CHALLENGES OF LIQUID WASTE MANAGEMENT IN HOSPITALS

Over the last few years I have been working extensively towards reducing the pollution caused to water bodies and the environment as a whole by the discharge of Effluents from different sources like industries and hospitals. Hospitals however are a much dicier territory as they give out Biomedical waste which is one of the most dreaded forms of waste. In my en-devour to regulate the quality of waste water discharged from hospitals, i have facilitated the installation of numerous Effluent Treatment Plants in Hospitals across Northeastern States Of India. After many years my hard work seems to have started yielding results.

BIOMEDICAL WASTE SEGREGATION AND DISPOSAL

For a seminar that I was embarking upon on 6th January 2015, my son gathered and combined this video from the internet. After a long and arduous search, this video proved to be the best and most easily understandable to all walks of people across different platforms. Apart from its simplicity, the information provided in the film is highly accurate and to the point. The narration is pitch perfect and the information provided about the instrument to be used for the disposal is just as correct as the rest of the info. This video could serve as a one stop information for all those who are looking to understand the process of segregation and disposal of biomedical waste.

SHARP BIOMEDICAL WASTE DISPOSAL IS A SERIOUS PROBLEM

In hospital industries, quite a large quantity of glass items are used and discarded every day and without any proper treatment the same items are disposed in the most unethical manner. We have visited many hospitals in this region and in most of the cases we have observed the hospitals having a practice to sell the empty bottles and other glass items from different departments including pathology department. As a result the chance of reuse of the bottles, vials, Glass slights become more and it may cause serious health hazards at any point of time.

As per Guideline given by Pollution control board. proper autoclaving and shredding are not done in most of the hospitals.  Instead of proper treatment and disposal, the used glass items are sold to the scrubbers/vendors. The vendors take it to the dump site and open the bottles, clean it in dirty water and re-sale it to the various manufacturers. As a result the maximum chances of contamination remain intact.
Solution of this problem is simple, used glass items should be treated in autoclave and there after it should be crushed by a ‘JAW CRASHER’ and disposed in to sharp burial pith. I have the experience of installation of “JAW CRUSHER” in a hospital of Nagaland and the huge quantity of glass bottles, ampules etc are now being disposed easily without any trouble.

MERCURY IN THE AIR

Mercury is a chemical element with the symbol Hg and atomic number 80. It is commonly known as quicksilver. Mercury is t only metal which is liquid at standard temperature and pressure. It is a metal which is a good conductor of electricity and bad conductor of heat. It has a varied range of applications and the most prolific being its usage in thermometers and sphygmomanometers (blood pressure checking machines). Depending on the extensivity of its use, Mercury with time and usage has also become a source of major pollution. The pollution that mercury can cause is of extreme nature as it has been attributed with the power to affect the immune system, the nervous system, child birth, skin diseases and also bone and bodily development.

From the year 1983 to 2001, Unilever ran a thermometer manufacturing unit in Kodaikanal, India. the unit even though off records was one of the biggest contributors to the overall pollution of the Kodaikanal lake and in addition to that resulted in the death of over 50 workers of the factory. As the family members of the workers went on board against the company leaving no stone unturned to bring the unit down, the company kept pressing at the fact that their unit was in fact not disposing off no harmful bi-products. However the workers and the citizen had enough proofs in their hands to put an onus on the factory.

The question that however remains that 12 years after the events of Kodaikanal, the same menace of mercury keeps plaguing us the citizens in more than one way. Consider the fact that 1 gram of mercury has the ability to pollute 20 acres of pond or lake destroying the wildlife of the lake. If this is true than we have a serious problems in our hands. Here in Assam, we hundreds of hospitals both private and government where a large number of mercury thermometers and Sphygmomanometers are used. Even if 1 thermometer is broken in a month, you can well imagine the amount of hazard it can cause. Leaving that aside, mercury is used in laboratories and other associated spheres. the question though remains that what is being done to manage its propagation in the human sphere.

