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Journal o f Financial Management and Analysis, 27(2):2014:(41 -50) © Om Sai Ram Centre for Financial Management Research

ANALYSIS OF COST CONTAINMENT, COST RECOVERY AND SUSTAINABILITY OF HOSPITAL WASTE MANAGEMENT SYSTEM CASE S TU DY OF SANJAY GANDHI POST GRADUATE

INSTITUTE OF MEDICAL SCIENCES, LUCKNOW, INDIA Professor (Dr.) HEMCHANDRA M .B.B.S.,M .H .A.,M .B.A.,Ph.D . H ead D epartm ent o f H o sp ita l A d m in istra tio n E -m ail : h ch a n d ra 5 55@ gm ail.com

Ms. LEELA MASIH B.Sc (Nursing), M .Sc (H ospital Adm inistration) N u rsin g S u p e rin te n d e n t E-m ail: leela h 9 j@ ya h o o .co .in

SUNIL SH ISH O O ,M.Sc., P.G.D., H.H.M. D eputy S u p e rin te n d e n t E -m ail : ssh ishoo@ yahoo.com

BHARAT SA H ,M .B .A . A sso c ia te S u p e rin te n d e n t E -m ail : bharatsah3@ yahoo.com

Dr. ARVIND VASHISHTA RINKOO M.B.B.S., M.D., D.N.B.

S enior R esid en t E m ail- docavr@ gm ail.com

Department of Hospital Administration S a n ja y G andhi P ost G raduate In stitu te o f M ed ica l Sciences

Lucknow, UP. India

Professor, (Dr.) T. N. DHOLE M.B.B.S., M.D. Head, D ep a rtm en t o f M icro b io lo g y S anjay G andhi P ost G raduate In stitu te o f M edical Sciences Lucknow, India E m ail : tn d h o le@ sg p g i.a c.in

Abstract Sanjay Gandhi Post Graduate Institute o f Medical Sciences , Lucknow, Uttar Pradesh State o f India, - - a 886- bedded, tertiary care hospital, - - is implmenting the methods o f waste utilization /recycling, for wealth generation from solid waste and also containing the cost o f treatment for needy patients. The study is intended to analyze the outcome o f measures adopted by the hospital for solid waste utilization/recycling, in terms o f cost recovery and cost reduction in treatment o f patients. During the period (January 2008 to March 2014). The hospital earned Rs. 7669621 (U S$127827) by selling the hospital solid waste materials such as disinfected/sterile, plastic/latex m aterials, card board, glass bottles, etc and, for containing the cost o f the patients treatment, the plastic/rubber made consumable valued at Rs. 137.20 million (US$ 2.85 million) were sterilized, recycled and released.

Key words : Hospital solid waste and disinfection recycling; cost containment-cum-cost recovery, sustainability JEL C lassification - D61; I I 1; 131; 0 5 3

ANKITA PANDEY M. Tech S en io r R esearch Fellow Indian In stitu te o f Toxicology Research Lucknow, India E -m ail : ankitaakasom u@ gm ail.com

Introduction scarce re so u rces which are many and varied. This is e s p e c i a l l y so in a c o u n t r y like In d ia . The

A Hospital Administrator is prim arily a manager o f success o f a h o s p ita l a d m in is tr a to r dep ends on

The authors own full responsibility for the contents of the paper.

mailto:[email protected]

42 JOURNAL OF FINANCIAL MANAGEMENT AND ANALYSIS

how well he or she o r g a n i z e s and ut i l i z e s the available r esour ces. A hospi t al admi ni s t r at or may be c o m p a r e d to a c o n d u c t o r o f an o r c h e s t r a ; maki ng o p t i mu m use o f each r e s our ce. ' Equal l y i mper ati ve is the d e v e l o p me n t o f new innovat i ve ideas on the par t o f h o s p i t a l a d mi n i s t r a t o r s to g e n e r a t e w e a l t h a n d r e v e n u e as m o n e y is invar i ably a scarce ent i t y in most cases.

