Tuesday, September 15, 2015

Biomedical waste – status as per CPCB report of situation analysis and some suggestions

Biomedical waste – status as per CPCB report of situation analysis and some suggestions
Author- Prof. Dr. Niraj Pandit, Professor, Department of Community Medicine, SBKS Medical Institute & Research Center and Deputy Director Research Cell, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat – email- drniraj74@gmail.com

Even though it is known fact that biomedical waste is potential dangerous to community and after more than 17 years of implementation of BMW rules, still biomedical waste management and disposal is problematic area. The regulators are trying hard to make sufficient implementation. There are various actions taken place to make it proper implementation. As per the rule, each hospital or nursing home has to register with the authority state level and they have to submit report to state authority every year by 31 January. The compiled report of all HCF (Health care facilities) needs to submit to Central Pollution Control Board (CPCB) by 31 March of year. The CPCP is providing compiled report on the web page http://www.cpcb.nic.in/Bio_medical.php, which was accessed in first week of July 2015 and author prepared the situation analysis.
Table-1 Basic information
Key area / Year
No. of HCF
No. of beds
No of CBWTFs in operation
No of CBWTFs under installation
No of HCF using CBWTFs
1,31,837 (78%)
No. of HCF using own Rx & disposal facilities
22,245 (13%)
21,870 (14%)
23,361 (15%)
20228 (14%)
Gap in own facility and CBWTFs use
BMW generated kg per/day
BMW generated bed per day
0.28 kg/day/ bed
0.25 kg/day/ bed
0.27 kg/day/ bed
0.24 kg/day/ bed
HCF violating rules
7,894 (4.6%)
12,990 (8.1%)
5472 (3.6%)
6653 (4.8%)
Notice issued
4,391 (55.6%)
11,583 (89.1%)
3585 (65.5%)
5829 (87.6%)

The above table is showing interesting information. As per World Bank report[i], India has 0.7 beds per 1000 population. But this record shows that the bed strength of country rose to 1.4 beds per 1000 population in 2013, which is almost double. In last four years the number of CBWTFs increased from 188 in 2010 to 198 in 2013. There is observed gap in the use of CBWTF and using own BMW treatment & disposal facilities. But the positive aspect is that the gap reduced from 15% in 2010 to 9% in 2013. The waste generated per bed per day is almost near constant 0.24 kg/day/bed in 2010 and 0.27 kg/day/bed in 2013. There are almost around 5% of registered health care facilities who are violating rules and pollution control board is issuing notice.
I enjoyed to analyze these reports. While analysis these reports I personally found some missing information in the reports. If CPCB starts to collect the missing information, they can monitor the waste management in better way. As per my personal opinion, the points which need to incorporate in report are-
1.      The number of HCF is divided to three category primary HCF, secondary and tertiary HCF. In report if type of HCF is collected, it will help to understand the distribution of beds in secondary and tertiary hospitals. The primary care centers and nursing homes may not have indoor facilities. Thus it will help to understand the bed distribution and waste production pattern.
2.      In this report it is not clear the category of waste. If the waste per bed per day if we calculate it is coming to 0.28 kg/day per bed. It looks like that the reported data is for infectious waste only. As it matches with 10-15% of infectious waste from total waste generated per bed per day. But plastic waste and non-infectious waste details can be collected.
3.      The report did not have anything on radioactive and cytotoxic waste. They are potential dangerous for community in different way. If authority plan to collect data on same will be helpful to track such hospitals.  
4.      There is no clarity on liquid waste. Also report also does not ask anything on liquid waste. But it was found in last committee meeting the CPCB has made committee on liquid waste disposal.  
5.      Many hospitals are doing training and capacity building workshops. If they report in yearly reporting system, it will help to monitor hospital’s involvement in capacity building of staff.
6.      As per BMW rules, each hospital needs to report accident or injury to authority. There is no discussion or report found in yearly report. This is a key to understand the needle stick injury pattern and incidence in a year. Also if hospital reports accidents like spillage blood on floor in ward or operation theater, leakage of BMW bags and similar other accidents to authority, it will help to understand the dangerous aspect of wastage management.
7.      One more suggestion to monitor the Hepatitis-B vaccination programme. All hospital staff should receive Hepatitis-B vaccine as per prescribe interval. If authority monitor, it will be great help to hospital staff and thus community.
In addition to this state pollution control board should spare some 5% to 10% of fees collected from health care facilities registration for the purpose of research and generation of evidence.  There are lots of gaps in available evidences in biomedical waste and require to generate. This research fund will be helpful to generate new knowledge and new technology in context to our country need. Every year pollution control board can invite applications form all health care people and medical – paramedical students or research associates. Team of expert will evaluate the proposal and best 10 proposals can be awarded with adequate funds.

Thursday, February 19, 2015

Research leadership in medical college - research cell

Plan of action –
Research leadership in medical college –
 This is the best time to start Research Cell in each medical college like Medical Education Unit. This leadership needs to develop and monitor at state level, regional level and national level. The functions and activities of the research cell are
1. Regular training and capacity building of all the faculties for research and ethical issue
 2. Research Development Committee under research cell who can brainstorm every year various topics for research and percolate to each department so there is no difficulty in searching topics for the thesis in department.
3. Fully functional laboratory to measure all chemical levels in blood including drug assay study in central laboratory. With department of pharmacy we can plan animal trial for drugs.
4. Multidisciplinary Research Unit (MRU) under Research cell where all different disciplines come closer and work together for research. Collaborative research and multicentric research
5. ICMR is giving extra-mural grant support for any research work. Research Development Committee can plan the capacity building workshops for faculties and apply for grant support. Research proposal writing workshops can plan and do regular follow up for applying grant for research.
6. Active Researcher will be identified and special incentive form the research cell for doing research.
 7. Like Pre-PhD, if feasible incorporate the one section on research methodology in paper -1 of all postgraduate exams.
 8. Institute can think to do consultancy on research to external bodies live government and private.

Structure for developing Research Cell National level -One committee at national level in MCI
Zonal level - There are four zonal committees to look after the state level activities
State level -Each state has on state level research development committee with all representatives of medical college research cell.
 Medical College level -Each medical collage has one research cell with full structure like department of research. With support staff and various faculties on rotation.
 There should fix tenure for various post in rotation
Developing Research Agenda -
In the beginning of the year the national committee meets and gives the core area of research for the year short term and long term for all departments. The committee will take interest of country with focus on drugs, national programme, policy, forecasting, human resource development, innovation and other interest area. They will send this agenda to all zonal level committee. Zonal level will think according their priority and send to state level committee. State level committee will focus their priority and send to each medical college. So the medical colleges have list ready before new postgraduate batch enter for admission. So they can think over topics easily. Various muticetric studies also can be plan and get outcome research where the government require data and inputs.

The report is prepared by Dr. Niraj Pandit and views and comments are his personal.

Thursday, August 21, 2014

Azim Premji Fellowship for young turk

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