Studies shows that there is up to 50 times more mercury in hospital waste than general municipal waste and the amount of mercury emitted from Medical Waste Incinerators average more than 60 times from Pathological Incinerators. the various sources of mercury generation in hospitals are Thermometers, Blood pressure cuffs, feeding tubes, dilators and batteries, dental amalgam, used in laboratory chemicals like Zenekers solution and histological fixatives. Other than its handling as a compound in the laboratory, mercury is most frequently handled due to breakage of medical equipments. most hospitals do not have a set procedure to handle such mercury  spills. It is cleaned up without the use of protective gear or a proper disposal system. This not only exposes the worker who is cleaning up the spill but also the community at large as it is either thrown in the community waste bin, flush down the sewer or incinerated. Asking ourselves the question that how we can come into contact with mercury would be the fact mercury can be consumed via food, inhaled or be absorbed via skin.

The biggest problem that we face now is there is neither a proper legislation nor any proper guidelines on how to negate with mercury and its ill effects. Moreover in the state of Assam, the people who handle mercury in the hospital industry have very little knowledge about the ill effects of mercury on them. One way that I can think of is the introduction of digital thermometers and blood pressure measuring equipments but that will still leave room in areas where it is used as an element. We could make available, mercury contaminate kit(Gloves, face masks, eye shields a syringe two stiff pieces of cardboards, two plastic bags, packing tape, a flash light and a container should be available) in every ward. In case of a spill, remove any jewelry/watch. Put on all protective gear; use flash light to locate the mercury. For collecting, use cardboard sheets to push beads of mercury together. Use the syringe to suck the beads of mercury. Carefully place the mercury in a container with water. Never use vaccum cleaner or broom.

We have to take into consideration the fact that the reaching of mercury in our water bodies and contaminating it would not only result in potentially harmful water bodies but in course of time, mercury will come back to haunt in along with the mist in the air.

CANCER IN THE AIR

“These are very expensive equipments and we do not have the funds to buy them for proper measurement of all pollutants”
-R.M Dubey
Chairman APCB

The above line screamed out of the newspaper front page along with the obvious headline of the Daily Telegraph(dated 18th Oct) coupled with an alarming graphic showing a huge rise in the number of cancer occurrences in Assam. Being a citizen of the state my attention was immediately drawn to the distressing news as I knew in some way or the other the graphics depicted would come to my doorsteps some day and haunt me. I knew the news item was laid out for me and every other citizen of this state. Once a lush green tropical heaven, how did this state come to be a heaven for cancer?

Being in the field of waste management I have come across a wide range of infections and their causative agents with cancer being one of them. A word kept popping up in my head every time I thought of the News item. The word was Dioxin (diagram enclosed). Feared as one of the most common and causative agents of cancer, Dioxin has been instrumental in spreading cancer ever since its discovery. According to sources, Dioxin is a general name given for a large group of chemical compounds with similar structure. These compounds are mostly made up of Carbon, Oxygen, Hydrogen and Chlorine atoms. The way of arrangement of the elements in the structure of the Dioxin determines its toxicity. The most toxic Dioxin has 4 chlorine atoms in 2, 3, 7 and 8th positions and is referred to as TCDD. The TCDD is the most studied and the most toxic Dioxin.

What then are the possible sources of Dioxin? This question becomes more important in the light of the present circumstances as the knowledge of the source would help us to draw a line to control the upsurge of the Dioxin and also provide us with a clear line of sight as to in what way we could approach to devise a control methodology for it. Looking at the sources and how they are produced we could sum up a few sources:

1. Burning of municipal Waste, Hospital waste, Backyard Burnings and Automobile emissions continue to contribute to the release of Dioxin into the environment.
2. The primary source of Dioxin in the environment is man-made.
3. In the past these included metal smelting, pulp and paper bleaching and the use of certain herbicide that were contaminated at the time of their manufacture.
4. Forest fires can also be a source of release of Dioxin in the environment.