It is ironic that the hea l t h care facilities, whi ch restor e the healt h o f the di s eas e d, pos e a huge health risk and en v i r o n me n t a l degr adat i on due to i mpr ope r hospi t al wast e ma n a g e me n t . Safe and sust ai nabl e healt h care wast e ma n a g e me n t is not p o s s i b l e w i t h o u t a f a v o u r a b l e a t t i t u d e a mo n g healt h care p r o v i d e r s . 2 One o f the most import ant mat t ers in pl a nni ng a hos pi t al is to cons i der the di sposal routes o f all wast e and i nfect ed material. In every part o f the hospi t al wher e pat i ent s are t r e a t e d , t h e r e wi l l be i n f e c t e d m a t e r i a l to be di sposed of. Dirty mat er ials should, in general, go into a bin, bag or ot her di sposal cont ai ne r at its point o f origin and r emai n in that cont ai ner until it r e a c h e s a p o i n t a t w h i c h it is s t e r i l i z e d or i nc i ne r a t e d3. It is not ewor t hy that Gove r nment of India enacted an Act in July 1996, f ollowed by laying down Bi ome d i c al Wast e (Handl i ng and Ma n a g e m e n t ) Rul es in 1998 to e ns ur e p r ope r handl i ng and di sposal o f hospi t al wa st e s 4.

T h o u g h w e a l t h m i g h t n o t be c o n s i d e r e d as si gni f i cant as healt h, it is a uni ver sal truth that weal th and funds are salient inputs for any system. Thus it is a r e f r e s h i n g l y c o n f o u n d i n g fact that weal th can actual ly be g ene r at ed by uti li zi ng the solid / medi cal wast es in hospi t al s after adequat e t r ea t me nt 5.

Prelude In India, the aver age pr oduc t i on o f hospital waste is 1.5 kg. /bed/day (range: 1-2.50 k g/ be d/ da y) 5, out o f whi ch 20 per cent is bi ome di c a l (hazar dous) in n a t u r e . H o w e v e r , w a s t e p r o d u c e d h a s b e e n q u o t e d up to 5 . 2 4 k g / b e d / d a y in d e v e l o p e d c o u n t r i e s . 6 T h e s e h i gh e r f i g u r e s in d e v e l o p e d count ri es are due to gr eat er use o f di sposables in those countries. On an average, 1.8 million wastes are gener at ed per day from about 1.2 million beds o f about 11000 hospi t al s in India. Cost benefit m e a s u r e s o f h o s p i t a l w a s t e s , e s p e c i a l l y the biomedi cal wastes, are not practiced; therefore e m p h a s i s is g i v e n in t h i s s t u d y on c o s t c o n t a i n m e n t / c o s t e f f e c t i v e n e s s . T h u s the d o m e s t i c w a s t e s u c h as c a r d b o a r d , p a p e r , container, glass bot t les and a part o f biomedi cal wast e such as plastic mat er ials (IV bottle, tube s y r i n g e s , g l ov e s , c a n u l a , bags etc. ) and ot her rubber materials can be utilized by recycling after di sinfection/ st erilization to recover some revenue out o f it or to bri ng down the cost o f treat ment like in the case o f recycling of high cost disposables such as c a t he t er i za t i on tube, dialyzers, etc. The benef i t can be s har ed with low s oci o-economi c pat i ent s by pr ovi di ng t hem quality state o f the art healt h care at an af f or dabl e (low) cost. Law does not ment i on whe t he r re use the waste or not, but All India Audit Report on Management of Waste e mpha s i z e s on 3 Rs. i.e., Reduce, Recycl e and R e u s e 7. De v e l o p e d count r i es have also adopt ed the pr act i ce o f reuse after recycle.

Methodology Used The S a n j a y Ga n d h i Post G r a d u a t e I nst i t ute o f Medical Sciences (S.G.P.G.I.M.S.), Lucknow, Uttar Pradesh, State o f Indi a whi ch is a tertiary care

