1. INTRODUCTION:

Waste includes items that people no longer use. Also, wastes are those that people tend to discard due to their hazardous properties. It is very important that the wastes are properly discarded to avoid them going into the landfill. They can be in different forms such as household rubbish, sewage, car waste, and garden waste. Many people donate vast amounts of pharmaceutical drugs to help those affected by natural disasters and conflicts. However, many of these donations may cause problems due to their intended recipients' lack of knowledge about the drugs and their shelf life. Waste streams from a healthcare facility can vary widely. Some of these include unused drugs, old syringes, and broken or discarded instruments. For minimization and treat this potentially harmful waste various treatment options available.

Donated drugs may be mismanaged due to their shelf life or have been poorly stored. Also, when used for development assistance, the donated drugs may end up in the hands of local authorities or be discarded carelessly. The discovery of various pharmaceuticals in various forms in drinking water and surface waters around the country has raised concerns about their potential negative effects on human health.

Pharmaceutical waste is disposed of in most hospitals according to specified procedures. However, it is possible that the trash will have negative environmental consequences. Proper disposal of pharmaceutical waste is an important aspect of a hospital's environmental management. This process involves carefully analysing and managing the different items that are commonly used in hospitals. Frequently used prescription drugs, consisting of epinephrine, warfarin, and nine chemotherapeutic agents, are regulated as dangerous waste underneath the Resource Conservation and Recovery Act (RCRA). Failure to conform to hazardous waste rules through improperly managing and doing away with such waste can result in potentially severe violations and big penalties.¹

2. Biomedical Waste Rule 1998:

The Biomedical Waste Rules of 1998 are a set of regulations that govern the disposal of biomedical waste The Biomedical Waste Rules of 1998 in India, which were updated again in 2000, are founded on the premise of separating communal waste from BMWs, then containing, treating, and disposing of various kinds of BMWs. The standards divide BMWs into ten categories, each with its own set of requirements for containment, treatment, and storage.

The Biomedical Waste Rules of 1998 in India (as revised twice in 2000) have the following features. The Biomedical Waste (Handling and Management) Rules were pre- drafted and issued by India's Ministry of Environment and Forests in 1998.

The following are the key aspects of the current regulations, as summarised here and below:

· Definition:

Any waste created during the diagnosis, treatment, or vaccination of humans or animals, or in related research activities, or in the manufacturing or testing of biologicals, is considered biomedical waste, which includes the categories listed in Schedule I of the Rules.

· Applications:

These rules apply to anyone who generates, collects, receives, stores, transports, treats, disposes of, or handles biomedical waste in any form, including hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories, blood banks, ayush 2 hospitals, clinical establishments, research or educational institutions, health camps, medical or surgical camps, vaccination camps, blood donation camps, and school first aid rooms.

· Duty of occupier (operator):

It is the responsibility of the occupier (operator) of a health care facility, such as a hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, or blood bank, to ensure that BMWs are handled safely and in accordance with the Biomedical Waste Rules' treatment and disposal requirements.

· Prescribed authority:

State Pollution Control Boards (SPCBs) in states and Pollution Control Committees in territories are in charge of granting permits and executing the Biomedical Waste Rules' criteria.

· Permitting:

A permit from the prescribed authorities is necessary for any occupier (operator) handling BMWs and delivering services to 1,000 or more patients per month.

· Storage of Records:

The generation, collection, receipt, storage, transportation, treatment, and disposal of BMWs must all be documented by the occupier (operator). At any moment, the specified authority has the right to check and verify all records.

· Accident reporting:

Any accident involving the administration of BMWs must be reported by each occupier (operator).

· Annual Reporting:

Each occupier is expected to submit an annual report to the appropriate authorities detailing the types and amounts of waste generated and processed, as well as the treatment methods used.

· Sites for disposal/incineration:

The Biomedical Waste Rules compel local public authorities to offer common disposal/incineration sites, and the occupants (operators) of such sites must follow them.

· Segregation, packaging, transportation, and storage:

BMWs should not be thrown out with other trash. BMWs must be separated into labelled bags/containers, according to the rules. BMW automobiles must be transported in approved vehicles. Unless specific approval is acquired from the regulatory authorities, no untreated trash should be held for longer than 48 hours.

· Standards of Waste:

The Biomedical Waste Rules provide technology and discharge criteria for burning, autoclaving, microwaving, liquid waste discharges, and deep burial.¹⁵

3. Pharmaceutical Waste:

Pharmaceutical wastes are doubtlessly generated throughan extensive sort of activities inside the fitness care device, along with syringes, and are not restricted to intravenous (IV) preparation.

