Journal of Environmental Management (2001) 63, 211–220

doi:10.1006/jema.2001.0453, available online at http://www.idealibrary.com on

Health-care waste management in India

A. D. Patil and A. V. Shekdar*
National Environmental Engineering Research Institute Nehru Marg, Nagpur 440 020, India
Received 21 June 2000; accepted 27 March 2001

Health-care waste management in India is receiving greater attention due to recent regulations (the Biomedical Wastes
(Management & Handling) Rules, 1998). The prevailing situation is analysed covering various issues like quantities and
proportion of different constituents of wastes, handling, treatment and disposal methods in various health-care units
(HCUs). The waste generation rate ranges between 0Ð5 and 2Ð0 kg bed"1 day"1 . It is estimated that annually about
0Ð33 million tonnes of waste are generated in India. The solid waste from the hospitals consists of bandages, linen and
other infectious waste (30–35%), plastics (7–10%), disposable syringes (0Ð3–0Ð5%), glass (3–5%) and other general wastes
including food (40–45%). In general, the wastes are collected in a mixed form, transported and disposed of along with
municipal solid wastes. At many places, authorities are failing to install appropriate systems for a variety of reasons, such
as non-availability of appropriate technologies, inadequate financial resources and absence of professional training on
waste management. Hazards associated with health-care waste management and shortcomings in the existing system are
identified. The rules for management and handling of biomedical wastes are summarised, giving the categories of different
wastes, suggested storage containers including colour-coding and treatment options. Existing and proposed systems
of health-care waste management are described. A waste-management plan for health-care establishments is also
proposed, which includes institutional arrangements, appropriate technologies, operational plans, financial management
and the drawing up of appropriate staff training programmes.
© 2001 Academic Press

Keywords: biomedical wastes, disinfection, health-care establishment, infectious waste, regulations,

waste-management plan, waste disposal, India.

Introduction systems to meet legal requirements. A number

of difficulties are being faced at many places for
implementation of these requirements in practice.
The establishment of health-care is a basic require- In order to help resolve these problems, the present
ment of every civilised society. Food, medicines, paper analyses the issues and identifies current
chemicals, equipment and instruments are used shortcomings. Further, it suggests an improvement
while treating out-patients and patients admitted plan to develop appropriate waste-management
into hospital, producing a variety of wastes. The systems.
wastes generated from the treatment of patients
suffering from infectious diseases may spread
infection either through direct contact or indi-
rectly through the environment. Globally, this
Existing health-care waste
issue has been seriously considered and appropri- management
ate waste management systems are being devel-
oped and installed. In India, this problem has In India, there is a large network of HCUs, both in
been recognised by the concerned agencies and the public and private sectors. There are large num-
Government regulations have been framed to sys- bers of small clinics or dispensaries, which provide
tematise implementation. Accordingly, authorities only out-patient care. The community health cen-
at health-care units (HCUs) are trying to install tres provide health care facilities in rural areas.
The next group ranges from sub-divisional and
Ł Corresponding author Email: [email protected] district hospitals to medical college hospitals, and

0301–4797/01/100211C10 $35.00/0 © 2001 Academic Press

212 A. D. Patil and A. V. Shekdar

hospitals in the public and private sectors. Also, waste generated in the establishment. Hence, the
the recent trend of establishing multi-speciality quantities of different categories of waste have to
hospitals in urban centres is growing rapidly. The be estimated by discussions, interviews and by
normal bed strength in all such hospitals ranges physical checks. The quantities generated vary
from 30 to 1000 beds or more. These hospitals from hospital to hospital and depend on the type of
generate waste in substantial quantities, which health-care facility and local economic conditions.
needs to be managed by the hospitals themselves. Normally, the data on waste quantities are not
However, in rural hospitals the quantity of waste maintained by the hospitals. In one of the studies
generated is much less. According to health infor- carried out in Indore City, the waste quantities
mation statistics 20% of total beds are in rural were physically weighed in different hospitals
hospitals while 80% are in urban hospitals (Min- having specialised units. The average values are
istry of Health and Family Welfare, India, 1998). presented in Table 1 (Malviya, 1999). In India,
Extrapolating from past figures of number of beds many hospitals are over-occupied and hence the
and average quantity of waste generation at the waste quantities are estimated assuming 100%
rate of 1 kg bed"1 day"1 , it is estimated that about
bed-occupancy.
0Ð33 million tonnes year"1 of hospital waste is being
generated overall.
Table 1. Quantity of solid waste from health-care units
Hazards of health-care waste (HCUs)
management Category of HCU Quantity
(kg bed"1 day"1 )a
At present, there is no specific system ensuring
separation of infectious and non-infectious waste at Paediatric unit 0Ð53
source. This results in mixing of infectious wastes Eye unit 0Ð66
with others which are normally disposed of along Orthopaedic unit 2Ð15
Gynaecology unit 1Ð43
with municipal waste leading to various types of
Medicine unit 1Ð80
hazards (Kelkar, 1998). These are illustrated in Surgery unit 1Ð04
Figure 1. OPD, burns, X-ray and canteen 2Ð64
General hospital 1Ð95
Multi-speciality hospital 2Ð23
Quantities
Average 1Ð60
In order to prepare a well-planned waste-manage- Number of beds per HCU ranges from 50 to 125.
ment system, it is essential to know the quantity of a Assuming 100% bed occupancy.