*The Sanj ay Gandhi Post Gr a duat e Institute of Medical Sci ences (S.G.P.G.I.M.S.) is d ed i ca t ed to qual i t y t ert iary care at an a f f o r d a b l e cost. Over t he years, it has achi eved success to be c o me a r obus t cent r e o f excel l ence for pr o v i d i n g s uper s p e ci a l t y care, medi cal educat i on and r esearch f aciliti es o f hi ghes t order. The (S.G.P.G.I.M.S.), established under an Act of State Legislature of Uttar Pradesh in 1983, functions as a university. The I nstitut e cat er ed to 4 0 0 7 6 8 OPD pat i ent s, 35188 di s char ges , 26281 12 i nve s t i ga t i ons wer e done in 2013. On an aver age, in a year, about 8734 sur gical pr oce dur e s are per f or med incl udi ng mor e than 134 renal t r ans pl ant s 8. This is made possi bl e by a t eam o f hi ghl y qual i f i ed- cum-r i chl y experienced doct ors and paramedical personnel using state of the art t e c h n o l o g y and hi g h - en d s oph i s t i c a t e d equi pment . Table 1 the hospit al stat i st i cs for last nine years. The hospi t al f aci l i t i es are pr o v i d ed on p a y me n t bas i s but rates are h i ghl y subsi di zed.

A n a l y s i s O f C o s t C o n t a i n m e n t , C o s t R e c o v e r y A nd S u s t a i n a b i l i t y O f H o s p i t a l W a s t e M a n a g e m e n t S y s t e m C a se S t u d y O f S a n j a y G a n d h i P o s t G r a d u a t e

I n s t i t u t e O f M e d i c a l S c i e n c e s , L u c k n o w , I ndi a

TABLE 1 S.G .P .G .I.M .S. H O S P IT A L ST A T IST IC S : 01st JA N U A R Y 2005 TO 3 1 st D E C E M B E R 2013

Y e a r ------- -> 2005 2006 2007 2008 2009 2010 2011 2012 2 0 1 3 O P D N e w patie nts 43530 46566 52521 58894 65547 71335 76620 80650 8 2 1 4 1 F o ll o w u p pat ients 132415 146355 168831 183687 204095 243027 284062 307712 3 1 8 6 2 7 D i s c h a r g e 35190 36732 38994 40596 29259 33705 34762 34926 3 5 1 8 8 B O R 69.5% 68% 74.4% 76.1% 78.6% 74.4% 76.1% 77.1% 7 6 . 5 % S u r g e r y 6213 6296 7331 7680 7353 7724 8202 8402 8 7 3 4 R e n a l T X 97 113 115 115 92 100 114 116 1 34 L i v e r T r a n s p l a n ML 3 1 0 ML ML NIL ML 1 B M T x Of 4 1 0 2 2 ML 2 3 L i t h o t r i p s y 21* 326 295 125 ML 130 329 199 303 O p e n H e a r t S u r 433 519 474 478 465 382 402 389 4 2 5 M . R. I 4664 5496 5984 6392 6395 8709 8286 6943 6 3 4 0 H . d i a l y s i s 8342 10483 12555 16097 14966 17433 18495 19220 1 8 7 2 3 P. D i a l y s i s 417 354 156 57 32 15 28 ML 2 I n v e s t i g a t i o n s 1277982 1426779 1587304 1658143 2051488 2282945 2385210 2567901 2 6 2 8 1 1 2 E n d o s c o p y 8042 9452 10723 12588 13277 13642 13546 15382 1 3 4 2 7 C o r o . A n g i 2004 2333 2396 2520 2712 2433 2193 2188 2 0 5 9 P T C A 922 1056 1081 1196 1407 1352 1250 1248 12 2 1 P a t h o l o g y 7208 7718 9044 9506 9878 10392 11473 11713 11 841 C T S c a n 3164 4253 4843 5889 7293 9138 10960 12550 1 2 6 5 4 U l t r a S o u n d 14322 18037 21049 21358 16810 20315 20694 21141 1 9 1 1 2 B l o o d D o n a t i o n 16768 17577 18995 21404 21541 22025 22486 22535 2 2 9 4 1 E R S P a t i e n t s 10853 11011 12476 12985 13417 122114 11505 10785 9 1 7 2 B l o o d D o n a t i o n 16768 17577 18995 21404 21541 22025 22486 22535 2 2 9 4 1 E R S P a t i e n t s 10853 11011 12476 12985 13417 122114 11505 10785 9 1 7 2 R e v e n u e Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. C o l l e c t i o n 207147959 226260238 262842359 278251815 315291091 397711615 458548028 465860018 4 7 3 4 8 9 7 4 0