Generally Pharmaceutical waste may include:²

· Expired drugs

· Waste materials containing chemotherapy drug residues;

· Open containers of drugs that cannot be used

· Containers that held acute hazardous waste (p-listed) drugs

· Drugs that are discarded

· Contaminated garments, absorbents and spill clean-up material.

· Patients’ discarded personal medications

· Waste materials containing excess drugs (syringes, IV bags, tubing, vials, etc.)³

Table 1. General Pharmaceutical Waste

Sr. No.	Type of Waste	Example
1	Communal waste (solid wastes that are not infectious, chemical, or radioactive)	Cardboard boxes, paper, food waste, plastic and glass bottles
2	Chemical waste	Laboratory reagents, film developer, solvents, expired or no longer needed disinfectants, and organic chemical wastes (for example, formaldehyde, phenol-based cleaning solutions)
3	Biomedical wastes Infectious waste (wastes suspected of containing pathogens)	Cultures, tissues, dressings, swabs, and other blood-soaked items; waste from isolation wards
4	Anatomical waste	Recognizable body parts
5	Sharps	Needles, scalpels, knives, blades, broken glass
6	Pharmaceutical waste	Expired or no longer needed medicines or pharmaceuticals

Pharmaceutical waste is further classified in 3 categories:

1. Hazardous waste,

2. Non-hazardous waste,

3. Chemo waste (Chemical Waste)

3.1 Hazardous Waste:

Wastes that are dangerous or probably dangerous to human health or the surroundings is known as unsafe waste. These can be beverages, solids, contained gases, or sludge’s.

They further have two categories:

1. Listed wastes

2. Characteristic of wastes.

Pharmaceutical wastes come under listed wastes for the reason that they incorporate industrial chemical products. Characteristic wastes are regulated due to the fact they showcase sure dangerous residences– Corrosivity, Ignitability, Toxicity & Reactivity. Wastes that are not listed and do now not show off a function are taken into consideration stable waste. Solid wastes must be discarded in line with nation and/or nearby regulations, such as regulated clinical waste requirements.

3.1.1 Listed Wastes:

1. D-Listed Pharmaceutical Wastes:

Waste with EPA Characteristics (D-List) Ignitability, corrosivity, reactivity, and toxicity are all characteristics of distinctive wastes. Ignitability is defined as a flash point of less than 140 degrees Fahrenheit. Corrosivity is defined as a pH of less than 2 or more than 12.5. Reactivity is an unstable property that produces harmful fumes when it reacts with water or air.

Table 1: D-Listed drugs with waste code

Waste Codes	Description	Waste Codes	Description
D001	Characteristic Of Ignitability	D022	Chloroform
D002	Characteristic Of Corrosivity	D023	O-Cresol
D003	Characteristic Of Reactivity	D024	M-Cresol
D004	Arsenic	D025	P-Cresol
D005	Barium	D026	Cresol
D006	Cadmium	D027	1,4-Dichlorobenzene
D007	Chromium	D028	1,2-Dichloroethane
D008	Lead	D029	1,1-Dichloroethylene
D009	Mercury	D030	2,4-Dinitrotoluene
D010	Selenium	D031	Heptachlor (And Its Hydroxide)
D011	Silver	D032	Hexachlorobenzene
D012	Endrin	D033	Hexachlorobutadiene
D013	Lindane	D034	Hexachloroethane
D014	Methoxychlor	D035	Methyl Ethyl Ketone
D015	Toxaphene	D036	Nitrobenzene
D016	2-4dichlorophenoxy Acetic Acid	D037	Pentachlorophenol
D017	2,4,5tp(Silvex)	D038	Pyridine
D018	Benzene	D039	Tetrachlorethylene
D019	Carbon Tetrachloride	D040	Trichlorethylene
D020	Chlordane	D041	2,4,5-Trichlorophenol
D021	Chlorobenzene

2. U-Listed Pharmaceutical Wastes:

U-indexed chemicals consist of a broader range of prescription drugs and again should be the sole energetic aspect to come under law. Technically, these items could no longer be regulated as hazardous waste while discarded considering neither U-indexed factor is the sole energetic ingredient. There are 21 drugs on the U-listing a number of them are shown in desk 2. These chemicals are indexed mostly for his or her toxicity. Whilst a drug waste containing this sort of chemicals is discarded, it need to be controlled as risky waste if conditions are fulfilled:

· The discarded drug waste contains a sole active ingredient that appears on the U list, and it has not been used for its intended purpose.

