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I found that Delhi has 93 ICTCs (Integrated Counselling and Testing Centres) - where one may get tested for HIV for free. Here's a link to the entire list Page on naco.gov.inThe procedure consists of 4 simple steps:1. Visit: You reach the ICTC - preferably early in the workday - and get yourself registered. If it is relatively empty, the process starts immediately. Else, you may have to wait for a small while, just like in the doctor's clinic.2. Pre-Test Counselling: Before testing, you meet the HIV/AIDS counsellor for a brief session. The Counsellor discusses your reason for the visit, collects your medical history, if necessary, describes to you the process of testing, tells what to do if result is negative and what to do if result is positive, answers any questions you may have about HIV/AIDS, and notes down certain details for documentation purposes under National AIDS Control Organization.3. Testing: You go for the testing - i.e., donate a small sample of your blood to the technician. You are requested to be back in a while. In the ICTC setup, they prefer to hand over your report on the same day. However, if you have visited late in the afternoon, you may need to come over the next day to collect the report. The testing takes around 2-4 hours (depending on the workload) - during which the blood sample is tested for HIV antibodies.4. Post-Test Counselling: When the report arrives, the counsellor calls you for the post-test counselling. Here, all the details that were shared before (What is HIV/AIDS, how it spreads, what to do if result is negative and what to do if result is positive) are touched upon again. Then the report is shared with you. The Counsellor explains to you the result (positive/negative), the implications of that results, what needs to be done next (retesting and ART in case of positive result/ retesting after window period in case of negative result), what services are available for you next, and what needs to be done in terms of your lifestyle or habits. He/she also answers any question you may have in your mind.4. Retesting after the Window Period: Since the present tests used in ICTCs are antibody tests, they cannot detect the HIV until the body starts reacting to it and produces antibodies. So, if the result is negative, the client is asked to come back after 3 months (or less) to be retested. The client has to be on safe behaviour during this period to get rid of any suspicion of a dormant infection.I feel this also calls for sharing a few FAQs regarding HIV Testing:1. Is it necessary to document my details? Is anonymity assured?There is a 100% assurance that your personal details are completely protected. This data goes to NACO for research so that interventions may be designed better than before - to cater to the exact needs of the client (for instance, if a large number of clients are college students, NACO may launch college-wide awareness drives). Individual data is hardly of consequence here - and cannot be re-shared under any circumstance.Details are also needed to provide you a meaningful counselling experience. It is mandatory that the client understands what is HIV and what is testing before providing the blood sample. But understandably, a college professor and a truck driver would not have the same awareness, or even the same vocabulary about important issues. Information helps customize the experience to your needs.2. Can't I skip the pre-test counselling?In India, it is absolutely illegal to test blood for HIV without the Pre-test and Post-test Counselling (if some private clinics do that, they can land in jail). The testing for HIV is a very simple process, but it is important to remember that HIV/AIDS is an emotionally loaded/highly stigmatized/little-understood problem in India. Most clients come with lots of misconceptions about the illness, or come armed with internet research whose reliability is doubtful. Some come after a rape, some with symptoms of other STDs, some are even suicidal - and the ICTC is probably the only place where they can freely talk about their problem to trained personnel under assurance of complete anonymity. Sometimes the talk reveals things you didn't even know that you are unaware of. So it is actually a valuable opportunity.2. Can't I skip the post-test counselling? Especially when my result is negative?Imagine giving a person a paper that contains what he/she believes to be the death sentence and letting him/her walk out just like that! It is imperative to take care of the emotional needs of the client, tell him/her a diagnosis is not the end of road, share the various treatment options available for free, talk about the lifestyle changes, disclosure to family members, therapy and so on. The ICTC counsellor provides linkages to therapy centres, psychologists, rape and trauma centres and other important setups, gets one registered for therapy immediately, sets up the next appointment, and chalks out the next plan of action. It assures the client nothing is lost and that he/she is not alone in the battle.Sometimes, clients may go on the denial mode, and this is even more dangerous - not only for the client, as she/she will get no treatment, but also for those to whom the infection may spread. Talking breaks down the inhibitions, and helps one get over the initial shock responses.When results are negative, the client is usually jubilant. He/she tends to forget that this is just an anti-body test (it won't detect HIV if it is not yet active in the blood stream), that he/she needs to be back for the test after the window period, that he/she needs to give up on the risk behaviour that got him/her at the ICTC, that he/she may need other medication -such as for venereal diseases. Counselling is imperative here, to bring the client back to the earth, reinstate the safety rules and ensure that he/she is back for the window period testing and does not engage in risk behaviour during the period.3. What other service may I expect at an ICTC?ICTC has 3 purposes: Testing, Education and Linkage.Testing: Testing and retesting for HIV antibodies is free, and can be done as many times as one wants (though it should not be done indiscriminately! It is an expensive test and a valuable service).Education: Education is primarily delivered through