Biomedical waste is often not safely disposed off by hospitals and institutions despite there being Biomedical Waste (Management and Handling) Rules
By Papia Samajdar
In mid-2013, a journalist friend fell seriously ill while investigating a story on biomedical waste (BMW) and she contracted tuberculosis in her uterus. As she was working for a television channel, she was denied permission to use a facemask, and she did not realize the grave implications of searching through the waste dumped outside a well-known lung facility in Delhi. Both the hospital and authorities passed off this waste as municipal waste and as she looked for evidence, her deteriorating health confirmed the story she was working on.
Not only does biomedical waste find a convenient way to municipal waste, dumped right outside healthcare facilities, but used syringes are collected by rag-pickers, sanitized and ready to be sold again with practised ease. These syringes should ideally be disposed off in a stipulated manner, but most clinics and hospitals, including high-end ones, don’t follow protocols when it comes to their safe disposal.
Needless to say, the story outside Delhi is just as grave, if not worse.
In January 2013, women from three neighboring villages in Sambalpur district of Odisha approached a local NGO complaining that the municipal authorities were illegally dumping BMW on their land. The NGO, which inspected the site, found a high amount of biomedical waste there and, shockingly, this was also a place where children played. As children started falling sick, the villagers were forced to leave their land. While the authorities were requested not to use the land for dumping and the state pollution control board was notified of this ill-practise, the dumping reduced, but there was no action to clear it.
A 2012 report by INCLEN Program Evalua-tion Network, a Delhi-based international network of healthcare professionals analyzing the state of BMW disposal across India, came out with a report which had depressing results. It looked at 25 districts in 20 states to document the practices related to BMW. The study categorized 82 percent primary, 60 percent secondary and 54 percent tertiary healthcare centers as red, signifying poor management and disposal practises. It called for immediate action and commitment to the policies and regulations laid down in BioMedical Waste (Management and Hand-ling) Rules, 1998.
Though the government talks about Swachh Bharat Abhiyaan, it does not include BMW. While huge money is being pumped into building toilets, little attention is being paid to ensure safe and hygienic disposal of this potentially dangerous waste. Clean India cannot be achieved only by ridding her of open defecation; there are many more battles to be fought. Safe and proper disposal of BMW is one such battle but gets lukewarm response from the government.
When it comes to awareness of health hazards, it is often minimal.
So why is BMW such a huge health hazard? Biomedical waste is waste generated by healthcare, research facilities and associated laboratories. It includes both (a) “communal waste” such as paper and bottles that can be dealt with through local solid waste management system; and (b) potentially dangerous “biomedical waste” such as sharps (needles, scalpels, knives, blades, broken glass) and wastes with infectious, hazardous, radioactive and genotoxic properties (which damage the genetic information within a cell,causing mutations).
One ton of BMW, which can be as little as one percent of the total daily municipal solid waste (MSW) generated in a Tier II city, can infect the total MSW generated by the city. The MSW treatment plant converts the polluted waste into compost, which is used in agriculture, thus entering our food chain.
Without proper management of BMW, environmental pollution would increase, leading to multiplication of flies, insects, rodents, worms and dogs. This could further lead to the transmission of diseases like rabies, plague, typhoid, cholera, hepatitis, AIDS and other communicable diseases through infected syringes. Rag-pickers, who usually sort out the municipal waste, can contract HIV, tetanus and TB.
Apart from that, hospital staff and those handling the waste can contract infections. Improper disposal of expired drugs can lead to their being retrieved and sold to unsuspecting people, not to mention air, water and soil pollution from improper or defective incineration of BMW.
Though there are laws and regulations for safe disposal of BMW, there is poor implementation. Achieving the desired result is nowhere in sight as regulations are ignored by hospitals, dispensaries and other medical set-ups and treated with disdain by regulatory authorities.
What do the regulations say? The Biomedical Waste (Management and Hand-ling) Rules, 1998, which was amended in 2003, mandates safe and proper disposal of BMW. Draft of a new rule in 2011 is yet to be notified by the government.
These rules are meant for any institution generating BMW. These include hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories and blood banks. They have to take all steps to ensure that such waste is handled without any adverse effect to human health and environment.
These rules define the methodology for segregation, packaging, transportation, storage, treatment and disposal. Schedule 1 of the rules defines the categories of biomedical waste, while Schedule 2 lays down the color coding and type of container for disposal (see box above).
The regulatory authority is the State Pollution Control Board (SPCB). Every institution generating, collecting, receiving, storing, transporting, treating, disposing and/or handling BMW, when treating more than 1,000 patients per month, is mandated to apply for grant of authorization to the SPCB. Every operator of a BMW facility is also required to seek authorization from them.
But these rules are of no use till implementation is taken seriously.