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By Dr. Osama Ummer
Image courtesy: The News Minute
Globally, knowledge about the potential harm from biomedical wastes has gained the attention of governments, medical practitioners, and civil society. The erratic handling and disposal of waste produced from healthcare facilities is now widely recognized as a source of avoidable infection. Wherever waste is generated, safe and reliable methods for its management are therefore essential.
What do you mean by biomedical waste?
The term biomedical waste/healthcare waste includes all the waste generated within healthcare facilities, research centres and laboratories related to medical procedures. In addition, it includes the same types of waste originating from minor and scattered sources, including waste produced in the course of health care undertaken in the home (e.g. home dialysis, self-administration of insulin, recuperative care).
Typically, between 75% and 90% of the waste produced by healthcare providers is comparable to domestic waste and usually called “non-hazardous” or “general healthcare waste”. It comes mostly from the administrative, kitchen and housekeeping functions at facilities. It may also include packaging waste and waste generated during maintenance of healthcare buildings. The remaining 10-25% of healthcare waste is regarded as “hazardous” and may pose a variety of environmental and health risks.
What is an infectious waste?
Waste suspected to contain pathogens (bacteria, viruses, parasites or fungi) in sufficient concentration and that poses a risk of disease transmission (e.g. waste contaminated with blood and other body fluids; laboratory cultures and microbiological stocks; waste including excreta and other materials that have been in contact with patients infected with highly infectious diseases in isolation wards).
Who is at risk from biomedical waste?
All individuals coming into close proximity with hazardous healthcare waste are potentially at risk from exposure to a hazard, including those working within healthcare facilities who generate hazardous waste, and those who either handle such waste or are exposed to it as a consequence of careless actions. The main groups of people at risk are:
Medical doctors, nurses, healthcare auxiliaries and hospital maintenance personnel
Patients in healthcare facilities or receiving home care
Visitors to healthcare facilities
Workers in support services, such as cleaners, people who work in laundries, porters
Workers transporting waste to a treatment or disposal facility
Workers in waste-management facilities (such as landfills or treatment plants), as well as informal recyclers (scavengers).
The general public could also be at risk whenever hazardous healthcare waste is abandoned or disposed of improperly. The hazards associated with scattered, small sources of healthcare waste should not be overlooked. These sources include pharmaceutical and infectious waste generated by home-based health care, and contaminated disposable materials such as that from home dialysis and used needles from insulin injection, or even illegal intravenous drug use.
Regulations and guidelines in India related to COVID-19 waste management
On March 18, 2020 the Central Pollution Control Board (CPCB) issued a set of guidelines for the handling, treatment and disposal of waste generated during treatment, diagnosis and quarantine of COVID-19 patients. This was in addition to existing practices under Bio-Medical Waste Management (BMWM) Rules, 2016. The guidelines were prepared from previous experiences in management of other viral diseases like HIV, H1N1, etc.
Under CPCB guideline, COVID-19 isolation wards in healthcare facilities have to maintain separate colour coded bins for the segregation of waste. The guideline notified all healthcare facilities, as a precautionary measure, to use double-layered bags (using two bags) for the collection of waste from COVID-19 isolation wards to ensure adequate strength and no-leaks. A dedicated collection bin, labelled as ‘COVID-19’, needed to be kept in a separate, temporary storage room and should only be handled by authorised staff. Separate deployment of sanitation workers in these wards for biomedical waste management was also recommended. The board also requested to maintain a separate record of waste generated in isolation wards. Any biomedical waste generated from quarantine camps/home care of the suspected patients is to be collected separately in yellow coloured bags and bins as per the CPCB guidelines. It should also be handed over to authorised waste collectors engaged by local bodies.
What India could be facing?
In India, biomedical waste generation per day has increased by 18% from 517 tonnes in 2016 to 608 tonnes in 2018. Currently, there are 200 Common Bio-Medical Waste Treatment Facilities (CBMWTFs) in operation and 28 more are being installed, and also around 225 captive incinerators. Seven states do not have CBMWT facilities. Only about 78% of India’s total 200,000 tonnes of biomedical waste was treated by CBMWTFs since 2017. The rest was treated and disposed of either by captive treatment facilities or deep burials. Most healthcare facilities follow the BMWM Rules 2016 and more strictly in the times of COVID-19. However, in 2018 it was reported on an average 75 instances per day violations of rules against healthcare facilities/CBMWTFs. But it is waste disposed of by quarantined households, where there is limited awareness about the issue, that could expose sanitation workers to bigger risks, said experts.
