ABSTRACT Immunisation protects children and adults against harmful infections before they come into contact with them in the community

Jurel Sk

Kumari R

Singh A

Srivastava K

Wakhlu A

CiteSeerX

Kumari R et al: Managing immunisation waste  
 
 
IJMDS ● www.ijmds.org   ● January 2013; 2(1) 39 
 
Short Communication 
Managing immunisation waste in a tertiary healthcare facility 
Kumari R1, Jurel SK2, Srivastava K3, Wakhlu A4, Singh A5 
 
ABSTRACT 
Immunisation protects children and adults against harmful infections 
before they come into contact with them in the community. 
Immunisation is given as an injection or, in the case of polio vaccine, 
taken as drops by mouth. The waste generated during the whole 
immunisation process must be disposed off properly. Improper waste 
disposal leads to serious health risks to recipients, health workers and 
the public. In King George’s Medical University (KGMU) immunisation 
programmes are conducted regularly. Waste generated during the 
process are properly mutilated, collected, transported and disposed 
off. In KGMU a well established biomedical waste management 
system which disposed offs the waste as per the norms and 
legislation. 
Key Words: Immunisation, biomedical waste, management  
Introduction 
The management of waste from 
healthcare facility and immmunisation 
programmes is serious public health 
concern. According to the World Health 
Organization, 16 billion injections are 
given each year in developing countries. 
According to Assessment of Injection 
Practices in India (AIPI) conducted by the 
International Clinical Epidemiology 
Programme Evaluation Network (IPEN), 
nearly 300 crore injections are given in 
India annually. [1] The huge amount of 
Injections and introducing autodisable 
syringes further leads to the problem of 
disposal of injection related waste 
materials. According to WHO (World  
Health Organization) estimates that each 
year there are about 8 to 16 million new 
cases of Hepatitis B virus (HBV), 2.3 to 4.7 
million cases of Hepatitis C virus (HCV) 
and 80,000 to 160,000 cases of human 
immune deficiency virus (HIV) due to 
unsafe injections and mostly due to very 
poor waste management systems. [2, 3] 
The Ministry of Environment and Forests 
notified the “Biomedical Waste 
(Management and Handling) Rules, 1998” 
in July 1998. [4] In accordance with these 
rules, it is mandatory for the producer of 
biomedical waste to ensure its safe 
disposal. The World Health Organization 
 
1Dr  Reema kumari 
Associate Professor  
Dept. of  Community Medicine & 
Public Health 
2Dr Sunit kumar Jurel 
Assistant Professor 
 Dept. of Prosthodontics 
3Dr Kirti Srivastava 
Associate Professor 
 Dept. of Radiotherapy 
4 Dr Anupam Wakhlu 
Assistant Professor 
 Dept. of Rheumatology 
5Dr Anshita Singh 
 Ph.D Scholar 
1,2,3,4,5King George Medical University 
 Lucknow, Uttar Pradesh, India 
 
Received: 21-10-2012 
Revised: 21-11-2012 
Accepted: 26-12-2012 
 
Correspondence to: 
 DR. Reema Kumari 
reema_tua05@yahoo.co.in 
Kumari R et al: Managing immunisation waste  
 
 
IJMDS ● www.ijmds.org   ● January 2013; 2(1) 40 
 
reports that the number of sharp and 
needlestick injuries per person among 
healthcare staff is 4 per year in Africa, 
Western Mediterranean and Asia. [5] 
 According to IPEN study in India [6] 
(2012) three billion injections are 
estimated to be administered annually in 
India; of them 1.89 billion were unsafe. 
According to WHO – a safe injection does 
not harm the recipient, does not expose 
the provider to any avoidable risk, and 
does not result in any waste that is 
dangerous for the community. At least 
50% of the worlds 16 billion injections 
administered each year are unsafe-posing 
serious health risks to recipients, health 
workers and the public. Most injections 
given for therapeutic may be unnecessary, 
ineffective or inappropriate. The safe 
disposal of used needles and syringes is a 
critical component of any vaccination 
programme if infection is to be prevented.  
 