the two counselling sessions. Counselling sessions are not time-bound (esp. post test) and the client may talk as long as he likes. The ICTC also can provide information on diet, lifestyle, prognosis, and share IEC leaflets and brochures.Linkage and Referrals: ICTC counsellors will have links to testing centres for sexually transmitted diseases, tuberculosis and other infections commonly associated with AIDS, ART (Anti Retroviral Therapy) centre, psychologists, NGOs, rehabilitation centres and so on.Referrals are probably the best services ICTCs provide next to testing. One may also obtain free condoms from the ICTC and request a condom demonstration.4. Will the counsellors discriminate against me if my lifestyle is too deviant? Is it safe to share?ICTC counsellors are highly qualified personnel (most hold graduation or post-graduation degrees in social sciences). In addition, they are provided rigorous training on their subject matter as well as on counselling skills. Hence, they often are the most trustworthy, professional and non-judgmental individuals one may hope to come across. It is safe and even therapeutic to share your inhibitions and worries openly with the counsellor. There is no time limit to how long a session can last.That's one long answer! Hope it helps.

Entrepreneurs start with an idea and a belief that their vision can have a massive impact. It doesn’t always work out that way. But when it does, the effect can be world-changing: A breakthrough startup can scramble industries, alter how we work or live, and shift talent flows around the world. It’s no wonder that we tend to follow the fortunes of these founders and those who choose to follow them so carefully.With the LinkedIn Top Startups list, we wanted to provide professionals with a look at the young companies reaching that escape velocity. As always, we started with the data — the billions of actions generated by LinkedIn India's more than 50 million members — and focused in on four pillars: employee growth; jobseeker interest; the level of professional engagement with the company and its employees; and how well the startup pulled talent from our flagship LinkedIn Top Companies list. In other words, which startups are commanding the attention and working hours of top talent? To be eligible for Top Startups, companies must be seven years old or younger, have at least 50 employees, be privately held and headquartered in India. For more about our methodology, scroll to the bottom of this article.(For more insights, do read Ravi Venkatesan’s data-driven analysis of Top Startups, Shalini Prakash’s piece on why fewer women pursue entrepreneurship and Sid Pai’s take on the need for more successful founders to turn mentors.)Will these companies continue with their explosive growth and world-changing work? That’s in the hands of the talent flocking to these startups. Maybe you’ll want to put your own hat into the ring. Check out who made the cut and join the conversation using #LinkedInTopStartups.Here are this year’s top 25 startups in India.Going full throttle: OYO is on an expansion spree. The 5-year-old hospitality startup is already India’s largest hotel network with more than 100,000 rooms in 230 cities (compared to Marriott’s 23,000 and Taj Hotels’ 17,000). Over the last nine months, the budget hotel brand has ventured into Malaysia, China and the UK. | Global headcount: 4,700 | Headquarters: Gurugram | Baptism by fire: All new hires, or “OYOpreneurs”, are exposed to actual business problems on their first day so they imbibe a sense of ownership.Fit as a fiddle: Wellness startup Cure.Fit has four offerings: no-equipment gyms, health food, yoga and meditation centres, and primary care. The company just raised $120 million from existing investors and acquired premium gym chain Fitness First in a deal worth $30-35 million. | Global headcount: 120 | Headquarters: Bengaluru | Perks galore: Cure.Fit offers its employees unlimited leave, fixed increments every six months, weekly cricket matches and a concierge service for personal tasks.Delivering the goods: Dunzo has the distinction of being Google's first direct startup investment in India and is fast becoming a verb in Bengaluru. Users of the concierge services venture are “dunzoing” everything from buying groceries to picking up laundry and arranging last-minute gifts. | Global headcount: 160 | Headquarters: Bengaluru | Entry ritual: New hires are asked to complete an order using Dunzo’s partner app so that they understand the business inside out.Logical logistics: Rivigo attained near-unicorn status recently when it raised $50 million at a valuation of $945 million. Why are investors betting on the logistics services firm? A unique driver relay model that reduces turnaround time, marquee clients such as Maruti Suzuki, ITC and Marks & Spencer, and a freight e-marketplace that's already India's biggest. | Global headcount: 3,700 | Headquarters: Gurugram | Warriors wanted: Rivigo plans to hire 5,000 people over the next year for scaling up its fleet, warehouses and technology.Simplifying insurance: The online general insurer says that 87% of its claims are approved in 24 hours. Digit believes in simplifying processes: every insurance product is explained to customers in a 2-page document. Billionaire Prem Watsa's Fairfax Holdings recently put $44 million more in the two-year-old startup. | Global headcount: 630 | Headquarters: Bengaluru | Quick cover: If an insured flight is delayed by more than 75 minutes, customers immediately receive a claim notification to their mobile device.Lifestyle guide: Little Black Book (or LBB) started as a Tumblr blog with an initial investment of ₹80,000 before it morphed into an online platform for cultural goings-on. Its recommendations span everything from food and fashion to theatre and shopping across eight cities. Presently, the company is busy scaling up its curated marketplace for local products and events. | Global headcount: 80 | Headquarters: Delhi | Open doors: Every employee is encouraged to give feedback directly to the co-founders.Anchored in growth: Arnab Goswami's Republic TV has ruled viewership ratings in the English news genre since its launch in May 2017, but bigger rival Times Now seems to be clawing its way back. Republic was successful in monetising eyeballs and went on to clock ₹155 crore in revenue for FY18. But the channel is often accused of having a pro-establishment stance and being over-dependent on Goswami. | Global headcount: 400 | Headquarters: Mumbai | The TRP race: Republic will set up a Hindi news channel ahead of the 2019 general elections.Redefining design: A bootstrapped design and digital agency, The Minimalist started as a Facebook page for witty content. It works with clients such as Saint-Gobain, Bharti Airtel, Berkshire Hathaway, Coca-Cola and Abbott. The last fiscal year was a watershed moment for The Minimalist, one in which its revenue and headcount doubled. | Global headcount: 60 | Headquarters: Mumbai | Team huddle: The company’s HR conducts team-building activities every week.Powering transactions: Online payment solutions provider Razorpay now services more than 100,000 businesses, including names such as Bharti Airtel, IRCTC and Goibibo. The company is clocking a monthly growth of 35% and it bagged $20 million in a Series B funding round led by Tiger Global and Y Combinator earlier this year. | Global headcount: 230 | Headquarters: Bengaluru | Undiluted focus: All team members, regardless of role or seniority, take customer support calls for four hours every month.Cracking the code: Nineleaps accelerates product development for other startups by providing web and mobile application services. It is expanding into new markets such as Singapore and Indonesia and diversifying into data science, blockchain and other emerging fields. | Global headcount: 200 | Headquarters: Bengaluru | Hiring binge: Nineleaps doubled its headcount since July 2017, and plans to hire as many as 300 people this year.Flexibility factor: Innov8 says it’s in the business of building entrepreneurs. The Y Combinator-backed coworking venture has 13 centres across the country. This year, Innov8 aspires to add 100 employees and treble its seat count to 12,000. | Global headcount: 75 | Headquarters: New Delhi | Stable income stream: The company pivoted its model to ensure that the lion’s share of the revenue comes from enterprise clients and the rest from early-stage startups and freelancers.Growth by design: Schbang is a digital solution agency that also dabbles in original content. It counts marquee names — Ashok Leyland, Hot Wheels, Amazon Fashion, and RAW Pressery — as clients. Schbang wants to be India’s first agency export and plans to open an international office next year. | Global headcount: 240 | Headquarters: Mumbai | New joiners get the sack... of a different kind! The Schbang 'Potli' has symbolic objects like an eraser (to fix small mistakes), a rubber band (to stretch the limits) and a coin (so employees are never broke).Cover drive: Acko raised $30 million even before its launch and went on to bag $12 million from Amazon exactly a year later. The digital insurance firm solves everyday pain points with solutions such as in-trip covers for Ola users and screen protection for devices. Its biggest draw? Personalised policies based on user behaviour. | Global headcount: 115 | Headquarters: Mumbai | Time for a breather: Employees can decompress at frequent board game nights, football tournaments and Counter-Strike leagues.Rooms galore: Treebo scorched its way to 9,000 rooms in three years. The budget hotel chain’s headcount grew by 18% over the past year but it laid off a tenth of the workforce in July, shortly after the data window for this list closed. Bigger rival OYO’s strong investor backing, rapid growth and its rekindled partnership with travel site MakeMyTrip are hurting Treebo, media reports suggest. Treebo did not respond to a LinkedIn survey. | Global headcount: 795* | Headquarters: Bengaluru | Innovators: Treebo has filed four patents in India and the US for its quality management system.Loanwallah: InCred offers personal, education and home loans as well as credit to small and medium-sized businesses. The firm counts former Deutsche Bank co-CEO Anshu Jain as a backer and has secured the banking regulator’s nod for launching wholesale lending operations. | Global headcount: 1,000 | Headquarters: Mumbai | Family feel: New employees are greeted with a welcome kit that contains a booklet on the company's culture and trivia about its key personnel.Complementing kiranas: Jumbotail is a B2B e-marketplace that connects neighbourhood stores with their suppliers. The Nexus Venture Partners-backed startup also provides shopfront delivery of groceries and arranges working capital credit for store owners through its lending partners. | Global headcount: 125 | Headquarters: Bengaluru | Peer power: The appraisal process at Jumbotail gives 80% weightage to peers’ feedback and just 20% to the manager’s rating.Datagiri: Zapr Media analyses TV viewership data to provide actionable insights to broadcasters, advertisers and media agencies. To date, the media-tech startup has raised $13 million from Star India, Flipkart, Saavn and Micromax, among others. | Global headcount: 110 | Headquarters: Bengaluru | Scouting for talent: Zapr will fill 70 job openings over the next 12 months with new hires in data analytics, audio processing and other non-engineering functions.Weaving a web: After being bootstrapped for 7 years, BrowserStack hit the headlines for the largest ever Series A funding round – $50 million, led by Accel Partners. As many as 2 million testers and more than 25,000 paying customers — including Disney, Tesco, and Facebook — use its mobile app and web-testing platform. | Global headcount: 165 | Headquarters: Mumbai | Gracious welcome: Every new joiner is greeted with a personalised letter from BrowserStack’s founders.Ready to fly: Founded by three former Flipkart executives, Udaan: India's B2B Marketplace of Retailers, Manufacturers, Traders, Wholesalers is an online B2B marketplace for food, clothing and electronics. In just two years of existence, the company became the fastest Indian startup to bag unicorn status and expanded its reach to more than 500 cities. | Global headcount: 401* | Headquarters: Bengaluru | Growth pangs? LinkedIn data shows that the company’s headcount grew by about 92% in the last 12 months. With such a new team, the average employee tenure stands at 9 months.Disrupting diagnostics: SigTuple applies robotics and AI to make medical screening tests more accurate. Its offerings include smart hematology