Why India is losing the biomedical waste battle?

Lack of implementation, a lax monitoring system, inadequate training and knowledge have led biomedical waste being handled in unscientific and inappropriate ways.

The National Green Tribunal (NGT) recently came up with a formula to penalise those violating Biomedical Waste Management Rules 2016, hearing  a case on the implementation of  the rules by private and government hospitals including medical teaching and research institutes in Tamil Nadu.

However, experts argue that across the country, there have been several instances of ineffective handling – from improper segregation of waste to reckless dumping of waste in water bodies. According to a paper published by the National Center for Biotechnology Information (NCBI), in 2018, titled ‘Biomedical waste management in India: Critical appraisal’, the waste generated in the country is 484 TPD (tonnes per day)  and only 447 TPD is treated.” The amount untreated is worrying the paper noted. “In India, biomedical waste (BMW) problem is compounded by the presence of scavengers who sort out open, unprotected health-care waste with no gloves, masks, or shoes for recycling, and second, reuse of syringe without appropriate sterilisation,” it said.

The waste has also reported to have reached unmanageable levels. Recently, it was reported that in New Delhi, 75 tonnes of raw biomedical waste being generated daily have made it a public health hazard. A few months ago, trucks were seized near Tamil Nadu-Kerala border after they were found to be loaded with medical waste from Kerala.

Inefficient treatment

Dharmesh Shah, a Kerala-based environmental activist says that the problem is with the way biomedical waste is handled. He adds, “About 30% of the total waste in hospitals is biomedical, but they are mixed with the rest indiscriminately by staff at healthcare facility. One single swab is enough to contaminate the rest of it. Now with 100% waste being contaminated, they are overrun and cannot handle it. This waste landing in municipal waste is enough to infect a larger section of people”

He adds that there are incinerators that are run ineffectively and they aggravate the danger, citing the example of a incinerator operating in Delhi. “It is a small oven like structure covered with soot and is burning PVC plastic.  This is all the more harmful,” he adds.

Make it part of curriculum

With doctors and nurses not being aware of the rules, it is difficult to rein in biomedical waste, admits a doctor at one of the government hospitals in Chennai. The doctor said on condition of anonymity, “After a surgery, when I take off my gloves I might often wonder in which bin the gloves should go into. However, the nurse suddenly suggests I put it in the red bin. This is the case with most doctors and nurses. The paramedical staff are not trained in it. Hospitals should make an effort to train every health worker in it to ensure 100% results from the healthcare facility’s side.”

The source adds that the curriculum for all of them being trained for various roles should include biomedical waste rules. “However, what do we do with the ones who have qualified in the courses and are grappling with the segregation part of their waste? The medical fraternity has to take stock of the awareness and conduct sessions for the staff,” he says.

A success model

Fortis Malar Hospital, a multi-speciality hospital, has been putting out reports of its biomedical waste periodically on its website. Besides segregating waste in four codes- yellow, red, blue and black across operation theatres, intensive care units and wards.

The yellow bin contains infected waste like bandages and placenta, the red has infected dressing, plaster of Paris and cotton, blue contains gloves and syringes and the black bin is for chemical or hazardous waste.

Dr Senthil Kumar R, unit head, administration, Fortis Malar, said, “Each of these categories has a separate room for storing them. They are sealed in disposable covers with unique barcodes, indicating the source (ICU, OT, etc.) and the nature of waste They are disposed within 24 hours. We generate as much as 7,000 kgs of them every month and spend ₹1.3 lakh on their disposal through a private concern approved by the Tamil Nadu Pollution Control Board.”

Environmental activist Shah admits that there are very few hospitals setting a good example, while countries like Nepal has come up with some laudable solutions. He explains, “The facility in Nepal has gone completely zero waste. They use biogas to dispose of tumours and severed body parts for bio-degradation alongside food waste. Autoclaving in hot steam to disinfect plastic and non-organic waste to recycle them later.”

The ethical part of biomedical waste is ignored

Dr Nandini K Kumar, former senior deputy director general, Indian Council of Medical Research (ICMR), observes that there also ethical issues related to the disposal of bio medical waste.

“There are backdoor agents who procure the waste which is used to experiment or create cell lines. Placentas are also used for stem cell regeneration. The waste, therefore, has a lot of commercial value while some have an agreement with the patients, but it is highly unlikely that a woman in labour room would be able to decide on the consent or not. Moreover, if you commercialising the waste, it is only fair that the owners get a share,” she says.

The way forward

The NGT in a recent hearing sought Tamil Nadu government’s response to see if there is a need for common biomedical waste treatment facilities.

Jawahar Shanmugam, an activist who had filed the case, points out that there are just 11 Common Biomedical Waste Treatment Facility Providers (CBMWTFP) of which three have been issued closure notices.

Effectively, we are talking of eight CBMWTFP to handle approximately 47 tons generated in a day. A few CBMWTFPs are handling  multiple districts to collect the biomedical waste,  he added. This assumes significance, as the 2016 rules are more specific regarding the dependence of healthcare facilities on CBMWTF and who will provide land for setting up CBMWTF.

State government or Union Territories will provide land for setting up CBMWTF and no occupier of an HCF shall establish an on-site treatment and disposal facility if a CBMWTF is available within 75 kms.

The NGT has also come up with a formula to penalise the violators. The factors  considered are the type of healthcare facility (HCF), size of the HCF, environmental compensation factor and number of days of violation.

Kumar puts the onus on the state’s board to ensure the guidelines are followed. “The pollution control boards of the state have the responsibility of not just monitoring the management of the waste but also their implementation,” she said.