Health care waste management

Occupational Recycling Environmental Accidental

Nosocomial infections Type of infection Environmental pollution Pressurised

• HIV • Respiratory • Carbon monoxide containers
• Hepatitis B • Gastroenteric • Hydrocarbons • Explosion
• Tuberculosis • Skin • Aeropathogens • Injuries
• Tetanus • Ocular • Pathogenic organisms Radioactive isotopes
• Pneumonia • Viral etc. to: • Toxic chemicals • Radiation
• Cholera etc. to: • Wasteworkers Epidemics
• Medical personnel • Wastepickers
• Patients • Workers in
• Visitors recycling
• Supporting staff units
• Maintenance staff

Figure 1. Hazards associated with health-care waste management.

 Health-care waste management in India 213

Composition Table 3. Composition of hospital waste in Calcutta

Ingredients Average SD
Health-care wastes are categorised as infectious (% by wet
and non-infectious (Saini and Dadhwal, 1995). weight)
Infectious wastes contain pathogens in sufficient
concentration or quantity that exposure could Bandage, cotton cloths, etc. 36Ð10 8Ð27
Plastic, PVC and rubber 6Ð86 1Ð97
result in transmission of infectious diseases. These Paper 7Ð65 3Ð27
wastes include cultures and spatulas of infec- Disposable syringe 0Ð43 0Ð31
tious agents from laboratory work, and waste Food waste 39Ð85 8Ð14
from surgery and autopsies on patients with infec- Glass 4Ð56 2Ð41
tious diseases. Also, wastes that have been in Inerta 4Ð55 1Ð79
contact with animals inoculated with infectious Source: NEERI (1995).
a Includes stones, earthenware, bricks and ash.
agents or suffering from an infectious disease,
including human tissues, organs, body parts, items
contaminated with body fluids, cotton dressings transportation workers in the hospital segregate
and other materials contaminated with blood etc. the recyclable material for sale. In a similar way,
Non-infectious wastes are generated from packag- all disposable plastic items are segregated by the
ing, food preparations and visitors’ activities. This wastepickers, from where the waste is deposited
waste is large compared to infectious waste. either inside the hospital grounds, or outside in
A large fraction is potentially recyclable but may the community bin for further transportation and
be contaminated with infectious agents. This has to disposal along with municipal solid waste (Rao,
be stored separately and sterilised before sending 1995).
for recycling. The proportion of solid waste gener-
ated in various hospitals in a study carried out in
Indore City is given in Table 2. The composition Treatment and disposal
of various constituents varies widely depending on
the type of facilities provided by the HCUs. A com- In large hospitals, infectious waste has usu-
prehensive field survey was conducted in Calcutta ally been disinfected and disposed of along with
wherein eight major hospitals were surveyed for general waste. Waste generated in out-patient
solid-waste composition covering three seasons of Departments (OPD) is similarly treated. Wastes
the year; the average values with standard devia- from operation theatres, wards and patholog-
tion are presented in Table 3. ical laboratories are disposed of without any
disinfection/sterilisation. Amputated body parts,
anatomical wastes, and other highly infectious
Handling methods wastes are incinerated wherever incinerators are
available; the remainder is burnt in some corner of
In India, normally the waste is collected in open the hospital grounds, mostly in open pits.
containers without disinfection. Bandages, cotton In small towns, health-care waste is often buried
and other items used to absorb body fluids are col- in pits on the available onsite space, or sent to
lected in plastic or other non-specified containers. municipal waste-disposal sites.
Waste is collected in mixed form. Some hospitals Smaller private nursing homes and clinics do
in the country have developed their own system not take any precautions and often dispose of their
of colour coding (CPHEEO, 1998). Waste sharps waste in the community bins intended for storage
are discarded without disinfection and mutila- of municipal solid waste.
tion, which may result in their being re-used thus Therefore, it is a common practice to dispose
spreading an infection. The waste collection and of health-care waste along with municipal waste.
Open burning is also normally observed for its
Table 2. Proportion of solid waste from HCUs disposal. The existing pathways for management
of health-care waste are shown in Figure 2.
Type of waste Range (%) Average (%)