analyser Shonit and AI100, a low-cost device that digitises pathology samples. The team has applied for 19 patents in the US and India. | Global headcount: 120 | Headquarters: Bengaluru | Eclectic mix: Seven in 10 SigTuple staffers, including the three co-founders, are newcomers to healthcare but have cut their teeth in robotics, data science, software, and intellectual property.Cloud classroom: Online educator Online Courses & Education Programs for Professionals | UpGrad offers industry-relevant courses in subjects such as digital marketing, data science and product management. Co-founded by media magnate Ronnie Screwvala, the startup claims to have empowered more than 300 career transitions in the last year and has earmarked ₹200 crore for expansion in Southeast Asia and the Middle East. | Global headcount: 390 | Headquarters: Mumbai | Learn while you earn: Employees looking to upskill themselves can take several company courses for free.Tech support: InterviewBit is a preparation site for tech jobs. The self-funded startup also sources pre-screened technical talent for coveted employers such as Facebook, Amazon, Uber and Google. | Global headcount: 45 | Headquarters: Pune | Enterprise bet: The company has launched three new enterprise products since July 2017, resulting in sharp growth in B2B revenue. It plans to hire 50 employees over the next year.In the fast lane: Bus aggregation startup Shuttl recently raised $11 million from Amazon, Dentsu Ventures and existing investors including Sequoia Capital. The company clocks 45,000 daily rides in five cities. It aims to expand to two new cities by the end of the year, even as experts feel achieving healthy unit economics remains a challenge. | Global headcount: 300 | Headquarters: Gurugram | Seats up for grabs: To meet its goal of ten-fold growth in daily ridership, Shuttl plans to double its employee numbers over the next year.Leveraging social: Reseller marketplace Meesho uses social media platforms like WhatsApp and Facebook to connect sellers directly with suppliers. In June, the Y Combinator-backed firm raised $11.5 million in Series B funding from Sequoia India and a bunch of existing investors. | Global headcount: 225 | Headquarters: Bengaluru | Focus on localisation: The social commerce startup plans to launch an interface in Indian regional languages in a few months.Numbers-driven: Exadatum positions itself as a one-stop shop for everything Big Data. Its offerings make Big Data implementation faster, cheaper and standardised for Fortune 500 clients, the two-year-old venture says. Exadatum’s next target — developing products and rendering services in machine learning and artificial intelligence. Global headcount: 70 | Headquarters: Pune | Talent hunt: The bootstrapped startup also has a base in New York and is actively scouting for freshers with Java, Python and C++ skills.Originally Published on LinkedIn Top Startups 2018: The 25 most sought-after startups in India

Ramnarain Ruia Jr. College, Matunga05/09/2015Environmental studies ProjectHospital Waste Management in Kurla Area:ü1.Selection of Topic (10 marks)ü2.Objectives(4 marks)ü3.Review of literature(4 marks)ü4.Relevance(4 marks)ü5.Proposed methodology(8 marks)6..Description of the method followed(8 marks)ü7.Observation(2 marks)ü8.Analysis(4 marks)ü9.conclusion(2 marks)10.Report writing(4 marks)11.viva-voice(10 marks)“Hospital (Medicinal) Waste”An Environmental Hazard and Its ManagementSelection of topic:The proper management of biomedical waste has become a worldwide humanitarian topic today. Although hazards of poor management of biomedical waste have aroused the concern world over, especially in the light of its far-reaching effects on human, health and the environment.2Now it is a well-established fact that there are many adverse and harmful effects to the environment including human beings which are caused by the “Hospital waste” generated during the patient care. Hospital waste is a potential health hazard to the health care workers, public and flora and fauna of the area. The problems of the waste disposal in the hospitals and other health-care institutions have become issues of increasing concern.Hospital is a place of almighty, a place to serve the patient. Since beginning, the hospitals are known for the treatment of sick persons but we are unaware about the adverse effects of the garbage and filth generated by them on human body and environment. Now it is a well-established fact that there are many adverse and harmful effects to the environment including human beings which are caused by the "Hospital waste" generated during the patient care. Hospital waste is a potential health hazard to the health care workers, public and flora and fauna of the area. Hospital acquired infection, transfusion transmitted diseases, rising incidence of Hepatitis B, and HIV, increasing land and water pollution lead to increasing possibility of catching many diseases. Air pollution due to emission of hazardous gases by incinerator such as Furan, Dioxin, Hydrochloric acid etc. have compelled the authorities to think seriously about hospital waste and the diseases transmitted through improper disposal of hospital waste. This problem has now become a serious threat for the public health and, ultimately, the Central Government along with state government had to intervene for enforcing proper handling and disposal of hospital waste and an act was passed in July 1996 and a bio-medical waste (handling and management) rule was introduced in 1998.A modern hospital is a complex, multidisciplinary system which consumes thousands of items for delivery of medical care and is a part of physical environment. All these products consumed in the hospital leave some unusable leftovers i.e. hospital waste. The last century witnessed the rapid mushrooming of hospital in the public and private sector, dictated by the needs of expanding population. The advent and acceptance of "disposable" has made the generation of hospital waste a significant factor in current scenario.As I live in Kurla I am very much familiar with the present day conditions regarding the above topic. The area is much crowdy as compared to other areas of the city. It is the main site where one can find slum areas, so the chances of effects due to improper hospital waste management are more in this