· Empty Containers of U-Listed Wastes (40 CFR Part 261.7(b)(1)):- A container that has held a U-listed waste is considered “RCRA empty” if two conditions are met:

· All the contents have been removed that can be removed using normal means, such as drawing liquid out with a syringe

· No more than 3% by weight remains.

If both of those standards aren't met, the field have to be managed as hazardous waste. Any residues eliminated from the empty container ought to be controlled as hazardous waste.⁸

Table 3: U-Listed drugs with waste code

U-listed pharmaceutical	Waste code
Chloral hydrate (CIV)	U034
Paraldehyde (CIV)	U182
Chlorambucil	U035
Phenol	U188
Cyclophosphamide	U058
Reserpine	U200
Daunomycin	U059
Resorcinol	U201
Dichlorodifluoromethane	U075
Saccharin	U202
Diethylstilbestrol	U089
Selenium sulfide	U205
Lindane	U129
Trichloromonofluromethane	U121
Mitomycin C	U010
Warfarin	<0.3% U248
Mercury	U151
Uracil mustard	U237
Melphalan	U150
Streptozotocin	U206

3. P-Listed Pharmaceutical waste:

P-listed wastes are commercial chemical merchandise which are categorized as acutely unsafe under RCRA as proven in desk no.1. One of the primary standards for which include a drug at the P-listing as acutely hazardous is an oral lethal dose of fifty mg/kg (LD50) or much less. LD50 is the quantity of a cloth, given abruptly, which reasons the loss of life of 50% of a group of take a look at animals. They are toxic and might cause loss of life or irreversible infection at low dose.⁹

When a drug waste containing a P-indexed constituent of difficulty is discarded or meant to be discarded, it must be managed as unsafe waste if two situations are fulfilled:

· Empty Containers of P-Listed Wastes (40 CFR Part 261.7(b)(3)):-A container that has held a P-listed waste is not considered “RCRA empty” unless it has been:

· The discarded drug waste contains a sole active ingredient (54 FR 31335) that appears on the P list, and it has not been used for its intended purpose (54 FR 31336).

Table 4: P-listed drugs with waste code

P-listed pharmaceutical	Waste code
Arsenic trioxide	P012
Epinephrine	P042
Nitroglycerin	P081
Nicotine	P075
Physostigmine	P204
Warfarin	>0.3% P001
Physostigmine salicylate	P188

3.1.2 Characteristics of Waste:

Ignitability: D001 (40 CFR 261.21)

The objective of the ignitability characteristic is to discover wastes that either present a hearth chance beneath routine garage, disposal, and transportation or are capable of exacerbating a fireplace once it has started. There are numerous approaches that a drug method can show off the ignitability characteristic. Many of the dangerous wastes that pharmacies handle are dangerous due to the fact they are ignitable. These wastes regularly pose the finest control problems for pharmacies. Ignitable wastes are easily combustible or flammable.

Corrosivity: D002 (40 CFR Part 261.22)

Corrosive wastes corrode metals or different materials or burn the skin. These liquids have a pH of two or decrease or 12.5 or better. Examples of acids that show off a pH of two or lower include glacial acetic acid. Examples of bases that show off a pH of 12.Five or higher include Potassium Hydroxide and Sodium Hydroxide. Generation of corrosive pharmaceutical wastes is normally limited to compounding chemical substances within the pharmacy.

Reactivity: D003 (40 CFR Part 261.23)

Reactive wastes are volatile under "ordinary" situations. They can cause explosions, toxic fumes, gases, or vapours when heated, compressed, or blended with water.⁴

Toxicity: Multiple D Codes (40 CFR Part 261.24)

Wastes are poisonous in the event that they comprise toxic organic chemical compounds or positive heavy metals, including chromium, lead, mercury, or cadmium. Approximately 40 chemical compounds meet unique leaching 12 concentrations which classify them as toxic. Wastes that exceed these concentrations should be managed as dangerous waste.

3.2 Non Hazardous Wastes:

Materials on this category are taken into consideration to give no vast dangerous houses. It is really worth nothing, but, that this isn't always an illustration that there are not any dangerous components present, simplest that this kind of additives are underneath the threshold for causing harm to human health. Importantly, this non-unsafe country is difficulty to change and the addition or elimination of specific items from the waste circulate might also substantially alter the control options available. Pharmaceutically inert: Certain medicinal products haven't any pharmaceutical houses however are nonetheless controlled and administered by medical stuffs (examples include sodium chloride or dextrose solutions). Through use, however, those products may additionally emerge as contaminated, or mixed with different compounds and consequently require assessment for unsafe properties previous to disposal.^5,6