My attention was drawn to a research article published by Imran Ali, Waseem A Wani and Kishwar Saleem (Department of Chemistry, Jamia Millia Islamia Central University) in the year 2011. According to their study, 90% cancers were owing to the environmental pollutants and believed to be due to ill effects of the polluted environment. The risk of lung cancers is increased by a number of outdoor pollutants such as poly aromatic hydrocarbons. Long term exposure to Polyaromatic Hydrocarbons was found to increase the risk of deaths associated with Lung Cancer. Indoor pollutants like organic compounds and pesticides increased the risk of leukemia and lymphoma. Risk of cancer was also noticed in people using chlorinated water. High level of air pollution was seen as a major cause of lung cancer.
Now that we know the vast potential of Dioxin to wreak havoc, the most important question to ask is how I could come in contact with dioxin. The answer to that question is rather exhaustive.

1. We are exposed to Dioxin through air that we breathe. The pollutants in the air carry large amounts of it which could target us at any given instance
2. We could come in contact with Dioxin through chlorinated water.
3. Because Dioxin are resistant to breakdown in the environment and can be stored in fat cells, they concentrate in the food chain once they are released into the environment. At the top of the food chain are the humans and they consume dioxins primarily from the ingestion of animal fats in fish, milk and beef mostly? (Diagram enclosed)

That brings us to the question that since Dioxin is everywhere, what we can do to save ourselves from it. Should we stop breathing or drinking water or eating animal fats? The answer to that question would be the only way to save ourselves from this menace would be to limit its release into the environment. That again takes us to the source of its release in the environment. Burning of municipal Waste, Hospital waste, Backyard Burnings and Automobile emissions continue to contribute to the release of Dioxin into the environment. We can start off by limiting the burning of our Municipal and Hospital Wastes. I have for the years gone by always spoken in favor of non-burning technology in the various hospitals and municipal waste disposal units. Sighting deep burial as a much better option, I have often come under some serious flack. The reason that I pertain to it would be that Incineration is an easier and easily manageable way of disposal of waste.
But in doing so we forgot the long standing effects of the release of Dioxin in the environment. But now with the fearsome figures of the cancer affected in our hands we cannot turn a blind eye to the same. Taking Assam’s figures into consideration, we arrive at the following conclusions:
1. The limited air quality monitoring in the northeastern states shows 68% urban areas have particulate matter higher than the required amount.
2. Kamrup (urban) has the highest number of Lung Cancer patients per lakh in the whole country
3. Pollution control board of Assam lacks the facilities and equipments to monitor the cancer causing pollutants in the atmosphere.
4. Assam alone has recorded 4443 cancer cases in the year 2011-12 which by the way is the highest in North East.
5. Even though the rate of Cancer cases is rising at an alarming rate, the awareness among the people is dismal with many of the cases coming for treatment at a time when they are at an untreatable stage.

The only solace can be derived from the fact that Punjab has a much higher rate of cancer standing at 107.4 per lakh which is much higher than the national average.

State Cancer               Cases
Assam                          4443
Meghalaya                  101
Nagaland                     84
Arunachal Pradesh     65
Tripura                          14
Manipur                        38
Mizoram                        59

Referring to the Ecologist Asia, April-June 2003 issue, Waste to Energy projects were initially touted as the solution to the India’s waste management and electricity problems and a huge amount of money was invested in it. However Energy Development Limited’s project in Delhi’s Gazipur gasification was shelved following pollution-related objections. The issues that were rising were the fact that gasification of waste would lead to release of Dioxin in the environment. Gasification is an incineration process that emits dioxins, the most poisonous cancer-causing toxin known in the world. Incineration transfers the hazardous characteristics of the waste from solid form to air, water and ash. It also releases new toxins which were not present in the original waste stream, besides generating heavy metals. However, here in Assam, we have a private party freely disposing off biomedical waste in a tropically rich place near Guwahati called Rani. How can a technology which has been found polluting in Delhi and subsequently in Chennai in 2003 become nonpolluting here in Assam? In Delhi and Chennai strict and quick measures were taken to halt any such project related to burning of wastes and subsequently tried to shift over to non-burning technology.