area. Also the people are not aware of the fact that there is something called hospital waste management. Most of the people categorize all the waste under same column and that’s the worst part of it.Therefore in order to catch people’s attention towards this problem I choose this topic under environmental studies.I am sure that it may contribute a little fraction in creating awareness among the citizens.Objectives:Need of biomedical waste management in hospitals:While selecting this topic, the question aroused in my mind was “why do we need to separate this waste from household waste?” I gone through various articles and the reports served by municipality officials and came to know that how dangerous it would be if we are not separating this waste. Still separating wasn’t enough. It has to be decomposed or manage properly in order make it safeHospital waste management is a part of hospital hygiene and maintenance activities. In fact only 15% of hospital waste i.e. "Biomedical waste" is hazardous, not the complete. But when hazardous waste is not segregated at the source of generation and mixed with nonhazardous waste, then 100% waste becomes hazardous. The question then arises that what is the need or rationale for spending so many resources in terms of money, man power, material and machine for management of hospital waste?The reasons due to which there is great need of management of hospital waste such as:1.Injuries from sharps leading to infection to all categories of hospital personnel and waste handler.2.Nosocomial infections in patients from poor infection control practices and poor waste management.3.Risk of infection outside hospital for waste handlers and scavengers and at time general public living in the vicinity of hospitals.4.Risk associated with hazardous chemicals, drugs to persons handling wastes at all levels.5.“Disposable” being repacked and sold by unscrupulous elements without even being washed.6.Drugs which have been disposed of, being repacked and sold off to unsuspecting buyers.7.Risk of air, water and soil pollution directly due to waste, or due to defective incineration emissions and ash3.To make people aware of the fact, what is hospital waste?Hospital waste refers to all waste generated, discarded and not intended for further use in the hospital.According to Biomedical Waste (Management and Handling) Rules, 1998 of India “Any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological.Review of literature:As this topic is very much familiar with metro cities like Mumbai I got a lot of information regarding above topic from following sources:ØRecent reports given by local municipality and state government officials.ØGuidelines given by WHO regarding hospital waste management and their disposal.ØInterviews of respected hospital officials (waste managers).ØEfforts carried out by various NGO’s in respective areas.ØAt the State level, many States are developing new standards to control medical waste disposal.ØBecause of the information need to support the implementation of the regulations, both the Federal Government and the States have conducted various studies. This paper represents a discussion of what has been learned as a result of these studies.ØEvaluation of medical waste treatment technologies conducted by private industries;ØCase study: hospital waste management (Kurla area)Relevance:Scientific Relevance:·In order to understand how this topic is related scientifically following points must be understood. The following information provides how this waste is classified:-(1) General waste: Largely composed of domestic or house hold type waste. It is non-hazardous to human beings, e.g. kitchen waste, packaging material, paper, wrappers, plastics.(2) Pathological waste: Consists of tissue, organ, body part, human foetuses, blood and body fluid. It is hazardous waste.(3) Infectious waste: The wastes which contain pathogens in sufficient concentration or quantity that could cause diseases. It is hazardous e.g. culture and stocks of infectious agents from laboratories, waste from surgery, waste originating from infectious patients.(4) Sharps: Waste materials which could cause the person handling it, a cut or puncture of skin e.g. needles, broken glass, saws, nail, blades, and scalpels.(5) Pharmaceutical waste: This includes pharmaceutical products, drugs, and chemicals that have been returned from wards, have been spilled, are outdated, or contaminated.(6) Chemical waste: This comprises discarded solid, liquid and gaseous chemicals e.g. cleaning, house keeping, and disinfecting product.(7) Radioactive waste: It includes solid, liquid, and gaseous waste that is contaminated with radionucleides generated from in-vitro analysis of body tissues and fluid, in-vivo body organ imaging and tumour localization and therapeutic procedures.·How this waste is disposed?Based on Bio-medical Waste (Management and Handling) Rules 1998, notified under the Environment Protection Act by the Ministry of Environment and Forest (Government of India).1. Segregation of wasteSegregation is the essence of waste management and should be done at the source of generation of Bio-medical waste e.g. all patient care activity areas, diagnostic services areas, operation theaters, labour rooms, treatment rooms etc. The responsibility of segregation should be with the generator of biomedical waste i.e. doctors, nurses, technicians etc. (medical and paramedical personnel). The biomedical waste should be segregated as per categories mentioned in the rules.2. Collection of bio-medical wasteCollection of bio-medical waste should be done as per Bio-medical waste (Management and Handling) Rules. At ordinary room temperature the collected waste should not be stored for more than 24 hours.Types of container and colour code for collection of bio-medical waste.CategoryWaste classType of containerColour1.Human anatomical wastePlasticYellow2.Animal waste-do--do-3.Microbiology and Biotechnology waste-do-Yellow/Red4.Waste sharpPlastic bag puncture proof containersBlue/White Translucent5.Discarded medicines and Cytotoxic wastePlastic bagsBlack6.Solid (biomedical waste)-do-Yellow7.Solid (plastic)Plastic bag puncture proof containersBlue/White Translucent8.Incineration wastePlastic bagBlack9.Chemical waste (solid)-do--do-3. TransportationWithin hospital, waste routes must be