NEED FOR MANAGING IMMUNISATION 
WASTE 
Sharp and needle stick injuries are 
important problems for healthcare 
workers as they increase the risk of 
spread of infection, [7] thus an urgent 
need to dispose injections related waste 
and to prevent infections from blood born 
pathogens. The different risks associated 
with unsafe injections are: 
 Occupational risk - Health care 
personnel and waste handlers are 
exposed to the risk of diseases and 
injuries during waste collection and 
transportation if not handled properly, 
risk can occur if sharps are not 
collected and transported in puncture 
proof container, no mutilation of 
sharps done, no personal protective 
devices used, no disinfection process. 
 Community risk - The reuse of syringe 
by the general public is one of the 
greatest public health related to the 
health care waste in developing world. 
WHO estimates that, in 2000 
worldwide, injections with 
contaminated syringes caused about 
23 million infections of hepatitis B and 
C and HIV. [8] 
  Indirect Risk via the Environment. AIR 
AND WATER POLLUTION CAUSED BY 
burning of waste and indiscriminate 
disposal of waste and can cause 
serious illness to people.  
Central Pollution Control Board (CPCB) 
has formulated guidelines for disposal of 
bio-medical waste generated during 
Universal Immunization Programme. The 
categories of waste as per Schedule1 of 
the Biomedical Waste (Management and 
Handling) Rules, 1998 [4] which would be 
included as part of immunization waste is 
shown in Table 1  
Due to the health and environment 
hazards associated with open burning and 
incineration, the immunisation waste 
management guidelines recommend only 
non burn technologies for treating 
immunisation wastes. This has been 
recognized globally by different 
government and international 
organisation. Sharp and needle stick 
injuries in healthcare staff are also 
important due to their frequency and 
because they may lead to the spread of 
infectious agents such as hepatitis B virus, 
hepatitis C virus and human 
immunodeficiency virus. [9,10] Present 
study is done in Healthcare institution 
with the objective to find solution to the 
Kumari R et al: Managing immunisation waste  
 
 
IJMDS ● www.ijmds.org   ● January 2013; 2(1) 41 
 
problem of managing waste from 
immunisation activities, to promote safe 
injection practices according to Indian 
Regulations Act. 
Waste 
Category 
Description Treatment Option 
(as per Rules/guidelines) 
Disposal 
(as per Rules/guidelines) 
4 Sharp waste Chemical disinfection/ 
Autoclave/ Microwave/ 
Hydroclave and Mutilation 
Recycling/Municipal landfill/ 
Deep burial 
7 Plastic waste Chemical disinfection/ 
Autoclave/ Microwave/ 
Hydroclave and Mutilation 
Recycling/Municipal landfill 
6 Bandages/ 
Swabs 
Chemical disinfection/ 
Autoclave/ Microwave/ 
Hydroclave and Mutilation 
Municipal landfill 
 
Table 1: Waste Categories Generated due to Immunisation Waste 
 
Methodology 
King George Medical University, Lucknow, 
U.P, India is a premier 100 years old, 3000 
bedded tertiary care Institution. 
Immunisation activities are conducted by 
the department of Community Medicine 
and Public Health of the University. 
Vaccines are stored at Ice-lined 
Refrigerator at Community Medicine 
department. There is a room allotted for 
performing immunisation session at 
Obstetric and Gynecology Department. 
Daily required vaccines are taken from the 
department by Lab technician and 
assistant in Vaccine carrier for the session. 
Vaccines are given continuously according 
to National Immunisation Schedule to the 
children up to five years age. Children 
receive doses of BCG, DPT, Polio, Hepatitis 
B, Measles and Vitamin A.  
Results 
In the KGMU, the continuous 
immunisation programme is conducted 
according to National Immunisation 
Schedule. After the session most 
important part is the proper disposal of 
different type of waste generated during 
the immunisation process are: sharp 
waste, plastic, cotton swab and general 
waste, out of these sharp waste is the 
most critical part of waste should handle 
very carefully. During immunisation 
approximately 11,000 syringes used over 
a period of 6 month and large quantity of 
immunisation waste generated. (Table 2) 
 
Kumari R et al: Managing immunisation waste  
 
 
IJMDS ● www.ijmds.org   ● January 2013; 2(1) 42 
 
 Month 
           (Jan-june 2012) 
Through Injection Through Oral route  
BCG, DPT, Polio, 
Hepatitis B, Measles(n) 
Polio doses (n) Vitamin A doses (n) 
Total vaccine given  11,781 1,226 975 
 