In this continuation I would like to highlight, the recent amendments in the Biomedical Waste Management rules recommending deep burial over Burning technologies like Incineration and random installation of small units of Incinerators in and around Human establishments.
There was a huge hue and cry about Waste Incineration as renewable energy. Using the term Renewable to describe these technologies is dishonest and highly misleading as incineration actually destroys waste resources, turning them into toxic ash and air emission. Thus waste which cannot be reused, recycled, or composted cleanly, ought to be landfilled rather than incinerated. This will help in lesser release of dioxin in the environment.

In its study of the Perungudi dumpsite in Chennai, Environment Resources Management, London, has clearly certified the garbage as most suitable for composting rather than for burn-based technologies. This will be true for most if not all dumpsites of India and is in fact the sanest waste management option.
People’s participation alone will not suffice. Strict legislation has to be passed and implemented with vigor in order to curb out the burning technologies. Educating individuals about its ill effect will suffice to stem down the burning up to a level, but to curb it out completely, Legislations and laws are our only hope.
Waste Management in the state has to be looked at from two prospective of that of Biomedical Waste and Municipal Waste. Non burning technology has to be adopted for both the prospective and alternate solutions have to be devised to look into the disposal of the said waste. Speaking of alternatives, landfills have been over the years sighted as one of the most relevant and viable alternatives to stop the spread of the Dioxin into the environment. For Biomedical Waste, segregation at the point of generation of the waste plays a key role in reducing the amount of infectious waste. Improper segregation will only lead to conversion of the overall hospital waste (both infectious and non-infectious) into infectious waste.

Our city has also seen the rise of door to door collection of Municipal waste over the last two years. The segregation of Municipal waste at the home-level would further help to properly classify waste which is of extreme nature. Thus bio-degradable wastes like food leftovers, table scraps etc. could be put in a specific colored container while non-degradable and infected wastes could go into another colored container. A two color system would not be difficult for the house holds to follow.
Thus to conclude, the responsibility that us Guwahatians have towards our own ecosphere would make us shy away from the path of burning technologies. We must and have to promote non burning technologies for our waste management needs if we are to have a piece of healthy earth to survive in. Being responsible citizen of this state it is our earnest responsibility to educate each other about the harms of Waste incineration in any form. We have to understand that burning the waste doesn’t destroy its cancer causing ability but propagates it by the means of ash and gives it a far more and extensive reach. Apart from Dioxin, we have multiple other sources of Cancer like Tobacco, radiation, ill food habits etc. but Dioxin by far is the most threatening and dangerous simply owing to the magnitude of its reach and its toxicity. Thus its removal from our environment is of utmost importance. A person can stop consuming tobacco at his will but you cannot stop the spread of Dioxin by a third individual who may be doing it knowingly or unknowingly. Hence our duty to spread awareness and introduce strict legislations is mandatory.

I urge anyone reading this article to rise up against this extremely toxic substance and do whatever is in your reach to stop its spread. The best gift that we can give to our successors is a clean and green piece of earth. Let’s all work together towards achieving the same.

WHY BIOMEDICAL WASTE MANAGEMENT FAILED IN NORTHEASTERN INDIA ???

After my 12 years of experience in the field of Biomedical Waste Management I have come up with the following reasons for a failed Biomedical Waste Management System in most of the Hospitals of the North Eastern Region.

1. Lack of administrative attention to the subject:- The administrators are busy with many other job and lack of attention to this subject. As a result the sweepers are the key persons to control this department.
2. The sweepers are not duly trained about this system and there is very little control on their daily work. They often mix the infected and non infected waste and dispose the same in municipal dump site. Due to their own poor physical condition and ill health their attention to their own work is liquidated.
3. No education facilities for them and their children for a bright future, resulting physiological setback which reflect in their daily work.
4. Poor Pay: – Excepting very few hospitals they are poorly paid and it becomes very difficult for them to maintain their family. There is evidence that they cannot reside in a healthy area with minimum requisites of a life.
5. Nobody pays sympathetic or even a little caring attitude to them and their work. As a result there is no sign of happiness in their life. They fall prey to various toxic addictions and life span become short.
6. Insufficient supply of components for waste management system is another factor. It is an administrative failure for the hospitals.
7. There is less check or evaluation of the job of the staff involved in this project which includes Doctors, Paramedical staff, waste handlers and finally disposer.
8. Lack of ethical planning as per guideline implementation and control is also responsible for failure.
9. No system to upgrade the effectiveness of the performances which is most important to control the various new waste are generating by men and new machine.
10. Hospital’s concern is very less about the hazardous impacts on surrounding habitat of the hospital in the city. They should take all possible care to that.
11. Unhygienic condition of Ambulance in most of the hospital is spreading the infections from door to door from one city to another.