designated to avoid the passage of waste through patient care areas. Separate time should be earmarked for transportation of bio-medical waste to reduce chances of it's mixing with general waste. Desiccated wheeled containers, trolleys or carts should be used to transport the waste/plastic bags to the site of storage/ treatment.Trolleys or carts should be thoroughly cleaned and disinfected in the event of any spillage. The wheeled containers should be so designed that the waste can be easily loaded, remains secured during transportation, does not have any sharp edges and is easy to clean and disinfect. Hazardous biomedical waste needing transport to a long distance should be kept in containers and should have proper labels. The transport is done through desiccated vehicles specially constructed for the purpose having fully enclosed body, lined internally with stainless steel or aluminium to provide smooth and impervious surface which can be cleaned. The drivers compartment should be separated from the load compartment with a bulkhead. The load compartment should be provided with roof vents for ventilation.4. Treatment of hospital wasteTreatment of waste is required:· to disinfect the waste so that it is no longer the source of infection.· to reduce the volume of the waste.· make waste unrecognizable for aesthetic reasons.· make recycled items unusable.4.1 General wasteThe 85% of the waste generated in the hospital belongs to this category. The, safe disposal of this waste is the responsibility of the local authority.4.2 bio-medical waste: 15% of hospital waste· Deep burial: The waste under category 1 and 2 only can be accorded deep burial and only in cities having less than 5 lakh population.· Autoclave and microwave treatment Standards for the autoclaving and microwaving are also mentioned in the Biomedical waste (Management and Handling) Rules 1998. All equipment installed/shared should meet these specifications. The waste under category 3,4,6,7 can be treated by these techniques. Standards for the autoclaving are also laid down.· Shredding: The plastic (IV bottles, IV sets, syringes, catheters etc.), sharps (needles, blades, glass etc) should be shredded but only after chemical treatment/microwaving/autoclaving. Needle destroyers can be used for disposal of needles directly without chemical treatment.· Secured landfill:: The incinerator ash, discarded medicines, cytotoxic substances and solid chemical waste should be treated by this option.· Incineration: The incinerator should be installed and made operational as per specification under the BMW rules 1998 and a certificate may be taken from CPCB/State Pollution Control Board and emission levels etc should be defined. In case of small hospitals, facilities can be shared. The waste under category 1,2,3,5,6 can be incinerated depending upon the local policies of the hospital and feasibility. The polythene bags made of chlorinated plastics should not be incinerated.· It may be noted that there are options available for disposal of certain category of waste. The individual hospital can choose the best option depending upon the facilities available and its financial resources. However, it may be noted that depending upon the option chosen, correct colour of the bag needs to be used.5. Safety measures5.1 All the generators of bio--medical waste should adopt universal precautions and appropriate safety measures while doing therapeutic and diagnostic activities and also while handling the bio-medical waste.5.2 It should be ensured that:· drivers, collectors and other handlers are aware of the nature and risk of the waste.· written instructions, provided regarding the procedures to be adopted in the event of spillage/ accidents.· protective gears provided and instructions regarding their use are given.· workers are protected by vaccination against tetanus and hepatitis B.6. Training· each and every hospital must have well planned awareness and training programme for all category of personnel including administrators (medical, paramedical and administrative).· all the medical professionals must be made aware of Bio-medical Waste (Management and Handling) Rules 1998.· to institute awards for safe hospital waste management and universal precaution practices.· training should be conducted to all categories of staff in appropriate language/medium and in an acceptable manner.7. Management and administrationHeads of each hospital will have to take authorization for generation of waste from appropriate authorities as notified by the concerned State/U.T. Government, well in time and to get it renewed as per time schedule laid down in the rules. Each hospital should constitute a hospital waste management committee, chaired by the head of the Institute and having wide representation from all major departments. This committee should be responsible for making Hospital specific action plan for hospital waste management and its supervision, monitoring and implementation. The annual reports, accident reports, as required under BMW rules should be submitted to the concerned authorities as per BMW rules format.8. Measures for waste minimizationAs far as possible, purchase of reusable items made of glass and metal should be encouraged. Select non PVC plastic items. Adopt procedures and policies for proper management of waste generated, the mainstay of which is segregation to reduce the quantity of waste to be treated. Establish effective and sound recycling policy for plastic recycling and get in touch with authorised manufactures.Social relevance:This project completely focuses on why do we need to separate this waste and why do we need to dispose them effectively.§It has a great impact on health of local citizens. So it is completely socially relevant.§A major issue related to current Bio-Medical waste management in many hospitals is that the implementation of Bio-Waste regulation is unsatisfactory as some hospitals are disposing of waste in a haphazard, improper and indiscriminate manner. Lack of segregation practices, results in mixing of hospital wastes with general waste making the whole waste stream hazardous. Inappropriate segregation ultimately results in an incorrect method of waste disposal.