Source : Sanjay G andhi In stitu te o f M edical S ources, Hospital Statistics 2005-2013 (Lucknow )

super special ty ( 868- bedded) is a pi one e r in using moder n ma n a g e me n t (innovat i ve) t echni que s vis- a-vis c o s t - c o n t a i n me n t , c o s t - e f f e c t i v e n e s s and s a v i n g s m e t h o d s in w a s t e u t i l i z a t i o n a n d recycl i ng*. The pr e s e nt st udy was done wi t h an i n t e n t i o n to a n a l y z e the o u t c o m e o f me a s u r e s a d o p t e d f o r h o s p i t a l s o l i d w a s t e u t i l i z a t i o n / r ecycling, in t erms o f we a l t h / r e venue gener at i on and medical ‘t r e a t me nt c o s t ’ r eduction.

A retrospective study was carried out in the month o f Apr i l 2014 at S.G.P.G.I.M.S. - - data per tai ning

to selling o f solid wast es incl udi ng some o f the bi ome di c a l wast es and r e cycl i ng/ r eus e of wastes (after di si nf ect i on/ steri l i zat i on), for the last six years was col l ected and ana l yz e d assiduously.

Like in any hea l t h care facility, solid wastes at S.G. P.G. I. M. S. may be d i v i d e d into two br oa d categori es, viz., general wast e or domestic waste or mu n i c i p a l wa st e o r i g i n a t i n g p r i ma r i l y from ki t chen and me di c a l stores, and the bi omedical w a s t e . G e n e r a l w a s t e or d o m e s t i c w a s t e or muni ci pal wast e consi st s pr i mar i l y of cardboard,

44 JOURNAL OF FINANCIAL MANAGEMENT AND ANALYSIS

TABLE 2 MAJOR BIOMEDICAL WASTES GENERATED AT SGPGIMS

ALONG WITH THEIR MODE OF DISPOSAL. CATEGORY 4, 6 AND 7 ARE THE MAJOR SOLID WASTES USED FOR SELLING AND RECYCLING*

Category Method of Disposal Colour Code of Collection Bag Human anatomical waste (organ, tissue, blood etc.)

Incineration/DB Yellow plastic bag

Anim al tissue (organ, tissue, blo o d etc)

Incineration/DB Yellow plastic bag

M icrobiology and Autoclave, microwave, Yellow-red plastic bag B iote chnology incinerator Sharp Disinfe ction at site-chemical Puncture p ro o f white container (needle, syringes, blades etc.) disinfection D iscard ed and cyto-toxic Incineration/DB Black plastic bag Solid waste Autoclave, microwave, Yellow-red plastic bag (plastic, cotton, banda ge etc.) chemical disinfection Solid waste (rubber, catheter, Autoclave, microwave, Red - b l u e plastic bag plastic material) chemical disinfection. Liquid waste** (washing, cleaning fluid)

Chemical disinfection D ischa rged in drain

Incinera tion ash Land fill Black plastic bag Chemical waste** (disinfectan t, pe sticides)

Chemical treatment Discharg ed in drain

Notes : * Classification based on Biom edical Waste (Handling and Managem en t) Rules : 19985 ** A m ende d rules 2011 - ca tegory No. 8 & 10 have bee n omitted.

p a p e r an d w r a p p e r s , c o n t a i n e r s , g la ss b o ttle s , ea ta bles and d is c a r d e d food, k itch en waste etc. B io m e d ic al waste, in turn, is an y solid, fluid and liquid or liquid waste inclu d in g its c o n ta in e r and a ny i n t e r m e d i a t e p r o d u c t , w h i c h is g e n e r a t e d du ring the d iag n o sis, tr e a tm e n t or im m u n iza tio n o f hum an being, anim als in re se a rc h p erta inin g there to or in the p ro d u c ti o n o f testing biolo g ic al and the animal wa ste from slaughter houses or any other like e s t a b l i s h m e n t s 8. In a hospital setting, ca te gories 4, 6 an d 7 o f the b io m e d ic a l wastes (as d e lin e a te d in Table 1) are the m ajor solid wastes w h i c h c a n be r e c y c l e d , r e u s e d or s o l d a f t e r s t e r i l i z a t i o n . A r e a s t h a t g e n e r a t e m a x i m u m b iom edical wastes at S.G.P.G.I.M.S. are Operation T h e a t r e s , I n t e n s i v e C a r e U n i t , B l o o d B a n k ,

Dialysis, Laboratory , Sam ple collection area and wards.