What can be do about this ??? The question is upon us…..

WASTE AND US…!

After 12 years of my journey to implement the waste management programme and system laid down by Central Pollution Control Board of India I have come across a plethora of problems and their subsequent solutions. In the city of Guwahati in Assam (India), this is a burning problem which is known to every citizen. But very little action has been taken so far to get out of it. Time to time press meetings are conducted for awareness but no significant change has taken place. People do not care about the waste. Be it a CFL lamp or table trash, waste management is never a concern for the citizen.

The municipality board only changes the place of the waste i.e. from the road side to dump yard in a mixed condition to say a place at the outskirt of the city. In our country, recycle industries nurture and poverty sicken rag pickers are the segregators from the dump yard of various scraps like plastics, metals, pieces and many more including dry animal bones and empty containers of various pesticides. They do it with full life risk and without any knowledge of the danger of the job they are doing. I have seen a boy of 15 years become blind from an infection due to exposure to such media. There is no body to resist them or suggest them for alternate lively hood, rather municipal officers are happy because they are reducing the quantity of waste.

The status of the dump yards have become so dangerous that scavenger birds and animals do not visit the dump site for the safety of their lives. Lot of projects have come to resolve the problem; excepting Incineration no other constructive solution has come so far. But incineration of such huge quantity will destroy the atmosphere of the state and adjoining countries.

Then what could be the solution? Awareness has to be created at a grass root level. Especially the social status should be improved to the waste handlers so that they understand the gravity of the various wastes and how to dispose the same in an effective manner. It may be house hold waste, biomedical waste or Industrial waste. From house the waste should not be disposed in sporadic manner as the same waste will pollute the surrounding areas. Every kitchen must have covered bin with bin liners to collect the house hold waste and send it to disposal area finally.

Every citizen must realize and co-operates with the limited number of waste disposer to perform their duties effectively. Without careful attitude to the waste management it has already become an impossible task to perform. Government has brought very many projects to solve the problem but without the mass participation in the subject, no project can be implemented. Mass awareness is the key factor to solving this problem.

Due to the mass negligence, place like National Park (A protected area) for flora and fauna is under threat. Every day due to industrial pollution biomedical waste pollution the water bodies are becoming poisonous and drinking that water, the birds and animals are facing extinction. Due to industrial emission, birds are changing their habitat.

My attempts have bore some fruit for the community who are directly involved with the waste management. For example the boys and girls become educated to handle the waste in effective manner keeping their health out of hazard. They have started implementing the gadgets and machines involved in the process. They have learned the concept of waste water treatment and reuse of the same water. Ultimately the income has increased and their life style has also improved.

The paramedical staff used to use old hand gloves but now they have changes their habit and discard the disposable after each use. This year many nursing schools wished me for being a good teacher in biomedical waste management, on teacher’s day. To me it’s a great moment since all the hospital staff has become the part of my mission ie “war against waste”. Its little successes like this which gives me encouragement to work more and more for a pollution free India.

THE ROLE OF NGOs IN BIOMEDICAL WASTE MANAGEMENT

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In a vast country like India, to control the Biomedical Waste, the participation of NGOs is very important. Fortunately, we have one or two such NGOs which to my knowledge have been rendering quality services for the last few years; academically they are sound enough to ensure the implementation of projects in the field. They got global acceptance for their sound knowledge. There are many service providers in some states who are efficiently serving us as per their respected capacity. But for many states it is a business and nothing more than that. But India is one of the largest and most densely populated countries of the world. Not only that, the rate of sickness is also very high with less healthcare institutes with required facilities to combat the new diseases.