3.3 Chemo Waste:

That means waste containing the ones pills is hazardous waste. In a health center these tablets are most usually employed in oncology and radiotherapy units. Chemotherapy-containing waste rarely makes up more than 5 percentage of a facility's waste, but their hazardous nature drives up disposal fees. Trace chemotherapy boxes have lengthy been used to discard listed chemotherapy drug waste that must be managed as unsafe waste. This isn't best unlawful however additionally beside the point seeing that hint chemotherapy waste is incinerated at an RMW incinerator, risky waste incinerator. RMW incinerators have much less restrictive emissions limits and allow necessities. Discarding “bulk” P- or U- listed chemotherapy retailers as trace chemotherapy waste has been the cause of tremendous enforcement movements and fines and need to be one of the first modifications you implement for your pharmaceutical waste management application. ⁹

4. Bio-medical Waste:

Any waste that is generated during the diagnosis, treatment, or immunization of human beings or animals, or in research activities pertaining to or in the production or testing of biological. Biomedical waste is broadly defined as any solid or liquid waste that is generated within the diagnosis, remedy of immunization of people or animals in studies pertaining thereto, or in the manufacturing or trying out of biological cloth. Sources of BMWs in fitness care centres consist of wards, shipping rooms, operating theatres, emergency and out- patient offerings, laboratories, and pharmaceutical and chemical shops. Persons prone to exposure include fitness care facility personnel (medical doctors, nurses, health care, etc.)

5. Methodology:

5.1 Treatment and Disposal of Pharmaceutical waste:

Regulatory bodies that oversee pharmaceutical waste management;^10,11

· Environmental Protection Agency (EPA)

· Department of Transportation (DOT)

· Drug Enforcement Administration (DEA)

· Occupational Safety and Health Administration (OSHA)

· State Environmental Protection Agencies,

· State Pharmacy Boards, and

· Local Publicly Owned Treatment Works (POTW)

Pharmaceutical Waste Treatment and Disposal Technologies Specified in India’s Pharmaceutical Waste Rules as Follows:

5.1.1 Incineration:

Incineration is a powerful approach used for disposal of wastes, wherein solid natural wastes are subjected to combustion which will convert them into residue and gaseous merchandise. This technique is beneficial for disposal of residue of both strong waste control and strong residue from waste water control. This manner reduces the volumes of solid waste to 20 to 30 percent of the authentic extent. Incineration and other excessive temperature waste treatment structures are occasionally defined as "thermal remedy". Incinerators convert waste materials into warmth, gas, steam and ash. Incineration is done each on a small scale by individuals and on a huge scale by using industry. It is used to take away strong, liquid and gaseous waste. It is identified as a realistic technique of disposing of sure unsafe waste materials.

Incineration is a debatable approach of waste disposal, because of troubles consisting of emission of gaseous pollution. Incineration isn't suitable for such health care wastes as pressurized gasoline bins, large amounts of reactive chemical wastes, wastes dealt with with halogenated chemical compounds, halogenated plastics including polyvinyl chloride, wastes with mercury or cadmium (together with broken thermometers, used lead or mercury batteries), or radiographic wastes. Incinerators that comply with the CPCB's draught incineration laws must have a complex (for example, double-chamber) design and an air pollution control scrubber. These incinerators' ash must be disposed of safely in a landfill. Such incinerators have substantial up-front and ongoing expenditures, as well as a high demand for highly trained operators.¹²

5.1.2 Autoclaving:

Autoclaving kills pathogens by putting saturated steam in direct contact with the BMW in a pressure vessel for long enough periods of time and at high enough temperatures. For safe disinfection, the Biomedical Waste Rules establish the minimum temperature, pressure, and residence time for autoclaves. Human anatomical, animal, chemical, or pharmaceutical wastes are not suited for autoclaving.

Autoclaving kills germs by putting saturated steam in direct contact with the BMW in a pressure vessel for long enough periods of time and at high enough temperatures. For safe disinfection, the Biomedical Waste Rules establish the minimum temperature, pressure, and residence time for autoclaves. Human anatomical, animal, chemical, or pharmaceutical waste should not be autoclaved. Autoclaving generates a waste stream that can be used to fill landfills with municipal trash. Autoclave operation necessitates the use of skilled experts as well as a moderate initial investment and ongoing operating cost.¹²

5.1.3 Microwaving:

When an electromagnetic field is applied to the BMW, the liquid in the trash begins to vibrate and heat up, killing the infectious components by conduction. If the waste material is exposed to UV light, this method is effective. BMWs must be shred to an appropriate size and humidified before being microwaved. Human anatomical, animal, chemical, or pharmaceutical wastes, as well as big metal pieces, should not be microwaved. Microwaving generates trash that may be used to fill landfills.