General 50Ð46–88Ð31 71Ð37

Infectious 10Ð00–36Ð23 18Ð83 Wastepicking
Pathological 4Ð06–19Ð71 8Ð11
Chemical 0Ð22–2Ð77 0Ð91 Large numbers of wastepickers collect recyclable
Sharps 0Ð41–1Ð42 0Ð78 items like plasticware, needles and glass materials
214 A. D. Patil and A. V. Shekdar

Health care waste management

Infectious waste Hazardous waste Non-infectious waste Liquid waste

• Anatomical • Chemical • Food
• Pathological • Pharmaceutical • Packaging
• Animal • Infected solid • General
Plastic,
• Sharps • Incineration ash papers,
• Soiled • Radioactive* metal for
Separation
recycling
Partial Partial
disinfection treatment Sewerage
system
Risk of
infecting:
Risk of spreading
• Patients
diseases e.g.
• Hospital
HIV, hepatitis B,
staff
tuberculosis, cholera,
• Visitors
etc. to wasteworkers,
ragpickers and visitors

* Returned to Supplier Mixed with municipal

solid waste for disposal

Figure 2. Existing pathways for management of health-care wastes.

from the waste to sell. Many times cleaning ž unplanned waste-management systems;
workers in HCUs have been observed to pick up ž inadequate provision of budget allocation;
recyclables like plastics, glass and metals from ž lack of awareness of better waste management;
waste and sell them. This practice is dangerous, ž lack of waste management training for HCU
as it is associated with high risk of infection and staff.
serious disease.
In view of these shortcomings, efforts have
been made in the past by several agencies for
Shortcomings in the existing improvement in this area. The Bureau of Indian
system Standards (1989) has prepared the guidelines for
hospital waste management. A working manual
(Pruthvish et al., 1998) has been prepared by
Rapid urbanisation in the country has resulted
another group of experts. In this manual, practical
in medical facilities in urban centres improving
aspects of safe management of hospital waste,
faster than those in the rural areas. Waste
including handling, disinfection, housekeeping and
management systems in the urban areas are
disposal are dealt with in detail.
already overburdened. Hence, an additional load
Shrishti, a non-governmental organisation, has
due to mixing of infectious waste from HCUs
prepared a guide for developing a system for hos-
aggravates the problem. Separate systems for
pital waste management. It has been written to
disposal of HCU waste are available in only a few
encourage participation by both management and
establishments. The shortcomings in the existing
staff, and ensure resourcing. A two-stage planning
system are:
process is outlined, addressing issues like organi-
ž mixed collection of wastes increases the quantity sation, evaluation of existing practices, collection,
of infectious waste; processing, equipment, training and reporting.
ž absence of colour-coded storage containers for Simple techniques for waste classification, mainly
different categories of waste; as infectious and non-infectious, their segregated
ž non-availability of treatment and processing collection, handling and treatment are described in
devices compatible with waste generation; detail. Waste collection in in-patient departments,
ž lack of common treatment and processing facili- operating theatres, etc. are dealt with in greater
ties; detail. The guide includes the training methodology
 Health-care waste management in India 215