§Inadequate Bio-Medical waste management thus will cause environmental pollution, unpleasant smell, growth and multiplication of vectors like insects, rodents and worms and may lead to the transmission of diseases like typhoid, cholera, hepatitis and AIDS through injuries from syringes and needles contaminated with human.6§Various communicable diseases, which spread through water, sweat, blood, body fluids and contaminated organs, are important to be prevented. The Bio Medical Waste scattered in and around the hospitals invites flies, insects, rodents, cats and dogs that are responsible for the spread of communication disease like plague and rabies. Rag pickers in the hospital, sorting out the garbage are at a risk of getting tetanus and HIV infections. The recycling of disposable syringes, needles, IV sets and other article like glass bottles without proper sterilization are responsible for Hepatitis, HIV, and other viral diseases. It becomes primary responsibility of Health administrators to manage hospital waste in most safe and eco-friendly manner6.The problem of bio-medical waste disposal in the hospitals and other healthcare establishments has become an issue of increasing concern, prompting hospital administration to seek new ways of scientific, safe and cost effective management of the waste.· Municipal authority : As quite a large percentage of waste (in India upto 85%), generated in Indian hospitals, belong to general category (non-toxic and non-hazardous), hospital should have constant interaction with municipal authorities so that this category of waste is regularly taken out of the hospital premises for land fill or other treatment.· Co-ordination with Pollution Control Boards: Search for better methods technology, provision of facilities for testing, approval of certain models for hospital use in conformity with standards 'aid down.· Development of non-PVC plastics as a substitute for plastic which is used in the manufacture of disposable items• Establishment of training programs for workers to improve the quality and quantity of work.• Protection of workers against occupational risks.·Economic Relevance:Medical waste requires more amount of money as compared to household waste or any other waste as it has to be decomposed very efficiently and carefully. Regardless of how much money is being spent we need to check for whether the money spent is being used properly or not for that we need to search for cost effective and environmental friendly technology for treatment of bio-medical and hazardous waste. Also, to search for suitable materials to be used as containers for bio-medical waste requiring incineration/autoclaving/ microwaving. This project mainly focuses on reducing expenditure regarding waste management.Cost reductions can be achieved by taking particular measures at different stages in the management of wastes: On-site management• Comprehensive management of chemicals and pharmaceuticals stores.• Substitution of disposable medical care items by recyclable items.• Adequate segregation of waste to avoid costly or inadequate treatment of waste that does not require it.• Improved waste identification to simplify segregation, treatment, and recycling. Comprehensive planning• Planning collection and transport in such a way that all operations are safe and cost-efficient. • Possible cooperative use of regional incineration facilities, including private sector facilities where appropriate.• Selection of a treatment and disposal option that is appropriate for waste type and local circumstances.• Use of treatment equipment of appropriate type and capacity. Measures at personnel levelPROPOSED METHODOLOGY:In order to collect all the information and to have a descriptive look on the topic stated above, the best way was to take interviews of the respective people in the field of waste management. As most of the people in this area are not that much familiar with the things like how waste in managed and how all things take place, there was no use of taking interviews of local people. So most important task in front of me was to collect all information and put this in front of local citizens so that they would understand what this thing is.Interviewee:Hospital waste managers.Workers or handlers.Transporters.BMC officials in respective areas.Local people facing problems regarding the same.Medical students in the area stated above.Active NGO’s in above area.Citizens in damping areas.Requirements:As I have to conduct interviews I have to be prepared with all the questions.A camera is must for recording all statements given by respective people.List of prestigious hospitals in the area.List of hospital waste managers in respective hospitals.Sufficient information regarding the questions which I need to ask.Permission of hospital authorities to conduct interviews.A guide.How to proceed?As stated earlier, my motto was to conduct interviews of officials and put them in front of local citizens:Questions to officials:1.What are Biomedical wastes?2.What are biodegradable and non-biodegradable wastes?Questions to workers:3.What is the quantum of waste that is generated by a hospital?4.What are disinfection and sterilization?5.What are the colour codes and type of containers used for disposal of biomedical waste?6.What materials can be recycled?7.How long can bio medical waste be stored?Questions to BMC officials:8.What are the hazards associated with poor health care waste management?9.Who are the persons at risk of the hazards of medical procedures?10.What are the rules and regulations governing the disposal of these wastes?Questions to medical students:11.What are the responsibilities of health care institutions regarding biomedical waste management?Questions to NGO’s:12.What are the different hospital waste categories?13.What is Biosafety?14.What are the disinfectants commonly used for disinfection of materials contaminated with blood and body fluids?15.How is disinfection of the various items commonly used in the hospital carried out?Thus, this is how I need to proceed in order to complete my project work. Along with that I may require methods like mouth publicity, pamphlets regarding the same. And most important in order to complete it effectively I need to be guided by my EVS teacher.DESCRIPTION OF THE METHOD FOLLOWED:Answers to the questions asked:1.Biomedical wastes are defined as waste that is generated during the diagnosis, treatment or immunization of human beings or