The benefits of this treatment technique are low electrical energy requirements and the absence of steam. The requirement for skilled personnel and frequent shredder breakdowns are some of the drawbacks. This technology has a medium initial investment and ongoing operational cost. Disinfection with chemicals. Pathogens in the BMW are killed or inactivated when powerful oxidants are added, such as chlorine chemicals, ammonium salts, aldehydes, or phenol compounds.¹³

5.1.4 Chemical Disinfection:

Chemical disinfection is best for treating liquid wastes including blood, urine, faeces, and sewage from health-care facilities. Chemical disinfection can be used to treat microbiological cultures, mutilated sharps, and shredded substances. The type and amount of chemical used, as well as the extent and duration of contact between the disinfectant and the BMW, all affect disinfection effectiveness. Solid BMW would have to be shredded to improve the contact. Users should wear protective clothing since chemical disinfectants have dangerous (in particular, poisonous) characteristics.

Chemical disinfection is best for treating liquid wastes including blood, urine, faeces, and sewage from health-care facilities. Pathogens in the BMW are killed or inactivated when powerful oxidants such as chlorine compounds, ammonium salts, aldehydes, or phenol chemicals are added. The type and amount of chemical used, as well as the extent and duration of contact between the disinfectant and the BMW, all affect disinfection effectiveness. Chemical disinfection can be used to treat microbiological cultures, mutilated sharps, and shredded substances. The type and amount of chemical used, as well as the extent and duration of contact between the disinfectant and the BMW, all affect disinfection effectiveness.^12,13

5.1.5 Deep Burial:

The soil is relatively impermeable, there are no residents or shallow wells in the region, and the possibility of surface water pollution is unlikely. Half-fill the hole with BMW, then cover with lime to within 50 cm of the surface before filling the rest of the pit with soil. When BMW is put to the pit for the first time, a layer of 10 cm of dirt should be placed to conceal the waste. Human anatomical and animal wastes must be disposed of by deep burial in towns with populations under 500,000 people and in rural regions, according to the Biomedical Waste Rules. As a result, the deep burial site should be prepared by constructing a 2 metre deep pit or trench in an area that is not prone to floods or erosion, has reasonably impermeable soil, no residents or shallow wells nearby, and the danger of surface water contamination is minimal.¹²

5.1.6 Secure Land Filling:

Secured land filling is dumping solid BMWs in a landfill that is specifically constructed and maintained to handle hazardous trash. Discarded medications, cytotoxic drugs, solid chemical wastes, and incinerator ash must all be disposed of in safe landfills under the Biomedical Waste Rules. In most nations, trash disposal in landfills entails burying the garbage. In abandoned or disused quarries, mining voids, or borrow pits, landfills were frequently formed. A well-designed and managed landfill may be a sanitary and cost-effective way to dispose of garbage. Wind-blown trash, vermin recruitment, and the formation of liquid leachate are all potential negative environmental consequences of older, poorly built or managed landfills. Perforated pipes are used to pump gas out of the landfill, which is flared or burned in a gas engine to produce power.^12,13

5.1.7 Waste Immobilization: Inertization:

Inertization is a type of encapsulation that includes removing the packaging materials from the medicines, such as paper, cardboard, and plastic. The blister packs of pills must be removed. After that, the medicines are crushed and mixed with water, cement, and lime to make a homogeneous paste. Because there is a risk of dust, workers must wear protective gear and masks. The paste is then delivered to a landfill in a liquid form by a concrete mixer truck and decanted into regular municipal trash. The paste subsequently solidifies into a solid mass that is distributed throughout municipal solid trash. The procedure is generally low-cost and may be completed using basic equipment. A grinder or road roller to smash the stones, a concrete mixer, and supply of cement, lime, and water are the most important necessities.^12,13

5.1.8 Waste Immobilization: Encapsulation:

The medicines are immobilised in a solid block inside a plastic or steel drum during encapsulation. Prior to usage, drums should be cleaned and should not have previously held explosive or dangerous chemicals. They are filled to 75% capacity with solid and semi-solid medicines, with the remaining space filled with a medium such as cement, cement/lime combination, plastic foam, or bituminous sand. Drum lids should be cut open and bent back to make filling easier and faster. When inserting medicines in the drums, take care not to cut your hands. After the drums have been filled to 75 % capacity, a 15:15:5 (by weight) mixture of lime, cement, and water is added and the drum is filled to capacity. To get a suitable liquid consistency, a higher amount of water may be necessary at times. Steel drum lids should then be bent back and sealed using seam or spot welding, if possible. The sealed barrels should be buried with fresh municipal solid trash at the bottom of a landfill. The barrels may be placed on pallets, which can then be loaded into a pallet transporter for easy transportation.