for various levels of staff. Finally, case-studies (Management and Handling) Rules for regulating
are presented for better understanding for the the management of biomedical wastes (The Gazette
techniques in the guide (Kela et al., 2000). of India, 1998). The Ministry, while establishing
SKAT (Swiss Centre for Development Coopera- the legal framework, introduced the term biomed-
tion in Technology and Management), has compiled ical waste for all types of waste generating from
case-studies from various developing countries like HCUs and veterinary establishments. Biomedical
Ghana, India, Nepal, Palestinian Territories, Sene- wastes are classified into ten categories, listed in
gal and Tanzania; these are presented in question Table 4.
and answer form. In keeping with the answers to The Rules also make the generator of the
each question, conclusions are drawn appropriate waste liable for segregation, packing, storage,
to the situation of the agencies in the field. Lessons transportation and disposal of the wastes so that
learned from earlier studies are summarised. The they will not harm public health. Table 5 indicates
authors stress that management of health-care the colour coding and type of containers for
waste is not simply a matter of data compilation different categories of biomedical wastes and their
and technology; it requires training, commitment, corresponding treatment and disposal options.
management, leadership and effective legislation The categories are grouped together to facilitate
(Code and Christen, 1999). waste handling by unskilled staff. The containers
A comprehensive document has been prepared used for storage of biomedical waste should be
by the World Health Organization, with defini- labelled with the appropriate biohazard or cytotoxic
tions, characterisation, health impacts, legislation, symbol.
policies and planning of waste management for Authorisation by prescribed authorities such as
health-care waste described in detail (Pruss et al., the State Pollution Control Boards, is mandatory
1999). Related costs and safety practices for both for HCUs (termed occupiers) providing services to
personnel and waste workers, hygiene and infec- more than 1000 patients per month. This is granted
tion control are also discussed. A similar compre- for a trial period of 1 year.
hensive report has been prepared in India (Mehta, The rules describe the duties of occupiers in the
1998). treatment and disposal of biomedical wastes. Incin-
eration, deep burial, autoclaving, microwaving,
Biomedical wastes (management disinfection, mutilation and disposal in municipal
landfill are among the disposal options identified.
and handling) rules As the system of waste management in India is in
its initial stages, the technologies prescribed in the
In 1998, the Ministry of Environment & Forests rules are generic and are expected to be developed
issued a notification on the Biomedical Wastes for specific conditions.

Table 4. Categories of biomedical waste

NoÐ Category Type of waste

1 Human anatomical waste Human tissues, organs, body parts

2 Animal wastes Animal tissues, organs, body parts, carcasses, fluid, blood; experimental animals
used in research, waste generated by veterinary hospitals
3 Microbiology and Waste from laboratory cultures, stocks or specimens of micro-organisms, live or
biotechnology wastes attenuated vaccines, human and animal cell cultures used in research, infectious
agents from research and industrial laboratories, wastes from production of
biologicals, toxins, dishes and devices used to transfer of cultures
4 Waste sharps Needles, syringes, scalpels, blades, glass, etc., capable of causing punctures and
cuts. This includes both used and unused sharps
5 Discarded medicines and Waste comprising outdated, contaminated and discarded drugs and medicines
cytotoxic drugs
6 Soiled wastes Items contaminated with blood fluids including cotton, dressings, soiled plaster
casts, linens, bedding
7 Solid wastes Disposable items other than the waste sharps, such as tubing, catheters, IV sets etc.
8 Liquid wastes Waste generated from laboratories, washing, cleaning, house-keeping and
disinfection activities
9 Incineration ash Ash from incineration of any medical wastes
10 Chemical wastes Chemicals used in production of biologicals, disinfection, insecticides, etc.
Source: The Gazette of India (1998).
216 A. D. Patil and A. V. Shekdar

Table 5. Colour coding and type of container for disposal of biomedical waste

Waste category Type of Colour Treatment options with standards

container code

ž Human anatomical Plastic bag Yellow Incineration

waste Temperature of primary chamber:
ž Animal wastes 850š50° C
ž Microbiology and Secondary chamber: 1050š50° C
biotechnology waste Stack height: 30 m
ž Soiled wastes Deep burial
Pit: 2 m deep
Lime cover: 50 cm
ž Microbiology and Disinfected Red Autoclaving
biotechnology wastes container/ 121° C at 15 psi for 60 min.
ž Soiled wastes (body fluids, plastic bag 135° C at 31 psi for 45 min.
cotton, dressings, soiled 149° C at 52 psi for 30 min.
plaster casts, linens, items Microwaving
contaminated with blood) Bacillus subtilis as an indicator in the
form of spores using vials or spore
strips with at least 1ð104 spores
per ml
ž Waste sharps Plastic bag/ Blue/white Autoclaving
ž Solid waste (wastes puncture translucent 121° C at 15 psi for 60 min.
generated from disposable proof 135° C at 31psi for 45 min.
items other than the waste container 149° C at 52 psi for 30 min.
sharps such as tubings, Microwaving
catheters, intravenous Bacillus subtilis as an indicator in the
sets, etc.) form of spores using vials or spore
strips with at least 1ð104 spores
per ml
ž Discarded medicines and Plastic bag Black Disposal in secured landfill
cytotoxic drugs
ž Incineration ash
ž Chemical wastes (solid)
Source: The Gazette of India (1998).
Colour coding of waste categories with multiple treatment options as given above shall be selected depending on treatment option
chosen. Waste collection bags for waste types needing incineration shall not be made of chlorinated plastics, namely, Polyvinyl Chloride
(PVC); other chlorinated waste should not be incinerated. Liquid waste and Chemical waste in liquid form do not require containers
and bags. Microbiology and biotechnology waste, if disinfected locally need not be put in the containers/bags. Deep burial should be
adopted only in towns with population less than five lakhs and in rural areas.

