Biomedical Waste Management

Compliance with Biomedical Waste Management Rules across the country has not been proper even now. The NGT has flagged this issue several times in the past. Mishandling Medical waste will continue to compromise public health and the environment. Read here to understand better about biomedical waste management.

Of the total amount of waste generated by healthcare activities, about 85% is a general, non-hazardous waste. The remaining 15% is considered hazardous material that may be infectious, toxic, or radioactive.

Every year an estimated 16 billion injections are administered worldwide, but not all of the needles and syringes are properly disposed of afterward.

Open burning and incineration of health care wastes can, under some circumstances, result in the emission of dioxins, furans, and particulate matter.

Measures to ensure the safe and environmentally sound management of health care wastes can prevent adverse health and environmental impacts from such waste including the unintended release of chemical or biological hazards, including drug-resistant microorganisms, into the environment thus protecting the health of patients, health workers, and the general public.

Also read: E-Waste: Causes, Concerns and Management

Biomedical Waste

Waste generated from the healthcare facility is classified as:

• Bio-Medical Waste
• General Waste
• Other Wastes

Biomedical waste means any waste, which is generated during the diagnosis, treatment, or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or health camps.

• Bio-Medical waste includes all the waste generated from the Health Care Facility which can have any adverse effect on the health of a person or to the environment in general if not disposed of properly.
• All such waste that can adversely harm the environment or health of a person is considered infectious and such waste has to be managed as per Biomedical Waste Management (BMWM) Rules, 2016.
• The quantity of such waste is around 10% to 15% of total waste generated from the Health Care Facility.
• This waste consists of the materials that have been in contact with the patient’s blood, secretions, infected parts, biological liquids such as chemicals, medical supplies, medicines, lab discharge, sharps metallic and glassware, plastics, etc.

Biomedical Waste Management Rules, 2016 categorizes the bio-medical waste generated from the health care facility into four categories based on the segregation pathway and color code.

Various types of biomedical waste are further assigned to each one of the categories, as detailed below:

1. Yellow Category
2. Red Category
3. White Category
4. Blue Category

General waste

The general waste consists of all the waste other than bio-medical waste which has not been in contact with any hazardous or infectious, chemical, or biological secretions and does not include any waste sharps.

This waste consists of mainly:

• Newspaper, paper, and card boxes (dry waste)
• Plastic water bottles (dry waste)
• Aluminum cans of soft drinks (dry waste)
• Packaging materials (dry waste)
• Food Containers after emptying residual food (dry waste)
• Organic / Bio-degradable waste – mostly food waste (wet waste)
• Construction and Demolition wastes

These general wastes are further classified as dry wastes and wet wastes and should be collected separately.

This quantity of such waste is around 85 % to 90 % of the total waste generated from the facility.

Such waste is required to be handled as per Solid Waste Management Rules, 2016, and Construction & Demolition Waste Management Rules, 2016, as applicable.

Also read: Microplastics

Other wastes

Other wastes consist of used electronic wastes, used batteries, and radio-active wastes which are not covered under biomedical wastes but have to be disposed of as and when such wastes are generated as per the provisions laid down under E-Waste (Management) Rules, 2016, Batteries (Management & Handling) Rules, 2001, and Rules/guidelines under Atomic Energy Act, 1962 respectively.

Biomedical waste management

At the central level, the Central Pollution Control Board (CPCB) ensures strict compliance with biomedical waste management rules and scientific disposal of waste.

• At the state level, the Chief Secretaries of all the States/UTo oversee compliance and ensure that authorization is secured by every healthcare facility in their respective jurisdiction and also there is adherence to the norms.
• At the district level, the District Magistrate by the District Environmental Plans.

The management of bio-medical waste can overall be summarized in the following steps:

• Waste Segregation in color-coded and barcode-labeled bags/ containers at the source of generation
• Pre-treat Laboratory and Highly infectious waste
• Intra-mural transportation of segregated waste to the central storage area
• The temporary storage of biomedical waste in the central storage area
• Treatment and Disposal of biomedical waste through Common Biomedical Waste Treatment Facility (CBWTF) or Captive facility.

The first five steps (Segregation, Collection, pre-treatment, Intramural Transportation, and Storage) are the exclusive responsibility of the Health Care Facility (HCF).

While Treatment and Disposal are primarily the responsibility of the CBWTF operator except for lab and highly infectious waste, which is required to be pre-treated by the HCF.

• Pre-treatment of the laboratory waste, microbiological waste, blood samples, and blood bags is through disinfection or sterilization on-site in the manner prescribed by the World Health Organization (WHO) or by the National AIDS Control Organisation (NACO).

It is the responsibility of the in charge of the healthcare facility to ensure the occupational safety of the healthcare workers and other staff involved in the handling of Biomedical waste in the healthcare facility.

Risks of biomedical waste

Healthcare waste contains potentially harmful microorganisms that can infect hospital patients, health workers, and the general public.

Other potential hazards may include drug-resistant microorganisms which spread from health facilities into the environment.

Adverse health outcomes associated with healthcare waste and by-products also include:

• sharps-inflicted injuries;
• toxic exposure to pharmaceutical products, in particular, antibiotics and cytotoxic drugs released into the surrounding environment, and to substances such as mercury or dioxins, during the handling or incineration of health care wastes;
• chemical burns arising in the context of disinfection, sterilization, or waste treatment activities;
• air pollution arising as a result of the release of particulate matter during medical waste incineration;
• thermal injuries occurring in conjunction with open burning and the operation of medical waste incinerators;
• radiation burns

Challenges to waste management

• Lack of awareness about the health hazards related to healthcare waste
• Inadequate training in proper waste management
• Absence of waste management and disposal systems
• Insufficient financial and human resources
• Low priority is given to the topic
• Many countries either do not have appropriate regulations or do not enforce them.

Also read: Waste to Wealth

Way forward

The management of healthcare waste requires increased attention and diligence to avoid adverse health outcomes associated with poor practice, including exposure to infectious agents and toxic substances.

Key elements in improving healthcare waste management are:

• promoting practices that reduce the volume of wastes generated and ensure proposer waste segregation;
• developing strategies and systems along with strong oversight and regulation to incrementally improve waste segregation, destruction, and disposal practices with the ultimate aim of meeting national and international standards;
• where feasible, favoring the safe and environmentally sound treatment of hazardous health care wastes (e,g, by autoclaving, microwaving, steam treatment integrated with internal mixing, and chemical treatment) over medical waste incineration;
• building a comprehensive system, addressing responsibilities, resource allocation, handling, and disposal. This is a long-term process, sustained by gradual improvements;
• raising awareness of the risks related to healthcare waste, and of safe practices; and
• selecting safe and environmentally-friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating, or disposing of waste.

Government commitment and supporters are being put in for universal, long-term improvement, although immediate action should be taken locally by the healthcare and related facilities.

-Article by Swathi Satish