5.1.9 Sewer:

Some liquid medicines, such as syrups and intravenous (IV) fluids, can be diluted with water and flushed into sewers in modest amounts over time without causing harm to public health or the environment. Small amounts of well-diluted liquid medicines or antiseptics can also be flushed into fast-flowing watercourses. In cases when sewers are in disrepair or have been destroyed by conflict, the help of a hydro geologist or sanitary engineer may be necessary.¹⁴

5.1.10 Municipal landfilling:

Municipal land filling is the process of disposing of community HCWs and disinfected solid BMWs at a landfill that is specifically constructed and operated to accept municipal solid waste.¹⁵

5.2 Treatment and Disposal of Hazardous waste:

5.2.1 Minimization of Waste:

Preventing waste material from being generated, often known as waste reduction, is an essential approach of waste management. Reusing second hand items, repairing broken items rather than buying new, designing products to be refillable or reusable (such as cotton instead of plastic shopping bags), encouraging consumers to avoid using disposable products (such as disposable cutlery), removing any food/liquid remains from cans, packaging, and designing products that use less material to achieve the same purpose are all examples of methods of avoidance (for example, light-weighting of beverage cans). ¹⁶

5.2.2 Re-use:

The term "re-use" refers to the use of a product on several occasions, either for the same or a different purpose, without the need to reprocess it. When a material's first usage is complete, re-use prevents it from being discarded into the waste stream. Returnable plastic pallets, utilising an empty glass jar for storing goods, and wearing second hand garments are examples of products that should be re-used in their original condition. Reuse is usually preferred over recycling since it does not necessitate the material to have gone through a thorough treatment procedure, resulting in energy and material savings.¹⁷

5.2.3 Recycling:

The treatment or reprocessing of discarded waste material to make it acceptable for later reuse, either in its original form or for other uses, is referred to as recycling. It comprises organic waste recycling but excludes energy recovery. Recycling reduces the usage of virgin resources, which is good for the environment. Recycling is possible with a wide range of materials. Debris materials can be recycled into goods that are comparable to their original use (for example, paper recycling) or products that are distinct from their original use (for example, recycling plastic bottles into fleece jackets or utilising construction and demolition waste as road gravel). Up to 13% of municipal trash in the EU gets recycled.

5.2.4 Energy Recovery:

Waste products can have their energy content directly captured by utilising them as a direct combustion fuel or indirectly by converting them into another form of fuel. Thermal treatment includes anything from using trash as a source of fuel for cooking or heating to using gas as a fuel for boilers to create steam and power in a turbine (see above). Pyrolysis and gasification are two types of thermal treatment that involve heating waste materials to high temperatures with little oxygen available. Under high pressure, the procedure is generally carried out in a sealed vessel.

Solid waste is pyrolyzed to produce solid, liquid, and gaseous products. The liquid and gas can be burned to generate energy or processed into other chemicals (chemical refinery). The solid residue (char) can be processed into activated carbon and other goods. Organic materials are converted directly into a synthetic gas (syngas) comprised of carbon monoxide and hydrogen using gasification and enhanced Plasma arc gasification. After that, the gas is burned to generate power and steam. High temperature and pressure supercritical water breakdown (hydrothermal monophasic oxidation) is an alternative to pyrolysis.¹⁸

The following are the steps to take while dealing with pharmaceutical waste:

· Step 1: Create a pharmacy management strategy.

· Step 2: Sort your garbage into hazardous and non-hazardous categories.

· Step 3: Put optimal management practises into action.

· Step 4: Determine your waste generating status.

· Step 5: Follow transportation and disposal standards.

6. Pharmaceutical Waste Storage and Handling in Laboratories:

To prevent leaking or ejection of contents during future storage, handling, or transport, use tiered biohazard bags.

· Place red biohazard bags in a rigid secondary container for storage, handling, or transport.

· Rigid secondary containers must be leak-proof, have tight-fitting lids, and be kept clean and in excellent condition. Containers may be any colour and must be labelled on the lid and sides with the phrases "Bio-hazardous Waste" or the worldwide biohazard emblem, as well as the term "BIOHAZARD," such that they are visible from any lateral direction.

· BSL-1 trash should be disposed of in a red bag. After being deposited in a red bag, these wastes are termed medical waste.

6.1 Pharmacy Employees Training:

When dispensing hazardous waste medicines directly to nursing units, pharmacy personnel should be trained to mark all hazardous waste drugs with the proper hazardous waste warning sticker.