Therefore patients have to travel from one corner to another corner, which is time taking and very expensive too. There is no Air lifting special facilities available for a common man at affordable rates. To shift a patient from a distant town to capital of India will touch few Lakhs depending on the time and situation. This sometimes becomes impossible for a common man.

Else you travel like a common man in train without any medical support, on the way your patient may die. At the same time the patient on transit will spread the disease across the country. This is happening regularly. A boy of 25 years of age, employee of an IT company, was attacked by chicken pox at Guwahati. Due to lack of treatment facilities (i.e. HOSPITAL) he had to travel to Kolkata by air. In doing so, the whole aircraft became contaminated without anybody’s notice. This is just one example. Everyday something or the other happens which goes unnoticed unless something big happens. The problem is, the role of NGO, here is restricted only publishing books, audiovisuals with very little distributions. Holding seminars in cities in star hotels will be not much effective in grass root levels. I mean where the promotion is needed the activities are to be concentrated in the local language and in a meaningful manner. Lectures in English colorful presentation in power point are needed but it will not be of much use to explain the matter to the waste generators and handlers in rural India.

I have visited many nursing schools where even the principals are not aware of biomedical waste management. There what can you expect from the students? In few states contract has been given to some NGOs to promote BMWM but as on date I have not noticed any NGO to work in our region. They are getting the necessary funds from the government but when I requested a reputed NGO to arrange a workshop for nursing schools, there is no reply.

Here my questions are? Who will read your books and implement it in the field? Most of the people actively related to waste management cannot write their own name because education is a dream to for this community. So, scientific English lecture in an air-condition rooms followed by delicious lunch will apparently have no impact on them. In 2011 September I attendee a workshop organized by MPCB with toxic link a renowned NGO at Shillong, the capital of Meghalaya. The saddest part was most of the participant were the office bearers of departments invited by pollution control board. They were not in a position to participate actively, as solid waste management is not their subject. Only few participants from local hospitals were interested and came with preparation to speak for 10/20 munities on the subject. No paramedical staff was present from any hospital, not even the administrators. They are the key person to deal with the facts of Biomedical Waste Management. From the meeting it appeared as if no hospital were aware of the facts that there is something called Effluent Treatment Plant. They are not aware of the minimum requisite equipments for Biomedical Waste Management. In a place like this what effect is expected from one day meeting/workshop??? In 1998 the rules came into force. This is 2012 which means that even after 14 years, it has not been properly implemented in 25% of total health care establishment in Meghalaya. Although regional office of CPCB and head of state pollution control board is seating in the same town. There is no accountability of their departments.

It is interesting to note all the hospitals have obtained the authorization and no objection certificate from Pollution Control Board without implementing any norms and rules. After the lunch season of that meeting most of the participants left the venue because it was not attracted their attention/interest.

I am the person moving around the region promoting biomedical waste management in the grass roots, educating the waste handlers free of cost, giving training to the nursing schools free of cost still our NGOs have got reservation to extend little support to my noble venture.

Yes lots of papers will be prepared and presented to even global forum but ground truth will never change i.e. a group of qualified intelligent people control this subject. Utilization of fund will have nothing to do for the community directly involved in biomedical waste management and the office bearers of NGO will never see the life of sweepers and their children.

I appeal all and any such NGO to contact me to see and upgrade the situations. Further more you are in the capital of country and with direct touch with law makers’ ensure legal action to the institutions that have ignored the rules and are spreading infection in and outside the country. It is a crime and they should be booked under criminal law.

BIOMEDICAL WASTE AND BIRDS

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Innocent, gift of God, birds!!! There are few species who love to stay closed to human habitat like Sparrows, Pigeon, crow and some more. Reasons are simple, for food and safe stay. Left over of our food is their life. The small corner of our Roof/ventilator is there nesting place especially during breeding season.