Disposal o f Solid Wastes The S.G.P.G.I.M.S. fo llows the Biomed ica l waste (M a n a g e m en t and H a n d lin g ) Rules : 1998 for disposal o f hospital waste. But in addition to this, it h a d d e v e l o p e d its o w n m e t h o d s o f w a s t e disposal for cost re covery, cost containm ent and s e lf su stainability o f system without violating the rules. S.G.P.G.I.M.S. being a government hospital, t r a n s p a r e n c y in t h e s y s t e m is a p r i m e re q u irem en t, th er efor e, a tender was floated to invite the bid ders to get maximum revenue for d isc ard ed / sterilized w aste . Table 3 re flects the h i g h e s t s e l l i n g r a t e s a t t a i n e d f o r d i f f e r e n t

I n s t i t u t e O f M e d i c a l S c i e n c e s , L u c k n o w , I ndi a

categories o f solid waste by tender process.. Some o f the solid wastes like card board, bottle s are sold as such an d some o f them like plastic, rubber etc. are shredded after sterilization and made ready for sale. (F ig u re 1). The In stitu te also develo ped the m o d a lity for solid w aste to re c y c le some o f

the w a ste s i n c l u d i n g b i o m e d i c a l waste, afte r disinfe ction/ sterilization to reuse it on subsidized rates and fa c ilita tin g the ec o n o m ic ally p oor class p a tie n ts by c o s t c o n t a i n m e n t / cost re duction. (Figure 2). Prior to 2008, the same hospital wastes were discarded af ter t re atment.

FIGURE 1 IMAGES SHOWING THE STERILIZED SOLID SHREDDED WASTE READY FOR SALE

FIGURE 2 IMAGES SHOWING THE STERILIZED SOLID WASTE READY FOR USE FOR PATIENTS

TABLE 3 SELLING PRICE OF SOLID WASTES : SEPT. 2009

(Solid Waste ) S ellin g P ric e p e r Kg. (Rs.)

Card Board 6.80 Glass 3.00 Gloves 17.25 T u b e s/C a th e te r s/P ip e s 17.50 Syringe 27.25 L.D. Bottles 39.00

Cost Containm ent/reduction, Cost Recovery and Sustainability

The average p rod uction of 868-bedded h ospital w aste ranges from 1.50 to 1.75 kg. per bed per day. Out of th is, ap proxim ately 20 per cent is biom edical (hazardous) in nature and rest is like general/ dom estic w aste. Bulk of hospital waste is solid in nature, but revenue cannot be generated from all solid wastes. The hospital selected certain w a s t e s w h i c h c a n e a s i l y be s o l d w i t h o u t

46 JOURNAL OF FINANCIAL MANAGEMENT AND ANALYSIS

TABLE 4 REVENUE GENERATED BY SELLING DISINFECTED / STERILE PLASTIC / LATEX MATERIALS,

C A R D B O A R D , GLASS BOTTLES, ETC. : 2008-2014

Financial Year Items W eight (kg) Revenue (Rs.) Total (Rs.) 2013-2014 Pla stic , gloves etc. 42137

C ard board 39110 Glass bottles 16900 14,30,528 14,30,528

2012-2013 Plastic 33058 7,72,626 11,05,784 Card boar d 38710 2,79,967 Glass bottles 16460 53,191

2011-2012 Plastic, gloves etc 40670 9,85,147 12,82,867 Card board 38390 2,41,538 Glass bottles 17835 56,182

2010-2011 Plastics, Gloves, 55197 11,55,195 15,45,232 R ubber M ateria ls etc. Card Board 48740 3,31,432 Glass Bottles etc. 19535 58,605

2009-2010 Plastic 32551 6,41,953 9,44,642 Card boar d 41030 2,68,612 Glass bottle 13360 34,077

2008-2009 Plastics, Gloves, 41233 8,24,673 10,98,101 R u b b er M ateria ls etc. Card Board 35200 2,39,625 Glass Bottles etc. 11490 33,803

January 2008 - Plastics, Gloves, 10300 1,98,000 2,62,467 March 2008 R u b b er M ateria ls etc. •