6.2 Marking Compounded Items and IV Admixtures:

Create a system for labelling any compounded preparations and IV admixtures that, when discarded, fulfil the requirements for being classified as hazardous waste.

6.3 Medical Waste Segregation:

At the point of origin, separate all medical trash from other waste.

6.4 Labelling Requirements for Bio hazardous Waste:

Non-medical trash (BSL-1) may be autoclaved in autoclavable white opaque bags in any autoclave and disposed of as solid waste.¹⁹

7. Minimizing Pharmaceutical Waste:

Because the hazardous character of the chemical frequently delivers the therapeutic benefit, there are inherent limits on substituting a less hazardous medication when you develop and implement your pharmaceutical waste management programme. Waste reduction, on the other hand, may reduce compliance headaches, expenses, and hazards. The next section contains a list of minimising options to examine and investigate.

1. Taking lifecycle impacts into account during the purchasing process

2. Making the most of chemotherapy vials that have been opened

3. Putting a samples policy in place

4. Drug labelling for home use

5. Using a saline solution to prime and flush IV lines

6. Comparing container sizes to use

7. Using patient-specific oral syringes instead of pre-packaged unit dose liquids

8. Controlled substances

9. Chemotherapy Drug Delivery

10. Keeping an eye on the dates on emergency syringes

11. Examining inventory controls to reduce outdated items

12. Examining management alternatives

13. Preparing for implementation

· Locating Your Satellite Accumulation Areas

· Evaluating Your Storage Accumulation Area

· Conducting a Pilot Program

14. Procedures and Policies:

Pharmaceutical waste management policies and procedures should at the very least include the following:

· Developed to explain how the organisation goes about identifying medicines that need to be handled as hazardous waste.

· Choosing which non-regulated medications will be treated as hazardous trash.

· Drug labelling to aid in the separation of hazardous waste

· Separation of waste streams

· Staff education (e.g., which staff, what information and how often)

· Creating and maintaining satellite storage and accumulation regions

· Creating and keeping manifests for hazardous waste

· Figuring out how much hazardous trash they generate

· What criteria are utilised to choose hazardous waste

· Establishing a schedule for programme evaluations on a regular basis;

· Keeping management up to date

· Using pharmaceutical waste management as a stepping stone to a facility-wide waste management system. ²⁰

Table 5: Summary of pharmaceutical categories and disposal methods in and after emergencies²¹

Category	Disposal methods	Comments
Solids	Landfill	No more than 1% of the daily municipal waste should be disposed of daily in an untreated form (non-immobilized) to a landfill.
Semi-solids	Waste encapsulation
Powders	Waste inertization
	Medium and high temperature incineration
Liquids	Sewer	Antineoplastic not to sewer
	High temperature incineration
Ampoules	Crush ampoules and flush diluted fluid to Sewer	Antineoplastic not to sewer.
Anti-infective drugs	Waste encapsulation	Liquid antibiotics may be diluted with water, left to stand for several weeks and discharged to a sewer.
	Waste inertization
	Medium and high temperature incineration
Antineoplastic	Return to donor or manufacturer	Not to landfill unless encapsulated
	Waste encapsulation	Not to sewer
	Waste inertization	No medium temperature incineration
	Medium and high temperature incineration
Controlled drugs	Waste encapsulation	Not to landfill unless encapsulated.
	Waste inertization
	Medium and high temperature incineration
Aerosol canisters	Landfill Waste encapsulation	Not to be burnt: may explode.
Disinfectants	Use to sewer or fast-flowing watercourse: small quantities of diluted disinfectants (max. 50 litres per day under supervision)	No undiluted disinfectants to sewers or water courses. Maximum 50 litres per day diluted to sewer or fast-flowing watercourse. No disinfectants at all to slow moving or stagnant watercourses.
PVC plastic, glass	Landfill	Not for burning in open containers
Paper, cardboard	Recycle, burn, landfill

8. CONCLUSION:

Wastes are undesirable or useless items that people no longer need and are either destined for the landfill or have already been dumped. Pharmaceutical waste management is a difficulty for medical professionals working in the recycling industry, government administrations, policy development, quality assurance, and other areas. New classifications for medical wastes, as well as effective techniques for their removal, must be developed on a continual basis, and it must be assured that these can reduce waste management costs. Authorities must employ a variety of tactics and initiatives to reduce waste materials. Pharmaceutical waste continues to represent a new frontier in health-care environmental management. Pharmaceutical waste management is a significant problem for policymakers, city administrators, medical professionals, and recycling sector workers. It is multidisciplinary, encompassing pharmacy, nursing, environmental services, infection control, quality assurance, risk management, and other areas. As a result, a cost-effective system for providing improved medical care facilities is required, as is the creation of a new system to ensure appropriate waste management and minimise waste generation via increased awareness and education among all stakeholders.