“It is very critical to manage this waste related to COVID-19, be it mask, gloves, the hazmat suit. This waste could infect rag pickers, children or the poor living on the streets.” said Satish Sinha, associate director at Toxics Link, an NGO that works on municipal, hazardous and medical waste management and food safety.
India has an estimated 1.5 to 4.0 million waste pickers’ workforce that performs waste collection, sorting and recycling manually. Public health experts and waste management specialists have raised caution about the higher risk of sanitation workers and waste pickers from handling unmarked medical waste emerging from homes where COVID-19 patients are quarantined. As per the Solid Waste Management Rules, 2016, the waste generators are supposed to segregate the waste at source and then hand it over to the authorised waste pickers or collectors. Adherence to these basic rules of waste segregation is still low in our country and a high number of violations have been witnessed recently.
In Bhiwandi (Thane), a man was caught putting over 1 lakh used face masks out to dry so that he could resell them in the market, The Times of India reported on March 12, 2020.
In Pune, face masks dumped by users in household garbage were being collected by waste pickers, The Indian Express reported on March 23, 2020.
In Chennai, sanitation workers described their anxiety about handling domestic waste mixed with used face masks discarded by households, The New Indian Express reported on March 24, 2020.
In Sharan Vihar (Delhi), a pile of discarded face masks, tunics, gowns, caps, gloves, empty tablet packets and syringes were found lying in the open, The Indian Express reported on April 1, 2020.
The carelessly discarded masks, gloves and tissues could be potential sources for the spread of this highly contagious virus, they said. Equally important is the proper disposal of Personal Protective Equipment (PPE), including protective suits, gloves, masks, and other waste from hospitals, medical facilities or clinics through appropriate CBMWTFs. The concern that this creates for sanitation workers and informal sector waste collectors cannot be neglected.
“Used masks, tissue paper, cotton, medicine left-overs or any other material disposed of by quarantined persons can be highly infectious , and unless collected separately and incinerated; there is a high risk of the infection to spread through this waste,” said Dr U. K. Chattopadhyay, director of All India Institute of Hygiene & Public Health in Kolkata
Inadequate and inappropriate handling of biomedical waste may have serious public health consequences and a significant impact on the environment. Appropriate management of these waste is thus a vital element of environmental health protection. Moreover, we have seen a surge in sales and usage of masks, sanitiser, and other safety essential. But this growing demand was never guided by rules of appropriate disposal mechanism. Most often the contaminated waste was thrown or disposed in common grounds which poses a greater threat to the public and sanitation workers. Thus, there is an urgent need for public to be sensitised about segregated and protected disposal of household waste.
“Sanitation workers are highly at risk, like the medical professionals, police and community health workers who deal with COVID-19 patients. Doctors, nurses and other health workers know about the precautions to be taken but sanitation workers do not and that makes them vulnerable.” said Dr S. S. Darokar, Associate Professor at Centre for Study of Social Exclusion and Inclusive Policies in TISS Mumbai.
Improved public awareness of the problem is vital in encouraging community participation in generating and implementing policies and programmes. Management of biomedical waste should thus be put into a systematic, multifaceted framework, and should become an integral feature of healthcare services. This is urgently required in light of the nation’s increased testing strategy and the requirement that made face masks mandatory in public places. There is an urgent need to strengthen the capacity of waste management system across the local bodies and establish an appropriate review mechanism to ensure proper functioning of waste treatment facilities. It is also critical to ensure a collaboration between healthcare facilities, civil society organisations and others engaged in waste management to come forward for safe disposal of biomedical waste in this pandemic.
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This article throws light on one of the most neglected yet critical topics. Thank you for this wonderful piece and for highlighting this issue! In a time when we are trying to adapt to the new normal, and taking certain preventive measures to stay protected, I hope that due attention is paid and relevant measures are taken for biomedical waste management too at all levels of the society and the healthcare system.
Good article. Well thought and prepared. This may be an eye opening to all. The problem mentioned in your article, each individual should be careful and take precautionary measures themselves. The waste collecting people status are kept low. They should be protected and helped by others and government too.
Good article. Very informative and very much relevant for the time. I hope concern authorities will take care of the same. There is a massive awareness program for the sanitation workers for proper disposal mechanism.
Quite informative piece. Road ahead looks challenging when it comes to handling waste, because it requires strong guidelines along with mass public awareness and their support