Table 2: Total Vaccine given from Jan to June, 2012 
 
 
 
 
 
 
 
                                                     
  
 
 
 
 
 
 
Fig. 1 Immunisation waste disposal process at KGMU 
                                                 *Central Treatment Facility 
 
Discussion 
Steps for immunisation waste disposal: 
1. Waste management at the Point of 
Generation: 
The appropriate immunisation process 
includes proper waste disposal. In KGMU, 
after injection immediate used syringe’s 
needle cut with hub cutter. At the 
immunisation site four colour coded bins 
are placed for segregation at source along 
Soiled Cotton Swab  Yellow bin 
Used Syringe 
Plastic material of 
syringe put into red 
bin 
Needle collect in 
hub cutter 
collection box 
Hub 
cutter 
INFECTIOUS WASTE 
Autoclave Recycling 
Autoclave & 
Shredding 
Recycling 
Emptied Vaccine vials White bin 
Packaging material Black bin 
Non-INFECTIOUS WASTE 
Send to nagar-nigam 
for land filling 
Send to CTF* for Incineration 
Chemical treatment 
Kumari R et al: Managing immunisation waste  
 
 
IJMDS ● www.ijmds.org   ● January 2013; 2(1) 43 
 
with different posters that indicate which 
type waste goes in which colour of bin. 
The needle with hub automatically 
collects in the hub cutter collection box, 
remaining plastic part & covering wrapper 
of syringe goes into red & black bin 
respectively. Soiled cotton swab goes into 
yellow bin. 
 
2. Collection of waste & transportation to 
Central Collection & Treatment Site 
(CCTS): 
Infectious & non infectious waste is 
collected in separate trolleys. Hub cutter 
collection box is replaced with new one & 
filled collection box collected, kept 
separate in infectious waste 
transportation trolley. With the help of 
rickshaw trolley waste is transported in 
the storage site i.e. Central Collection & 
Treatment Site (CCTS). At CCTS all hub 
cutter collection box emptied in to large 
metal collection box and infectious, non 
infectious waste store in separate rooms 
before disposal. Two autoclave and two 
plastic shredders are installed at CCTS for 
disposal process. 
 
3. Treatment & final disposal: 
Facilities available for waste treatment at 
CCTS are Autoclave, Shredder and 
chemical treatment. Incinerable waste 
send to Synergy Pvt Ltd. (Central 
Treatment Facility) for final disposal which 
is located out skirt of Lucknow city. 
 Sharp waste: Autoclave and send for 
recycling 
 Infectious plastic waste: Autoclave, then 
shred into small pieces with shredder and 
send for recycling 
 Infectious non plastic waste: Send to 
Synergy Private Ltd. for incineration 
 Glass waste: Treat with 10% hypochlorite 
solution for ½ an hour and send for 
recycling.  
 General waste: Send to Nagar-nigam for 
landfilling 
 
Waste disposal during the 
immunisation process is the crucial issue 
which is avoided by the majority of the 
hospitals. In the present study we 
revealed that the immunisation waste is 
properly disposed off from the hospital 
and about 11,000  syringes are used in six 
month, a great amount are disposing off 
according to the BMWM rules, 1998. This 
proper management of waste minimises 
various health hazards to the health 
workers and to the public. 
 
Acknowledgement: 
We would like to thank clinician, lab 
technician and those entire people 
involved in the whole process that help us 
to encourage for the formulation of this 
paper. 
 
References 
1. Training Manual, Model Injection Centres 
(MICs): A program to Improve Injection 
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2. World Health Organisation. Unsafe 
injection practices and transmission of 
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3. Townend WK, Cheeseman CR. Guidelines 
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4. Bio-Medical Wastes (Management and 
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Cite this article as: Kumari R, Jurel SK, 
Srivastava K, Wakhlu A, Singh A. 
Managing Immunisation Waste in a 
Tertiary Healthcare Facility. Int J Med and 
Dent Sci 2013; 2(1):39-44. 
Source of Support: Nil 
Conflict of Interest: No 


Short Communication Managing immunisation waste in a tertiary healthcare facility

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Short Communication Managing immunisation waste in a tertiary healthcare facility

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