The agency responsible for implementation of Every occupier is required to submit an annual
the regulations is the prescribed authority to report to the prescribed authority in a prescribed
be constituted by each State Government/Union format. The report will present information about
Territory. Recycling and reuse of sharps and the categories and quantities of biomedical wastes
disposable devices have been prohibited. They have handled during the preceding year. The author-
to be disinfected/sterilised and mutilated before ity is required to send this information to the
disposal. Central Pollution Control Board by March 31st
An advisory committee has to be constituted every year.
which will include experts from medical and
health, animal husbandry and veterinary sciences,
environmental management, municipal adminis-
tration, and any related department HCUs are Implementation of the regulations
included. Representatives from the State Pollu-
tion Control Board/Pollution Control Committee The Rules should be implemented by the different
shall also be included in the advisory committee. HCUs. Waste treatment facilities like incinerators,
The committee as and when required should advise autoclaves, microwaves etc. have to be adopted in
the Government of the State/Union Territory about a phased manner by the end of 2002. Facilities
matters related to the implementation of the Rules. for storage, collection, treatment and disposal have
 Health-care waste management in India 217

to be provided. However, efforts to provide the charges to be collected by private HCUs and bud-
appropriate technologies have so far been limited. get allocation in Government hospitals for waste
The Rules have not been publicised as widely as management.
required. Hence, smaller HCUs may not be fully
aware of them. A number of issues have not been
dealt with in detail, such as standards of collection Waste management plan for HCUs
and storage devices, equipment, etc. However, due
to lack of availability of the appropriate equipment,
Members of a Waste Management Team (WMT)
it is difficult for them to manage their waste as per
should be appointed to carry out a review of existing
the provisions. The prescribed pathways in the
waste management in their area of responsibility.
regulations are shown in Figure 3.
Existing practices should then be evaluated in the
light of provisions made in the Rules and an appro-
priate system developed.
Need for additional provisions in the
regulations
Institutional arrangements
A critical review of the Rules indicates that there
is a need to address the following issues for effec- Management of health-care waste depends on the
tive implementation: (1) the responsibility of a input from the administration and active partic-
local agency, such as the municipal authority, for ipation by trained staff in segregation, storage,
transport and disposal of the wastes after disin- collection, transportation, treatment and disposal.
fection; (2) provisions for occupational health and The personnel responsible for these activities are
safety for waste handlers; (3) provisions against mainly ward attendants and other supporting staff.
waste picking and scavenging of medical waste; Hence, it is desirable to form a committee consist-
(4) awareness programmes for the generators of ing of the head of the establishment, all the depart-
biomedical wastes including authorities of veteri- mental heads, hospital superintendent, nursing
nary institutions, etc.; (5) provision of common superintendent and hospital engineer. A waste
processing and disposal facilities for small gener- management officer could be appointed by the com-
ators of biomedical wastes; (6) provision of special mittee who would be advised by an environmental

Health care waste management

Infectious waste Hazardous waste Non-infectious waste Liquid waste

• Anatomical • Chemical • Food
• Pathological • Pharmaceutical • Packaging
• Animal • Infected solid • General
• Sharps • Incineration ash Treatment
• Soiled • Radioactive*

Sewerage
Source Separation: system
Storage in Colour
Coded Containers
Destruction and
Treatment
Disinfection Plastic,
Separation papers,
metal for
Mutilation of sharps recycling
and plastic disposables
Disposal: Incineration/ Residue Mixed with municipal
microwaving/controlled solid waste for disposal
landfill/deep burial
* Returned to Supplier

Figure 3. Prescribed pathways for management of health-care wastes.

