II – Section 3 No 460
  • Basu R.N,Issues involved in hospital waste management- an experiment from a large teaching hospital.J. Acad.Hosp.Admn.1996, 8:79-83
  • Frost and Sullivan – Alternative Methods of Medical Waste Treatment:“Availability, Efficacy, Cost, State Acceptance, Owner Satisfaction, Operator Safety And Environmental Impacts” – A report for the Environmental protection agency (US EPA) April 1996
  • Knox E. Childhood cancers, birthplaces, incinerators, and landfills.Int. J Epidemiol 2000, 29(3): 391-397
  • Thorton J, McCallyM, Orris P, Weinberg J. Hospitals and plastics- Dioxin
    Pollution and Medical Waste incineration.
    Public Health Rep 1996, 111(4): 299-313
  • Bhawalkar U.S. (1997) Vermiculture Ecotechnology, 2nd edition, Bhawalkar Earth worm Research Institute, Pune India.
  • Collee JG, Miles RS, Watt B, Tests for the identification of bacteria. In Mackie & McCartney
    Practical Medical Microbiology, 14th Edition, Collee JG, Fraser AG, Marmion BP, Simmons A.
    Eds. (Churchill Livingstone Inc. New York) 1996: 131-149.
  • Willis AT. Examination and Identification of Anaerobes. In Anaerobic
    Bacteriology:Clinical and Laboratory Practice,3rd Edition, Butterworths, London- Boston 1977:68-104.
  • Rippon J.W. Medical Mycology: The Pathogenic Fungi and The Pathogenic
    Actinomycetes. Third edn. Philadelphia: W B Saunders Company 1988.

 

TEL & E-MAIL ADDRESS:
Dr. Nirmala Ganla 020 6693855, 6633746 (Pune) hganla@hotmail.com
Dr. Renu Bharadwaj 020 5440791 (Pune) bharadwaj@vsnl.com
Dr. Uday Bhawalkar 020 4225208 (Pune) ecobhawalkar@gmail.com

 

 

 

 
 

 

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