Milestone Multi-centric study: Current study was conducted by ISHWM president Prof. A K Agarwal, Principal Investigator and Dr K S Baghotia, Secretary and Co-Investigator to assess Impacts of Sound Healthcare Waste Management on Hospital Associated Infections in Bowring & Lady Curzon Hospital, Bangalore and ESI Hospital, Okhla New Delhi. Bowring Hospital has 686 Beds with 70% bed occupancy whereas ESI Hospital Okhla has 109 functional beds. Once the study was started, the ESI hospital Okhla went under partial renovation/construction for 500 beds. However, the functional beds remained 109 during the study period. At the beginning of the study it was found that hospital administration was willing to improve the health care services. General cleanliness in OTs and ICUs was acceptable. Most of staff was in uniform. Posters illustrating hand hygiene, Bio-medical waste segregation etc. was displayed at some of locations. Knowledge and awareness of staff was not very good. After intervention and the training of healthcare personnel there was significant improvement in Knowledge and skills of staff specially segregation, sharp management and blood and body fluids spill management. Hospital Infection control committee (HICC) was formed and meetings were being held. Hospital needs to document the HICC minutes. HAI surveillance was rudimentary and needed to be improved with involvement of consultants. The intervention improved the availability of color coded containers and liners. The hospitals started packaging and labeling. Health care waste was collected by a private entrepreneur namely Maridi Eco Industries Private limited from Bowring Hospital Bangalore and Synergy Waste Management Pvt. Ltd from ESI Hospital Okhla New Delhi. With direction of prescribed authority the effluent treatment plant was established in both hospitals. At the end of intervention, the quantum of solid waste generated was 517 grams per bed per day whereas liquid waste generated is 437 litres per bed per day. It was informed by the hospital that there is shortage of water supply in the hospital. Therefore, liquid waste generation is low. With improvement of healthcare waste and infection control in the hospitals there was a decreasing trend in average length of stay. The intervention ensured appointment of Nodal officers in each department to monitor waste management practices regularly as per regulations; establishment of Hospital Infection Control/ Waste management Committee and regular meetings and sensitisation of BMW associated infectious disease; Provision of Incentives/certificates for best practices included; Conduct of regular training programmes to nodal officers/Committee members and ensure adequate supply of colour coded bins/liners. The study needs to be replicated in different states at multiple locations. Membership of ISHWM has been raised to 368 with 5 corporate Members         Conducted External Audit of selected 10 hospitals in Delhi as identified by the department of health, government of NCT of Delhi. Project was for six months - September, 2008 to March 2009. Project was completed within the timeframe and report has since been submitted to the department of health, govt of NCT of Delhi. Main findings were that there was demonstrable improvement in the BMW management at these hospitals, especially in segregation, and safety measures. Medical staff was aptly concerned with safe handling and associated risks. However, there was lack of structured awareness and training programmes, and SOP, protocols, and guidelines resulting in very slow progress towards achieving 'best practices' in the management of BMW     Department of Health, Govt of NCT of Delhi had constituted an independent Committee to look into the complaint of residents of Sukhdev Vihar about alleged pollution being caused by operating a bio medical waste incinerator near their residential colony, and appointed the President, ISHWM chairman of the committee. Members were Dr TK Joshi, and rep DPCC. The committee made several visits to the site of CBWTF, Okhla, as well as the residents of Sukhdev Vihar. The committee examined all relevant papers heard views of the residents, and the CBWTF operator, and came to conclusion that possible health effects to the nearby population could not be ruled out, and the fear of the residents was not without basis. The committee therefore recommended that the incinerator may be moved out to another alternative location. It came to light that chairman DPCC has already moved papers for allocation for an alternative site. In the mean time the committee recommended that waste load on the incinerator be reduced by putting category 3 and 6 in red bags (meant for autoclave) and not in the yellow bags (meant for incinerator), and then shredded after disinfection. Only waste category 1 and 2 be put in yellow bags meant for incineration. The report was submitted to the dept of Health, Govt of NCT of Delhi vide ISHWM/Projects/07/Corr dated January 15, 2008.         Consequent to some doubt about working of the APL (Automated Programme Logic) system attached with the incinerator Chairman DPCC has requested ISHWM chairman (with others) to carry out an inspection and submit a report. Inspection was carried out on the 15th of October, 2008 with Dr TK Joshi, and rep DPCC; and it was found that APL system was working satisfactorily. A report has been submitted.     Chairman ISHWM along with Member Sec DPCC, and Scientific officer, DPCC have been asked to examine some sites to locate an alternative site for shifting the CBWTF from Okhla. The team visited some sites near Narela, and inspected suggested land sites along with the local patwari etc on 24th October, 2008. It was deduced that all sites at the vicinity of Narela shown to the team as possible sites were not suitable due to varied reasons. A report has been submitted.     Hosted a workshop jointly with WHO-India in New Delhi on 31st May 2000 where all hospitals who were awarded WHO aided pilot projects (there were 10 civil hospitals apart from the Air Force Hospital, Bangalore from the Armed Forces, granted support from WHO India for the pilot project during 1999-2000 biennium) participated and discussed progress on their projects.     “Ishwm con 2010 was held at IHC New Delhi on 30th and 31st October 2010. The theme was “Safe and Effective Biomedical Waste Management”. The conference was inaugurated by His Excellency the Lt Governor of Delhi Shri Tejendra Khanna as the Chief Guest. It was attended by more than 170 delegates, including delegates from the UK, Sri Lanka, and Nepal. The chief guest emphasized need for ‘gold standard’ in dealing with biomedical waste management; and indeed in healthcare delivery in the country with focus on infection control and workers safety. Many eminent speakers took part in deliberations. “         Hosted annual conferences - First conference (founding Conference) at the Air force auditorium, New Delhi in 2000, at MS Ramiah Medical College, Bangalore in 2001, at IHHMR Jaipur in 2002, at AFMC, Pune in 2003, at the Army Hospital R & R in 2004, at INHS Asvini, Mumbai in 2005, at India Habitat Centre, New Delhi in 2006 and and at the India Habitat Centre, Lodhi Road, New Delhi in September 2007.     Held a mid- term conference in Apr 2004 at the Air Force Hospital, Bangalore.     Issued Delhi Declaration after the annual conference 2006.     Society's Foundation President is in the Steering Committee (on hsopital waste management) in the MoEF     A representative of the society is in the committee of the DGAFMS (who is a 'prescribed authority' under BMW 1998, as amended), to render advise on authorising healthcare establishments of the Armed Forces.