BIOMEDICAL WASTE & MANAGEMENT

 

Healthcare waste is also often referred to as medical waste, clinical waste etc. All these terms pertain to the waste coming out of medical establishments and research institutions although there are subtle differences in the meaning and connotation of the different terminologies.

Medical waste is a term applied to the waste generated in the diagnosis, treatment or immunization of human beings or animals in research and in the production or testing of biological products. It also includes waste coming out of medical treatment given at home. Infectious waste includes all those medical wastes, which have the potential to transmit viral, bacterial or parasitic diseases. It includes both human and animal infectious waste and waste generated in all healthcare activities including laboratories and veterinary practice. Infectious waste is hazardous in nature as any other waste that poses a threat to human health and life. Such waste is also called hazardous waste. However, in a hospital, the waste that may not be infectious but is still hazardous because of its chemical composition or radioactivity is often referred to as hazardous waste. To avoid confusion and for the sake of simplicity, we propose to use the term healthcare waste to refer to all wastes generated in healthcare and research institutions while the term biomedical waste would refer to the infectious & hazardous components within such healthcare waste.

The Bio Medical Waste (Management & Handling) Rules, 1998 also describes biomedical waste as any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals.Growing urbanization has led to several changes in the healthcare sector in India. While on one hand, access to state of the art healthcare services are being provided to the community thereby resulting in the better health for all, improper management of biomedical waste (BMW) emanating from these healthcare establishments has also given rise to many environmental and health problems, thereby negating the benefits of the expanding health sector. Healthcare personnel and the general community face hazards from:
    • Radioactive and Cytotoxic medicines generally given to cancer patients. These, if left exposed, can cause death or disability to anyone.
    • Highly infectious diseases, a possibility that can occur in any hospital, nursing home, clinic etc. These can spread in the community unless proper precautions are taken.
    • Disposable items like syringes, catheters, canulas, IV sets, dialysis sets, etc. These, if not treated and disposed properly, can be repackaged and resold causing spread of infections and epidemics.
    • Chemicals, pesticides, and other hazardous liquid waste coming out of the hospitals. If these are not treated with care within the hospital or stored and transported to a safe place for treatment or secured land filling, can become hazardous to the community.

Contrary to the often repeated data that says that the biomedical waste form only 15-20% of the total waste generated, it has been ascertained through estimation at various locations that in larger hospitals (above 500 beds), the quantity of biomedical waste may vary from 20-33% of the total healthcare waste generated. However in nursing homes, dispensaries, diagnostic labs, blood banks, clinics and even veterinary and research institutions (where number of beds are nil or less than 500), the proportion of biomedical waste to the total waste is much higher ranging from almost 50% in clinics, labs, blood banks, to 95% in veterinary and research institutions. [Based on the CEE Delhi Cross-sectional study of knowledge and compliance to Biomedical Waste (Management and Handling) Rules, 1998 submitted to MoEF, GoI in September 2001 and subsequently validated in 2003, 2005 and 2007.]

It is estimated that India generates about 1 million tonnes of biomedical waste per day and its disposal has been mostly haphazard and unplanned throughout the country although hospital waste management is an integral part of the hospital infection control programme. Unscientific disposal of healthcare waste may lead to the transmission of communicable diseases such as gastro-enteric infections, respiratory infections, infections of skin, eye and several other organs besides having the potential to spread diseases like HIV-AIDS, Hepatitis B, C, E & TB which are spread through direct human contact with the blood and infectious body fluids and through contaminated air & water. Healthcare professionals and the general public are equally at risk that arise due to improper treatment and disposal of biomedical waste, which are known to spread diseases. Rag pickers expose themselves to diseases like Hepatitis B, Tetanus, Septicemia etc. while handling needles, surgical gloves and blood bags disposed in municipal bins and dumpsites.

Due to the emphasis being placed on the management of biomedical waste in the country, it was specifically mentioned in the High Power Committee Report of the Planning Commission 1995. Consequently, as part of its National Environment Protection Plans, The Biomedical Waste (Management & Handling) Rules, 1998 (BMWM Rules 1998)  are promulgated by the Ministry of Environment and Forests, Govt. of India making it mandatory for every healthcare establishment in the country, whether big or small, to manage and treat their waste as per the Rules. This was done in exercise of the power conferred on it by section 6, 8 and 25 of the Environment (Protection) Act 1986. The Central Government notified the rules for the Management and Handling of Biomedical Waste in 1998. The Rules along with subsequent amendments dated 6th March, 2nd June 2000 and 17th September 2003 are welcome steps towards improving the overall status of waste management in healthcare units in India.  To be effective, the Rules need be implemented along with the active involvement of concerned institutions, authorities and the cooperation of the general public.

Bio Medical Waste Management (BMWM) refers to management of the biomedical waste from the point of generation till its scientific disposal.The various activities involved in BMWM are: 

  1. Source Segregation
  2. Segregated Storage
  3. Collection in dedicated carriers
  4. Transportation in vehicles exclusively dedicated for the purpose
  5. Treatment as per the BMWM 1998 Rules &
  6. Disposal as per the BMWM 1998 Rules
 
Source Segregation
Segregation
Segregated Storage, Collection & Transportation
Treatment & Disposal
Common Biomedical Waste Treatment Facility (CBWTF)
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