animals, or in research activities pertaining thereto, or in the production of biological.2.Biodegradable waste means any waste that is capable of undergoing anaerobic or aerobic decomposition, such as food and garden waste, and paper and paperboard. It also includes waste from households, which because of its nature and composition is similar to biodegradable waste from households.Non-biodegradable wastes are the wastes that cannot be decomposed by bacteria eg.plastics, bottles and tins.3.The quantum of waste that is generated in India is estimated to be 1-2 kg per bed per day in a hospital and 600 gm per day per bed in a general practioner’s clinic. e.g. a 100 bedded hospital will generate 100 – 200 kgs of hospital waste/day. It is estimated that only 5 – 10% of this comprises of hazardous/infectious waste (5 – 10kgs/day)4.Proper disposal of biomedical waste is of paramount importance because of its infectious and hazardous characteristics. Improper disposal can result in the following:· Organic portion ferments and attracts fly breeding· Injuries from sharps to all categories of health care personnel and waste handlers· Increase risk of infections to medical, nursing and other hospital staff· Injuries from sharps to health workers and waste handlers· Poor infection control can lead to nosocomial infections in patients particularly HIV, Hepatitis B & C· Increase in risk associated with hazardous chemicals and drugs being handled by persons handling wastes· Poor waste management encourages unscrupulous persons to recycle disposables and disposed drugs for repacking and reselling· Development of resistant strains of microorganisms5.ProcedurePerson at riskMode of TransmissionCollection of blood samplesPatient Health workerContaminated needle, gloves, Skin puncture by needle or container,Contamination of hands by bloodTransfer of specimens (within laboratory)Laboratory personnelContamination of exterior of specimen container, Broken container,Splash of specimenHIV serology and virologyLaboratory personnelSkin puncture, splash of specimen,6.The Government of India has promulgated the Biomedical Waste (Management and Handling) Rules 1998. They are applicable to all persons who generate, collect, receive, store, transport, treat, dispose or handle biomedical wastes. This includes hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories and blood banks.7.It is mandatory for such institutions to:Set up biomedical waste treatment facilities like incinerators, autoclave and microwave systems for treatment of the wastesMake an application to the concerned authorities for grant of authorizationSubmit a report regarding information about the categories and quantities of biomedical wastes handled during the preceding year by 31 Jan every yearMaintain records about the generation, collection, reception, storage, transportation, treatment, disposal and/or any form of handling bio medical wasteReport immediately any accident to the prescribed authority8.Biosafety is essentially a preventive concept and consists of wide variety of safety precautions that are to be undertaken, either singly or in combination, depending on the type of hazard by all medical, nursing and paramedical workers as well as by patients, attendants, ancillary staff and administrators in a hospital.9.Disinfection and sterilization are important procedures in biosafety. Disinfection refers to procedures which reduce the number of microorganisms on an object or surface but not the complete destruction of all microorganism or spores. Sterilisation on the other hand, refers to procedures, which would remove all microorganisms, including spores, from an object. Sterilisation is undertaken either by dry heat (for 2 hours at 1700C in an electric oven – method of choice for glass ware and sharps) or by various forms of moist heat (i.e. boiling in water for an effective contact time of 20 min or steam sterilization in an autoclave at 15 lb/sq inch at 1210C for 20 min)Name of DisinfectantAvailable chlorineRequired chlorineRequired chlorine Contact periodAmount of disinfectant to be dissolved in 1 ltr of waterSodium hypochlorite5%0.5%30 min100 mlCalcium hypochlorite70%0.5%30 min7.0 gmNa OCl powder-0.5%30 min8.5 gm10.OBSERVATION:Amount and composition of hospital waste generated(a) AmountAreaQuantity (kg/bed/day)SionDadarAndheriKurla2.54.52.53.0b) (Hazardous/non-hazardous)Hazardous15%a) Hazardous but non-infective5%b) Hazardous and infective10%Non-hazardous85%c) Composition(By weight):Plastic14%CombustibleDry cellublostic solid45%Wet cellublostic solid18%Non-combustible20%ANALYSIS:Following observations were made during my visit to respective clinics and hospitals in Kurla area.Major Sources§Govt. hospitals/private hospitals/nursing homes/ dispensaries.§Primary health centers.§Medical colleges and research centers/ paramedic services.§Veterinary colleges and animal research centers.§Blood banks/mortuaries/autopsy centers.§Biotechnology institutions.§Production units.Minor Sources§Physicians/ dentists’ clinics§Animal houses/slaughter houses.§Problems relating to biomedical waste§advances in this area. The need of proper hospital waste management system is of prime importance and is an essential component of quality assurance in hospitals§Blood donation camps.§Vaccination centers.§Acupuncturists/psychiatric clinics/cosmetic piercing.§Funeral services.§Institutions for disabled personsCONCLUSION:Medical wastes should be classified according to their source, typology and risk factors associated with their handling, storage and ultimate disposal. The segregation of waste at source is the key step and reduction, reuse and recycling should be considered in proper perspectives. We need to consider innovative and radical measures to clean up the distressing picture of lack of civic concern on the part of hospitals and slackness in government implementation of bare minimum of rules, as waste generation particularly biomedical waste imposes increasing direct and indirect costs on society. The challenge before us, therefore, is to scientifically manage growing quantities of biomedical waste that go beyond past practices. If we want to protect our environment and health of community we must sensitize our selves to this important issue not only in the interest of health managers but also in the interest of community.