9. REFERENCES:

1. Shafir W. Pharmaceutical waste: why is it an issue now? Environmental Protection Agency. www.wrppn.org/hospital/pdf/az/0

2. %20 Pharms%20Waste%20(AZ).pdf (accessed on 23rd september 2013).

3. Kuspis DA, Krenzelok EP. What happens to expired medications? A survey of community medication disposal. Vet Hum Toxicol. 1996; 38(1):48–9.

4. Heberer T. Occurrence, fate, and removal of pharmaceutical residues in the aquatic environment: a review of recent research data. ToxicolLett. 2002; 131(1–2):5–17.

5. Pratyusha K, Nikita M, Gaikwad AA, Phatak PD, Chaudhari. Review On: Waste Material Management In Pharmaceutical Industry. Int. J Pharm. Sci. Rev. Res. 2012; 16(2):nᵒ 27, 121-129

6. Sreekanth K, Vishal Gupta N, Raghunandan HV, Nitin Kashyap U. A Review on Managing of Pharmaceutical Waste in Industry. International Journal of PharmTech Research. 2014; 6(3):899-907

7. Smith CA. Managing pharmaceutical waste. J Pharm SocWisc. 2002; 6:17–22.

8. Occupational Safety and Health Administration (OSHA), Technical Manual Section 6, Chapter 2, Appendix IV: 2-1 OPNAVINST 5090.

9. Pines E, managing pharmaceutical waste: a 10 step blueprint for health care facilities in the united states, 2011.

10. Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams, 1999- 2000: A National Reconnaissance”; Environmental Science & Technology, V. 36, no. 6, pages 1202- 1211.

11. Sharma Natasha, AgharwalDilip, KhinchiMahaveer G, Gupta MK, Bishtshradha. Pharmaceutical waste management: A challenge to make environment ecofriendly. International Journal Research in Ayurveda and Pharmacy. 2010; 1(2):332-338.

12. Singh VP, Biswas G, Sharma JJ, Biomedical Waste Management - An Emerging Concern in Indian Hospitals, Vol. 1, No. 1, 2007.

13. K. Pratyusha, Nikita M. Gaikwad, A.A Phatak, P.D Chaudhari, P. E. Society’s Modern College of Pharmacy, Nigdi, Pune-411 044 (Maharashtra), India. Review on: waste material management in pharmaceutical industry.

14. Waste minimization opportunity assessment manual, USEPA, Hazardous Waste Engineering Research Laboratory, Cincinnati, Ohio. EPA/625/7- 88/00, 1988.

15. Green S. Sewer disposal of pharmaceutical waste. Tri-Tac; 2003–07

16. BekirOnursal, 2003,Health Care Waste Management in India; epa.gov

17. Waste minimization opportunity assessment manual, USEPA, Hazardous Waste Engineering Research Laboratory, Cincinnati, Ohio. EPA/625/7- 88/00, 1988.

18. “A Guide on Hazardous Waste Management for Florida's Pharmacies,” For Solid and Hazardous Waste Management, 1-21.

19. Waste Watch: A Model for Managing Discarded Pharmaceuticals, Health Facilities Management Magazine, March 200

20. Eydie Pines, 2006, Managing Pharmaceutical Waste: A 10 Step Blueprint for Health Care Facilities In the United States, h2e-online.org/docs/h2epharmablueprint41506.pdf

21. Smith CA, “Rationale for Inclusion of Criteria for Proper Disposal of Monograph Pharmaceutical Preparations Based on the Resource Conservation and Recovery Act,” Pharmacopeial Forum, vol. 25, No. 3, May-Jun. 1999, 8309-8312.

22. Rushbrook PE, Pugh MP. Solid waste landfills in middle and low income countries: a technical guide to planning, design and operation. (Jointly produced by the WHO Regional Office for Europe, World Bank, Swiss Development Corporation (SDC), and Swiss Centre for Development Cooperation in Technology and Management (SKAT)). Washington DC: World Bank; 1999.

23. SD Mankar, M Kawade, S Parjane - Research Journal of Pharmaceutical Dosage Forms and Technology,2021, Vol-13, Issue-03,247-252.

Received on 09.02.2022 Modified on 03.03.2022

Asian Journal of Management. 2022;13(3):200-208.

DOI: 10.52711/2321-5763.2022.00036