218 A. D. Patil and A. V. Shekdar

control advisor and an infection control advisor. transportation of waste, which incurs additional
The committee could be constituted according to cost.
facilities and personnel available in the HCU. A At present, as the system is not fully devel-
typical organisational structure for a large hospi- oped in the country, even the large hospitals
tal with a medical education facility is shown in are apprehensive about installing their own facil-
Figure 4. ity and looking for a common treatment facility.
However, due to enforcement of regulations aware-
ness of the need for action is gaining momen-
Appropriate technologies
tum.
Waste-management technology should be compat-
ible with the waste characteristics, affordable and
conform with operation and maintenance con-
ditions and legal provisions. In India, as the Operational plans
systems are in the initial stage of evolution,
there is vast scope for the development of appro- Operational plans should include the following
priate technologies for storage, transfer, collec- elements: (1) location and capacity of the storage
tion, transportation, processing and disposal of containers; (2) frequency of collection for various
health-care wastes. These include: (1) source- types of wastes; (3) schedule of activities.
specific storage containers; (2) closed handcarts; Infectious wastes should be stored in the desig-
(3) mutilation devices for disposables, such as nated colour-coded containers which are rigid for
needles, syringes and plastic items; (4) disin- safe handling and can be disinfected/sterilised by
fection/sterilisation devices of appropriate sizes; the available facility in the hospital.
(5) disposal equipment such as incinerators and Transportation of waste within the hospital
microwave furnaces, including dry and wet thermal should be carried out in closed handcarts to a
technologies. disinfection or treatment facility. After disinfec-
A range of storage containers, disinfecting tion/sterilisation the waste is transported to a
devices and processing equipment could be made common treatment facility, such as an incinera-
available to help the HCUs select devices suit- tor or controlled landfill. General wastes from food,
able for their use. A centrally located common packaging, etc. from the HCU should be kept sep-
waste-treatment system could be set up for small arately and disposed of along with municipal solid
establishments which have insufficient space. How- waste. Liquid waste after necessary treatment is
ever, such a system requires safe and regular disposed of in the sewerage system.

Head of HCU

Hospital waste management committee

(Departmental heads & administrator)
• Environmental
control advisor
Waste management officer • Infection control
advisor
• Clinical staff

Sanitary inspector Maintenance engineer

Collection of Collection of Transport devices Processing &

general waste hospital waste (handcarts, trolleys, disposal
(kitchen & (wards, operation tricycles) (autoclaving,
premises) theatres, microwaving,
out-patient incineration, secure
departments, landfill, burial)
laboratories)

Figure 4. Typical organisational structure for health-care waste management.

 Health-care waste management in India 219

Financial management Conclusion

With dedicated systems being installed in most of
the HCUs, financial provision is necessary for cap- Health-care waste management is not only a tech-
ital and recurring expenditure. A long-term plan nical problem, but is also strongly influenced by
for resource recovery should also be included. Nor- economic conditions. On its own, enactment of leg-
islation will not make it more efficient. Sustainable
mally, a separate allocation of funds for waste man-
solutions can be effected by involving local bodies
agement is not made. However, provision of funds
engaged in waste management and making sure
for sufficient manpower, disinfectants, devices and
they follow the principles of effective management.
equipment needs to be made. It is estimated that
Health-care waste should be subjected to disin-
Rs. 3000–4000 (US$ 70–93) per tonne of hospi-
fection and mutilation prior to reuse, recycling or
tal waste is required. Private HCUs could itemise
disposal. Precautions have to be taken so that dis-
this when charging patients. However, Govern-
posable items like needles, syringes, IV sets and
ment hospitals should make appropriate provision
other plastic items are not reused. Efforts have to
of funds for waste management and meet the
be made for minimisation of waste: an appropriate
expenditure from the budget.
plan has to be evolved as per the prevailing condi-
tions. Finally, adequate financial provision needs
to be made.
Awareness and participation

Awareness of appropriate handling and disposal Acknowledgements

of health-care wastes among health personnel is a
priority; it is essential that everybody should know Authors gratefully acknowledge the assistance of Dr
the potential health hazards. Regular programmes P. V. R. C. Panicker, Ex-Scientist, National Environ-
will help prevent exposure of health-care wastes mental Engineering Research Institute, Nagpur (India)
during the preparation of the manuscript.
and related hazards. Poster exhibition, proper
labelling, and explanation by staff are effective
methods. Seminars and workshops, and participa- References
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