Card Board 8810 58,025 Glass Bottles etc. 2873 6,442

GrandTotal — — — 7669621 (US$ 127827)

co m p ro m isin g the e n v ir o n m e n ta l factors. It was o b s e r v e d that the h o s p ita l e a rn e d Rs. 7669621 (US$. 127827) during 75 m onths (January 2008 to M arch 2014) by se llin g the h o sp ita l solid waste m ateria ls such as d i s in f e c te d / ste riliz e d p lastic/ latex m ateria ls, card board, glass b o ttle s etc. The selling price p er un it for these wastes is tabulated in Table 2 and the re venue earn ed yea r wise is b e i n g t a b u l a t e d in T ab le 4. F ig u r e 3 c l e a r l y indicates the u n ab a te d incre ase in re venue over the years. The hospital started the p ractice in late 2008, there fo re pro p o rtio n ate re venue o f 2,62,467 rupees was gene rated by selling the solid wastes

in th a t y e a r as s h o w n in T able 4. T h e r e a f te r, c o n t i n u o u s l y t h e h o s p i t a l h a s g e n e r a t e d reasonable amount o f money every year to the extent o f earning o f m ax im u m revenue Rs. 15,45,232 in 2 0 1 0 - 2 0 1 1. F ig u r e 4 s h o w s th e i n d i v i d u a l c o n trib u tio n in re v en u e gene ration by differe nt types o f solid waste during 2008-2013. The revenue so gen erated is used in system maintenance and up-g rad atio n as and when re quired - - thus, the hospital re covers some o f the cost incurred.

So far as cost c o n ta i n m e n t in m edical care is concerned, the hospital sterilized the used plastic/

A n a l ys i s O f C o s t C o n t a i n m e n t , C o s t R e c o v e r y A nd S u s t a i n a b i l i t y O f H o s p i t a l W a s t e M a n a g e m e n t S y s t e m C ase S t u d y O f S an'j a y G a n d h i P o s t G r a d u a t e

I n s t i t u t e O f M e d i c a l S c i e n c e s , L u c k n o w , I ndi a

ru b b e r d is p o s a b le s su ch as c a th e te rs , ca n u la , tu b e s/p ip e s etc. o f w orth o f Rs. 137.20 m illio n (U S$.2.85 m illion) during the last six years, which predom inantly b elo n g ed to dep a rtm en t o f CVTS, R ad io lo g y , N e p h ro lo g y , N u c le a r M e d ic in e and O peration T heatres (Table 5A and 5B). By using these ste riliz e d d isp o sa b le s/a p p lia n c e s b ase d on discretion o f the treating doctor, treatm ent cost was brought down in com parison to a new er one bought by p a tie n ts . It is p e r tin e n t to m e n tio n th a t as cost - b en efit an alysis can n ot be done in such

s it u a t io n s , th e n eed fo r c o s t - e f f e c t iv e n e s s / containm ent analysis becom es imperative.

In addition to above, other types of non infected/ disinfected hospital solid wastes was utilized for land filling, which is not mentioned here in monetary terms. The recycling o f solid waste was thus found to be cost contained for waste management at S.G.P.G.I.M.S. and also sufficient am ount o f money was recovered. The e n v iro n m e n ta l p o llu tio n th re a ts w ere also m itigated, this was an additional plus point.

FIGURE 3 REVENUE BY SELLING THE HOSPITAL SOLID WASTE MATERIALS OVER THE YEARS

1 6 0 0 0 0 0 -i

1 4 0 0 0 0 0 - /

1 2 0 0 0 0 0 - /

1 0 0 0 0 0 0 - / Total R evenue 8 0 0 0 0 0 - (Rs.) ' 6 0 0 0 0 0 - /

4 0 0 0 0 0 -

2 0 0 0 0 0 -

0 - /

< /

iT '

TABLE 5 TOTAL APPLIANCES / ITEMS STERILIZED AND THEIR COST

A. TOTAL COST Departments Total items Total Cost (Rs.) R adiology 218323 13,41,84,409 CVTS 635 22,40,096 Uro OT 71 8,491 N uclear m edicine

350 72,8417

C ath lab 143 37,857 Total 219529 1 3 ,7 1 ,9 9 ,2 7 0

(US$ 2.85 million)