Regularly I visit some hospital or other and observed in out patient and surrounding areas, birds are eating the leftover of food from patients and there is no fear. Same scene is prevalent in dump yard of hospitals for anybody to see…

In breeding season (March to September) they collect nesting materials from hospital area. They don’t know what is infected and non-infected waste often they collect cottons and cloth pieces which may be contaminated by Blood or body fluid or some other waste of hospital. Thus they become carriers of infection from ground to roof top of hospital or to a nearby tree top. Thereafter, the infection starts spreading anywhere and everywhere and can even become air born to spred from one country another. It is a serious lapse which can be controlled by only one means PROPER BIOMEDICAL WASTE MANAGEMENT.

Biomedical waste should be under special care so that it is out of reach of rag pickers cats, dogs and birds. There should be proper care and vigilance to control the spread of food and eatable from patients. Biomedical waste should at no point be disposed in Municipal dumps. The innocent creations of God, the birds, are not aware of the dangers and are falling pray to something which we alone can control. After my observation in many places and 6 successive breeding seasons and nesting habit, this is my appeal to all to be careful about this danger which may affect you also. Our alertness will result in protection of birds and human alike.

MERCURY THREATS AND PREVENTIVES

In health care sector use of Mercury is not uncommon. For example thermometer, sphygmomanometers, dental amalgams, laboratories reagents etc are a very potent neuro and nephrotoxic substances. The health impacts of this heavy metal have been well documented. Many reposts and studies has been conducted on the adverse effect of Mercury in health industries to adept the alternatives.

There is one gram of mercury in a typical fever thermometer. This is enough mercury to contaminate a lake with a surface area of about 20 acres, to the degree that the fish would become unsafe for eating purposes. Mercury is called quick silver as at ordinary temperature it becomes liquid. Mercury is known as one of the most toxic substance. Mercury can cross skin, blood brain placental barrier and cause devastating effect to brain and the growth of the fetus.

Most likely routes of exposure are inhalation or absorption of inorganic mercury vapor after a spill or during manufacturing process, or ingestion of methyl mercury from the contaminated fish.

Hospital instruments’ mercury can be seen but batteries, florescent lamp, CFL lamps are more dangerous in disposal. Hospital is a major contributor of the mercury in the waste stream. A number of products contain mercury used in the health care industries, starting from thermometer to relay. If these products are disposed off with our regular trash the environment can be contaminated by mercury. Breakage spill and waste disposal from these products release mercury to the atmosphere or to drains, where it can persist many years in waste water stream from the hospital, which often shows higher Mercury level than expected.

Incineration is the 4^th largest source of mercury emission in to the atmosphere. The mercury can travel anywhere from few hundred feet to thousand mile away from its original source.

Guide line to clean up:

Immediately after a spill keep all people and pet away from the spill area. To minimize the mercury that vaporizes, turn off heater and turn up any air conditioners ventilating the area by opening windows and keep it open for two days if possible.

Never use Vacuum cleaner to clean up a mercury spill. Not only vaccum cleaner will be contaminated the heat from the vacuum cleaner further evaporate the metal and contaminate the whole area. Similarly use of broom to clean the area is not allowed. This will only distribute the mercury into smaller beds; all will contaminated by the broom. Care must be taken not to touch the mercury.

Assemble the necessary supplies before attempting a cleanup. Eye protection and gloves, to the cleaner, to be ensured. Do not take the mercury lightly.”Mercury contamination kit should be available to every ward “gloves, face mask, Eye shields, a syringe, two stiff pieces of card board two plastic bags packing tape a flash light and a container is necessary.

In case of Mercury spill, do not touch the mercury remove the watch and jewelry and use protective gear use a flash light to locate the mercury. Use cardboard board sheet to push the mercury spills together. Use the syringe to suck the mercury pills. Carefully keep the spills in a container with some water. Pickup the remaining spills with a sticky tape and keep the tape in a plastic bag along with syringe cardboard pieces and gloves.

DISPOSE MURCURY PROPERLY. The collected mercury is a hazardous waste and should be disposed off at a hazardous waste facility or given to a mercury manufacturer. Under no situation mercury should be taken lightly.