Table 5 contd. on next page

48 JOURNAL OF FINANCIAL MANAGEMENT AND ANALYSIS

TABLE 5

B. DEPARTMENT-WISE COST • R A D I O L O G Y

Item A verage U nit C ost (Rs.) Dilator 50 Sheath 900 Rining bilary 1500 Guide wire 1051 Catheter 950 Stiff wire 1250 Blue sheath 20 Sheath 750-1050(900) M icro catheter 10,000-25000(17500) Small wire 350 C onnecting tube 999 Super stiff wire 3500 Green stiff wire 4000 LMP cath 1500 Long diltor 50 M icro puncture set 1150 LES wire 2500 Swan gang 3500 Zebra wire 6000 Mandrill wire 5000 M icro couth 20000 Ans stiff700 Connecting tube 900 Vigan needle 20 Dilate tern 45 Micro balloon 100-16000(8500) Infiltration device 4500 skinny needle chiba tip 501

• C A T H LAB

Item S iz e Average Unit C ost (Rs.)

T.K.D. 500,197,150 282.00 Reduce cap - 150.00 A ntisuture pdm c bulb 200,143,94 145.00 Aortic punch 500,47,144 230.00 Troca dilator tip - 100.00 Auto suture 200,302,150 217.00 Vushe seal _ 200.00

• C V T S

Item Size A verage

U n it C ost

(R s.l

Aortic arch cannula 8 F R = 827,2952,2652 2159 10 F R = 872,2952,2652 2159

12 F R = 872,2952,2652 2159

14 FTL= 872,2952,2652 2159

2 0 F R = 1548,1881 1714

22F R = 1 4 5 3 ,1881 1278

24 F R = 1881,872,987,

1201,1453 1278

Vinous cannula 12F R = 1956,1651,1525 1710

14F R = 1651,1525 1528

16F R = 1711,1651,1525 1629

18F R = 1440,1651,1525 1538

20FR= 1956,1651,1525 1583

22FR=1453,1651,1525 1543

24FR=1651,1525 1588

28FR=1100,1651,1525,855,

1666,1307 1350

30FR=855,1666,1307 1276

32FR=869,1666,1307 1280

36FR=910,1666,1307 1294

36'46FR =828,1666,1307 1267

Femoral arterial cannula 10659,7001,3518,10659 7959

Chest drainage tube 68249 985

Venoussheath - 470

Suction tube - 4.90

Linear calh - 177

Dilator - 7300

Jejunal cath - 177

Folleycath 63,40 51

Drainage sheet - 9.00

Guide wire 4180,154m 1442 1925

Big tube - ' 500

CVCathTLR - 200

Dropping sheet - 100

I n s t i t u t e O f M e d i c a l S c i e n c e s , L u c k n o w , I ndi a

• D IA L Y S IS

Item Size Average Unit Cost (Rs.)

Tencuff traight cath - 3632.00 P.D. techkof cath 3135,2978,

3550,4796 3614.00 Dialator - 7300.00 Jemoral connector 88,600 344.00 CAPD connector - 999.00 Crude wire - 1250.00 Jugular kit - 3020.00 Guide wire 4130,154,1442 1925.00 Needle 5,26 15.00

• UROLOGY, NUCLEAR MEDICINE AND ANAESTHESIA '

Item Size Average Unit Cost (Rs.)

Bvf/ssf (merinic sigma)

141,94,90 282.00

Different type 3020,177,63,40, of cath (ep, abl, 150,2978,3550, duadph, regi.) 3632,3135,4796 2154.00 Ventilator device 3708,5000,1651, (plastic): regular basis

1525,82,555 2086.00

T-connector - 110.00 Endotracheal Tube Oxygen mask

- 67.50

(with tubing) - 23.00

FIGURE 4 REVENUE EARNED BY SELLIN G TH E HOSPITAL SOLID WASTE CATEGORY WISE : 2008 TO 2013

y . “ “ ~ ” ... .... .... ... .... ....

L400000 ^ 1079503 1210517

1200000

L000000

800000

600000

400000

200000

0 Saline Cardboard Glass Gloves IV set Syringe W ater Bottle Bottle bo ttle

C o n c lu sio n s a n d Im p lic a tio n s fo r Policy: T he p r e s e n t s tu d y w a s c a r r ie d o u t w ith an in te n tio n to a n a ly z e th e o u tc o m e o f m e a su re s a d o p te d fo r h o s p i t a l s o lid w a s te u t i l i z a t i o n / re c y c lin g , in term s o f w e a lth / re v e n u e g e n e ra tio n

a n d w a s t e t r e a t m e n t c o s t r e d u c t i o n . A re tr o s p e c tiv e stu d y w as c a rrie d out in the m onth o f A p r i l 2 0 1 4 a t S .G .P .G .I .M .S 5 w ith d a ta c o lle c tio n an d a n a ly s is p e r ta in in g to se llin g o f s o lid w a ste s in c lu d in g som e o f th e b io m e d ic a l

50 JOURNAL OF FINANCIAL MANAGEMENT AND ANALYSIS

wa st e s ( a f t e r d i s i n f e c t i o n / s t e r i l i z a t i o n ) for 75 mo n t hs and t h e i r r e c y c l i n g f or six year s.

The S. G. P. G. I . M. S. h o s p i t a l h a s b e e n u t i l i z i n g / r e c y c l i n g t he h o s p i t a l s o l i d w a s t e s i n c l u d i n g b i o m e d i c a l w a s t e s ( a f t e r d i s i n f e c t i o n / s t e r i l i z a t i o n ) f o r t h e l a s t si x y e a r s , a n d t he

j r u t c o m e o f w h i c h is h i g h l y s a t i s f a c t o r y in t erms o f c o n t a i n m e n t in t r e a t m e n t c o s t o f p a t i e n t s . Rs. 137.20 m illio n ( U S $ . 2 . 8 5 m illio n ) su r g ic a l items were recycled and used at subsidized rate for n e e d y and e c o n o m i c a l l y p o o r p a t ie n t s and g e n e r a t e d c o p i o u s w e a l t h r e v e n u e o f R s . 7 6 6 9 6 2 1 ( U S $ 1 2 7 8 2 7 ) d u r i n g t h e l as t 75 m o n t h s , w h i c h i n t u r n , is b e i n g u s e d f o r m a i n t e n a n c e a n d u p - g r a d a t i o n o f w a s t e m a n a g e m e n t f a c i l i t i e s a n d o t h e r h o s p i t a l

s e r vi c e s - - c o mm e n d a l l y , the s y s t e m has t ur ned o u t to be a s e l f - s u s t a i n a b l e c o m b i n e d w i t h c o s t - r e c o v e r y t e c h n i q u e d s y s t e m.

Solid waste recycling/reuse /selling of solid wastes practices, after proper treatment, are viable tools for cost c o n t a i n m e n t a nd wa st e ma n a g e me n t / wealth generation resulting in mobilization of funds towards reduct i on in cost o f patient treatment/ cost recovery. Thus the same practice and where t h e b u l k o f s o l i d w a s t e s is g e n e r a t e d w i t h envi ronmental polluti on threats almost mitigated, which is an additional plus point should be adopted by ot her hos p i t a l s ( e s p e c i a l l y t er t i ar y care) in almost all countries where the treatment cost is very hi gh and n o n- a f f or da bl e by the maj ori t y o f the needy patients.

REFERENCES

1. Francis, C.M., De Souza, M.C.; Hospital Administration (New Delhi, 2004)

2. Chattopadhyay, D, et. a i , Study of attitude regarding health care waste management among health care providers of a tertiary care hospital in Kolkata , Indian Journal of Public Health (April-June 2010)

3. Davies, R L, Macaulay, H.M.C.; Hospital Planning and Administration (New Delhi, 1995)

4. Gove r nme nt o f India, Mi ni st r y o f Forest and Envi ronment , Biom edical Waste (Handling and Managem ent) Rules : 1998.

5. Chandra, H, Jamaluddin, K; Hospital Administration at a Glance (Lucknow, 2010).

6. i) Sakharkar, BM; Principles of Hospital Administration and Planning (New Delhi, 2006)

ii) Shah, H.K., Ganguli, S.K.; Hospital waste m a n a g e m e n t - A review: Journal of Academy of Hospital Administralion (3 : 2000).

7. All India Audit Report on Management of Waste : 2008, Chapter 3 (PA 14 o f 2008)

8. Hospital Statistics of Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow for the Year 2005-2 013.

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